Being exposed to compassionate caring and loss of care

Students identified compassion as an important value in high quality nursing practice and that compassion depended on the empathising with the patient’s situation. Compassion is considered as being at the core of nurse caring (Wilkes and Wallis, 1998; Chambers and Ryder, 2009). However, students provided numerous examples of witnessing nursing practice that lacked compassion.

Numerous open and in vivo codes were identified during the coding of transcripts and were brought together into substantive codes. Each substantive code was analysed and two of these were brought together into the selective code ‘being exposed to compassionate caring and loss of care’ (figure 7). Both of the substantive codes within this selective code are discussed below.

Being exposed to compassionate caring

and loss of care

i

Empathy is central to compassion

Witnessing a lack of compassion and its

impact on quality

Figure 7. Substantive codes within the selective code ‘Being exposed to compassionate caring and loss of care”

8.4.1 Empathy is centrai to compassion

The students likened compassion to empathy more than any other aspect of their practice and identified that having compassion was only possible when a nurse had the time or opportunity to see ‘the person in the patient’ and understand their suffering through empathising with what they were going through:

I think it (being compassionate) is about empathy rather than sympathy. Definitely empathy because I find when you put yourself in other peoples’ shoes you understand it a iot more, even drug users... if I ’d had their kind of life how do you know that that couldn’t have been me. So I think it helps me to try and understand and not be judgmental of people. So that is compassion, understanding and empathy and just

listening... being genuinely interested. (P1 )

Students saw compassion as accepting and trying to understand the patient’s experience or suffering as real, whether or not the student had experienced something similar:

Whatever someone is going through, be it real to you or not, it is real to them and you have to be able to empathise. To show compassion I think you have to be able to empathise. (P12)

Students understood compassion depended on being able to ‘be there’ for the patient and so enabling them to identify and relieve their suffering:

Compassion is being there for a person and being able to give them what they need. (P11)

Understanding a person’s viewpoint is fundamental to being empathie and therefore understanding an individual patient’s experience or suffering enabled students’ practice to be directed at what the patient wanted alongside what was needed for a ‘condition’. This empathie approach can take nursing care from being task-centred to person-centred (Smith, 2012). Such expressions of empathie understanding were common to all the students and reflected the professional ideals of partnership working for individualised patient-centred nursing practice (NMC, 2008).

8.4.2 Witnessing a lack of compassion and its impact on quality

Students saw wide variation in RNs’ compassionate practice and not all the qualified staff they witnessed working were compassionate in their approach. Students appeared disappointed in the lack of compassion displayed by some RNs:

It would be nice if everybody had it (compassion) but not everybody is compassionate... it shouldn’t be difficult should it? (P14)

The belief that compassion should be the essence of nursing but that it was not always evident within nursing practice was recognised within nurse education literature (Chambers and Ryder, 2009). The students were able to provide examples of practice they had witnessed that was not compassionate and had left them feeling very concerned about the upholding of professional values:

A gentleman was confused and kept buzzing saying ‘my wife is in that bed’ so they

(nurses) tucked the buzzer under his pillow so he couldn’t buzz anymore. I thought ‘you can’t do that, you have to go and sit with him and talk to him’, and he had dementia as well. I just thought that was really poor (P14)

The patient was distressed and needed comfort but his suffering was not recognised or attempts made to relieve it; the attention he received was therefore not compassionate. Many of the students used examples of caring for a patient with dementia in relation to concerns about compassionate practice. Sadly discrimination and stigmatism against older people, particularly those with dementia, have been widely reported in the UK (Age Concern,

2006) and have been shown to influence nurses’ desire to work within this speciality (Chan and Chan, 2010).

Students identified that some RNs appeared to be 'disillusioned’ and to have lost their compassion and that they treated nursing as a 'job' where they needed to get tasks done:

There was one lady who had been diagnosed with terminal cancer and when her

family had gone I said ‘are you OK?’ and she said ‘do you mind just having a chat with me?’ and then I got called away by Sister saying leave her alone... go and sort out a bay... it’s sad because that’s what nursing is all about, therapeutic relationships, but they’re (RNs) not bothered though, the jobs need to get done. (P2)

This student explained how she had tried to reason with the Sister but found her relative inexperience and junior position made it difficult for her to get her concerns heard. This left her feeling frustrated and powerless to relieve the suffering of this woman, and she felt vulnerable to forces outside her control that could prevent her from engaging in practice she felt was ideal, unable to challenge constraints.

Students differentiated between 'good' nurses and 'bad' nurses based upon the compassionate relationships the individual RNs built with patients. The ‘good’ nurses had a ‘passion’ for nursing and this attitude was also seen within their relationships with patients and other staff, including students. Students saw nursing documentation or ‘paperwork’ as sometimes providing an ‘excuse’ not to engage with patients:

Really good nurses, they are the ones with the passion for nursing. Whereas the others, it’s just a job. That’s why I think some of them hide behind the paperwork because they have that feeling they don’t want to be there with the patients (P3)

Students were not sure why some staff became disillusioned and ‘lost their compassion’ but all believed these staff should leave the profession if they no longer ‘cared’. Students were distressed at witnessing loss of compassion and poor standards of practice, they had not expected to see this and they expressed that the reality of practice in some placements was not living up to their expectations. However, they also witnessed excellence in practice and RNs who ‘took the time’ and lived up to the professional ideals and the students' expectations.

Students identified that a lack of compassionate practice often ran alongside a lack of interest in the students’ learning, that the two appeared to go together and were related to the support and leadership within a placement. The students identified that having good leaders in placements enabled them to access better learning support and to better understand the roles of the various members of the caring team:

The Sister was into education, into teaching, and knowing things, and showing to

students how to do things, and so therefore all the staff tried to adhere to the

standards of the Sister... I think that was beneficial for patients. (P4)

The impact of leadership on learning and compassionate practice is explored in more detail within Chapter 10.