Navigating Vulnerability: Strategies for Compassionate Nursing Practice

Introduction

Nursing care involves assessment, diagnosis, evaluation and planning of care for the patients by the nurses through autonomous and collaborative action taken with the inclusion of patients, their family members, expert health and nursing professionals (Adam et al. 2017). The key aim of nursing care is to prevent deterioration of the health of individuals and control as well as manage the illness so that better health and well-being can be assured to the patients. In nursing care, compassion is one of the key aspects to be followed while delivering care to patients. Thus, in this assignment, the concept of compassion in nursing and the way it is executed by the nurses is to be discussed. Moreover, the factors which influencing vulnerability of patients are to be explained and policies present to maintain compassion along with reduce vulnerability of the patients is to be discussed. Further, the way health and nursing professionals maintain positive practice and resolve challenges in poor practice acting as hindrance to deliver compassionate care is to be explained.

Concept of Compassion in Nursing

The study by Tierney et al. (2019) mentions that historians have found highly gendered perception of care that is invariably framed in emotional and moral terms and has been centre to rise of the nursing profession since the portrayal of untrained and uncaring nurse Sarah Gamp by Charles dickens. In the 19th century, the selflessness, caring and sympathy were regarded as the heart of transmission to nursing profession from it being trade. The compassionate underpinning by Florescence Nightingale in her depiction of nursing character provides roots to the initiation of sympathetic and concerned care (Fontaine and Keeling, 2017). This was further expressed in the thoughts of Virginia Henderson who is known as the First Lady of Nursing. She mentioned that it is the duty of the nurse to take all nature of care of the patients and deliver them support until the patients feel unhindered regarding their health. This is to be executed by overcoming troubles and showing proper support and sympathy regarding the health towards the patients (Tierney et al. 2019). In the 1980s, the compassionate care was further established through caring of HIV/AIDS patients where the nurses supported the individuals in all manners irrespective of stigmatisation and incurability of the disease (Tierney et al. 2019). In current state, the NMC Code of Practices for Nursing is found to be built on the same principles. This is evident as under “Prioritise Patients” the first code indicates that it is the duty of the nurses to deliver compassionate care to the patients by respecting their dignity and rights (NHS, 2018a).

In nursing, compassionate care is referred to concerned and emotional care for the patients who are suffering from illness and have poor health condition. This is important so that the nurses can make the patients realise they perceive their pain as well as suffering from the illness and are concerned to offer them appropriate care to ensure their effective well-being (Hofmeyer et al. 2018). As mentioned by Zamanzadeh et al. (2018), nurses to deliver compassionate care are to show altruistic behaviour towards the patients. This is because it leads the nurses to show selfless and disinterested concern towards the service users. It makes the patient realise the nurses are focussed only on the patient’s needs and well-being and they have perceived their pain and suffering for which the nurses are going to take appropriate action for their quicker well-being. As criticise by Blomberg et al. (2016), lack of altruistic behaviour from the nurses makes them work with the focus to achieve their work goals rather than focus on key needs of the patients. This leads the service users feel the nurses are selfish towards their care and create a non-compassionate environment of care.

The nurses to deliver compassionate care to the patients are required to practice good manners and uphold the rights and dignity of the patients without being anxious (Gould et al. 2018). This is needed as key to compassionate care is being polite and showcasing good manners towards the patients to make them develop trust and feel supported by the nurses to be cared appropriately and in selfless manner. As criticised by Jones et al. (2016), rude behaviour of the nurses towards the patients makes them feel lack of concern towards their well-being. This is because rude behaviour makes nurses shows they are do not understand the emotions of the patients regarding their pain with the illness, in turn, creating non-compassionate care environment where the patients avoid accessing care from the nurse out of disrespect and lack of trust. As asserted by Henderson and Jones (2017), showing empathy is one of the key ways of delivering compassionate care by the nurses. This is because empathy makes the nurses show that they not only understand and concerned about the pain of the patients but also wish to share part of their distress to act collaboratively with them to make the patients cope with their health condition establishing the notion of compassionate care.

In the study by Wynia (2018), it is mentioned that compassionate care by the nurses can be provided by showing non-maleficence attitude. The non-maleficence attitude indicates non-harming behaviour of the nurses towards the patients regarding their condition. The harmless feeling by the patients during care makes them feel the nurses perceive their problem and willing to support them in overcoming their health complication setting a notion of compassionate care environment where nurses sympathise their condition (Wynia, 2018). As commented by Efstathiou and Ives (2018), nurses to show compassionate care takes time to communicate with the patients to discuss the background and history of their health complication. This is because it leads the nurses to understand the diverse negative situations the patient has gone through due to their health complication. This, in turn, makes the nurses perceive the way to show pity and sympathise as well as express concern towards the patient's health and care which are keys to compassionate care. As criticised by Chambers and Ryder (2017), lack of communication between patients and nurses creates hindered environment of compassionate care. This is because without interaction the nurses are unable to understand the pain and suffering of the patients that lead the nurses to lack clue regarding the way to show sympathy and concern to establish compassion.

The beneficence is referred to the act of mercy, charity and kindness shown by the nurses with strong connotation of executing good deeds of care for others involving moral obligation (Pope et al. 2016). The showcasing of beneficence attitude by the nurses leads them to deliver compassionate care. This is because in this act the nurses are able to express their obligation and concern of positive intention towards protecting patients from harm by resolving bad situation to promote their enhanced health (Durkin et al. 2019). As stated by Casagrande (2016), nurses to deliver compassionate care are to take care of their own emotional needs. This is because fatigue and anxious feeling of the nurses out of delivering continuous care to the patients makes them show lack of pity and sympathy for the patients out of stress. It leads the service users feel the nurses are not concerned and kind towards their suffering, in turn, creating a compassionate care environment where the patients feel lack of support by the nurses to overcome their health complication.

Factors influence vulnerability among patients or service users in the healthcare

In health and social care, there are various reasons and factors which make patients or service users face vulnerability. The concept of vulnerability for patients is essential in nursing as vulnerable patents are found to be stressed and anxious that adversely affects their psychological, physiological and social functioning leads the nurses face hindrance in ensuring proper well-being for them (Sarvimäki and Stenbock-Hult, 2016). The nature of illness results patients to face vulnerability in the health and social care field. As mentioned by Junewicz et al. (2017), in health and social care patients with mental illness are found to have hindered cognitive and emotional ability to understand and take decision regarding their care. This creates opportunity for malpractices by professionals where they exploit the health of the patients out of their inability to avoid abuse or harm. It leads to hindered compassionate care as instead of understanding the suffering of patients the health practitioner causes suffering to the patients, in turn, making them experience vulnerable health condition. As argued by Serra et al. (2018), mental illness is stigmatised as bad reputation for the family which intends the family members to abuse or harm the mentally ill people to get rid of them. This leads towards vulnerability of care for the patients in health environment as they have risk of being facing intended harmed by their family members out of stigmatisation and discrimination while receiving care under family caregivers.

The age of the patients also acts as a key factor towards making them face vulnerability in the health and social care field as well as in the society. As commented by Rosay and Mulfor (2017), elderly individuals suffering from complex illness leads to have hindered mobility and ability to care for them. This leads the elderly become burden of care on the family and nurses while accessing care. The family members as well as service providers unable to manage the burden often lead to abuse or harm the elderly individuals physically making them face vulnerability in the society and during care. As argued by Guerci et al. (2019), lack of delivering persistent treatment to support complex health condition of the patients is regarded as a key factor that poses vulnerable condition in health and social care for the patient. This is because without the persistent medical support fluctuation in the health condition of the patients is seen making them face hindered consequences regarding their health that negatively affects their well-being. For instance, lack of persistent care delivery to type-2 diabetes patients makes them face increased blood sugar level. This creates vulnerable condition for their health to develop diabetic neuropathy, leg ulcer, cardiovascular disease and others that would more adversely impact their health, in turn, deteriorating their well-being (Wilke et al. 2016).

The children who are cared in the health environment by professionals having previous involvement in child abuse incidences are found to be vulnerable to cause harm towards the child during care. This is because of influence of presence of unstable mentality of the professionals out of their hindered thinking ability and emotional efficiency to care for children makes the people develop violent attitude during care (Euser et al. 2016). The socio-economic condition acts as factor which creates vulnerability towards health and well-being of patients in healthcare. This is evident as people who belong from lower social class are found to lack the required amount of finances along with effective health education and awareness to access proper services to manage complex health issues (Islam, 2017). Thus, lack of proper information and social condition along with money influences the lower social groups living in deprived areas to face risky health condition out of lack of timely care.

The lack of proper training regarding the way nurses are to deliver care for the patients develop vulnerable condition for the service users. This is because without knowledge and skills of proper care nurses deliver hindered and duplicated intervention for the patients which adversely affect their health performance (Maurits et al. 2016). For instance, lack of proper knowledge of the nurses regarding the way to manage care actions for elderly who are prone to falls makes the patient vulnerable to face physical health issues. This is because way the care environment is to be managed for fall prevention of the elderly is not done which makes the elderly experience falls making them face fracture and wounds (Amacher et al. 2016).

Policy drivers to maintain compassion

In 2011, the Francis Report was published that highlighted the hindered steps in care taken by the health and nursing professionals in the Mid Staffordshire Hospital that led to the disastrous care environment. The report highlighted few policy recommendations to be implemented in the healthcare field of the UK so that better and compassionate care delivery can be established (health.org.uk, 2011). On the basis of the Francis Report, the General Medical Council (GMC) made some changes in policy regarding care delivery to the patients to ensure their proper care and well-being. The GMC developed the policy that routine quality assurance visits are to be made for each local healthcare provider to assess their level of efficiency of delivering care (GMC, 2013). This nature of visits is effective to maintain compassionate care as the continuous monitoring leads to identify the barriers faced by health and nursing professionals in delivering compassionate support to the patients. On the basis of the information, training and knowledge programs are developed to ensure the barriers are resolved so that the health and nursing professionals are able successfully deliver compassionate care (GMC, 2013).

The GMC ensured survey of the medical professionals and trainees are executed to understand the perception they have regarding care standards provided to the patients. In this aspect, the GMC consulted the Care Quality Commissions (CQC) to organise the survey to routinely share the information about care standards managed by health and nursing professionals towards the patients (GMC, 2013). It was an effective policy by the GMC as by accessing feedback regarding the care standards being delivered by the health and nursing professionals they can accordingly understand the actions to be taken to promote effective compassionate care. Since the development of Francis Report in 2011, the NHS has made various policy changes in the care environment by following 6 C’s of nursing (health.org.uk, 2011). The 6 C’s of nursing are care, competence, compassion, courage, compassion and commitment if the nurses towards achieving well-being of the patients (Bradshaw, 2016). The communication is referred to interaction with the patients regarding their experience of care to ensure proper improvement for their greater care satisfaction (Simamora and Fathi, 2019).

In the Compassionate Care Policy from 2010 to 2015, in 2013, the NHS had introduced Friends and Family Test which is a feedback assessment tool that supports communicating experiences of care by patients and to what extent they suggest the same care to their family and friends to be shared (gov.uk, 2015). This was an effective policy driver to maintain compassionate care environment as based on the feedback received the NHS would improve their care services and efficiency of health and nursing professionals in the hospitals to ensure compassion is established while offering care support. The NHS has also created Healthwatch England which is an independent organisation that would report the feedback of the public regarding health and social practices (gov.uk, 2015). This is an effective policy driver to ensure compassionate care as the organisation communicates with the service users to avail reports regarding their care satisfaction. This would lead NHS understand the barriers and vulnerable factors being faced by the public that is creating hindrances to make them receive satisfactory compassionate care. On the basis of the information, the health and nursing professionals skills are to be improved and change in care principles are to be done to maintain compassionate care.

In respect to Care from the 6 C's of nursing, the Care Act 2014 has been developed that ensures the local healthcare authorities are effectively acting to resolve needs and demands of the patients in the locality. This is to ensure patient’s remain empowered, protected from harm, prevented from any vulnerable diseases and delay in care which could deteriorate their health is avoided (legislation.gov.uk, 2014). This policy acts to ensure maintaining compassionate care for the patients by making local authorities understand and provide services as per the needs of the patients to alleviate their pain and suffering regarding health complications. The competence in 6 C’s of nursing indicates that nursing professionals are to have proper ability and skills to execute care successfully (Bing-Jonsson et al. 2016). In relation to competence, the NHS has established compulsory background and skill checking of the staffs to be recruited for care (NHS, 2018a). This is because it would make the NHS aware regarding the eligibility and skills of the staffs to deliver compassionate care. The courage referred to taking actions by avoiding fear to ensure the health and nursing professionals acted according to take care of the patients (Numminen et al. 2017). In the NHS, Whistleblowing is allowed for the health and nursing professionals where they are protected by law regarding the activity. In the process, the nurses and health professionals report any nuisance without fear to ensure proper care delivery to the patient (NHS England, 2018). This is effective to maintain compassionate care for patients as the barriers which would avoid the compassion in care is resolved through active involvement of the NHS by taking disciplinary actions.

Ways health and nursing professional ensures positive practice

In order to deliver compassionate care, it is the responsibility of the health and nursing professionals to adhere to positive care practices. This is because in this way the principles of care which leads towards compassionate support can be developed in the care environment (Tierney et al. 2017). As commented by Harrison (2018), accountability in healthcare indicates proper responsibility to be taken by health and nursing professionals for their actions, judgements and omissions. This is because it relates to their life-long learning along with management of competency and upholding the care quality outcomes of the patients. The health and nursing professionals when show accountability to remain aware regarding the suffering and pain of the patients in all condition within the care ensures they are responsible to provide support to the patient in each aspect till their health condition is enhanced (Srulovici and Drach-Zahavy, 2017). This leads towards positive compassionate practice as the health and nursing professional never leaves the patient in pain and ensure the person is answerable and responsible to fulfil all needs of the patients to make them feel supported in care. As argued by Lee and Clancy (2016), lack of accountability in healthcare leads towards non-compassionate care. This is because it makes professionals show lack of responsibility in fulfilling and supporting the needs of patients by understanding their pain and suffering.

The Code of Conduct developed by the healthcare organisation is to be followed by health and nursing professionals while providing care to ensure positive care practices are established. According to NHS Code of Conduct, under “Prioritise People” the conduct to be performed by nursing professionals for compassionate and positive care is upholding the dignity of the patients by respecting their rights and showing kindness towards them while offering care (NHS, 2018a). This is because kindness and respect make the patient's feel valued by the nurses, which in turn, makes the nurses show they are properly concerned towards fulfilling their needs in an appropriate manner that is the principle of compassionate care. The NHS Code mentions that nurses are to recognise when people are in distress or anxious and are to respond politely and compassionately (NHS, 2018a). The following of the code is essential in practice to promote positive compassionate care as it is going to show good manners towards the patients. Moreover, it would ensure patients that the nurses have understood their emotional suffering and accordingly trying to help them cope up with the condition. In order to maintain care practice, the NHS Code mentions the nursing professional to ensure when they delegate task to other it is verified the person is properly supervised and supported to have skills to deliver safe and compassionate care (NHS, 2018a). This code of conduct is able to ensure delegation of care is made to competent professionals and positive care practice without any error is established.

The patient advocacy in nursing refers to promotion of equality of the patient, offering freedom to the patient to avoid suffering and ensuring human dignity. The advocacy is ensured in nursing through established of successful communication between patients and nurses where the patients are offered the freedom to make choices regarding the care to be provided for their health (Ahmadinejad et al. 2016). The proper advocacy by the nurses with the patients leads them to execute positive compassionate care practice as it makes them understand and act on the key needs of the patients. This, in turn, leads nurses politely to accept the shared choice of care by the patients to be delivered accordingly to ensure their pain and considerations are understood by them.

Ways professionals are challenging poor care service

The hindered compassionate practice by professional leads to create challenges of poor practice that is able to be managed through effective promotion of safeguarding of service users. As mentioned by Solbakken et al. (2019), safeguarding is healthcare is referred to the legal obligation of the service providers to arrange services and care for protection of patients or service users from any harm, abuse and neglect. This is required so that the patients feel safe and supported by nurses to avoid any suffering or pain during the care. As argued by Kaya (2019), harm and abuse towards the service users in care environment lead them to suffer pain which indicates that the professionals and service providers are incapable to understand their needs and suffering to act according in delivering proper compassionate care. This indicates that promotion of safeguarding helps the professionals in the medical field to show proper concern and sympathy that is the key to establish compassionate care. For instance, creating safeguarding environment for a domestic violence patient, who is current receiving care within a hospital, to avoid their partner visiting them help health and nursing professionals avoid poor care towards the service users. This, in turn, shows compassionate support towards the patient as the person feels the nurses have understood the individuals suffering or fear regarding meeting their partner by perceiving her situation and has taken appropriate actions.

In health and social care, the whistleblowing is referred to raising concerns and illegal activities in care environment which is able to act as risk for the patients to increase their suffering and pain while receiving care (NHS England, 2018). This is effective to challenge poor care as through whistleblowing the negative incidences, error in care, suffering caused to patients and others are reported appropriately in time to take effective actions to ensure compassion towards the patients. In Francis Report, the recommendations regarding the establishment of whistleblowing in the care environment are also mentioned. This recommendation is developed on the context that lack of proper reporting of maltreatment of patients in the Mid Staffordshire hospital leads to increased fatal incidences and non-compassionate care (health.org.uk, 2011). Moreover, whistleblowing allows the care environment to be open and transparent regarding care as well as show accountability in taking appropriate steps to ensure prevention of future negative concern in care delivery (Pohjanoksa et al. 2019).

The Duty of Candour is referred to statutory action where health and nursing professionals and nurses are to inform the patients and their families openly and honestly about any wrong treatment or care issues which have the potential to cause distress or harm to the patients (NMC, 2018). As argued by Hooper (2019), avoiding to inform patients regarding the wrong actions taken by professionals which could adversely affect their health makes the service users feel deceived. This is because the patients understand the professionals are not careful or has no realisation of the consequences to be faced by the patient out if their action resulting to create hindered compassionate care. In Duty of Candor, the professionals who have done wrong are to offer apology to the patient and explain in detail the short-term as well as long-term impact of the action on the patients (Lee and Pradhan, 2019). This is because it would make the patient perceive that the professional has realised their wrong action and is feeling genuinely guilty for their deed. It leads to challenge poor compassionate care as professionals avoid keeping the patient in dark regarding their health complication which has been done by their wrong action showing real concern towards the patient.

The patients are to be properly offered detailed information about the positive and negative aspects of care to be delivered to them by the health and nursing professionals. This is because it would provide them the advocacy to take decision whether or not to progress with the care (Hargraves et al. 2016). Moreover, it would avoid health practitioners to offer poor compassionate care as by informing the risk and benefits of care practice they indicate that they are concerned regarding pain and suffering to be faced by the patient and offering them the choice to either accept or reject it (Spatz et al. 2016).

Conclusion

The above discussion informs that compassionate care in health and social care is emotional care delivered to the patients by understanding their pain and suffering regarding their health complication. The history mentions that compassionate care is rooted from the beginning of nursing support initiated by Florescence Nightingale. The compassionate care in healthcare care is delivered by showing kindness, pity, sympathy, respect and others towards the patient. The vulnerability factor in health and social care for the patients includes inappropriate care practitioners, stigma regarding mental illness, the burden of care and others. The policy drivers developed to ensure compassionate care include Family and Friends test, quality assurance test and others. The ways in which professionals are to establish positive compassionate care include the safeguarding of patients, showing accountability for care, advocacy and others. The ways in which challenges in poor compassionate care can be resolved include duty of candour, whistleblowing and others.

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