This essay, will be explore and discuss why ensuring compassionate care in nursing is important and how it relates to the NHS (National Health Service) values. Compassion can be described as, feeling sympathy for someone else’s misfortune (WordReference, 2015, cited in Perez-Bret et al., 2016). There is no correct definition for compassionate care as it is mainly demonstrated through the unique bond formed between the patient and nurse. It can be characterised by actions taken by the nurse to care and show an understanding for the patients’ needs and their suffering (Baughan & Smith, 2013). This essay will cover the different legislations which require nurses to provide compassionate, humanistic care to patients, theoretical frameworks and evidence-based practices which express the significance of compassionate care and therapeutic relationships. Additionally, how nurses implement techniques to form relationships with patients and relatives to provide patient-centred care.
Care and compassion being two of the 6 C’s express the importance of compassionate care and its importance to nursing. Being caring and compassionate is the minimum expectation of nurses, and it is endlessly stated by the NMC that care should be given effectively, without delays; this represents the significance of a caring nurse as they are the main aspects of nursing (NMC, 2015). Compassion is also stated in the NMC Code of Conduct (2015), it proclaims, compassionately is the way to respond to the needs to patients especially those who are in the last few days and hours of life. Compassion is fundamental, building trust between patients and nurses, also indicating patients are being treated as people rather than procedures. Bramley and Matiti (2014) held a study in compassion and what it means to patients; majority of patients stated, compassion is when nurses give them time and portray a caring attitude. This study also retrieved that patients find a striking link between care and compassion thus they would substitute care for compassion and vice versa. One of the patients in the study described compassion as “… a caring attitude to people as people and not things (Participant 5, ward D: L 4)” (Bramley and Matiti, 2014, p. 2794). Bramley and Matiti (2014) found that patients express nurses demonstrating caring and compassionate attributes through giving them time, talking to them as people, nurses placing themselves in the situation of patients and caring about their feelings. This study helps nurses as knowledge of patients understanding of compassionate care can help them improve on attributes patients anticipate when being cared for.
The NHS constitution establishes the principles and values of NHS England. The purpose of this is to clarify the right entitlements for service users, the public and also staff. NHS values are also included, these have been inspired by patients, the public and staff, making sure nothing is missed. A few of the values are; respect and dignity, commitment to quality of care, compassion, improving lives and everyone counts (Department of Health & Social Care, 2015). These values are to ensure patients are the centre of attention and they are delivered humanistic, person-centred care. NHS values explain the significance of compassion as it is a key value that is naturally expected from nurses and other health care staff. The Royal College of Nursing (2018) developed eight principles with the help of the Department of Health and the NMC (Nursing and Midwifery Council), the public and health care staff were also a part of the progression process. The principles are there for nurses and student nurses to apply when caring for patients. One of the eight principles are, nurses and nursing staff treat everyone with care ensuring dignity and humanity is maintained throughout – nurses should understand the patients’ needs and requirements and are to show compassion and sensitivity, overall nurses should provide care in a way in which everyone is respected and treated equally (Royal College of Nursing, 2018).
Professionalism in nursing is the autonomous decision-making of a group of medical professionals who share similar values (NMC, 2017). Nurses providing good healthcare through excellent, professional practice and behaviour upholds the expected nursing standards. The NMC focuses nurses on professionalism to guarantee safe and effective, person-centred care (Glasper, 2017). Professionalism being a vital attribute to nurses is to prevent publicised scandals such as the ‘Mid-Staffordshire Inquiry’. Partnership is recognised in healthcare guidelines therefore is an attribute for nurses to either develop improve on (Baillie, 2016). Nurses working in partnership with their patients allows patients to make decisions about their own treatment, also this leads to improved communication skills between a nurse and service user (Baillie, 2016). A scenario of working in partnership with patients can be, a patient at a&e is suicidal and overdosed on paracetamol. The nurse is responsible for taking care and explaining the effects and treatments for overdose. While explaining to the patients the effects, the nurse is able to build a therapeutic relationship with the patient over time as partnership means the service user can ask questions. On the other hand, if the patient refuses treatment and disregards the recommendations of the nurse, it could lead to conflict.
Conflict can occur when a nurse tries to build a relationship/partnership with the service user. However, conflict can also arise between healthcare professionals due to poor leadership and change, plus issues with interpersonal relationships (McKibben, 2017). This type of conflict can affect the quality of care patients receive, therefore the NMC has highlighted, nurses must communicate and work cooperatively in partnership to resolve any conflict within healthcare teams (NMC, 2015). There are many different reasons of why conflict can arise between nurses and patients, reasons like disagreements in decision-making, conflicting medical and religious beliefs additionally, conflicting opinions. Through conflict, nursing standards can rise. Oglethorpe and Oglethorpe (2009) stated, nursing conflict can result in critical thinking leading to well thought-out/quality decision-making by nurses, resorting in enhanced care quality received by patients.
A therapeutic relationship is when nurses and patients communicate effectively, whether it is regarding treatment or general conversations asking how they are. Through communication, nurses can provide exceptional medical care. Good communication and interpersonal skills allow nurses to communicate with patient’s relatives as well as other health professionals. A therapeutic relationship is called ‘therapeutic’ because it helps nurses to meet the needs of patients through a shared agreement (McQueen, 2000). Therapeutic relationships are fundamental as they signify compassionate care since it shows there is good nurse-patient interaction, which aid nurses with smoother care plan administration as patients are more trusting of nurses.
Marsham (2012) explored learning disability nurses therapeutic role and found that it is a big focus when it comes to interventions raising standards in nursing. This is because patient-nurse relationships reflect a more humanistic approach to nursing which can also be referred to as compassionate care since nurses take time to build a rapport with patients to provide unique patient centred care. Therapeutic relationships are all the more important as they are seen as the “… heart of care” (Marsham, 2012, p. 237). To build a relationship with patients, it can be easy for nurses to start using jargon without realising, also it is very easy for them to dominate treatment as nurses are the professionals and the patients are not. Therefore, the NMC stated “work in partnership with patients to make sure you deliver care effectively” (NMC, 2015, p. 4). Nurses are to make sure their patients understand their treatment and care plans. To help explain procedures to patients and build a relationship, there are a few key attributes nurses should acquire. Being sensitive, showing empathy, being approachable, a good listener and also being receptive to the patient. Callery and Milnes (2012) undertook a study of communication between nurses, patients and their parents. The study showed that there is a ‘triadic’ relationship formed when communicating with 3 people. In their study, the child was known as the ‘dyad’ who observed the conversations between the nurse and parent. Overall evidence from this study showed, communication is imperative with everyone including children (Callery and Milnes, 2012). Callery and Milnes study links to clinical practice as communication helps provide effective nursing care, in addition to improvement in patient mental health.
To provide person-centred care, the main focus for a nurse should be, is the patient happy. Carl Rogers, a humanistic psychologist believed patient health improves better once they improve their psychological state of mind (McLeod, 2014). This theory links to clinical practice as nurses are not just helping patients medically but also mentally. Hence, nurses tend to focus on encouraging elderly patients to focus on something or someone instead of an unconscious motive. McLeod (2014) stated, Carl Rogers’ humanistic approach to therapy is to ensure patients are benefitting by feelings of greater self-worth. Nurses are able to use Rogers’ person-centred approach to build therapeutic relationships with service users by taking time to ask them ‘how are you’. The main emphasis on a therapeutic relationship with patients is to increase the care and compassion received by the service users. Bettering nurses on attributes alike care and compassion improves quality of care; as stated by Glasper (2017); professionalism enhances and guarantees safe and effective patient-centred care, therefore professionalism is the leading attribute which nurses should possess and is repeatedly stated in the NMC: Code of Conduct. Rogers (1975, cited in McLeod, 2014) stated, showing empathy to patients means the nurse is able to understand the patients’ feelings, in return this slowly allows the patient to open up to the nurse. The best way to form a therapeutic relationship with patients is to show sensitivity, receptiveness and empathy towards patients. Contrariwise, showing sympathy can be demeaning for patients (Rogers, 1975, cited in McLeod, 2014).
With nursing comes a great deal of legal issues. With healthcare involving many laws and legislations, it means there is a bigger spotlight on the performance of health professionals, more importantly, nurses. The NMC: Code of Conduct incorporates many different laws to ensure nurses perform safe clinical practice. Nurses have a duty of care, to protect patient’s rights to privacy and confidentiality (NMC, 2015). The ‘duty of care’ nurses have is to provide humanistic care as it is their human right, and to prevent any neglect and poor, unsafe practice. The Nursing and Midwifery Council has set Codes of Conducts for nurses to follow when practicing their profession; nursing without being registered on the NMC register is a crime (NMC, 2015). An example of failed duty of care is the Mid-Staffordshire Inquiry of which’s findings were, poor leadership within healthcare teams and inadequate staff policies leading to extremely low standards of care (Hughes, 2013). Dimond (2015) states the accountability and expectations of nurses to the public also how nurses can be liable whether or not they are aware of the laws which are imposed in the nursing profession. An example of this could be, if there is a road traffic accident, if there is a nurse present (not on shift), they are expected to help and in some circumstances can be morally responsible if they refuse to assist, even if there is no legal obligation to volunteer nursing services (Dimond, 2015). To prevent any scandals like the Mid-Staffordshire inquiry, nurses should have knowledge of the laws they are to follow and aim to care for patients compassionately, with patient needs having the most attention.
Compassionate care is having the patients best interest at heart. Ethics are a fundamental in nursing; respect for autonomy, beneficence, non-maleficence and justice are the four principles of biomedical ethics (UK Clinical Ethics Network, 2001). In the Mid-Staffordshire inquiry, findings showed patients autonomy was not respected and were faced with maleficence as the Francis Report (2013) highlighted, patients were ‘so dehydrated they resorted to drinking water from vases’ (Hughes, 2013). Autonomy can be demonstrated by treating patients as autonomous individuals. An example of this is, although dementia patients do not have capacity, it is still the nurses’ responsibility and duty of care to treat them as an autonomous individual by being caring and compassionate and having a ‘holistic’ view (Skår, 2010). Correspondingly, attempting to get to know the patient no matter their capacity demonstrates autonomy; nurses carry out autonomous practice when they show courage and competence while taking dominating situations they are responsible for (Skår, 2010). Compassion and care are basic attribute to when providing ‘humanistic’ care. Humanistic care is to be received by all patients, majorly palliative patients as providing humanistic care for patients is to promote consolation and protect patient dignity in their last stages of their life (Wu & Volker, 2012).
To conclude, care and compassion are the most important attributes nurses should possess to provide exceptional patient-centred care. Building therapeutic relationships/partnerships with patients and relatives can help provide adequate tailored care as patients can make decisions concerning their treatment, leaving both patient and nurse in mutual agreement (McQueen, 2000). Conflict can arise between patients if therapeutic relationships are not formed. Conflict develops between healthcare professionals also due to changes in leadership. Nurses should follow laws and legislations when caring for patients, demonstrating professionalism and also as the NMC incorporates professionalism numerous time in the NMC: Code of Conduct. Overall, compassionate care can be demonstrated through excellent implementation of laws and the Code of Conduct in clinical practice.