Collection of research
Bibliography
For those interested in learning more about research in this field, we have collected some of the literature that explores the role of kindness in health care. You can use them, for example, to print out and discuss at a staff meeting or journal club.
Please visit here regularly for new material, and feel free to alert us to other work via the contact box at the bottom of the page.
Our great thanks go to Ali Maudarbocus for compiling the collection.
Kindness: At the Center of Patient Experience Strategies. Journal of Healthcare
The author discusses the efforts of University of California Los Angeles (UCLA) Health to transform its culture into one centered on their patients' experience. Topics mentioned include patient satisfaction data reported by the U.S. Centers for Medicare & Medicaid Services on its Hospital Compare website in 2008, selection of patient engagement strategies by organizations based on their organizational readiness, and UCLA Health's strategies to improve patient experience as reported by patients.
By Padilla T.
Management [Internet]. 2017 Jul [cited 2018 Oct 6];62(4):229–33
The relationship between perceived organisational threat and compassion for others: Implications for the NHS. Clinical psychology & psychotherapy
The National Health Service (NHS) is known to be a challenging place to work, with financial and performance targets placing increasing pressure on the organisation. This study aimed to investigate whether these pressures and threats might be detrimental to the quality of care and the compassion that the NHS strives to deliver. Quantitative data were collected via self‐report questionnaires from
healthcare professionals across 3 NHS trusts in England in order to measure Self‐compassion; Compassion for Others; Perceived Organisational Threat; and Perceived Organisational Compassion. Qualitative data were also collected to explore the threats considered most pertinent to healthcare professionals at present. The key findings suggest that an increase in Perceived Organisational Threat may reduce an individual's ability to give compassion to others; however, Self‐compassion and Perceived Organisational Compassion were better predictors of Compassion for Others. This highlights the need to consider compassion at a systemic level, providing interventions and training not only to cultivate self‐compassion in healthcare professionals, but also to encourage compassion across the NHS more generally. In promoting self‐compassion and increasing the level of compassion that employees feel they receive at work, healthcare professionals may be better able to maintain or improve their level of compassion for service users and colleagues.
by Henshall LE, Alexander T, Molyneux P, Gardiner E, McLellan A.
Clinical psychology & psychotherapy. 2018 Mar;25(2):231-49.
Leading with compassion in health care organisations: The development of a compassion recognition scheme-evaluation and analysis
Purpose
The purpose of this paper is to report an evaluation of a leading-with-compassion recognition scheme and to present a new framework for compassion derived from the data.
Findings
The scheme highlighted that compassion towards staff and patients was important. Links to the wider well-being strategies of some of the ten organisations involved were unclear. Awareness of the scheme varied and it was introduced in different ways. Tensions included the extent to which compassion should be expected as part of normal practice and whether recognition was required, association of the scheme with the term leadership, and the risk of portraying compassion as something separate, rather than an integral part of the culture. A novel model of compassion was developed from the analysis of 1,500 nominations.
Practical implications
The model of compassion can be used to demonstrate what compassion “looks like”, and what is expected of staff to work compassionately.
Originality/value
A unique model of compassion derived directly from descriptions of compassionate acts which identifies the impact of compassion on staff.
by Hewison A, Sawbridge Y, Cragg R, Rogers L, Lehmann S, Rook J.
Journal of health organization and management. 2018 Apr 9;32(2):338-54.
https://www.emeraldinsight.com/doi/pdfplus/10.1108/JHOM-10-2017-0266
Measuring health care workers’ perceptions of what constitutes a compassionate organisation culture and working environment: Findings from a quantitative
feasibility survey
Introduction
Health care organisation cultures and working environments are highly complex, dynamic and
constantly evolving settings. They significantly influence both the delivery and outcomes of care.
Aim
Phase 1 quantitative findings are presented from a larger three phase feasibility study designed to develop and test a Cultural Health Check toolkit to support health care workers, patients and organisations in the provision of safe, compassionate and dignified care.
Methodology
A mixed methods approach was applied. The Cultural Health Check Healthcare Workers Questionnaire was distributed across two National Health Service Hospitals in England, UK. Both hospitals allocated two wards comprising of older people and surgical specialities.
Findings
The newly devised Cultural Health Check Staff Rating Scale Version 1 questionnaire was distributed to 223 health care workers. Ninety eight responses were returned giving a response rate of 44%. The Cultural Health Check Staff Rating Scale Version 1 has a significant Cronbach alpha of 775; this reliability scaling is reflected in all 16 items in the scale. Exploratory factor analysis identified two
significant factors “Professional Practice and Support” and “Workforce and Service Delivery.” These factors according to health care workers significantly impact on the organisation culture and quality of care delivered by staff.
Conclusion
The Cultural Health Check Staff Rating Scale Version 1 questionnaire is a newly validated measurement tool that could be used and applied to gauge health care workers perceptions of an organisation's level of compassion. Historically we have focused on identifying how caring and
compassionate nurses, doctors and related allied health professionals are. This turns the attention on employers of nurses and other related organisations.
Implications for nursing management
The questionnaire can be used to gauge the level of compassion with a health care organisation culture and working environment. Nurse managers and leaders should focus attention regarding how these two factors are supported and resourced in the future.
McSherry R, Pearce P.
Journal of nursing management 2018 Mar;26(2):127-39
The colours and contours of compassion: A systematic
review of the perspectives of compassion among ethnically diverse patients and healthcare providers.
Objective
To identify and describe the perspectives, experiences, importance, and impact of compassionate care among ethnically diverse population groups.
Results
A total of 2296 abstracts were retrieved, out of which 23 articles met the inclusion criteria. Synthesis of the literature identified the perspectives, facilitators and barriers of compassion in healthcare within ethnic groups. Compassion was described as being comprised of healthcare provider (HCP) virtues (honesty, kindness, helpful, non-judgment) and actions (smile, touch, care, support, flexibility) aimed at relieving the suffering of patients. The importance and impact of providing compassion to ethnically diverse patients were also identified which included overcoming cultural
differences, alleviating distress at end-of-life, promoting patient dignity and improving patient care. This review also identified the need for more contextual studies directly exploring the topic of compassion from the perspectives of individuals within diverse ethnic groups, rather than
superimposing a pre-defined, enculturated and researcher-based definition of compassion.
Conclusions
This review synthesizes the current evidence related to perceptions of compassion in healthcare among diverse ethnic groups and the role that compassion can play in bridging ethno-cultural differences and associated challenges, along with identifying gaps in literature related to
compassionate care within diverse ethnic groups. Establishing an evidence base grounded in the direct accounts of members of diverse ethnic communities can enhance culturally sensitive compassionate care and improve compassion related health outcomes among diverse ethnic groups.
Singh P, King-Shier K, Sinclair S.
PloS one. 2018 May 17;13(5):e0197261.
What are healthcare providers’ understandings and
experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada.
Background
Healthcare providers are considered the primary conduit of compassion in healthcare.
Although most healthcare providers desire to provide compassion, and patients and families expect
to receive it, an evidence-based understanding of the construct and its associated dimensions from
the perspective of healthcare providers is needed.
Objectives
The aim of this study was to investigate healthcare providers’ perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model.
Conclusions
An empirical foundation of healthcare providers’ perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.
Sinclair S, Hack TF, Raffin-Bouchal S, McClement S, Stajduhar K, Singh P, Hagen NA, Sinnarajah A, Chochinov HM.
BMJ open. 2018 Mar 1;8(3):e019701
Compassion from a palliative care perspective.
“Compassion lies at the heart of good medical care, particularly for the most vulnerable end-of-life patients. However, even though compassion is crucial and central to medical care, it is poorly researched. Our goal was to understand patients’ experiences of compassion and lack of compassion so that we can inform doctors and nurses what compassion is and is not from a dying patient’s perspective. We found that though compassion is so valuable and treasured by patients, it is not that complicated and in fact is “cheap”, meaning it does not take much time and effort from the clinicians. Dying patients see compassion as clinicians connecting with them, talking to them in a way
that can be understood, treating them with respect, showing some interest in them and having a positive presence for them.”
Fernando A, Rea C, Malpas P.
NZ Med J. 2018 Jan 19;131(1468):25-32.
Kindness Can Move Mountains
a short commentary on how a simple act of kindness can make a big difference in someone’s life when there is chaos (in this case, Hurricane Harvey).
Savage DJ.
Texas Heart Institute Journal. 2018 Apr;45(2):61-2.
A Framework for Reducing Suffering in Health Care
This article discusses types of suffering, including those that are avoided by empathy, trust and staff coordination.
https://hbr.org/2013/11/a-framework-for-reducing-suffering-in-health-care
by Deirdre E. Mylod and Thomas H. Lee, MD
Harvard Business Review
November 14, 2013
Confronting Unprofessional Behaviour in Medicine
In medicine, we have tolerated and continue to tolerate behaviour that harms each other, our patients, and our relations with society. The solutions will need to come from within the medical profession because the context and culture of our work are unique.
https://www.bmj.com/content/360/bmj.k1025
Jo Shapiro, Center for Professionalism and Peer Support, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
The BMJ, March 08, 2018
Kindness and Competition: Are we striking the right balance in medical education?
This paper discussing workplace stress, bullying and harassment quotes the work of Dr Catherine Crock.
Brewster DJ, Rees CE, Leech M, Thompson G. Kindness and competition: Are we striking the right balance in medical education?
AMJ 2018;11(5):313–315.
A More Egalitarian Hospital Culture is Better for Everyone
A new study proves that hospitals can change, and that a more open culture can help patients do better.
https://www.nytimes.com/2018/05/31/well/live/doctors-patients-hospital-culture-better-health.html
By Pauline W. Chen, M.D.
May 13, 2018
Why Focusing on Professional Burnout is Not Enough
Abstract: Professional burnout rates in healthcare are well documented and are at an all-time high. But the goals of delivering exceptional patient care and improving the health of our communities go beyond preventing and treating caregiver burnout. At the Institute for Healthcare Improvement, we suggest shifting the focus from “burnout” to “joy in work.”
Jessica Perlo and Derek Feeley. Journal of Healthcare Management, March-April 2018, vol 63 issue 2
Code Lavender: Cultivating Intentional Acts of Kindness in response to Stressful Work Situations.
Abstract: Providing healthcare can be stressful. Gone unchecked, clinicians may experience decreased compassion, and increased burnout or secondary traumatic stress.
Code Lavender is designed to increase acts of kindness after stressful workplace events occur.
http://www.sciencedirect.com/science/article/pii/S1550830717300435
Davidson, JE, Graham, P, Montross-Thomas, L, Norcross, W, Zerbi, G. The Journal of Science and Healing; 2017;13(3); 181-185.
NEJM Catalyst Leadership Talk: What if Our care Were Designed by Patients?
"I want to ask ourselves to imagine, what would it be like if our care was designed by patients? And if our leaders were selected by patients? And if our organisations were designed by patients?”
http://catalyst.nejm.org/videos/care-designed-by-patients-three-wishes/
Stephen Swensen, MD, MMM, FACR
Management by Enlightened Self-Interest: Technique versus Kindness.
Abstract: The day of the pat answer is past. The day of the quick fix is over. Today we are looking beyond the quarterly report into the next century. We now speak of winning combinations, enduring values, and lasting corporate structures. This article examines the application of "enlightened self-interest" to the leadership functions in the highly competitive, hyperturbulent health care industry. Empirical evidence is offered that demonstrates that prosocial leadership behavior enhances the willingness of workers to sustain not only a high level of quality work performance but also an advanced degree of citizenship behavior in the workplace.
Campbell, C. A. Health Care manager Journal, 1997
Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs.
Abstract: Current daily general practice has become increasingly technical and somatically oriented (where attention to patients’ feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP–patient communication have shifted from a focus on listening and empathy to task-oriented communication.
http://bjgp.org/content/66/653/e887.short
Derksen FA, Olde Hartman TC, Bensing JM, Lagro-Janssen AL. Br J Gen Pract . 2016;66(653):e887-e895.
Patients as Ethnographers
Abstract: This reflection describes an innovative methodology to observe and measure work place culture in the healthcare setting. Dr. Launer draws on his personal inpatient experience and proposes that ethnography; the study of cultures, could provide an accurate perspective of culture in the workplace. An ethnographical study is an avenue to engage with patients during their own hospital admission in real time. This would provide an opportunity for the patient to give an account of their observations and health care experience of technical care, the human interaction around them, and the implications for patient safety.
http://dx.doi.org/10.1136/postgradmedj-2017-135044
Dr. John Launer. BMJ vol 93 Issue 1100
IHI Framework for Improving Joy in Work
This white paper is intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, “What matters to you?” — enabling them to better understand the barriers to joy in work, and co-create meaningful, high-leverage strategies to address the issues of burn-out and low engagement levels of staff which ultimately leads to poor patient care.
http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Improving-Joy-in-Work.aspx
Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI. White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017.
Breaking the Rules for Better Care
"If you were to break or change any rule in the service of a better care experience for patients or staff, what would it be?"
http://jamanetwork.com/journals/jama/article-abstract/2624332
Berwick D, Loehrer S, Gunther-Murphy C. Journal of the American Medical Association. 2017 Jun;317(21):2161-2162.
Reforming the culture of healthcare: the case for intelligent kindness.
Abstract: There has been increasing interest in the culture of healthcare in the light of the two reports by Robert Francis into the care at Mid Staffordshire. This editorial encourages a comprehensive exploration of the conditions that promote a benign caring culture and make outbreaks of cruel neglect and abuse of patients less likely. Creating and sustaining such a culture is dependent on being honest and realistic about the forces that threaten to undermine it. The editorial argues that being able to confidently articulate the positive values that should define healthcare culture is particularly important at this time. The case is made for a conscious focus on the concept of intelligent kindness.
http://pb.rcpsych.org/content/39/1/1.short
Campling P. British Jounal of Psychiatry Bulletin; 2015; 39(1): 1-5
Cultivating compassionate care.
Abstract: The term compassion is at the forefront of current healthcare policy, yet its meaning and how it can be realised in practice is far from clear. This article debates the meaning of compassion in the context of practice and argues that it essentially involves how people relate to each other. It highlights key processes to enhance compassion with self, patients and their families, healthcare professionals and the organisation.
http://journals.rcni.com/doi/abs/10.7748/ns2013.04.27.34.48.e7460?journalCode=ns
Dewar B. Nurs Stand . 2013 [cited 2013 Apr 24-30];27(34):48-55; quiz 56.
Kindness, not Compassion, in Healthcare.
Quote: “...by examining the meaning of compassion and where it sits in the spectrum of beneficence, I hope to provide convincing arguments that compassion is misused—it is the wrong adjective for the ideal type of interaction that should characterize the care we encourage be delivered in medical settings. In the spectrum of beneficence we should not aspire to compassionate care; instead we should aspire to kindness in caregiving.”
Faust SH. Cambridge Quarterly of Healthcare Ethics; 2009;18(3); 287-299.
Adding kindness at handover to improve our collegiality: the K-ISBAR tool.
This reflection from the Medical Journal of Australia proposes adding kindness at handover to improve collegiality.
Brewster, David J, Waxman, Bruce P. Adding kindness at handover to improve our collegiality: the K-ISBAR tool. MJA 209 (11). 10 December 2018.
Humanizing the healthcare experience: the key to improved outcomes.
Abstract: This is an uncertain time to be in medicine. Most of us entered the profession to be of service to patients, to provide great clinical outcomes, and to be fairly compensated. Today, when asked whether physicians would recommend the medical profession to their children, most of them say no.1 When pressed further, many point to an industry that is focused more on cost reduction, efficiency, and the adoption of health information technology that is dehumanizing medical care. When we add the increasing administrative and regulatory compliance burdens to the practice of medicine, you begin to understand the increase in physician burnout.
http://www.giejournal.org/article/S0016-5107(13)02461-9/abstract
Duffy MB. Gastrointest Endosc . 2014;79(3):499-502.
Kindness in medicine: appeal and promise.
Quote: “But in addition to helping patients, acts of kindness can transform how clinicians view themselves. A focus on kindness can be restorative and rekindle the enthusiasm that initially prompted careers in healthcare. To seek joy and meaning in clinical work is a challenge recently issued by Leape, et.al. Kindness can be key to achieving such objectives.”
http://europepmc.org/abstract/med/21957660
Freeman JW, Hoffman WW. S D Med; 2011
Acknowledging small acts of kindness.
Summary: An editorial that highlights, according to the author, the very best of nursing practice
Gallagher A. Nurs Ethics ; 2012;19(3):311-2.
Catching rudeness is like catching a cold: The contagion effects of low-intensity negative behaviors.
Abstract: In this article we offer a new perspective to the study of negative behavioral contagion in organizations. In 3 studies, we investigate the contagion effect of rudeness and the cognitive mechanism that explains this effect. Study 1 results show that low-intensity negative behaviors like rudeness can be contagious, and that this contagion effect can occur based on single episodes, that anybody can be a carrier, and that this contagion effect has second-order consequences for future interaction partners. In Studies 2 and 3 we explore in the laboratory the cognitive mechanism that underlies the negative behavioral contagion effect observed in Study 1. Specifically, we show that rudeness activates a semantic network of related concepts in individuals’ minds, and that this activation influences individual’s hostile behaviors. In sum, in these 3 studies we show that just like the common cold, common negative behaviors can spread easily and have significant consequences for people in organizations.
http://psycnet.apa.org/journals/apl/101/1/50.pdf
Foulk T, Woolum A, Erez A. Journal of Applied Psychology. 2016 Jan;101(1):50.
Ten approaches for enhancing empathy in health and human services cultures.
Abstract: Empathy is defined as a predominantly cognitive attribute that involves an understanding of experiences, concerns and perspectives of another person, combined with a capacity to communicate this understanding. Empathy in the context of clinical care can lead to positive patient outcomes including greater patient satisfaction and compliance, lower rates of malpractice litigation, lower cost of medical care, and lower rate of medical errors. Also, health professionals' wellbeing is associated with higher empathy. Enhancing empathic engagement in patient care is one of the important tasks of medical education. In this article, I briefly describe 10 approaches for enhancing empathy in the health care environment: improving interpersonal skills, audio- or video-taping of encounters with patients, exposure to role models, role playing (aging game), shadowing a patient (patient navigator), hospitalization experiences, studying literature and the arts, improving narrative skills, theatrical performances, and the Balint method. I conclude that empathic engagement in the health care and human services is beneficial not only to the patients, but also to physicians, other health care providers, administrators, managers, health care institutions, and the public at large.
http://www.jstor.org/stable/25790741?seq=1#page_scan_tab_contents
Hojat M. J Health Hum Serv Adm . 2009 [cited 2009];31(4):412-50.
"Tu Souffres, Cela Suffit": the compassionate hospital.
Abstract: The authors propose that the characteristics of personal (individual) compassion may be extrapolated to the concept of corporate (organizational) compassion. Modern health care facilities attract staff members who are able to exercise varying degrees of compassion in their busy daily routines. However, little discussion has taken place on how health care organizations might best harness and integrate aspects of individual compassion to create an organization with compassion as a core value. We define three characteristics of a “compassionate hospital” as 1) the presence of a healing environment, 2) a sense of connection among people, and 3) a sense of purpose and identity. We suggest how a “top down” focus on compassion as a core value by clinical leaders could maximize the compassion of health care workers, and reduce the suffering expressed and/or experienced by health care workers and patients in today's health care facilities. The compassionate hospital concept is intended to act as a proposition for health policy researchers and decision-makers in health care so as to reduce the suffering of sick patients, and to restore a sense of well-being, meaning, and purpose among health care workers.
http://online.liebertpub.com/doi/abs/10.1089/jpm.2011.0378
Kearsley JH, Youngson R. J Palliat Med . 2012 [cited 2012 Apr];15(4):457-62.
Your Best Life: Kindness is Its Own Reward.
Abstract: The article focuses on kind deeds which enrich the lives and can lift the mood of the most disheartened soul. It states that unforeseen complications can be portrayed in kind manner and orthopedists should embrace unexpected outcomes and should try to convey to a patient's family or friends. It mentions that in order to cross journey of vocation in orthopedic surgery, kindness to oneself is essential and difference in resiliency in medicine is due to presence of uplifts one receives.
https://link.springer.com/article/10.1007/s11999-016-4927-8
Kelly JD 4th. Clin Orthop. 2016;474(8):1775
Leadership with Compassion: Applying Kindness, Dignity and Respect in Healthcare Management.
Summary: The compelling book prompts fresh, and perhaps controversial, ideas about themes such as the role of the apology in healthcare settings; a whole chapter is dedicated to encouraging staff to say sorry when mistakes are made.
https://books.google.com.au/books/about/Leadership_with_Compassion.html?id=4JfsAwAAQBAJ&redir_esc=y
Lewis C. Globis Mediation Group; 2013
'Telling the Truth…With Kindness’.
Abstract: Cancer in a parent can have harmful effects on a child’s ability to cope with the situation, in particular if communication about the disease is limited. The aim was to evaluate whether the parent-child group run by a psychoanalyst and a doctor at the hospital helps facilitate communication about the disease with a child and helps to sooth the child and his/her symptoms.
Landry-Dattee, N, Boinon, D, Roig, G, Bouregba, A, Delaigue-Cosset, M-F, Dauchy, S Journal of Cancer Nursing, vol. 39, no. 2, pp10-18.
Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care.
This report highlights how working conditions can affect health care workers and recommends seven strategies for organizations to improve workplace safety.
https://psnet.ahrq.gov/issue/through-eyes-workforce-creating-joy-meaning-and-safer-health-care
Lucian Leape Institute. Boston, MA: National Patient Safety Foundation; 2013.
Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire.
Abstract: Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be ‘all changed, changed utterly’. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions?
http://jme.bmj.com/content/41/12/956.short
Newdick C, Danbury C. J Med Ethics. 2015;41(12):956-62.
The power of kindness. Acts of kindness by nurses live long in patients' memories.
Quote: “Acts of kindness are often small and fleeting, seen only by the person to whom they are directed, and are carried out without thought of reward. Acts of kindness are not judgmental, they are not rationed according to whether the person who benefits from the act is entitled to it. Nor is kindness a virtuous act of duty, performed out of a sense of obligation. Acts of kindness are acts of generosity. They do not demand recognition. They vanish in the moment”
https://www.ncbi.nlm.nih.gov/pubmed/26882759
O'Brien A. Nurs N Z; 2015;21(11):19
Compassion and the science of kindness: Harvard Davis Lecture 2015.
Abstract: The article discusses the importance of kindness in the consultations of general practitioners (GP) in Great Britain. It states that kindness should be in the central of the engagement of physicians with other people. It mentions that kindness activates the soothing and affiliation component of the emotional regulation system of the brain.
Mathers N. Br J Gen Pract. 2016
Autonomy, Trust, and Respect.
Abstract: This article seeks to explore and analyze the relationship between autonomy and trust, and to show how these findings could be relevant to medical ethics. First, I will argue that the way in which so-called “relational autonomy theories” tie the notions of autonomy and trust together is not entirely satisfying Then, I will introduce the so-called Encapsulated Interest Account as developed by Russell Hardin. This will bring out the importance of the reasons for trust. What good reasons do we have for trusting someone? I will criticize Hardin’s business model as insufficiently robust, especially in the context of health care, and then turn to another source of trust, namely, love. It may seem that trust-through-love is much better suited for the vulnerability that is often involved in health care, but I will also show that it has its own deficiencies. Good health care should therefore pay attention to both models of trust, and I will offer some tentative remarks on how to do this.
https://academic.oup.com/jmp/article-abstract/41/1/10/2563347
Nys T. J Med Philos . 2016;41(1):10-24
Respect, compassion and dignity: the foundations of ethical and professional caring.
Abstract: Throughout 2011, and for much of this year, the national and professional press have been dominated by reports of failures in health and social care. Stories have focussed on the avoidable harm and disturbing cruelty suffered by individuals and the distress of distraught families seeking answers in the light of systemic organisational failure on an incredible scale.
https://pubmed.ncbi.nlm.nih.gov/22919765/
Reid J. J Perioper Pract . 2012;22(7):216-9.
Perceiving the moral dimension of practice: insights from Murdoch, Vetlesen, and Aristotle.
Abstract: This paper situates the moral domain of practice within the context of a particular description of nursing practice - one that sees human interaction at the heart of that practice. Such a description fits not only with professional rhetoric but also with literature from patients and recent empirical work exploring the nature of nursing practice. Martha Levine in her 1977 description of ethics, within the context of nursing practice, indicated that what was important from an ethical perspective was how we interact with each other, with patients and colleagues, on a daily basis. What enables such interaction to display moral sensitivity, insight into patient need, and a focus on the good for the patient? Of relevance when answering this question is the empirical evidence indicating that professional socialization, as a nurse or a doctor, may dull the individual's moral sense. If this is the case, cognizance needs to be taken of such evidence when identifying theoretical approaches from mainstream ethics that may provide insight and value for nurse education. It is suggested that such insight and value can be gained from a consideration of the work of Aristotle, Murdoch, and Vetlesen.
onlinelibrary.wiley.com/doi/10.1111/j.1466-769X.2006.00270.x/full
Scott PA. NURS PHILOS. 2006;7(3):137-45.
Compassion.
Abstract: The term ‘compassion’ has been much used and little discussed. [She] argues that compassion is a virtue in the Aristotelian sense, one of a family of other-regarding properties and belongs to the affective qualities of a moral agent. Its exercise is an essential component of good medical care in many situations and requires grounding in moral principles. Although our dispositions vary, compassion is a quality that can be developed in all of us.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953728/
Saunders, John
Clin Med (Lond). 2015 Apr; 15(2): 121–124.
doi: 10.7861/clinmedicine.15-2-121
Physician well-being: A powerful way to improve the patient experience.
Taking a look at the factors that lead to physician burnout and seeing how managing them could also affect the way patients view their doctors.
Shannon D. ACPE Physician Executive Journal. July/August 2013.
Is It Possible to Develop a Compassionate Organization? Comment on "Why and How Is Compassion Necessary to Provide Good Quality Healthcare?".
Abstract: This paper represents a commentary to Marianna Fotaki’s Editorial: ‘Why and how is compassion necessary to provide good quality healthcare?’ Within this commentary, I discuss some of the issues raised by Marianna Fotaki, and conclude that we should work towards an organizational culture which considers the important concept of compassion by focusing on the well-being and teamwork of all involved.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629703/
Shea S. Int. j. health policy manag. 2015; 4(11):769-70.
A little bit of kindness can go a long way in the workplace.
Abstract: Despite the frenetic and pressurised environments nurses and other healthcare workers find themselves in on a daily basis, politeness and kindness towards colleagues, as well as patients, should never be overlooked.
http://journals.rcni.com/doi/abs/10.7748/ns.29.46.33.s40?journalCode=ns
Tallo D. Nurs Stand;29(46):33
The ART of maintaining the "care" in healthcare.
Abstract: Poor professional quality of life (PQOL) leads to difficulty with staff retention, lateness, absenteeism, and low morale—all of which result in an unhealthy workplace, ultimately affecting patient care and outcomes. We constantly hear that strong leadership is a key ingredient for a healthy work environment. But how can you support staff members who seem to be burnt out? And how do you keep going when you feel like you're running on empty?
Todaro-Franceschi V. Nurs Manage . 2015;46(6):53-5
When countertransference reactions go unexamined due to predetermined clinical tasks: How fear of love can keep us from listening.
Abstract: The psychotherapeutic work is characterized by processes that are involved in the development of the alliance, as well as processes that lead to the ruptures in the alliance (error) and its repair. The purpose of this article is to highlight the clinical error that occurs when a clinician fails to adequately respond to a patient’s emotional signals due to countertransference reactions that results in an overemphasis on predetermined tasks the clinician “naturally” deems as necessary. A clinical vignette is presented to illustrate the error and 3 alternative approaches to the error are discussed. These include—(a) shared decision-making, (b) addressing and repairing alliance rupture, and (c) management of countertransference. Brief theoretical and clinical context for each alternative approach is provided.
http://psycnet.apa.org/record/2016-43885-008
Sharma S, Fowler JC. Psychotherapy . 2016;53(3):302-7.
Preceptorship: embracing a culture of caring.
Abstract: This Magnet hospital embraces Jean Watson’s (2008) theory of caring; its preceptor program acts as a vehicle to bring to life a professional nursing model, going beyond patient care. The program offers dynamic content that engages staff, promotes the use of innovative learning methods, and provides strategies to deal with difficult situations. The program has successfully influenced staff to adopt more caring behaviors toward themselves, preceptees, and others.
Small GE, Good P. J. nurses prof. dev. 2013;29(6):301-4.
Enabling the flow of compassionate care: a grounded theory study.
Abstract: Compassion has become a topic of increasing interest within healthcare over recent years. Yet despite its raised profile, little research has investigated how compassionate care is enacted and what it means to healthcare professionals (HCPs). In a grounded theory study, we aimed to explore this topic from the perspective of people working with patients with type 2 diabetes – a long-term condition that involves repeated interactions with HCPs.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2120-8
Tierney S, Seers K, Tutton E, Reeve J.BMC Health Serv Res . 2017;17(1):174.
Intervention to promote physician wellbeing, job satisfaction, and professionalism: A randomized clinical trial.
Abstract: Despite the documented prevalence and clinical ramifications of physician distress, few rigorous studies have tested interventions to address the problem. An intervention for physicians based on a facilitated small-group curriculum improved meaning and engagement in work and reduced depersonalization, with sustained results at 12 months after the study.
West CP, Dyrbye LN, Rabatin JT, et al. JAMA Internal Medicine. 2014;174(4):527-533