Compassionate care: not easy, not free, not only nurses

1 Compassion has historically been defined as an underpinning principle of work conducted by health professionals, especially nurses. Numerous definitions of compassionate care exist, incorporating a range of elements. Most include a cognitive element: understanding what is important to the other by exploring their perspective; a volitional element: choosing to act to try and alleviate the other’s disquiet; an affective element: actively imagining what the other is going through; an altruistic element: reacting to the other’s needs selflessly; and a moral element: to not show compassion may compound any pain or distress already being experienced by the other. 3 Appeals for more compassionate care have become common within international discourses, through initiatives such as Schwartz Rounds established in America, Hearts in Healthcare in New Zealand, and the Asia Pacific Healthcare Hub of Charter for Compassion. In the UK, a policy document called Compassion in Practice outlined 6 ‘Cs’ associated with compassionate care (care, compassion, courage, communication, commitment and competence). It was written in the wake of high profile accounts of negative health services experiences, including the 2013 Francis Report (http:// webarc hive .na tionalarchives. gov.uk/ 2015 0407 0842 31/h ttp: //www. midstaf fspublicinq uiry. com/ report), which detailed the dehumanising treatment of patients at Mid Staffordshire NHS Trust. Positioned as a solution to neglect and unsafe treatment, contemporary debate around practice and policy often paints compassionate care as an easy, cost-neutral fix for entrenched problems in modern health services. Yet delivering compassionate care is not without costs. First, staff may have to engage in emotionally charged interactions, which can leave them feeling psychologically exhausted and at risk of burnout. Furthermore, for health professionals to be able to connect with patients and understand their unique situation, while also addressing fundamental needs (eg, hygiene, feeding) in a non-mechanistic manner, an appropriately resourced workplace is required. Nursing, in particular, has been linked to contemporary discussions of compassionate care. We surveyed UK coverage of ‘compassionate care’ using keyword searches for this exact phrase both alone and in conjunction with additional search terms (nurse*, doctor*, manager*) across the full-text digitised content of a mix of professional and lay periodicals available through Scopus, Factiva and on individual journals, between 2007 and 2017. We included unique articles only, eliminated content categories unrelated to current debates (eg, obituaries) and hand-searched a sample of texts from each periodical to ensure that our search parameters successfully identified relevant content. The results are displayed in figure 1. Notably, compassionate care received far greater attention from the nursing and health services press than from medical journals. In the medical journals, compassionate care discourse focused, unsurprisingly, on doctors’ roles in commissioning and ensuring a compassionate environment for patients. However, closer scrutiny reveals that nurses remained providers of that care at the bedside. In the popular press, too, discussions of compassionate care (largely critical) were generally associated with nursing. In the sole UK newspaper in which discussions of compassionate care did mention doctors marginally more often than nurses, coverage reflected the trend visible in the medical press to position nurses as its direct providers. Perhaps most revealingly, none of these outlets gave significant attention to senior managers as key agents facilitating the provision of compassionate care. Viewpoint