Nurses’ Compassionate Care Affects Patient Outcomes
By Debra Wood, RN, contributor
The holistic approach to nursing--being present, doing for patients and forming a connection--embodies the caring profession, and now new research shows that emphasizing the art of nursing and compassionate care during orientation can improve outcomes, including boosting patient satisfaction and reducing the incidence of falls and pressure ulcers.
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“Although there is a tremendous amount of science to our practice, there is still necessity to have the art, the communication and empathy,” said Mary Foley, PhD, RN, FAAN, director of the Center for Nursing Research and Innovation at the University of California, San Francisco School of Nursing.
Carol Toliuszis Kostovich, PhD, RN, and Pamela S. Clementi, PhD, RN-BC, associated with Loyola University in Chicago and Loyola University Medical Center, respectively, recently reported on the relationship between nurses’ compassionate care and patient outcomes in the Journal for Nurses in Professional Development.
In their study, a one-day training program was added to the general nursing orientation at a Midwestern academic medical center to address implementation of a patient-centered model of care and the compassionate side of nursing, including being there for patients and valuing them with active listening. The sessions covered communication, attentive body language, honesty, listening skills, empathy, concern and respect for patients.
“This provides evidence of the importance of some of these other aspects of care, meeting patients needs, empathy and compassion, and there are tangible benefits of such behaviors,” said Annette De Vito Dabbs, PhD, RN, FAAN, professor and department chair for acute and tertiary care at the University of Pittsburgh in Pennsylvania. “While we’ve long promoted these interactions, putting it forward in an orientation sends a clear message that it’s important and as important as any other rule or regulation.”
Dabbs indicated travel nurses and other staff also would benefit from orientations with an emphasis on empathy and compassion.
“When that is conveyed as an important part of being there, it would make a world of difference, especially for people with limited other connections to a [health] system,” Dabbs said.
The role of compassion and presence
“Patients want to feel cared for and listened to and [whether they feel that way] is based on the actions of the nurses,” said Kelly Hancock, RN, MSN, NE-BC, chief nursing officer at Cleveland Clinic in Ohio. “It begins with nurses providing compassionate, patient-centered care.”
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Compassion provides a sense to patients that their condition and concerns are being heard, recognized and acted upon, explained Robert Hanks, PhD, FNP-C, RNC, an assistant professor and family nurse practitioner track director at the UTHealth School of Nursing in Houston.
“Nurses that utilize compassionate behaviors can help foster feelings in the patient that both the nurse and patient are working toward the best possible outcome for the patient,” Hanks said.
Paulette Heitmeyer, RN, BSN, MSN/ED, chief nursing officer at Marina Del Rey Hospital in California, called compassion the essence of nursing.
“Compassion allows a patient to feel cared for, respected and trust that the nurse has his or her best interest in mind,” Heitmeyer said. “When patients feel that a nurse truly cares, they begin to allow you in, offering the small details that may lead to a diagnosis, or information that could help you better care for him or her.”
When the patients are relaxed, Heitmeyer added, they often have a shorter length of stay in the hospital, decreased pain, decreased anxiety and an overall optimistic outlook on their recovery.
“The patient looks upon the nurse for guidance, information and truly to make them better,” Heitmeyer explained.
Hanks explained that when a nurse practices anticipatory compassion, he or she becomes aware of how a fall or infection could cause the patient unnecessary suffering, and takes steps to mitigate those issues, such as critically analyzing the environment for potential hazards or practicing good infection control techniques.
Additionally, the patient may be more willing to reach out to a nurse who seems caring than one who seems rushed or more interested in the equipment than in the person in the bed. Consequently, the patient may be more willing to press the call bell for help rather than attempting to walk to the bathroom alone.
Foley explained that communicating with the patient and family with sincerity and equal respect usually works better than simply directing a patient to do or not do something.
“It’s not just what people say but how they say it,” Foley said. “We have to have heart and the ability to communicate with warmth and empathy.”
Creating and maintaining a caring culture
At the Cleveland Clinic, Hancock reported, the importance of empathy and compassionate care are woven throughout the entire residency program, instilling in new graduates the values of patient centered care and showing them how to develop a strong patient-nurse relationship. The hospital uses simulation and role playing.
“The relationship helps [patients] handle their fears,” Hancock said. “We give them skills about how to handle those conversations.”
Little things matter, such as smiling and addressing the patient as he or she wants to be addressed.
“Sitting in a chair next to the patient, listening without interrupting, following through on requests and simply asking the patients what they need from a physical, mental and spiritual standpoint is essential in truly understanding the patient,” said Heitmeyer, recommending nurses practice in a calm manner and answer all of the patient’s questions.
Foley added that when a new nurse comes into a hospital, the employer does not know much about the nurse’s talents and communication skills, beyond the fact he or she has a license. Yet to maintain a caring culture, every nurse must project a sense of compassion and empathy. She praised Loyola for adding the sessions.
“I applaud the medical center,” Foley said. “They probably understand what it takes to bring staff along if you have a positive culture.”
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