Nurses’ experiences of compassionate care in the palliative pathway

Abstract

Aims and objectives: The aim was to explore how nurses experience compassionate care for patients with cancer and family caregivers in different phases of the palliative pathway. Background: Compassion is fundamental to palliative care and viewed as a cornerstone of high-quality care provision. Healthcare authorities emphasize that patients should have the opportunity to stay at home for as long as possible. There are, however, care deficiencies in the palliative pathway. Design: This study employed a qualitative design using focus groups and a hermeneutic approach. Methods: Four focus groups with three to seven female nurses in each group were conducted in Mid-Norway in 2018. Nurses' ages ranged from 28-60 years (mean age = 45 years), and they were recruited through purposive sampling (N = 21). Compassionate care was chosen as the theoretical framework. Reporting followed the COREQ guidelines. Results: Three themes expressing compassionate care related to different phases of the pathway were identified: (a) information and dialogue, (b) creating a space for dying and (c) family caregivers' acceptance of death. Conclusions: This study showed that it was crucial to create a space for dying, characterized by trust, collaboration, good relationships, empathy, attention, silence, caution, slowness, symptom relief and the absence of noise and conflict. Relevance to clinical practice: The quality of compassion possessed by individual practitioners, as well as the overall design of the healthcare system, must be considered when creating compassionate care for patients and their family caregivers. Nursing educators and health authorities should pay attention to the development of compassion in education and practice. Further research should highlight patients' and family caregivers' experiences of compassionate care and determine how healthcare systems can support compassionate care. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Compassion in healthcare: an updated scoping review of the literature

“…emphasizing to patients their medical conditions that may result in their mortality), which was driven from practitioners’ desire to help prevent future medical complications in patients – an approach to care that was further emphasized in relation to compassion sometimes requiring a more conscious effort as opposed to it occurring spontaneously [ 84 ]. In studies involving physicians from palliative care and medical oncology contexts [ 81 , 89 ], while compassion was thought to consist of both intangible and tangible skills (i.e. being present, holding a patient’s hand, and supportive touch) to address patients’ emotional needs [ 81 ], having standardized end-of-life conversations with patients and their family caregivers was integral to ensuring that their needs were adequately addressed and to educating them about their disease trajectory [ 81 , 89 ].…”

“…In studies involving physicians from palliative care and medical oncology contexts [ 81 , 89 ], while compassion was thought to consist of both intangible and tangible skills (i.e. being present, holding a patient’s hand, and supportive touch) to address patients’ emotional needs [ 81 ], having standardized end-of-life conversations with patients and their family caregivers was integral to ensuring that their needs were adequately addressed and to educating them about their disease trajectory [ 81 , 89 ].…”

“…As such, the provision of compassion depended on the individual nurse’s own personal values balanced with their duty of care [ 90 ]. Compassion was also perceived as requiring HCPs to “slow down” [ 83 , 89 ], particularly in the palliative care context where creating a space for dying was characterized by ‘slowness’ [ 89 ].…”

“…This entailed not only being physically present with the patient and addressing their medical needs, but seeking to understand their unique needs (e.g. emotional) and appreciate the patient as a person [ 6 , 44 , 45 , 73 , 79 , 89 , 99 , 101 , 110 , 111 ]. An inability to understand the emotional state of the patient or leaving patients feeling worried or vulnerable was felt to be associated with uncompassionate HCPs [ 91 , 94 , 99 , 102 ].…”

“…An inability to understand the emotional state of the patient or leaving patients feeling worried or vulnerable was felt to be associated with uncompassionate HCPs [ 91 , 94 , 99 , 102 ]. Skills such as being able to express affection, kindness, tenderness, being able to actively listen [ 77 , 78 , 88 , 89 , 94 ], showing understanding, and being supportive were perceived to be more effective expressions of compassion than routine, task-oriented care [ 99 ]. The ability to relationally understand patients was further highlighted as a distinct feature from sympathy, in which a shallow and superficial emotional response from HCPs can leave patients feeling demoralized, depressed, and feeling pity for themselves [ 44 ].…”