Describing compassionate care: the burn survivor's perspective

Psychotherapeutic interventions for burns patients and the potential use with Stevens-Johnson syndrome and toxic epidermal necrolysis patients: A systematic integrative review

Background

The existing evidence demonstrates that survivors of SJS/TEN have reported long-lasting psychological effects of their condition. Burns patients experience similar psychological effects. It is important to look at ways to help allay the psychological complications of SJS/TEN. As there is an absence of evidence on SJS/TEN psychotherapeutic interventions, it was judged to be beneficial to determine the evidence underpinning psychotherapeutic interventions used with burns patients.

Aims and objectives

The aim of this systematic integrative review was to synthesize the evidence relating to psychotherapeutic interventions used with adult burns patients and patients with SJS/TEN.

Method

The systematic review was guided by Whittemore and Knafl’s integrative review process and the PRISMA guidelines. Nine databases were searched for English and French language papers published January 2008 to January 2021. The protocol for the review was registered with PROSPERO.

Results

Following a screening process, 17 studies were included in the review. Two themes were identified using content analysis, (i) Empirically supported psychotherapeutic treatments, (ii) Alternative psychotherapeutic treatments. This review revealed no evidence on specific psychotherapeutic interventions for patients with SJS/TEN. Some of the interventions used with burns patients, viz. relaxation therapy, hypnosis and cognitive behavioral therapy showed some significant benefits. However, the evidence for burns patients is mainly focused on pain and pain anxiety as outcomes.

Conclusion

Following further research, some of the interventions deployed in burns patients may be applicable to SJS/TEN patients, particularly stress reduction techniques. In addition, the caring behaviours such as compassion, respect, and getting to know the patient as a person are important components to psychological care.

The dignity of burn patients: a qualitative descriptive study of nurses, family caregivers, and patients

Background

As an ethical principle, showing respect for human dignity is a professional duty of all nurses. The aggressive nature of severe burn injuries makes it hard to respect the existential values and dignity of burn patients. However, only a few studies have been conducted on the preservation of the dignity of burn patients. The purpose of this study is to identify and describe burn patients’ dignity as perceived by nurses, family caregivers, and burn patients.

Methods

The present study has a descriptive, qualitative research design. Nurses, family caregivers and patients in the biggest burns hospital in the south of Iran were selected via purposeful sampling from October 2017 to August 2018 (n = 25). Data were collected using semi-structured, in-depth, individual interviews. Thereafter, data analysis was performed through conventional content analysis.

Results

Three main themes were extracted from the information obtained in the interviews: empathic communication, showing respect, and providing comprehensive support.

Conclusion

The care provided to burn patients should be combined with effective communication, spending time with them, and attending to their repetitive requests, so that they can freely express their feelings and concerns. In addition, the patients’ human values and beliefs should be respected and all aspects of their existence should be taken into account to preserve their dignity. Workshops designed based on the findings of the present study can help with improving the quality of burn nursing care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00725-w.

Developing and psychometric properties of the caring behaviors assessment tool-patient version-short form

PURPOSE

To develop and examine the psychometric properties of the caring behaviors assessment tool-patient version-short form (CBAP-SF) based on Human Caring Theory to evaluate caring behaviors by patients.

METHODS

This methodological study was conducted with 400 patients. The data were analyzed with SPSS 23.0 and LISREL 8.80.

FINDINGS

It was found that the scale with 27 items had good fit indices. The Cronbach's α was 0.96 for the scale and 0.77-0.94 for the subdimensions. Also, the item-total score correlation of the scale was 0.531-0.847.

PRACTICE IMPLICATIONS

The CBAP-SF was a valid and reliable tool to evaluate caring behaviors by patients.

Validation of the Persian version of the Compassionate Care Assessment Tool

OBJECTIVES

The present study aimed to translate and determine the psychometric properties of the Persian version of the Compassionate Care Assessment Tool (CCAT) ©.

METHODS

The study was carried out to translate and validate of the CCAT©. After securing permission from the designer of the tool and translating it, the psychometric properties were determined through examining face validity, construct validity, internal consistency, and test/retest reliability. With regard to construct validity, confirmatory factor analysis was used so that 300 patients in internal and surgery wards were selected by a simple random sampling method from three hospitals. Data were analyzed using SPSS (v.24.0) and LISREL statistical software version 8.8.

RESULTS

The results of the confirmatory factor analysis supported the validity and reliability of the Persian version of the CCAT© and its four factors. The reliability of the tool and internal consistency were confirmed through test/retest method with two weeks' interval. At the two areas of importance and provision of compassionate care, Cronbach's α coefficient equaled to 0.918 and 0.933 and intraclass consistency equaled to 0.848 and 0.907 respectively.

CONCLUSION

The results showed that the Persian version of the CCAT© was adequately valid and reliable for Iranian patients. Given the acceptable psychometric parameters of the tool, using it in future studies to measure importance and provision of compassionate nursing care to Iranian patients at internal and surgery wards is recommended.

The Behavioural Display of Compassion in Radiation Therapy: Purpose, Meaning and Interpretation

INTRODUCTION

Providing high quality patient care is a worldwide standard of proficiency across the radiographic workforce. As compassion and compassionate behaviours are considered synonymous with patient-centred care, the focus of professional practice throughout healthcare should be on a system that places compassion at its heart. Inadequate care and dispassionate practice have been blamed for failings within the National Health Service. United Kingdom healthcare legislation has been criticised for its failure to provide meaning or clarity to practical compassionate care. Consequently, it has hindered the ability of National Health Service Trusts, service delivery managers and Medical Radiation Technologists to interpret and implement policy recommendations regarding compassionate practice at a local level.

AIMS

To support the implementation of compassionate legislation, the study sought to understand the perspectives of those in receipt and those delivering compassionate practice. The research aimed to develop a context specific definition of compassion and identify commonly recognised compassionate behaviours. This article reports on the display of compassion through the behaviours of Medical Radiation Technologists.

METHODS/MATERIALS

Co-production underpinned the qualitative methodological inquiry and design of the research. Eleven focus groups were conducted, five with Medical Radiation Technologists three with cancer patients and care-givers and three with student Medical Radiation Technologists. On completion of thematic analysis from those groups, three co-production workshops were conducted, integrating the data to ensure the co-produced findings were equally representative of the perspectives of the three participant groups.

RESULTS

An understanding of compassionate display is illustrated through the construction of a conceptual framework. The findings established observable behaviours which a Medical Radiation Technologist must engage in to undertake compassionate display. Three compassionate behavioural classifications were established through the analysis; 'embodied connection', 'characteristic expression' and 'indicative communication'. A Medical Radiation Technologist must engage in all the three core behaviours to gain comprehension of the patient and person. Comprehension enables the Medical Radiation Technologist to establish practices that aim to address the compassionate needs of the patient.

DISCUSSION/CONCLUSION

Adoption of the behaviours by Medical Radiation Technologists should enhance compassionate care received by patients within clinical practice. The conceptual framework provides both a theoretical and practical understanding of compassionate display, making it a valuable tool for training and assessment.

Compassionate Care in Healthcare Systems: A Systematic Review

BACKGROUND

In spite of emphasis on patient-centered cares and promotion of their quality, shortcomings have been seen in health systems due to lack of compassion.

PURPOSE

The aim of the present study was to determine the definition, fields, facilitating and inhibiting factors of compassionate care in healthcare systems and the interventions designed to promote it.

METHODS

This study was conducted through narrative synthesis which is supposed to do systematic and synthesized review. Searching was done in English databases including Pub Med, CINAHL, Google Scholar, Web of Science, and Cochrane library, Ovid, Science Direct, WILEY by using keywords of Compassionate Care, Delivery of Health Care, Healthcare Systems, Compassion and Health Care Providers from 1987 to 2017.

RESULTS

Compassionate care has some dimensions including ethical, professional, effective communication, human, spiritual/religious and getting involve with patients. Facilitating and inhibiting factors consisted of the nurse's personal characteristics, patients' behavior and organizational factors included workload, role model, and value of compassionate care in healthcare systems. Educational interventions such as providing feedback and reorienting have been mostly used to improve the compassionate care.

CONCLUSIONS

Although compassionate care has been known as the main element of improving services quality in health care system, it has been studied restrictively from the viewpoints of the patients and all personnel in healthcare systems. The improvement of compassionate care through education cannot remove completely the gap between theory and practice, because it seems that clinical environment and organizational values of healthcare system are the largest facilitating and inhibiting factors for filling this gap. Therefore, it is necessary to take measures for promoting organizational culture.

Nurses', patients', and family caregivers' perceptions of compassionate nursing care

BACKGROUND

Compassion is the core of nursing care and the basis of ethical codes. Due to the complex and abstract nature of this concept, there is a need for further investigations to explore the meaning and identify compassionate nursing care.

OBJECTIVES

The purpose of this study was to identify and describe compassionate nursing care based on the experiences of nurses, patients, and family caregivers.

RESEARCH DESIGN

This was a qualitative exploratory study. Data were analyzed using the conventional content analysis method.

PARTICIPANTS AND RESEARCH CONTEXT

Nurses, hospitalized patients, and family caregivers in different educational hospitals in an urban area of Iran were selected from February 2016 to December 2017 using a purposeful sampling method (n = 34). In-depth and semi-structured interviews, focus group interviews, and field notes were used for data collection.

ETHICAL CONSIDERATIONS

The study was approved by the University's Ethics Committee. The participants were informed about the aim and method of the study, reasons for recording the interviews, confidentiality of data, and voluntary nature of participation in this study.

FINDINGS

Data from interviews and filed notes were analyzed and classified into three themes: "effective interaction," "professionalism," and "continuous comprehensive care."

DISCUSSION AND CONCLUSION

Emerged themes of this study involved holistic care in the current literature on nursing with an emphasis on effective interaction and professionalism. Nurses can understand patients' and family caregivers' comprehensive needs through interaction skills. In addition, clinical proficiency, maintaining professional ethics' standards along with holism, and continuity in care are examples of compassionate care. Education program about compassionate care can enhance the quality of nursing care.

Qualities, teaching, and measurement of compassion in nursing: A systematic review

BACKGROUND

Compassion has global implications for nursing care. However, failure to provide compassionate care is reported by patients. Nursing and nurse education have been scrutinized about the impact training can have on student's compassion. Furthermore, there is a paucity of standardised measures to assess levels of nurses' compassion.

OBJECTIVES

To identify (1) the qualities of a compassionate nurse, (2) how compassion is taught to nursing students, and (3) the instruments used to measure compassion in nursing.

DESIGN

Systematic literature review.

DATA SOURCES

CINHAL, EBSCO, SCOPUS, PubMed, Ovid Nursing.

SEARCH METHODS

A systematic review of published research was conducted with. No limitations in the search timeframe were used. Articles were included if they were (1) nurses (2) nursing students (3) educators and (4) patient groups, (5) written in English. Articles that were, peer reviewed, research articles, or articles grounded in evidence based practice were also included.

RESULTS

Fourteen studies (6 UK, 3 USA, 2 Canada, 1 Korea, 1 Thailand, and 1 Netherlands) identified eleven characteristics of a compassionate nurse. Two UK and one Australian study investigated teaching compassion to nursing students. Four articles reported on instruments used to measure compassion in nursing. Three were American, and one Korean.

CONCLUSION

This review identified only 21 papers overall. Several qualities of a compassionate nurse were found. In addition, few studies have explored how compassion is taught to nursing students. Also, there are a limited number of instruments for measuring compassion in nursing. More research is needed in nurse education to develop a teaching approach and psychometric measure for nurses' compassion.

Burn Survivors' Near-Death Experiences: A Qualitative Examination

Persons who come close to death but survive catastrophic accidents sometimes report very vivid experiences during times when their survival was in doubt, when they were believed to be dead, and during resuscitation efforts. This qualitative study builds upon existing research on near-death experiences (NDEs) by focusing on the oral accounts from a sample of individuals with large and life-threatening burns. The NDE accounts were obtained from burn survivors attending the Phoenix Society's World Burn Congress and are similar to reports by notable researchers ( Greyson, 2003 ; Moody, 1975 ; Ring, 1980 ) while reflecting the uniqueness of the individual survivor's experiences. Six major themes are reported. Counselors and health professionals need to be aware of and educated about NDEs as these experiences can have profound effects upon the individual. Patients who have had NDEs may need to discuss them but fear professionals will reject their stories as being crazy.

Compassion Competence in Nurses

The purpose of study was to identify the attributes of the concept of compassion competence for nurses. A hybrid model was used to develop the concept, which included fieldwork performed. The concept of compassion competence was found to possess 3 dimensions: (a) acquisition of a wealth of knowledge; (b) development of skills of emotional communication, sensitivity, insight, and self-regulation; and (c) development of attitudes of respect and empathy, and maintenance of occupational distance. Compassion competence could be useful for developing ways to enhance the knowledge, skills, and attitudes required for nurses to provide compassionate care in various nursing practices.

Compassion in Health Care: An Empirical Model

CONTEXT

Compassion is frequently referenced as a hallmark of quality care by patients, health care providers, health care administrators, and policy makers. Despite its putative centrality, including its institution in recent health care reform, an empirical understanding based on the perspectives of patients, the recipients of compassion, is lacking-making compassion one of the most referenced yet poorly understood elements of quality care.

OBJECTIVES

The objective of this study was to investigate palliative cancer patients' understanding and experiences of compassion to provide a critical perspective on the nature and importance of compassion.

METHODS

This grounded theory study used semi-structured interviews to investigate how patients understand and experience compassion in clinical care. Using convenience and theoretical sampling, 53 advanced cancer inpatients were recruited over a seven-month period from a specialized palliative care unit and hospital-wide palliative care service within a Canadian urban setting. Data were analyzed by four members of the research team through the three stages of Straussian grounded theory.

RESULTS

Qualitative analysis yielded seven categories, each containing distinct themes and subthemes. Together, they constitute components of the compassion model-the first empirically based clinical model of compassion. The model defines compassion as a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action.

CONCLUSION

The components of the compassion model provide insight into how patients understand and experience compassion, providing the necessary empirical foundation to develop future research, measures, training, and clinical care based on this vital feature of quality care.

Compassion: a scoping review of the healthcare literature

BACKGROUND

Recent concerns about suboptimal patient care and a lack of compassion have prompted policymakers to question the preparedness of clinicians for the challenging environment in which they practice. Compassionate care is expected by patients and is a professional obligation of clinicians; however, little is known about the state of research on clinical compassion. The purpose of this scoping review was to map the literature on compassion in clinical healthcare.

METHODS

Searches of eight electronic databases and the grey literature were conducted to identify empirical studies published over the last 25 years. Eligible studies explored perceptions or interventions of compassionate care in clinical populations, healthcare professionals, and healthcare students. Following the title and abstract review, two reviewers independently screened full-texts articles, and extracted study data. A narrative approach to synthesizing and mapping the literature was used.

RESULTS AND DISCUSSION

Of 36,637 records, 648 studies were retrieved and 44 studies were included in the review. Less than one third of studies included patients. Six themes emerged from studies that explored perceptions of compassionate care: nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical compassion, barriers and enablers of compassion, and outcomes of compassion. Intervention studies included two compassionate care trials with patients and eight educational programs that aimed to improve compassionate care in clinicians and students.

CONCLUSIONS

This review identifies the limited empirical understanding of compassion in healthcare, highlighting the lack of patient and family voices in compassion research. A deeper understanding of the key behaviors and attitudes that lead to improved patient-reported outcomes through compassionate care is necessary.

Development and validation of an instrument to measure nurses' compassion competence

AIM

To develop and psychometrically validate the Compassion Competence Scale.

BACKGROUND

Compassion is a vital asset in the nursing profession; thus, it is necessary to develop a suitable instrument for assessment.

METHODS

The 49-item preliminary instrument was developed using concept analysis (hybrid model). Content and face validity were confirmed by 10 experts and 10 nurses, respectively, and the number of items was reduced to 18. The tool was tested on 660 nurses working at three tertiary hospitals in South Korea in 2013.

RESULTS

We selected 17 items for the final scale and extracted three factors (variance explained: 55.9%): communication, sensitivity, and insight. Correlations with the Emotional Competence Scale (.68), Compassionate Love Scale (.62), and Interpersonal Reactivity Index (.41) supported the scale's convergent validity. The reliability (Cronbach's α and test-retest reliability) was acceptable.

CONCLUSIONS

The Compassion Competence Scale is a simple, effective screening tool for identifying compassion competence among nurses.

Rigorous, robust and systematic: Qualitative research and its contribution to burn care. An integrative review

Qualitative methods are progressively being implemented by researchers for exploration within healthcare. However, there has been a longstanding and wide-ranging debate concerning the relative merits of qualitative research within the health care literature. This integrative review aimed to exam the contribution of qualitative research in burns care and subsequent rehabilitation. Studies were identified using an electronic search strategy using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica database (EMBASE) and Scopus of peer reviewed primary research in English between 2009 to April 2014 using Whittemore and Knafl's integrative review method as a guide for analysis. From the 298 papers identified, 26 research papers met the inclusion criteria. Across all studies there was an average of 22 participants involved in each study with a range of 6-53 participants conducted across 12 nations that focussed on burns prevention, paediatric burns, appropriate acquisition and delivery of burns care, pain and psychosocial implications of burns trauma. Careful and rigorous application of qualitative methodologies promotes and enriches the development of burns knowledge. In particular, the key elements in qualitative methodological process and its publication are critical in disseminating credible and methodologically sound qualitative research.

To heal and restore broken bodies: a retrospective, descriptive study of the role and impact of pastoral care in the treatment of patients with burn injury

INTRODUCTION

Despite advances in resuscitation, resurfacing, and reconstruction, recovery in burn patients often depends upon emotional, psychosocial, and spiritual healing. We characterized the spiritual needs of burn patients to help identify resources necessary to optimize recovery.

METHODS

We performed a retrospective review of all patients admitted to a regional, accredited burn center, in 2011. We accessed multiple clinical, financial, and administrative databases, collected demographic data, including religious affiliation, and recorded the number and type of pastoral care visits. Outcome measures included length of stay (LOS), physician and facility charges, and mortality. We compared patients who had a pastoral care visit with those who did not, as well as patients with a religious affiliation with those who had no or an unknown affiliation.

RESULTS

During the study period, our burn center admitted 1338 patients, 314 of whom were visited by chaplains, for a total of 1077 encounters (3.43 visits per patient seen). Most frequent interventions were prayer, social support, and spiritual counseling. Compared to patients who had no visit, patients who saw a chaplain had a larger total body surface area burn, longer LOS, higher charges, and higher mortality (10.2% vs. 0.78%, P < 0.001). Patients who had a religious affiliation had slightly lower mortality than patients with unknown or no religious affiliation (0.87% vs. 3.19%), but this did not reach statistical significance.

CONCLUSIONS

In burn patients, utilization of pastoral care appears to be linked to size of burn, financial charges, and length of stay, with religious affiliation serving as a possible marker for improved survival. Plastic surgeons and burn providers should consider and address the spiritual needs of burn patients, as a component of recovery.