Propuesta del Manual de Funciones

The focus on compassionate practice has developed both nationally and internationally over the last few years with compassion seen as a recognised component of quality within nursing practice (Hudacek, 2007). Much of the recent focus on compassion in nursing has arisen through media and organisations’ reports on deficits of care within nursing practice (Templeton, 2004; Age Concern, 2006; The Patients Association, 2009 and 2011; Hill, 2010;

DH, 201 Od). However, deficits in the quality of nursing care and nurses’ ability to engage in caring relationships were causing concerns over 50 years ago.

In a classic paper by Menzies (1960) focusing on the provision of nursing care in England, nurses were seen to distance themselves from their patients as a means to protect themselves from the emotional consequences of nursing work. Menzies demonstrated how nursing care had been split into tasks to depersonalize the patient within that care provision, so nurses were protected from the anxiety of the relationship with patient suffering.

Ten years later during the 1970’s the RCN along with the National Council of Nurses of the United Kingdom undertook The Study of Nursing Care’, a series of twelve studies to explore a range of nursing care responsibilities (Anderson, 1973; McFarlane, 1974; Inman, 1975). The underlying reason for the studies was the adverse publicity on nursing care provision in hospitals where patients had no rights, no dignity, and no status (McFarlane, 1974). Anderson’s study (1973) was called The Role of the Nurse’ and found that wards where patient satisfaction was highest were also those where the ward Sister rated emotional support as more important than technical support (Anderson, 1973). In a concluding report by Inman (1975) called Towards a Theory of Nursing’, the importance of ongoing research and education in nursing was emphasized as important if improvements were to be made in the quality of nursing care. During the 1980s and 1990s further research identified challenges to understanding the role of the nurse and what nursing entails (Melia, 1987; Smith, 1992) and in first decade of the 21®' century, similar calls for improved understanding of nursing roles and care provision are being expressed.

A three year study referred to as the Leadership in Compassionate Care Programme was undertaken by Edinburgh Napier University in collaboration with NHS Lothian (2008) to address compassionate nursing in Scotland (Edinburgh Napier University, 2008). The study sought to embed the principles of compassionate care into their undergraduate curriculum through specified learning outcomes related to compassion, support newly qualified nurses

so they could provide compassionate care as they make the transition from student to staff nurse, establish centres of clinical excellence in compassionate care (Beacon Wards), and support the development of leadership in compassionate care in Scotland. Evaluation of this study is on-going and to date there are no comparable studies in England. Initiatives such as this and their subsequent evaluation may help the profession to understand the support and structures required by nurses to ensure provision of compassionate practice. The study started from the premise that compassionate care was deficient rather than exploring why this was so.

In 2009, The King’s Fund commissioned a study called The Point of Care: Enabling

compassionate care in acute hospital settings (Firth-Cozens and Cornwell, 2009). The King’s

Fund project commenced with a series of workshops aimed at understanding the factors that prevent or enable compassionate care from doctors, nurses and other staff involved in the patient’s hospital experience. The findings from the workshops indicated that compassion was regarded as a normal human response to another’s suffering and could reduce that person’s suffering, but for those providing the care and expressing compassion it could be a potentially painful experience. The study identified factors to help understanding of what prevents compassion in healthcare and factors to improve the experience for patients and staff. The teaching of values was seen as essential within clinical training, to ensure practitioners became person-centred, that clinicians were enabled to ‘see the person in the patient’. Furthermore, there needed to be recognition that caring for people who are unwell or dying can generate feelings of fear and distress, leading in some to feelings of stress, depression and compassion fatigue (Sabo, 2006).

Strategies were therefore required to enable management of these feelings, support healthcare workers and professionals to explore their emotions, individually and within teams. Organisational structures and cultures needed to recognise and support staff to manage distress. It was also found that the wider hospital management of meeting targets and achieving financial balance deeply affected the behaviours and priorities of some staff,

profoundly reducing the sense of value placed on caring work, inevitably making it more difficult to cope with the emotional demands of their jobs. The organisation of hospital care required greater emphasis on humanity within the process of high occupancy, fast throughput, and efficient care provision. These various factors made important links between recognising the value of compassionate care and recognising the implications on staff of providing compassionate care (Firth-Cozens and Cornwell, 2009).

Within The King’s Fund report (Firth-Cozens and Cornwell, 2009), several solutions to enabling these links have been proposed. There needed to be recognition that staff required time to support each other through dialogue, they needed time to engage in meaningful dialogue with patients, and there was a need for teaching and recognition of compassionate care. There also needed to be continued research into all aspects of compassionate practice and education (Firth-Cozens and Cornwell, 2009). Following another Kings Fund publication from the same report. Seeing the Patient in the Person (Goodrich and Cornwell, 2008), the British Medical Association (BMA) published guidance for medical education that identified compassion as a dimension of patient-centred care and set out guidance on supporting the psychological and social needs of patients (BMA, 2011). The compassion agenda was reaching out to multiple health professions in the UK.

The Kings Fund report also promoted the importance of support for all healthcare staff if they are to be expected to deliver compassionate care, which led to the trial of a new approach aimed at organising regular compassionate dialogue opportunities. This approach was based upon a U.S. multi-disciplinary initiative called the Schwartz Centre Rounds. The Schwartz Centre Rounds are organised meetings where a trained facilitator manages a group of hospital staff through discussion about a case or cases that the group found emotionally challenging (Cornwell and Goodrich, 2010). This trial has not yet been completed and it is hoped that qualified staff who feel supported by their employers will be found to be better able to engage in compassionate practice. Such a finding would support proposed measures to improve the health and well-being of NHS staff, as identified within

The Boorman Report (DH, 2009c), an agreed set of actions on the NHS to embed staff welfare into NHS infrastructure and systems.

The Department of Health and NMC drivers for compassion within healthcare and nursing have been formulated alongside a need to measure the quality indicators that represent this aspect of care (DH, 2008a; RCN, 2008a; DH 2010c). However, it is difficult to separate out different aspects of nursing for singular quantifiable measurement and measurement of compassion would probably rely upon measures of appearance and outcome only, possibly just exacerbating the facade of compassion (Bradshaw, 2009). Introducing a compassion index could just become another target for nurses to demonstrate without any real meaning behind the actions and this expectation could detract from the more important professional responsibility to provide high standards of care and build effective nurse-patient relationships within environments that face low staffing and economic pressures (Sturgeon, 2010). However, despite these reservations, many UK NHS Trusts are developing ‘measurement tools' for monitoring the care, kindness and compassion of the nursing staff (South East Coast NHS, 2011). Some NHS Trusts have introduced quick reference guides for staff on the ’21 vital signs’ of care, kindness and compassion in an attempt to promote compassionate practice (appendix 1). Within such guidance are examples of what is expected of nurses in relation to managing pain and distress, from a ‘positive’ to a ‘poor’ response. The positive response indicates the use of ‘emotional labour’ in that nurses are expected to ‘demonstrate’ they are trying to support the person and ‘show they care’ through trying to ‘resolve the problem’; in other words, trying to empathise with the other person’s situation and enact behaviours and emotions that relieve their suffering.