Optimising compassionate nursing care at the end of life in hospital settings

Abstract

Background: An urgent need to improve palliative care in hospital has been identified. Moreover, service users consistently report care delivered by nurses in hospital as lacking compassion. Compassion is a fundamental component of nursing care, and promoting compassionate care has been identified as a policy priority in many countries. To help address this within the hospital context, we recently completed research exploring bereaved family experiences of good end of life care in hospital.We found that family accounts of good care aligned with Nolan and Dewar's compassionate care framework and subsequently extended the framework to the bi-cultural context of Aotearoa, New Zealand. Aims and objectives:In this discussion paper, we explore synergies between our newly developed Kapakapa Manawa Framework: a bi-cultural approach to providing compassionate care at the end of life and the Fundamentals of Care. We argue that our framework can be used to support the implementation of the relational component of the Fundamentals of Care and the delivery of compassionate nursing practice in hospitals in Aotearoa, New Zealand. Design: Discussion paper. Methods: Review of relevant literature and construction of two vignettes describing good end of life care from the perspectives of bereaved family-one Māori and one non-Māori. The vignettes provide practical examples of how the values of the Kapakapa Manawa Framework can be enacted by nurses to provide compassionate care in alignment with the relationship component of the Fundamentals of Care. Conclusions: Whilst the Kapakapa Manawa bi-cultural compassionate care framework has grown out of research conducted with people nearing the end of their lives, it has the potential to improve nursing care for all hospital inpatients. Relevance to clinical practice: Addressing the wider policy and health system factors detailed in the Fundamentals of Care will support its implementation in the clinical setting. | 1789 ROBINSON et al.

Nurses’ experiences of compassionate care in the palliative pathway

“…Many of the definitions of compassionate care are general and do not consider that compassionate care will have different expressions in different contexts for different patients and situations. A discursive paper from New Zealand presented a bi-cultural approach to providing compassionate care during end-of-life care (Robinson et al, 2019…”

“…Many of the definitions of compassionate care are general and do not consider that compassionate care will have different expressions in different contexts for different patients and situations. A discursive paper from New Zealand presented a bi‐cultural approach to providing compassionate care during end‐of‐life care (Robinson et al, 2019). The Kapakapa Manawa Framework was developed by drawing on empirical research that captured the experiences of palliative care in hospitals from the perspectives of bereaved families (Dewar & Nolan, 2013; Durie, 1985; Gott et al, 2019).…”

“…This model differs from others by noting how compassion should be integrated into nursing practice by referring explicitly to compassion as a verb. The model considers patients’ cultural background in care provision and the family members involved, which may be used to support the implementation of the relational component of ‘Fundamentals of Care’ (Robinson et al, 2019). Knowing enough about patients and developing trust is an important element in this framework.…”

“…Knowing enough about patients and developing trust is an important element in this framework. Conceptualizing compassion as an action may be used as a platform on which to develop meaningful relationships (Robinson et al, 2019).…”

The culture conversation: Report from the 2nd Australasian ILC meeting—Auckland 2019

“…Developments are underway to address issues related to biculturalism with researchers developing new models of bicultural care such as the Kapakapa Manawa framework for providing compassionate care at the end of life (Robinson et al., 2019). The Kapakapa Manawa framework illustrates the need to establish a trusting nurse–patient relationship and to integrate the patients physical, psychosocial and relational care needs (Kitson, 2018).…”