Enabling the flow of compassionate care: a grounded theory study

Abstract

BackgroundCompassion has become a topic of increasing interest within healthcare over recent years. Yet despite its raised profile, little research has investigated how compassionate care is enacted and what it means to healthcare professionals (HCPs). In a grounded theory study, we aimed to explore this topic from the perspective of people working with patients with type 2 diabetes – a long-term condition that involves repeated interactions with HCPs.MethodsSemi-structured interviews and focus groups were conducted between May and October 2015 with 36 participants, selected from a range of roles within healthcare. Data collection explored their understanding of compassionate care and experiences of it in practice. Analysis followed the constructivist approach of Charmaz, which recognises meaning as being created by the interaction of people working under specific sociocultural conditions. It moved from open to focused coding, and involved the development of memos and constant comparison.ResultsOur analysis revealed that wishing to provide compassionate care, on its own, was insufficient to ensure this transpired; HCPs needed to work in a setting that supported them to do this, which underpins our core concept - the compassionate care flow. Data suggested that to be sustained, this flow was energised via what participants described as ‘professional’ compassion, which was associated with the intention to improve patient health and participants’ role within healthcare. The compassionate care flow could be enhanced by defenders (e.g. supportive colleagues, seeing the patient as a person, drawing on their faith) or depleted by drainers (i.e. competing demands on time and resources), through their impact on professional compassion.ConclusionsThis paper presents a model of compassionate care based on the notion of flow. It looks at processes associated with this concept and how compassionate care is delivered within health settings. Our new understanding of this phenomenon will help those working in healthcare, including managers and policy makers, to consider and potentially offset disruption to the compassionate care flow.

Compassion in nursing: Solution or stereotype?

“…During data collection, between May and October 2015, none of the 36 participants mentioned ‘Compassion in Practice’ at any point during interviews and focus groups. They did, however, emphasise the need for structural and interpersonal factors to be considered when exploring compassionate care, rather than focusing on and blaming individuals (Tierney, Seers, Tutton, et al., ).…”

“…According to Gilbert (), key attributes required for this to transpire are (a) sympathy (being able to feel for others), (b) empathy (being able to understand how others are feeling), (c) distress tolerance (letting things be, accepting emotions), (d) sensitivity to distress (picking up and noticing needs of self and others), (e) being non‐judgemental (not condemning others) and (f) care for well‐being (having motivation to support and help). Debate has been expressed about the possibility of augmenting such innate qualities, which may blossom or wither depending on the setting in which people work (Schwartz, ); hence, it is argued that environmental factors need to be conducive to accessing and realising attributes associated with compassionate care (Tierney, Seers, Tutton, & Reeve, ). This will be explored in more detail below.…”

What place does compassion hold in the conduct and production of health services research?

“…It is not always afforded the same status as more cognitive or technical skills [35]; even though being compassionate is complicated work [21], this might not necessarily be appreciated by those designing and managing investigations. One way to guard against this may be to have strong Patient and Public Involvement (PPI) within a project, although evidence is needed to support this notion.…”

“…Whilst undertaking studies in this area, which included a consideration of organisational responsibilities, the role of self-compassion for health professionals, and the position of patients in enabling compassion to flourish in healthcare settings [30,31], she reflected on the relevance of what had been written about compassion in healthcare to the research arena. Self-compassion, in particular, was a concept that she felt was important to address because she had found the work of writers like Neff helpful when encountering difficulties associated with the process of research (e.g.…”

“…In the busy reality of wards and surgeries, being cognisant of and feeling empowered to respond to suffering or distress can be difficult, if working in an environment that fails to provide the interpersonal and structural support required for compassion to flourish [21]. This has resulted in international concern and critique being expressed about contemporary healthcare cultures [22][23][24] where compassion is a common component of the values publicised by an organisation, yet staff can feel unsupported and under threat (e.g.…”