Editorial
Compassion in practice: connected, contested, conflicted, conflated and complex
Journal of Research in Nursing 2017, Vol. 22(1–2) 3–6 ! The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1744987117691170 journals.sagepub.com/home/jrn
Ann McMahon Co-editor-in-Chief, Journal of Research in Nursing
Mark White Programme Manager, Programme for Health Service Improvement, Health Service Executive, Dublin, Ireland, Fellow and board member of the faculty of Nursing and Midwifery, Royal College of Surgeons, Ireland and Honorary Research Fellow, School of Health Science, Waterford Institute of Technology, Ireland
‘‘There is a powerful existential imperative that we act with compassion towards all we are connected with, if we are to ensure healthy evolution of the ecosystems and communities we are part of. (West, 2016)’’
The focus of this edition of Journal of Research in Nursing (JRN) is on compassion in practice. Hardly a day goes by where there is not a reference somewhere in the media, in all of its forms, that indicates a growing sense that there is a deficit of compassion, whether that be at the societal, organisational, professional or individual level. The reasons for this are complex, multivariate and interconnected. Whilst our focus is on health and social care and the nursing contribution in particular, the evidence of this so called ‘compassion deficit’ is much wider than that, reaching deep into society. This edition of JRN brings readers plenty of food for thought about compassion, in its broadest sense, at organisational, professional and individual levels but these deliberations need to be considered within the context of the societal obligations and relationships that we all practise within. For instance, at the societal level, consider, just one example where people’s propensity for compassion is sometimes questionable – the attitudes towards and treatment of refugees seeking asylum. In this situation there are far-reaching consequences of political action and inaction, including the seismic ramifications of both of these on public health and wellbeing (Walsh, 2015) – in this situation the way nurses use compassion makes a considerable difference. Considering the plight of refugees and reflecting on the attitudes and behaviours of people towards the most vulnerable in society provides a powerful insight Corresponding author: Ann McMahon, Co-editor-in-Chief, Journal of Research in Nursing. Email:
[email protected]
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into what compassion in action and compassion deficit actually look like in practice. Equally it serves to illustrate the connections between the personal and the political and the challenges associated with addressing the compassion deficit or indeed, with maintaining our ability to provide compassionate care. It is therefore timely that our new year edition of JRN, guest edited by Mark White, focuses on compassion in practice. In commissioning and publishing nine peer-reviewed scholarly papers with their associated reviews and two Perspectives, we hope to make a significant contribution to our collective understanding of the policy and practice challenges of assuring compassion in nursing practice and provide not just helpful insights but practical solutions. The first two papers discuss the meaning of compassion: it is contested, connected to, and conflated with similar constructs and therefore inherently complex. The third paper illuminates the conditions where compassionate practices flourish. The following three papers examine the challenges associated with measuring compassion in practice and the final three papers illustrate the challenges associated with assuring compassion in practice. Two Perspectives conclude the edition.
The meaning of compassion and the conditions in which it flourishes In their literature review examining burnout and its relationship to empathy in nursing, Hunt et al. highlight just how difficult it is to define compassion and how complex its relationship with similar constructs, such as sympathy and empathy, actually is. They suggest that the ability to self-regulate emotions may be an important factor in reducing the risk of burnout in nurses. McSherry et al.’s paper identifies and analyses some of the factors that shape the values of student nurses. Their findings suggest that student nurses’ values are shaped by their own personal values, values dictated by the profession and some fundamental aspects of nursing that students found hard to define and conceptualise. However it was whilst trying to describe this abstract, fundamental concept that students identified it as being something patient-centric, dignified and compassionate. Beardsmore and McSherry interviewed staff to ascertain the factors they felt contributed to the culture of the organisation. They examined perceptions of how organisational culture (values, beliefs and assumptions) related to the provision of compassionate quality care. Their qualitative study findings suggest that professional practice, support in the workplace, size and quality of the workforce and a person-centred approach all help contribute to healthcare organisations’ ability to provide compassionate care and quality services.
Measuring compassion Lown et al. tested the US designed Schwartz Center Compassionate Care Scale (SCCCS) in Ireland and found that patients want the same compassionate care behaviours from their healthcare teams as patient/service users in the US. The fact that the US and Ireland operate quite different healthcare systems appeared to be immaterial. More importantly the study indicates that compassionate behaviours of Irish healthcare teams fall significantly short of patient expectations at both the individual and team levels. In response to a national policy call for indicators to measure nurses’ non-verbal compassion responses, McElroy and Esterhuizen describe methods used to test the face
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and content validity of a questionnaire to measure nurses’ non-verbal methods of compassionate communication in acute healthcare. Whilst the paper is methodologically sound and makes an important contribution, it is not apparent if, or how, the patient’s voice was incorporated into the development or testing of the instrument. In the face of nurses claiming that they no longer have time to ‘care’, White et al. explored whether the ‘Productive Ward’ intervention could negate burnout and compassion fatigue by releasing time for direct patient care and enabling nurses to feel more engaged (and therefore less likely to experience compassion fatigue). They used an exploratory longitudinal cohort design (with an experimental test outcome and a matched control group), to measure the impact of the Productive Ward intervention amongst ward-based teams involved the QI initiative in Ireland. Results indicate that whilst ‘time to care’ was not necessarily released universally within the cohort, engagement levels were reported higher in the teams participating in the intervention.
Building capability, increasing capacity Smith et al. evaluate a programme designed to enable NHS staff to listen to patients, and learn and respond to feedback in order to facilitate the development of practice. They highlight the considerable challenges in supporting and enabling the workforce to prioritise the feedback activity and develop compassionate care practice for patients. This raises a most pertinent question – is it ethical to introduce interventions that capture the patient experience in order to improve compassionate care practice without ensuring that the workforce have the capacity to respond? MacArthur et al.’s analysis of the ‘Leadership in Compassionate Care Programme’, which was implemented across a health board in Scotland over a three-year period, also highlights how difficult it is for interventions designed to promote compassionate care to succeed. In this study ‘leadership’ emerged as the most significant factor influencing the sustainability of the compassionate care programme. The significance of compassionate leadership was echoed in the study reported by Curtis et al. Their study in the south-east of England used appreciative inquiry and by focusing on and identifying real examples of evidence of compassion in practice, they aimed to cultivate compassion. Their approach also surfaced the importance of self-compassion and the benefits of mindfulness. To paraphrase their conclusions, leadership that lacks compassion has the power to extinguish the flame of compassion. All three papers appear to challenge any assumptions that frontline staff are the only ones in the healthcare system who have to be compassionate in their practice. It would suggest that all individuals at every level of the ‘system’ need to take responsibility for compassion in practice. All staff should model compassionate behaviours towards one another, not just the users of services. The attitudes and behaviours of individuals collectively make up the cultures of the teams, the departments and the organisation as a whole. This is echoed by West (2016) who argues from a societal level and proposes that at the very core of the expressions of anger, fear, pitilessness and hatred witnessed throughout last year is a lack of compassionate leadership. If compassion in practice is to be assured, everyone must recognise their individual and collective responsibility and leaders must show empathy towards their followers in order to create the conditions where compassion may flourish. There is no simple solution, no quick
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fix. Assuring compassion in practice requires compassionate political, professional and organisational leadership that fully engages with compassion and its complexity. We conclude this edition with two Perspectives that in turn focus on the political and the personal. In the first Maxwell warns against privileging compassion over competence and argues that professional nursing must acknowledge its interdependencies and resist nursing being defined exclusively on compassionate terms. In the second, Giovannoni shares the importance of self-compassion in his role as a forensic advanced practice nurse specialising in the care of convicted sexual offenders. References Walsh K (2015) Perspectives: Nursing, ethics, human rights and asylum seekers: An Antipodean perspective on 2015. Journal of Research in Nursing 20(8): 741–745.
West M (2016) New Year’s resolution: Compassion in the face of fear. Available at: blog.oup.com (accessed 16 January 2017).
