Ensuring Successful Delivery of Nursing Care - Research Paper Example

? Concept Analysis-Compassion Instituition: Background The extremity of nature is largely looked at from the economic or social aspect. Such perspectives are in order as they are geared at the restorative function where effort is taken to ensure a return to normalcy. However, the biggest restorative function is probably one that is never in the limelight. This is the task of ensuring that individual’s health is looked after beyond the apparent return to normalcy. It would be human nature for those charged with the responsibility of looking after the victims to feel alienated as their plight is never addressed. Fortunately, these are steadfast and always find a place for the duty of care as this form the tenets of their profession. This is the place of nursing in our contemporary set up. The importance of those in the profession is largely ignored by the public and their value is only recognized when one is need of their expertise. It is this maligned nature of the profession that has strengthened the call for “the heart of nursing”. The heart of nursing is an apparent reference to a set of qualities that a nurse needs to discharge their duty in oblivion of the external factors that would otherwise affect successful discharge of commensurate duties. This is a key part of ensuring successful delivery of nursing care in light of pandemic ailments affecting the world populace (Schnatz, 2007). In trying to understand nursing and what it encapsulates we must try to look at the underlying enablers of nursing care. It should be noted that nursing as a practice is as strongly reliant on professional education as it is on human duty and obligation to care for others. Notably, in primitive societies where the decision to be a nurse (caregiver) was made on behalf of a person at birth the successful discharge of nursing duties was still possible. As an example, in the Zuni tribe, if a newborn was born with their face partly covered with the placenta the child was marked as one predestined to be a caregiver (Egenes, 2010). For these individuals, there was no formal set up in which they learnt the art of nursing. Often, the art was learnt through oral traditions that were passed across generations, through observation of others caring for the sick, and often through a process of trial and error. In the midst of these informal means of gathering nursing expertise the sole or the basic drive was the willingness to care given the plight of patients. The fact that nursing has been existent since antiquity and the knowledge that the first formal nurse training school was established in 1872, nurse training school of Women’s Hospital of Philadelphia, further underlines the duty for care or compassion as the most fundamental aspect in nursing (Egenes, 2010). Method of concept analysis and why this method was chosen In discussing compassion as nursing’s most precious asset or as the most dominant altruistic ideal in nursing care this study adopts Chinn & Kramer’s (1991) approach to concept analysis. Chinn & Kramer (1991) identify the purpose of their concept analysis approach as “producing tentative definition of the concept and a set of tentative criteria for determining if the concept ‘exists’ in a particular situation (88). Under this approach the first step is selecting the concept, clarifying the purpose, identifying the sources of data, exploring context and values and formulating criteria. Data sources Data to be used in the concept analysis will be derived from existent studies on nursing care and specific review of compassion and compassionate care as a key ideal in nursing. A host of this information is published in peer reviewed journals and professional websites which have sought to explain and research on nursing. Equally important will be historical data on the place of nursing in our society as well as the foundations and prerequisites of being a successful care giver. In essence, this analysis envisions that successful care giving as a factor is determined by the compassion of the care giver and thus considers that any article on successful care giving will help in the concept analysis. Review of the literature At the moment, there is greater scrutiny and focus accorded to concepts of care, this is as part of a wider effort to augment the basis and aims of nursing. It is within this debate that concepts such as empathy sympathy and compassion continually crop up (Davidson & Williams, 2009). Notably, and to most scholars the use of these concepts has been continually interchanged with one used in place of the other. In light of this confusion and in a desire to understand and distinguish the concepts we consider defining these terms critical. Based on the Oxford English Dictionary, empathy is defined as ‘the power of projecting one’s personality into the object of contemplation’ a further definition is provided by Olsen (1991) who cites empathy as the ‘affective cognitive experience of understanding another person’ (Rankin, 2013). In this sense, empathy is seen as a means of allowing us to understand the feelings, expressions or insights of another individual so as to accord professional care (Rankin, 2013). In the field of nursing, empathy is seen as closely linked or taken as the same with another concept, sympathy. Again borrowing from the Oxford English Dictionary, sympathy is defined as ‘the capacity for being simultaneously affected with the same feeling as another’. In a professional context, Schwaber quoted by Olsen (1991) identifies sympathy as a ‘method of observation’ (Rankin, 2013). In this context, empathy and sympathy are identified not as indicators of good nursing care but prerequisites to appropriate remedial intervention. Unto our central concept, compassion, this is at times depicted as if it is just a mere emotion that only bears a single affective dimension. However, when one focuses on the past and continuous discussions on compassion and compassionate care an alternate perspective comes into play (Catalano, 2012). Notably, compassion may have and need emotion; nonetheless it also dominantly carries a rational dimension as it involves a purposeful altruistic involvement in another person’s anguish (Davidson & Williams, 2009). This aspect becomes quite elaborate on proper definition of the term. In the most basic way, the Oxford English Dictionary defines compassion as ‘suffering together with another, participation in suffering; fellow-feeling, empathy’. Of note in this definition is the inclusion of empathy, this underlines the priory mentioned confusion between the three concepts, empathy, sympathy and compassion (Schantz, 2007). The most elaborate definition in which is adopted as the actual meaning of compassion in nursing practice is forwarded by Boyatzis, Smith and Beveridge (2013). Boyatzis et al (2006) identify compassion as a composition of three elements, empathizing with the other, caring for the other, and acting in response to the other’s feelings (Boyatzis et al 2013). Using this definition we identify Burnell and Agan (2013) observation that compassionate nurses often immerse themselves into the pain, brokenness, fear, and anguish of a person, even in situations where the person is not known to them (180). This carries the characteristic of empathy which at this point and in subsequent discussion is considered a part of compassion and not synonymous with compassion. As part of understanding compassion, we note that this is often demonstrated through active listening, safeguarding patient dignity, anticipating anxieties and acting to avoid these (Horsburgh & Ross, 2012). However, Fox (1990) notes that compassion is not actually these actions but the way these actions are expressed underlining the attitude and approach (Shelly & Miller, 2008). In examining compassion as part of the nursing we can look at the moral dimension. Morally, nurses are obliged to act compassionately as they are caring for a person experiencing ill-health. Compassion, which is prompted by a situation, runs against the grain of our regular behavioral expectations. In shaping behavior, compassion is guided by altruism, this is defined as ‘the deliberate voluntary behavior in support of another person that is not given with the expectation of any reward or punishment’ (Childs et al 2009). In this sense, compassion can be justified by clear reasons as to why one decided to take specific action. Reason is not the only domain of compassion, as we have seen empathy and now sympathy also becomes a subject of reason. The uniqueness of compassion is that it provides congruence between reasoned justification and moral obligation. In essence, compassion is not simply an emotional response or a set of principles or reasoned justifications (Davidson & Williams, 2009). On the contrary, it is part of a larger human and spiritual experience. It meets the essential criterion of emotional and rational response but allows these to be portrayed in creative tension. As a prerequisite of good nursing care compassion necessitates taking sides and coming up with decisions, however this must be carried out in justifiable grounds other than the pressing self-interest. In discussion of compassion, Coetzee and Klopper (2010) introduce the idea of compassion fatigue. According to Joinson (1992), compassion fatigue is a result of burnout in nurses and is exhibited by the loss of their ‘ability to nurture’ (Smith, 2008). In conclusion of their study on compassion fatigue, Coetzee and Klopper note that compassion is a basis for nursing care. In cases where compassion fatigue is rife it erodes the power of recovery and it becomes difficult to restore the previous levels of compassionate functioning (241). This largely affects the power and essence of nursing a factor that underlines the importance of compassion as a nursing concept. It is noted that though compassion may not be explicably taught in nursing its sustenance can be achieved through education which is important in avoiding compassion fatigue. Results In gathering literature on compassion as a concept we appreciate that its effectiveness lies in its ability to provoke emotion and allow for rational thought. In collaboration, the two provide a sure way of offering the best in terms of nursing care. The presence of compassion, even in absence of technical nursing knowledge, allows a caregiver to considerably think and react to a patient’s situation by offering their best help. The type of help they would envision or want if they were ever to be in a similar situation. Here, we consider the observations of Benner (1984) and Dewar and Christley (2013) who provided evidence of the healing power of compassionate caring. He states that nurses cultivate this healing aura by marshalling hope, confidence and trust between the caregiver and the patient. In addition, it is noteworthy to note that the compassionate role of nurses does not only emanate from emotional or from moral obligations. It is also enshrined in the nurse’s professional code which designs the context in which the care givers provide compassionate care. The role of the nursing professional is to avail compassionate care not only in the midst of challenges and drawbacks of day to day work, but as the platform for professional nursing. Nurses are professionally obliged ‘to competently and compassionately attend to patients’ (Steenbergen et al 2013). This discourages indifference or insensitivity in sight of suffering. Conclusion In conclusion, compassion is a concept in nursing that has formed the bedrock of the profession throughout antiquity as well contemporary times. Even with the differences in approach and means of impacting nursing skills compassion appears to be the most integral component on nursing care. It is thus important that nurses are continually encouraged to understand and conceptualize the significance of compassion within the profession. In order to continually inculcate this moral virtue into the nursing profession and in the wider care giving role it is important that we reconsider delivery of patient care. An important shift is a reconsideration of the present view where nursing is considered as a product. This should intrinsically be addressed to portray nursing as a service with several components with compassion being the most basic. In so doing, nursing will not only be reevaluated but the nature of nursing care will be altered to include the very concept that was initially the foundation of care giving even before the contemporary revolution of nursing. References Boyatzis, R. E., Smith, M. L., & Beveridge, A. J. (2012). Coaching With Compassion: Inspiring Health, Well-Being, and Development in Organizations. Journal of Applied Behavioral Science 49(2) , 153–178. Dewar ,B, & Christley, Y. (2013) A critical analysis of Compassion in Practice. Nursing Standard 28:10, 46-50 Burnell, L., & Agan, D. L. (2013). Compassionate Care: Can it be Defined and Measured? The Development of the Compassionate Care Assessment Tool. International Journal of Caring Sciences 2013 May – August Vol 6 Issue 2 , 180-187. Catalano, J. T. (2012). Nursing now!: Today's issues, tomorrow's trends. Philadelphia: F.A. Davis Co. Coetzee, S. K., & Klopper, H. C. (2010). Compassion fatigue within nursing practice: A concept analysis. Nursing and Health Sciences Issue No. 12 , 235–243. Childs, L. L., Coles, L., & Marjoram, B. A. (2009). Essential skills clusters for nurses: Theory for practice. Chicester, U.K: Wiley-Blackwell. Davidson, N. & Williams, K. (2009). Compassion in nursing 1: defining, identifying, and measuring this essential quality. Nursing Times, Vol. 105 (36), 16-18. Egenes, K. G. (2010). Nursing in Early Modern Europe. In History of Nursing (pp. 1-26). New York: Jones and Bartlett Publishers. Horsburgh, D., & Ross, J. (2013). Care and compassion: the experiences of newly qualified staff nurses. Journal of Clinical Nursing, Issue no. 22 , 1124–1132. Rankin, B. (2013). Emotional intelligence: enhancing values-based practice and compassionate care in nursing. Journal of Advanced Nursing, Vol. 69 (12), 2717-2725. Schantz, M. L. (2007). Compassion: A Concept Analysis. Nursing Forum Volume 42, No. 2. , 48-55. Shelly, J. A., & Miller, A. B. (2008). Called to care: A Christian worldview for nursing. Downers Grove, Ill: IVP Academic/InterVarsity Press. Smith, P. (2008) Compassion and smiles: What’s the evidence? Journal of Research in Nursing; 13: 367–370.  Steenbergen, R., Smith, S., Bright,C. & Kaaijk, M.M. (2013) Perspectives of person-centred care. Nursing Standard 27:48, 35-41. Read More