Introduction to Relationship Centred Care assignment PDF

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Course Title: BSc Child Nursing Module Title: Introduction to Relationship Centred Care Module Code: 66-4576-01C Tutor: Sarah McDonald Assignment Title: Forming Nursing Relationships Deadline: 07/03/19 Declaration Iconfir mt hatt hi sas ses smenti smyownwor kandt hatIhav edul yac k nowl edged andc or r ec t l yr ef er encedt hewor kofot her s .Iam awar eofandunder s t andt hatany br eachest ot heCodeofAc ademi cConductwi l lbei nv es t i gat edands anc t i onedi n accor danc ewi t ht heAc ademi cConductRegul at i on,f oundons hus pace|Rul esand Regul at i ons|Conduc tandDi s ci pl i ne

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Compassion is a key characteristic required for the nursing profession. Providing compassionate relationship centred care is integral when caring for patients and their families involving many skills and attributes to do this successfully. Throughout this assignment, I will refer to the concept of compassionate, relationship centred carewhat it is, psychological concepts around it, and the barriers to providing this. Collectively, this will result in the formation of my own definition of compassionate, relationship centred care, whilst relating this to clinical experience.

Compassion can be defined in many ways and is integral to providing a safe, effective and patient centred care (Francis, 2013). It can be one of the many emotions felt towards others including pity, sympathy, and grief (Saunders, 2015). However, whilst being a compassionate individual involves many of these characteristics, it is more than this; requiring nurses and health professionals to act to relieve suffering, removing barriers to good care, whilst acting as an advocate for their patients (Firth-Cozens and Cornwell, 2009). Compassion is a big focus in the nursing profession and this is a value embedded throughout the Nursing and Midwifery Council’s Code of Conduct (NMC, 2015) stating the behaviours and standards expected of nurses from their peers, patients and the public. Youngson (2015), argues that compassion is fundamental and the love and care that a nurse gives to their patient is just as powerful as the drugs used. The NHS constitution identifies compassion as one of the core values of the nursing profession, therefore it should be present throughout all aspects of the patient’s hospital journey (DH, 2013).

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Family centred care is an important element of Children’s Nursing and involves working in collaboration with the whole family, recognising them all as care recipients and not just focusing on the individual child (Shields et al, 2006). Provided together, compassionate, family centred care can be beneficial both physically and psychologically. One of these is the empowerment it offers families, which is key in building that relationship, this is due to acknowledging parents as the experts in their child’s care, therefore empowering them and making them feel good as parents, whilst reassuring them (Ball et al, 2012; Ygge, 2007). Taking time to interact and listen to the family, showing a compassionate understanding of the experience they are going through is the first and most important step in building a therapeutic and family centred relationship (Svavarsdottir, 2006).

Providing compassionate, family centred care involves looking at psychological concepts associated with this. Focus on psychology in nursing allows the concept of ‘holistic care’ to be given as it considers all levels of care rather than focusing on the medical model (Jones, 1999). Devised by Rogers and Maslow, the humanistic approach focuses on the idea of free will and self-actualisation whilst finding meaning in the emotions and feelings of patients (De Vries and Timmins, 2017). The approach focuses on emotion and empathy, therefore a relevant school of thought linking to compassionate, relationship centred care. It sees the emotional wellbeing of the patient and in return the empathy and listening that nurses give back as vital (Roach, 2013). Patients are often vulnerable and may feel excluded from family, work and/or the community, and it is therefore down to nurses caring for them to compensate for this loss of control (Bastian and Haslam, 2010). The humanistic approach would suggest this can be done through showing empathy, listening well,

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and being respectful, as well as seeing self-actualisation as the goal (De Vries and Tommins, 2017). This can be reached if physiological needs, safety needs, and love and belonging needs are fulfilled, thus seeing psychological needs as important as physiological needs, but only in reach if those needs have been met first, this is shown in Maslow’s Hierarchy of needs (Maslow, 1943). However, more recent psychology criticises this concept of self-actualisation and argues that reaching this point is a process rather than a goal to be reached (Hsu, 2015). However those who do engage in self-actualising have a higher quality of life (Kehyayan et al, 2015). A major strength of this humanistic approach to compassionate, relationship centred care is the focus on how far the needs of the patient and their family are met and their level of satisfaction, which is the main goal of compassionate, relationship centred care (Kosco and Warren, 2000).

Through researching literature and information around compassion and relationship centred care, this has enabled me to come to my own conclusion on what I define this as. In my opinion, compassionate relationship centred care involves being empathetic, caring and non-judgemental, whilst offering an unconditional loving relationship focused on the patient and their families and their wishes. Whilst on placement as a student nurse, I have been privileged to witness nurses providing compassionate, relationship centred care to children and their families daily. One example of this is through a patient admitted for mental health reasons and attempted overdose. For the purposes of this essay and for confidentiality reasons as per the Human Rights Act (HMSO, 1998), I will give this patient a pseudonym of Daniel. Daniel was admitted to the ward after taking an overdose of paracetamol and ibuprofen. Before admission to the ward, the nurse and I looked through his notes

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and realised he is well known to mental health services and has previous admissions for the same reasons, his usual place of residence is in a full time mental health facility. Due to this, we decided to give him a separate room to allow him privacy and make him feel more comfortable in order for him to talk about his feelings. Once admitted to the ward he required a one-to-one special which involves a member of staff to be with him at all times to ensure he is not at harm to himself. I helped with this and started to build a relationship with Daniel and get to know him, I played card games with him and his friend. A few hours later, the emergency buzzer was pulled in his cubicle by a member of staff- Daniel had attempted to hang himself with a sock and she was unable to remove this from his neck. Staff nurses were required to use a ligature cutter to remove the sock. Daniel was visibly distressed and refused to speak to the many people that had entered his room, I felt I had built up a relationship with Daniel and felt able to attempt to speak to him. I used empathy in relating to how he felt and showing him that I understood how distressed he must be. Daniel seemed to relax after a while and opened up to me about his feelings and the triggers for his behaviour. At the end of my shift, both Daniel and his mother thanked me for the support and compassion I had shown them throughout their time on the ward.

Although compassionate, relationship centred care is a fundamental aspect of nursing and is considered the ‘hallmark of nursing’ (Winch et al, 2015), this is not always the case. There are many barriers to providing this and is a prominent issue in the healthcare setting. The Francis Report (Francis, 2013), illustrates the consequences of when there is a lack of compassionate, relationship centred care, when the failings at the Mid Staffordshire NHS Foundation Trust were shown.

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Francis (2013) reported that there was a lack of caring and compassionate culture and instead a focus on financial targets driven by management. Failings included patients being left in their own urine for large amounts of time, a lack of privacy and dignity, along with failing to hydrate and feed patients which together led to unnecessary deaths. This is an extreme case where there has been a lack of compassionate relationship centred care, but this illustrates how fatal it can be.

This example shows that there are obviously barriers to providing compassionate, relationship centred care, and these need to be explored with ways of overcoming them reached. Undoubtedly there is huge pressure on nursing staff due to low staffing, and is a factor in being able to provide compassionate care. Evidence clearly shows that the better the nurse/patient ratio, the higher the quality of care for patients (Curry et al, 2005). Nurses are having to deal with the growing demands of the healthcare setting and are caring for patients with increasingly complex and serious conditions (Cummins, 2016). With the lack of staff to provide this, it negatively impacts the nurses dealing with this- although nurses have a desire to deliver compassionate care, this isn’t enough to enhance compassion in practice (Cummins, 2016; Tierney et al, 2017).

This pressure on nurses and healthcare staff can lead to compassion fatigue, often described as ‘the lack of ability to nurture characterised by apathy and cynicism’ and is frequently the result of caring for others in emotional pain, as nurses do daily (Figley, 1995; Joinson 1992). Nurses care for patients who have experienced traumatic events, if this is an event with a family that they have built a relationship

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with, this can cause emotional exhaustion and lead to compassion fatigue (Yoder, 2010). Compassion fatigue not just affects the level of compassionate care shown to patients, but can and does have physical, emotional, social, spiritual and professional consequences on staff- examples include chronic fatigue, depression and anxiety, with some even choosing to leave the nursing profession altogether (Boyle, 2015). Depression and anxiety can commonly be a result of compassion fatigue, and is a growing issue in the healthcare sector, with rates of depression being high and of great concern, leading to staff sickness and burnout, resulting in more staff feeling this way (Cornwell and Fitzsimons, 2017).

Efforts have been made to improve staff wellbeing and enhance compassionate, relationship centred care in health services. Keogh (2013) and Berwick (2013) emphasised the need for engagement and valuing of staff, presenting a more open and transparent work environment, with this being directly related to patient experience and quality of care (Dixon-Woods et al, 2014). Therefore, Swartz Rounds have been introduced in some areas across the UK to improve staff support and in turn improve compassion and quality of care. Schwartz rounds are reflective groups which any member of staff across the multi-disciplinary team can attend to share their experiences and vulnerabilities in practice, to support each other and enhance connections between staff and patients (Penson, Schapira, Mack, Stanzler and Lynch 2010). This has had positive effects on staff and patients with staff reporting improved feelings of empathy and compassion towards patients as well as improved teamwork (Goodrich, 2012; Lown and Manning, 2010). The Francis Report highlighted this positive effect that Schwartz Rounds can have (Ford, 2014), this therefore can be used more widely in health services across the country to try and

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prevent compassion fatigue in staff hence improving the quality of care given to patients.

It is not just aspects such as compassion fatigue and financial pressures on the national health service that can affect the level of compassionate, relationship centred care provided. More basic things such as language and multicultural factors also act as a barrier to giving this care, making communication with patients and their families difficult. Communication was raised in the Francis Report (Francis, 2013) and clear links to compassion, dignity and respect were shown, but that this is not always effective. The UK is a multicultural society, which means there are lots of languages and cultures present in healthcare, which can provide a barrier for communication. Effective communication in healthcare involves considering the beliefs of these different cultures and how this may impact on the receiving of information and the building of a relationship, thus impacting the way we provide care (Northrop and Hingley, 2016). Burnard and Gill (2008) offer steps in overcoming this barrier and suggest actions such as researching different cultures to expand knowledge, a willingness to learn and being open to new learning about the culture of the patient, and lack of prejudice and understand new ways of living and new viewpoints different to your own. Other ways of overcoming this barrier to communication in regards to language are to include a professional interpreter to express essential information to the patient and the family, as communicating with a patient and family whose first language is not English and can inhibit a relationship between the patient and health professional as ‘less than adequate reciprocal information is being provided’ (Lambert, Long and Kelleher, 2012; Wales et al, 2008). Therefore, providing an interpreter to communicate with these patients is essential in

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providing culturally competent care and can give the patient the chance to ask questions around their care and cultural beliefs (Cone, 2007).

In conclusion, elements of this essay have shown the importance of compassionate relationship centred care and how barriers to this can often present issues if not overcome. Psychological aspects have been explored and shown how compassion is significant to human emotion and experience. Overall, compassion should be at the heart of everything a nurse does, as Youngson (2015) stated ‘the love and care you give to a patient is as powerful as the medicines you use’.

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Bastian, B., & Haslam, N. (2010). Excluded from humanity: The dehumanizing effects of social ostracism. Journal of Experimental Social Psychology., 46(1), 107.

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Berwick, D. (2013). A promise to learn—A commitment to act: Improving the safety of patients in england. . London: Department of Health.

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Boyle, D. (2015). Compassion fatigue: The cost of caring. The Point of Care Foundation, , 51.

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Burnard, P., & Gill, P. (2008). Culture, communication and nursing. Harlow: Pearson Education.

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Cone, S. (2007). The impact of communication and the neonatal intensive care environment on parent involvement. Newborn and Infant Reviews, 7(1), 33.

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Cornwell, J., & Fitzsimons, B. (2017). Behind closed doors. London: The Point of Care Foundation.

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Cummins, J. (2016, 25 February). The role of nursing is changing- and demand is greater than ever. The Guardian,

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Curry, V., Harvey, G., West, E., McKenna, H., & Keeney, S. (2005). Relationship between quality of care, staffing levels, skill mix and nurse autonomy: Literature review. Journal of Advanced Nursing, 51(1), 73.

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Penson, R. T., Schapira, L., Mack, S., Stanzler, M., & & L...