Presentatie Dr. Sue Shea - Providing Compassionate Healthcare

Getting to the ‘Heart’ of the Therapeutic Relationship – A Compassionate Approach

Sue Shea

http://www.routledge.com/books/details/9780415704960/

http://www.routledge.com/books/details/9780415704960/

http://www.jcompassionatehc.com/authors/instructions

http://www.jcompassionatehc.com/authors/instructions

Importance of ‘Compassion’ within the healthcare setting….

Applicable to all involved including:

Nurses

Doctors

Physiotherapists

Radiologists

Occupational Therapists

Healthcare Assistants

Administrative staff

Getting to the ‘Heart’ of the Therapeutic Relationship

What is compassion – how can we define it?

Compassion within the context of

healthcare – the therapeutic relationship

Applying compassion to specific conditions

– example of pain

Neurological/Physiological factors

Concluding remarks



What is Compassion...?

As a concept:

Spans 1,000s of years

Original strong association with religion

Considered in all major religious traditions as

one of the greatest virtues (love, kindness,

understanding, forgiving, etc)

from the Late Latin word ‘compassi’, meaning ‘to suffer

together’



First person thought to utilise wording in relation

to compassion – Confucius

500 years BC formulate Golden Rule:

‘Do not do to others what you would not like them to do to you’

Most religions have their own version

Requires we look into our hearts – what gives

us pain – never inflict that pain on anybody else


In recent times compassion might mean different things to

different people

What virtues could be included within the concept of

compassion?

How can compassion be defined?

According to Hoisington (2007):

‘the words compassion and empathy get thrown around as

much as the words love and kindness and yet we, as a

collective society, have not come to a consensus on what

these words mean’


Recent definitions of compassion include:

‘Witnessing another person suffering and experiencing a subsequent desire to help’

(Goetz, Keltner and Simon-Thomas, 2010)

…’[compassion] reflects a deep awareness of the suffering of another, coupled with the

wish to relieve it’

(Chochinov, 2007)

‘Compassion is how care is given through relationships based on empathy, respect and

dignity – it can also be described as intelligent kindness, and is central to how people

perceive their care’

(NHS Commissioning Board, 2012)


A concept containing many other virtues, e.g.:

Empathy

Sympathy

Respect

Awareness

Basic human kindness

Communication

Wish to engage in action

As such compassion involves:

Going beyond virtues such as sympathy and empathy

Wishing to help another person in a humanistic manner

Reflecting a desire to go beyond understanding the

patient’s suffering

Wishing to take some action to help another person


‘When someone gets hurt, we go and look after them,

and then we make funny faces to make them feel

better’.

(Definition from 5 year old William)


Compassion within the context

of healthcare – the therapeutic relationship

Why is compassion important?

International focus on the concept – much talked about/topic of research

Recent reports raise the issue of a decrease in compassion

Despite increasing scope and sophistication – healthcare sometimes fails at a

fundamental level

Compassion is believed to lead to faster patient recovery, and better management of

chronic illness, and reductions in pain and anxiety

People generally enter the healthcare profession with compassion - but may be

difficult to maintain – time, burnout, communication problems

Attention to basic human needs

Brought to the forefront in the UK, following Robert

Francis QC report on Mid-Staffordshire Hospital

Report gained international attention

Showed devastating events

Lack of basic care (hygiene, Nutrition, Pain, Discomfort)



Features of compassion

Patient centred care

Shared decision making

Communication

Action (listening, see patient as individual,

fit treatment plans around lifestyle)



Compassion or ‘tough Love’? – thoughts from a local

homeless centre…

Compassion – explicit (basic needs and kindness) and

implicit (encouraging independence)?

When is the right time to encourage independence in

healthcare setting?

Individuality, capability, understanding, of the patient



Features of compassion

Enough information for shared decision

making?

Confused, unable to understand?

Applies also to healthcare professionals

(as patient/carer)



Example where proper communication could have prevented distress and sadness –

Dr Keiran Sweeney

• British GP - died aged 58 from a rare form of cancer

• Known for devotion to compassion

• Applied ideas from philosophy, arts and social science to honour

patients above their diseases

• Colleagues too afraid to tell him of his diagnosis – found out by

himself

• Published his own experiences as a patient before his death -

speaks of ‘lack of bravery’

• Speaks of faultless technical expertise, but lack of relational

aspects of care

• Experience led Dr Sweeney to suffer great feelings of great despair

and hopelessness.

Keiran Sweeney –

British GP



Craig Brown - British GP

Wife died from cancer

Lack of information provided to family regarding

condition

‘…Attending staff assumed that our family would be

familiar with the clinical situation and procedures. Little

was explained to us, and we lacked information to

make decisions. …’ (Brown, 2015)



Assumptions that patient has enough

information

Crucial for shared decision making

Sensitivity, understanding, and communication

Seeing the patient as an individual



The personal impact of an illness, disease or condition

Experiences of care

Preferences and values

Outcomes people want from treatment and care

Impact of treatment or care on outcome, symptoms, physical & social

functioning, quality of life

Impact on family, friends and employers

The needs of specific groups

Areas needing further research

(Professor David Haslam CBE, Chair, Nice)

What can patients tell us?



Jenny’s Story – A Positive Experience

‘…lovely, they ask you what you want to be called…I’ve seen

that they’ve written ‘Jenny’ on my notes…very, very caring

people. They make you feel at ease. During the whole

procedure I always felt that they had my best interests at

heart, and they don’t talk down to you. Very very nice

people…’



…experience of physiotherapy, at a

basic/compassionate care level…

An intensive assessment of condition

Not to be kept waiting

Privacy

Cleanliness

Advice on self-management

Pain management

Rehabilitation

Good communication/kindness

Compassion - specific conditions - pain

How does the patient as an individual perceive and

experience pain?

Does the patient have other conditions that might

influence their experience of pain?

Not just physical – psychological and social –

depression, anger, family problems, helplessness

Mental experience of pain

Emotions and expression of symptoms

Other factors/disorders enhancing pain


Kathy’s Story – A Negative Experience

‘…While waiting for more than two hours for my turn for an X-ray the

pain became unbearable, and made me scream when the

radiologist tried to put it in place. When I asked her ‘can you

please handle it with care? it’s utterly painful’, the answer was an

indifferent “I need to put in the right angle, let me do my job”… I

caught a nurse in the corridor and said ‘could you please help

me, I need a strong analgesic as my hand aches terribly..’

She replied ‘we don’t dispense medicines here, but you may go to

the pharmacy outside the hospital and buy one’, and then she

went away.

I looked at her incredibly, how could she be so cruel?...’(‘Cruel’ – thus painful for Kathy emotionally as well as physically)


Person strongly associated with compassionate healthcare -

Dr Robin Youngson.

Founder of Hearts in Healthcare – global movement for compassion

Began to reflect on his role as a doctor following a

family accident

Daughter in spinal traction for 3 months

Left disconnected from the outside world

No attention to basic needs – left in severe untreated

pain

Robin Youngson –

New Zealand Anaesthestistwww.heartsinhealthcare.com


Kindness can go a long way

Small simple actions can help a patient

enormously.

‘...we respond with humanity and kindness to each person’s pain,

distress, anxiety or need. We search for the things we can do, however

small, to give comfort and relieve suffering. We find time for those we

serve and work alongside. We do not wait to be asked, because we

care...’

(UK Department of Health, 2009)

Patient centred care, and appropriate communication are important factors in

getting to the ‘heart’ of the therapeutic relationship, via a compassionate approach.


Example of dance and ‘working together’

Co-ordination and unison across the healthcare

team

Avoiding ‘burnout’ – recognising symptoms in

others

‘Dance’ analogy – Greek dance ‘Hasapiko’ –

working together in sequence

Patients condition might require input from various

healthcare professionals

Dance Analogy!

But how can such unity be achieved…?

…through practice…!


Touch and kindness affects healing and

recovery, reduces pain, modulates stress

response

‘…Through feelings of kindness and

compassion, the heart exerts a modulating

effect on brain function, leading to mental

calmness, and reduction in stress…’

(Youngson, 2012)


Deep interconnection between human

beings

Feelings, sensations, thoughts, emotions,

physiological responses closely linked

Neurodevelopment consistently shaped by

our interactions with others

Emotional display (facial expressions, smile,

tone of voice and body language) affects

others

Vulnerable patient is open to the emotional

impact of the practitioner‘s behavior.

(Youngson, 2012)


Extends to other members of the healthcare team

Resentful, fatigued and unhappy - those around us

infected by these feelings

Happy, caring, compassionate - healing effect on

those around us.

Every act of compassion is also an act of self-

healing.

(Youngson, 2012)


Reduces anxiety

Alters heart rhythm and brain

function

Changes brains response to

stress

(in both provider and recipient)

Increases pain tolerance

Evidence suggests that kindness and touch:

(Fogarty et al 1999; Shaltout et al 2012; Science Daily 2012, Youngson 2012).


Does compassion for others moderate

physiological stress reactions.

Role of compassion and social support in

reducing blood pressure reactivity

Practitioners in receipt of social support may

be more compassionate - decrease in blood

pressure

Those who are compassionate – benefited by

support they themselves receive


(Cosley, 2010)

Compassion benefits the provider

Associated with lower stress reactivity

particularly when social support is

available

Further research – understanding

mechanisms that lead compassion for

others to protect individuals from stress

Role of social support as a mediator in

the provision of compassion

(Cosley, 2010)


Roots in religion but important in healthcare setting

Empathy, kindness, communication, individuality

Involves action

Learning from patient experience

Communication across healthcare team

Practice of kindness – neurological and physiological benefits

Beneficial to all – recipient and provider

Concluding Remarks

Thank you very much for your

kind attention!

Presentatie Dr. Sue Shea - Providing Compassionate Healthcare

Healthcare

Transcript of Presentatie Dr. Sue Shea - Providing Compassionate Healthcare