Compassionate Practice in Nursing: What to Know
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“I believe that if you go into nursing for the right reasons, which is to help, then compassion is one of those core skills you will bring to every patient interaction. And it is not just patients you must be compassionate with. It extends to your fellow nurses and other members of the clinical team. Nursing can be a very stressful environment, so we must support each other.”Monica Cayemitte, Registered Nurse and Clinical Manager, VNS Health
Nursing, at its core, is the profession of caring for others. However, compassion, an essential trait for nurses, extends beyond caring for needs. According to researcher Beth Lown in a paper published in the Association for the Study of Medical Education Journal, “Compassion involves recognition, understanding, emotional resonance and empathic concern for another’s concerns, distress, pain and suffering, coupled with their acknowledgment, and motivation and relational action to ameliorate these conditions.”
Most nursing school curriculums incorporate compassion education into all aspects of the coursework, from didactic classes to in-person clinical experiences. Dr. Patricia Brenner, a nursing theorist and academic, has identified four hallmarks of compassionate care. They include a strong desire to help patients, families, and colleagues, the ability to collaborate, communicate, and partner with patients and family members to the extent they need and desire, a commitment of all who provide and support healthcare to communicate and collaborate, and the well-being and resilience of a healthcare professional.
“I believe that if you go into nursing for the right reasons, which is to help, then compassion is one of those core skills you will bring to every patient interaction,” says Monica Cayemitte, a registered nurse and clinical manager at VNS Health. “And it is not just patients you must be compassionate with. It extends to your fellow nurses and other members of the clinical team. Nursing can be a very stressful environment, so we must support each other.”
Compassion is a skill that has to be exercised often and can be pushed to the limit sometimes.
“I’ve had situations as a homecare nurse where I’ve walked in the door, and the patient’s starts yelling and screaming about something that happened that probably didn’t have anything to do with me,” says Cayemitte. “First of all, you have to remember it’s not personal. It’s not about you. This is a patient with underlying stress, is confused, or may be dealing with a new diagnosis and the financial impact of that diagnosis.”
She has found that the lack of connection with a care provider has been one of the main reasons patients don’t get the care they need: “You hear a lot about patients who are not compliant. If the patient’s not compliant, there’s probably a reason, so it’s my job as a nurse to dig down to determine the underlying reason so I can get them the necessary support to provide holistic care.”
She continues, “Regardless of where you work as a nurse, compassion is a core competency. I’ve worked in long-term care, hospice, ER, and ICU. There are a lot of competing priorities, and you are always trying to meet the patient’s needs. But as nurses, we have to remember that our role is more than that. We have to look at the entire patient, their family, and the caregivers. They are part of a care team and deserve support.”
Over the years, Cayemitte has developed techniques for showing compassion to patients, even when it isn’t easy. Keep reading to learn what compassion in action looks like for her, her tips for being compassionate in a busy workplace, and how to prevent burnout.
Meet the Expert: Monica Cayemitte, BSN, CCM COS-C
Monica Cayemitte is a registered nurse and clinical manager at VNS Health—one of the country’s largest home and community health nonprofits. She started her career as a clinical field manager in the Queens region, quickly moving to a management role for the organization’s Maternity-Newborn Pediatrics (MNP) program and its Behavioral Health specialty programs in the Queens region. From there, she became branch director for VNS Health Home Care’s Westchester Region.
In 2020, Monica took on a new role as clinical manager for the nurse residency program and home care infusion and began collaborating with VNS Health’s Clinical Education department on improving the onboarding process for all new Home Care clinicians.
Effects of Compassionate Care
Compassionate care isn’t just good medical practice. It can ultimately affect patient outcomes: “If you feel like your nurse cares and wants to help, support, and, in many cases, empower you to take control of your care, then that makes all the difference in the world,” says Cayemitte. “If you feel that somebody’s just dialing it in, they’re just checking off boxes, and they don’t care about you, that’s not a therapeutic relationship. The patient isn’t listening or trying to learn. When they understand that you care, they’re more engaged and have better outcomes.”
When compassion is extended amongst staff members, particularly from management to nurses, that can affect job satisfaction as well. A 2022 study published in the Journal of Caring Sciences found that “nursing managers can have a significant role in achieving care with affection by preparing appropriate work environment, paying attention to lack of nursing staff, ensuring the principles defined in compassion care, and supporting nursing staff.” The study also concluded that teaching compassion was among the most essential things nursing educators should impart to their students.
What Compassionate Care In Action Looks Like
While there are many ways to show compassion, here are the primary ways Cayemitte puts it into action.
First and foremost, Cayemitte believes in listening to her patients: “I think that when we’re talking about compassionate nursing, we’re talking about taking the time to let patients express what’s on their mind. It’s imperative to developing that therapeutic relationship with patients and building trust. If they don’t feel like they’re being heard, you’ll never get to the point where you can do anything productive to help them. You have to let them have a voice,” she says.
Put The Patient First
To provide compassionate care, all other competing interests must be set aside: “Understand it’s about the patient. Whatever’s going on in your head or happens during the day or before you got to work, you have to forget. When you’re with a patient, that’s what you focus on. Be present with them and care about what’s going on with them,” urges Cayemitte.
In addition to listening and putting patients first, compassionate nurses are masters of observation: “Notice what is going on around you and your patient and be able to put the pieces together,” encourages Cayemitte. “Particularly in home care, you must look at the big picture. Here in New York, we work with a lot of communities, cultures, and languages. Be aware of that diversity from the beginning, or you won’t gain trust. You may have a very good idea of what you’d like to do when you walk in the door. But if that patient isn’t ready for your plan, you have to adapt.”
“For instance, you can’t teach patients how to manage their diabetes if they don’t have enough food in their refrigerator. They can’t focus on a high-quality diabetic diet. So, you must pay attention to the environment and what is going on specifically with that patient. It can be very, very complex,” she adds.
Offer Patients Control Of The Situation
Over her years of experience, Cayemitte has learned that giving patients autonomy can be an excellent way to show compassion and build rapport for a strong therapeutic relationship. “I start by apologizing to the patient for what has upset them. It may or may not be valid, but from that point, I can say, ‘What can we do to move forward? What can we do to correct the situation?’ Then, I give them options. I think it’s crucial for patients to feel like they have some sense of control. Many things in healthcare are beyond their control, or they feel like they don’t have a lot of choice. Help them hold on to as much power as they can and as many decisions as they can.” she says
Balancing Compassion With Efficiency
Unfortunately, due to time and caseload constraints, it can be difficult for nurses to provide the compassionate care they want: “There are a lot of competing priorities, no matter where you are in nursing,” says Cayemitte. Since working in management, she has found that it is within her power to create space for both efficiency of care and compassionate nursing.
“I manage managers and have to help them determine priorities. My answer is that your first focus must always be on the patient. Everything else is secondary. Yes, it’s important to make sure the paperwork is filled out and that the insurance company is happy, but the first thing you have to do is focus on meeting the patient’s needs,” she says.
Ultimately, management is the one who can ensure that nurses are supported enough to be able to provide the most comprehensive and compassionate care to patients. It can be as simple as making sure staff know they are important: “A clinician who feels appreciated, valued, and heard will go the extra mile for their patient. When their manager reaches out to them for that last-minute emergency, they will do what they can to help. But if they come to work disgruntled and unhappy, that will carry over to how they are doing with their patients. Happy nurses have much happier patients,” explains Cayemitte.
How To Prevent Compassion Burnout
Nurses, no matter the level of care they provide, run the risk of burnout. However, compassion fatigue is a serious concern, especially for those who provide deeply compassionate care: “I’m a huge proponent of work-life balance. Set boundaries between work and home. Take time to do the things that make you feel good about yourself. Because if you don’t, then you can get overwhelmed. It can be as simple as taking a walk every morning before you start your day. Whatever it is, you have to take that time,” says Cayemitte.
For Cayemitte, one of the primary ways she has conquered burnout has been by recognizing the good work she has already done: “It’s important to take a step back from time to time and reflect on what you’ve accomplished. I always like to look at what has gone well,” she says. “I also examine interactions that didn’t go well because I want to learn from them, but recognizing your wins is very important. Sometimes, you’re going to work in places where they go out of their way to recognize your work, but that’s not always going to happen. So, you have to recognize your own wins. Give yourself a pat on the back and see what you have done.”