Compassion in Relation to Communication in Nursing Practice - Literature review Example

Compassion in Relation to Communication in Nursing Practice By Compassion in Relation to Communication in Nursing Practice INTRODUCTION Recent days witnessed National Health Service (NHS) in fray for the apparent lack of compassion exhibited by health professionals. In the much-debated incident at Winterbourne View, medical staff even resorted to torturing the patients to whom they were supposed to show compassion, and in the Stafford Hospital case, patients were found sitting in their own excretion. (Harris, 2013). It is at this juncture that the Francis Report came out, putting forward 290 recommendations aimed at avoiding any future fall in standards. The report found that the underlying reason in all these cases was a general lack of compassion. Based on this finding, the report suggested that it is highly necessary to promote a caring, compassionate and considerate nursing (Francis, 2013, pp. 5-6). Thus, it becomes evident that compassion is in fact the most important element of a patient-centered care (Frampton, Guastello & Lepore, 2013, p. 447). In the opinion of Torjuul et al. (2007, p. 530), being compassionate means being close to a patient more than a routine medical procedure, dealing with the emotional aspects of the relationship. It is pointed out by Woodward (1997, p. 999) that professional caring has two important aspects; instrumental caring and expressive caring. While the former deals with technical aspects, the latter looks into the emotional aspects. In fact, it is the latter which makes nursing into caring (Woodward, 1997, p. 1000). It is with this understanding that NHS introduced the 6Cs of Compassionate Care. The six Cs are care, compassion, competence, communication, courage, and commitment (NHS Commissioning Board, 2012, p. 14). According to NHS, communication in health care can be defined as communicating the needs and requirements of patients, carers, staff and others in order to ensure proper care (NHS Commissioning Board 2012, p. 15). Thus, one gains the insight that compassion and communication are two inseparable and important aspects of nursing. In addition, there are various guidelines for nurses to abide by, ranging from NHS Constitution and Nursing and Midwifery Council (NMC) legislative requirements. According to NMC, “An important determinant of good character is the individual’s commitment to, and compliance with” the rules (Nursing and Midwifery Council, 2010). Therefore, it is necessary to look into the relevant provisions in the legislation in order to identify what is right and what is wrong according to law in order to stay away from legal issues like the Winterbourne View. Thus, this work intends to discuss the importance of compassion and communication in nursing. This will be followed an analysis of how this new learning has influenced my understanding of nursing care along with a look into the way my future practice will be modified according to the new learning. Thereafter, the essay details how I will continue my learning in future, and the last two sections analyse the NHS and NMC directives on compassion and communication in nursing. The new learning- the role of compassion and communication in nursing care The new understanding I gained from the module is that compassion is one of the most important elements of nursing and that communication is an inseparable part of exhibiting compassion. It is pointed out by Davison & Williams (2009, pp. 16-17) that in order to be called a caring nurse, one should have qualities like honesty, compassion, wisdom, and respect. These nurses are able to see their patients as human beings with specific needs and interests and try their best to respect and accommodate them. With this quality, these nurses do not just function like machines completing their tasks in a timely manner. Instead, they give equal attention to the emotions of the patients while providing care, and develop a feeling of mutual respect and trust (Davison & Williams (2009, p. 18). Admittedly, innumerable numbers of studies have been conducted on how exactly should a compassionate nurse behave, and they all have something new to say on the ways of conduct. The study by Bramley & Matiti (2014) looks into what is expected by elderly patients from a compassionate nurse. The first point identified is addressing the patients’ basic needs in a timely manner. It involves cleanliness and management of pain and discomfort. In addition, the compassionate nurse is someone who has polite manners, good eye contact and a warm smile. In the opinion of Bramley & Matiti (2014), a compassionate nurse is supposed to be sensitive. For example, dealing with older patients is not as easy as dealing with young ones. To illustrate, the older ones have more difficulty hearing and understanding questions, responding appropriately, moving, and taking care of their needs. In such cases, compassion involves showing patience and not rushing. The role of a comfortable and soothing touch is acknowledged by Firth-Cozens & Cornwell (2009, p. 73) as a part of being compassionate. Moreover, according to Chambers & Ryder (2009, p. 47), communication is the most important compassionate technique because the more one knows ones patients, the easier it is to see them as valuable human beings. It is at this point that communication becomes an essential element of compassion. In fact, this topic is highly relevant at present because of the large number of reported cases which reflected lack of compassion and poor communication. In the notorious Mid Staffordshire Hospital scandal, it is reported that nearly 1200 people may have died due to apparent lack of care between 2005 and 2009 (Shipman, 2013). The Francis report pointed out that in order to achieve targets, patients were even denied basic levels of care (Francis, 2013, p. 19). It happened because the hospitals were following a culture which fully focused on business instead of the needs of the patients. Secondly, the report found a serious lack of communication between agencies (Francis, 2013, p. 36). In fact, there are various factors which affect compassionate care in a clinical setting. To illustrate, there are factors like availability of time (Pearcey 2007, p. 296). When there is lack of time, it leads to lack of care. Similarly, Tweddell (2007, p. 18) points out that lack of experience prevents newly graduated nurses from offering compassionate care because they are often overwhelmed by the challenging clinical situations. However, the problem can be overcome by spending more time with patients and relatives and witnessing their suffering (Torjuul et al. 2007, p. 530). That means compassion grows with experience. Admittedly, compassionate care has its impact on the welfare of nurses. To illustrate, it is pointed out by Absolon and Krueger (2009, p. 16) that helping people who are suffering leads to compassion fatigue. Moreover, personal philosophy (Koerner, 2007, p. 6) and personal beliefs (Castledine 2004, p. 353) will considerably influence compassion in care because to be truly compassionate, one should be kind by default. Similarly, there are various factors which can affect communication in clinical care. Firstly, basic qualities like genuineness, kindness, compassion, and communication skills in nurses will positively influence the effectiveness of communication while task-oriented work, low self-awareness and fear are found inhibiting effective communication (Patidar, 2012, p. 167). Furthermore, patients’ active participation in care and information-seeking behavior can promote communication while patients’ dislike to disclose or discuss disease or feelings, trend to use implicit cues, and preference to seek emotional support from friends or relatives can negatively affect communication. Moreover, a supportive ward environment and rapport among staff will promote nurse-patient communication (Patidar, 2012, pp. 113-134). It is pointed out by Knowlden (1998, p. 17) that being compassionate means being empathetic to the pain of others and respond with humanity. Very similar is the definition given by Kralik et al. (1997) that compassion means understanding others’ sufferings and acting to alleviate the same. It is pointed out by Kralik et al. (1997, p. 400) that the more one communicates, the easier it is to understand others’ concerns and consider them as valuable human beings. I understood that open and effective communication enables patients to reveal more about their conditions, and a soothing approach makes patients more comfortable in dealing with the condition. That involves activities like visiting them as frequently as possible, spending time talking to them, effectively listening to others, and keeping promises Williams & Davis (2004, p. 132). The effect of the new learning on my knowledge AND BEHAVIOUR Admittedly, the new learning considerably changed my perceptions and behavior. Before this learning, I used to possess the view that showing empathy would adversely affect the functioning of a nurse and that a kind heart is a hindrance to effective nursing. However, the new learning made me realize that a kind heart and compassion are essential features of nursing. In addition, I learnt the importance of effective communication in nursing care. Based on this new understanding of communication, in the group discussions, I started making good eye contact while talking. In addition, I learnt how to speak clearly and effectively, avoiding terminologies, taking into account the various features of the listener, ranging from age, education, knowledge and so on. Furthermore, the class regarding proper communication with the patient while giving care and explaining procedure was highly helpful in the practical session in the clinical skill lab. I learnt how to show empathy to patients and how to develop confidence and trust through visibly simple but powerful acts like giving the therapeutic touch, talking while carrying out the procedure, leaning forward with an open hand and so on. Effect of the new learning on future practice The new learning will have considerable influence on my future practice. Firstly, I have become fully aware about the fact that nurses have the responsibility to be compassionate towards patients and that NHS and NMC have placed compassion as the culture to be adopted. In addition, there is the realisation that being compassionate involves much more than simply following the usual medical procedures. Instead, I will do such things which will make the patients feel valued and respected. Based on the learning, I will adopt various common strategies like warmhearted smile, soothing touch, regular visits and so on. In addition, I will try to talk to the patients and their relatives so that they are encouraged to reveal their concerns and develop trust and confidence (Davison & Williams, 2009, p. 32). In addition, I have learnt the important role of communication in nurse-patient relationship. Based on this, I will be able to adopt various communication strategies enabling the patients to communicate more so that I can promote their emotional (Knowlden, 1998, pp. 138-142). In future, I will constantly try to improve in these areas. Moreover, I learnt that lack of proper communication among nursing staff can lead to serious errors in care (Ellingson, 2002, p. 9). For example, it is necessary to give a perfect patient report at shift change, and if any important information is not conveyed, there will be serious defects in care. I have observed in one situation that a nurse failed to inform the oncoming nurse that a patient fell on the previous shift. Therefore, the oncoming nurse failed to assess the patient for any injury from fall and to arrange fall precautions. Evidently, this mistake was the result of lack of communication. In addition, I have learnt that conflicts among staff can hinder communication and also that one should be aware about the effect of attitude and culture (Ellingson, 2002, p. 10). Continuing the learning in future As Ellingson (2002, p. 3) points out, new nurses find it difficult to show compassion as they are often perplexed by the challenges of a clinical setting but improve through experience as time passes. In addition, Tweddell (2007, p. 18) opines that the best way to develop compassion is to witness the suffering of patients and their relatives. Therefore, I will spend as much time as possible with the patients and talk to them so that I will be able to see them as valuable human beings. Secondly, I will adopt reflective learning. According to Howatson-Jones (2013, p. 6), reflection is an important aspect of learning. In fact, there are various tools helping reflective learning like Kolb’s Cycle of Experiential Learning, Gibbs Reflection Cycle, John’s Model for Structured Reflection and so on. In the opinion of Howatson-Jones (2013, p. 7), this reflection helps learners to understand the exact meaning of the textual knowledge they gained and the areas where they are lacking in knowledge. Furthermore, I will approach my mentor to improve in the areas where I am lacking. Furthermore, I will use the Johari window model for self-awareness and personal development. In fact, the Johari window model seems highly helpful in improving self-awareness (West & Turner, 2009, p. 12). The model has four regions in a person’s personality; an open area which is known by both the person and others, a blind area which others know and the person does not know, a hidden area which only the person knows and others do not know, and an unknown area which includes information about the person that neither the person nor others know (West & Turner, 2009, p. 12). I will try to reduce the blind area through soliciting feedback from my colleagues so that I can improve in the areas of deficiency. In addition, there will be effort to reduce the hidden area through disclosure and communication so that others who work along with me are aware about me. All the effort will be aimed at increasing the open area so that there is more cooperation, more communication and less conflict. Compassion and communication in NMC Code In fact, NMC gives considerable importance to compassion and communication. The first core principle of the code is that nurses should make the care of people their first concern and that patients should be treated as individuals, respecting their dignity (NMC, 2012, p. 1). It involves being polite, kind, caring and compassionate. In addition, there should not be any kind of discrimination based on culture, values, and beliefs (NMC, 2012, pp. 2-3). Similarly, communication is given much importance because communication is very necessary to collaborate with the patient under care. In order to ensure proper collaboration, the nurse is supposed to listen to the people in care and give answer to their concerns and respect their preferences (NMC, 2012, p. 4). For this purpose, proper arrangements should be made when patients have language and communication needs (NMC, 2012, p. 4). I understood the fact that when there is a patient who is unable to communicate in English, it is important to arrange the help of an interpreter so that the patient is able to communicate without any trouble. Furthermore, the code states that a nurse should communicate with people in a way they can understand the information they need (NMC, 2012, p. 4). To illustrate, patients commonly show curiosity to know about the way the drugs they use work. It is the duty of the nurse to explain the same to the patient in simple language avoiding complicated medical terminology. One of the key findings in the Francis report is lack of compassion and communication. The report points out that due to poor staffing policies, the complaints of the patients were often left unattended, and thus, they failed to place patients at the centre of their work (Francis, 2013, p. 16 ). Based on this finding, the report has put forward the recommendation that the NHS common values of service should be strictly followed, that is, the patient should be always put first. In addition, the report specifically points out that a caring, compassionate and considerate nursing culture should be nurtured (Francis, 2013, p. 36). Compassion and communication in NHS Constitution and the 6Cs NHS Constitution gives much importance to compassion and communication. The NHS values as pointed out in the NHS Constitution state that NHS puts the needs of patients and communities before organisational boundaries and that compassion is “central” to all the care provided (NHS, 2013, p. 1). For a nurse who follows NHS Constitution, this means walking the extra mile to ensure patient satisfaction. In addition, the constitution points out that compassion involves looking for things which can give comfort and relieve pain (NHS, 2013, p. 2). In a real medical setting, some examples are spending some time with patients and listening to them, responding to patients’ requests in time, keeping promises, offering a warmhearted smile, and so on. More importantly, NHS acknowledges that patients have the right to be treated with dignity and respect (NHS, 2013, p.3). That means compassion and communication have become the right of the patient and the responsibility of the nurse. It is with this understanding that NHS has introduced the Culture of Compassionate Care, which urges healthcare professionals to adopt the 6Cs. The 6Cs are care, compassion, competence, communication, courage, and commitment (NHS Commissioning Board, 2012, p. 1). NHS defines compassion as giving care through relationships based on empathy, respect and dignity or “intelligent kindness” (NHS Commissioning Board, 2012, p. 3). As already seen, respect and dignity have become the right of patients according to NHS constitution, and hence, compassion has become the right of the patients. Similarly, communication is described as central to successful caring relationships and effective team working (NHS Commissioning Board, 2012, p. 2). I understood the fact that it is highly necessary to follow the dictum “no decision about me without me” (NHS Commissioning Board 2012) and to achieve this, communication is vital. Conclusion In total, I have made the realisation that compassion is the element that makes nursing into caring. That is the reason why governing bodies like NHS and NMC insist that compassion should be an integral part of nursing care. Compassion involves treating the patients with kindness, and only a kind person can be truly compassionate towards others. Communication is an essential part of compassion because it is through communication that patients realise that they are valued and respected. Practices like frequent visits, spending time talking, warmhearted smile, and responding in time can be actions of compassion. To sum up, compassion and communication seem to have considerable influence on the wellbeing of both patients and carers. References Absolon, P. and Krueger, C., 2009. Compassion fatigue nursing support group in ambulatory care gynaecological/oncology nursing. Society of Nurse Oncologists, 19(1), pp. 16-19. Bramley, L. and Matiti, M., 2014. How does it really feel to be in my shoes? Patients’ experiences of compassion within nursing care and their perceptions of developing compassionate nurses. Journal of Clinical Nursing, [online] Available at: [Accessed 14 May 2014]. Castledine, G. 2004. Role of hospital nursing in promoting patient recovery. British Journal of Nursing, 13(7), p. 353. Chambers, C. and Ryder, E., 2009. Compassion and caring in nursing. Oxford: Radcliffe Publishing. Davison, N. and Williams, K., 2009. Compassion in nursing: defining, identifying and measuring this essential quality. Nursing Times, 105(36), pp. 16-18. Ellingson, L. L., 2002. Communication, collaboration and teamwork among health care professionals. Communication Research Trends, 21(3), pp. 3-11. Firth-Cozens, J. and Cornwell, J., 2009. The point of care, enabling compassionate care in acute hospital settings. London: The Kings Fund. Frampton, S.B., Guastello, S. and Lepore, M., 2013. Compassion as the foundation of patient-centered care: the importance of compassion in action. Journal of Comparative Effectiveness Research, 2(5), pp. 443-455. Francis, R., 2013. Report of the Mid Staffordshire NHS Foundation Trust public inquiry. London: Crown Copyright. Harris, D., 2013. A point of view: how important is compassion in healthcare? BBC News Magazine, [online] Available at: [Accessed 14 May 2014]. Howatson-Jones, L., 2013. Reflective practice in nursing. New York: SAGE Publications. Knowlden, V., 1998. The communication of caring in nursing. Indianapolis: Center Nursing Press. Koerner, J.G., 2007. Healing presence: the essence of nursing. New York: Springer. Kralik, D., Koch, T. and Wotton, K., 1997. Engagement and detachment: understanding patients’ experiences with nursing. Journal of Advanced Nursing, 26(5), pp. 399-407. NHS Commissioning Board, 2012. Compassion in practice. Leeds: Dept. of Health. NHS, 2013. The NHS Constitution. London: Department of Health. NMC, 2012. Guidance on professional conduct for nursing and midwifery students. London: NMC. Nursing and Midwifery Council, 2010. Legislative Requirements. [online] Available at: . [Accessed 14 May 2014]. Pearcey, P., 2007. Tasks and routines in 21st century nursing: student nurses’ perceptions. British Journal of Nursing, 16(5), pp.296-300. Patidar, A.B., 2012. Communication and nursing education. New Delhi: Pearson Education India. Shipman, T., 2013. NHS staff guilty of neglect or abuse face five years in jail under new legislation to prevent repeat of Mid Staffordshire hospital scandal. Mail Online [online] 15 November. Available at: . [Accessed 14 May 2014]. Torjuul, K., Elstad, I. and Sorlie, V. 2007. Compassion and responsibility in surgical care. Nursing Ethics, 14(4), pp. 522-534. Tweddell, L., 2007. Compassion on the curriculum. Nursing Times, 103(38), pp. 18-19. West, R. and Turner, L.H., 2009. Understanding interpersonal communication. Boston: Wadsworth. Williams, C. and Davis, C., 2004. Therapeutic interaction in nursing. London: Jones and Bartlett Publishers. Woodward, V.M., 1997. Professional caring: a contradiction in terms? Journal of Advanced Nursing, 26(5), pp. 999-1004. Read More