ReviewMeasuring compassion in nurses and other healthcare professionals: An integrative review
Introduction
The notion of compassion has occupied philosophers, religious and spiritual leaders for many centuries. The Greek philosopher Aristotle (384BCE – 322 BCE) declared that compassion was one of the five virtues a person needed to develop in order to flourish and be happy. Compassion has a great deal in common with empathy and sympathy (Goetz et al., 2010), and these words are often used interchangeably. However, compassion is a different construct (Nussbaum, 2003, Schantz, 2007). Compassion has been defined as understanding or being aware of another person's suffering and acting to end this suffering (Schantz, 2007, Crawford et al., 2013, von Dietze and Orb, 2000). Although compassion seems to be a universal concept (Austerlic, 2009), we hypothesise that there are likely to be aspects of it that are culturally specific, and therefore definitions of compassion may vary between different cultures.
Compassion is an important part of the ethos of nursing (Bradshaw, 2011, von Dietze and Orb, 2000). Florence Nightingale (1820–1910) viewed compassion as a moral virtue and an essential trait that should be possessed by all good nurses (Bradshaw, 2011). Nightingale's view of compassion as a virtue is echoed by von Dietze and Orb (2000). Moreover, compassion is one of the main values of the constitution of the British National Health Service (NHS) and features in the Royal College of Nursing's principles of nursing practice (Department of Health (2009); Royal College of Nursing (2012). Importantly, the Nursing and Midwifery Council (NMC)'s standards for pre-registration nursing education require that all students are assessed on whether they ‘act in a manner that is attentive, kind, sensitive, compassionate and non-discriminatory, that values diversity and acts within professional boundaries’ (NMC, 2010, p.100). The new NMC code of conduct for qualified nurses makes explicit their responsibility to treat people with respect, kindness and compassion. http://www.nmc.org.uk/standards/code.
The centrality of compassion in nursing and nursing education has been highlighted in the Department of Health/NHS England (2012) strategy entitled ‘Compassion in Practice: Nursing Midwifery and Care Staff. Our Vision and Strategy’ which articulated the 6Cs: Care, Compassion, Commitment, Courage, Communication, and Competence.
There are several studies which describe how nurses themselves define compassionate care. For example, van der Cingel (2011) asked nurses to describe the nature of compassion in their work with older people with chronic disease. Nurses defined compassion in terms of seven dimensions: attentiveness, listening, confronting, involvement, helping, presence and understanding. A study by Perry (2009) found that paying attention to the little things and keeping the promise to never abandon enabled nurses to recognise and alleviate the patient's suffering and strengthen the patient–nurse relationship.
Robin Youngson, a pioneer in compassionate care, asserted that it is beyond debate that “compassionate whole-person care is critical to good patient outcomes...” (Youngson, 2014, p. xxii). He provides evidence that compassionate care results in more satisfied patients, safer care, time-savings, cost-savings and happier and more resilient health professionals (Youngson, 2012). Despite all the benefits associated with compassionate care, recent public inquiries in the UK, such as the Francis inquiry into the Mid-Staffordshire NHS Foundation Trust, have brought to light poor standards of care which were linked to a lack of compassion (Abraham, 2011, Francis, 2013). Following these inquiries there have been several recommendations for improving standards of care. Suggestions have included providing better training and supervision for staff, improving communication, providing clear guidelines and procedures, and asking patients about their experience of care (Department of Health, 2013a, Francis, 2013, Keogh, 2013). It has also been suggested that candidates for pre-registration nursing degrees should be assessed on compassion and other values before being accepted (Francis, 2013, Health Education England, 2013).
The UK Department of Health called for a scientific measure of compassion to be developed as a high priority for the profession (Sturgeon, 2010). It has been reported that if levels of compassion are to be increased through a variety of interventions, current levels must be measured even though this will be challenging (Mooney, 2009). At present there are no standardised measures of compassion that are routinely used in the NHS. However, the Department of Health suggests that the Friends and Family test supports the 6Cs of nursing and will help to maintain a culture of compassionate care (Department of Health (2013b). This test is a general measure of patient experience, and does not assess compassion directly. Nevertheless, a patient who is treated compassionately may be more likely to perceive their care as more positive, and to recommend the service to their friends and family.
The original aim of this study was to review the current literature on measuring culturally competent compassion which has been defined as a human quality of understanding the suffering of others and wanting to do something about it using culturally appropriate and acceptable nursing interventions. This takes into consideration both the patients' and the carers' cultural backgrounds as well as the context in which care is given (Papadopoulos, 2011). The motivation for connecting compassion to cultural competence is the increasingly multicultural context of care provision, as well as the explicit statements from the NMC's standards for pre-registration nursing education and code of practice, for care to be compassionate, non-discriminatory and to value diversity. Sadly, the literature searches failed to yield any articles which addressed culturally competent compassion. Therefore the aim of the study was revised to be a review on how compassion is being measured in nurses and other healthcare professionals.
Section snippets
Methods
An integrative review approach was employed. This is defined as a “specific review method which summarises empirical or theoretical literature to provide a more comprehensive understanding of a healthcare problem” (Broome (1993), cited by Whittlemore and Knafl, 2005, p.546). This involved conducting a systematic search of the literature using electronic databases including CINAHL, PsycINFO, EBSCO (Allied and Complementary Medicine database, eBook Collection, Education research complete, EBSCO
Results
Fig. 1 shows the search process and the flow of articles through the study. The initial search produced 1683 articles. After abstract screening there were 305 articles remaining which appeared to meet the inclusion criteria (see Fig. 1). These articles were then full text screened. Only primary research articles were included in the final analysis. After full text screening, 6 studies were identified which met the inclusion criteria.
We extracted data on study characteristics such as design,
Summary of findings
The purpose of this study was to identify how compassion has been measured in nurses and other healthcare professionals. The six studies included in this review measured compassion using both quantitative and qualitative methods. The themes identified in this study can be seen in Fig. 2.
It is no surprise that our analysis found that the elements of compassion used in the measuring tools we reviewed were similar to some of those identified in previous research studies which explored the meaning
Conclusion
Compassion and cultural competence should underpin all care given to patients. We have undertaken this review following concerns about poor standards in healthcare and calls for promoting the values of compassion and competence in healthcare staff. During this debate many had concentrated on how compassionate care could be taught or learnt. We wanted to explore the possible contribution that measuring compassion could make. We made the first step by undertaking this integrative review of
Conflict of interest
None declared.
Acknowledgements
We would like to thank Laura Foley for her assistance with literature searching and abstract screening for this study, and the School of Health and Education, Middlesex University, for the small grant which made this study possible.
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