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Compassion 'not the key' to solving NHS problems

An emphasis on compassion could actually be dangerous to the NHS, according to a medical ethics expert.

Following the Francis Report into failings at Mid-Staffordshire Foundation Trust, the Prime Minister called for nurses to be hired and promoted on the basis of having compassion, not just academic qualifications.

But Dr Anna Smajdor, from Norwich Medical School at the University of East Anglia, believes compassion is not necessarily the key to solving the NHS’s problems - especially if it is to the detriment of other important duties.

“If Cameron’s ideas come to fruition, the compassion served up by healthcare professionals will be at best inauthentic and at worst dangerous,” she said.

“Healthcare professionals are responsible for many individuals, working to fulfil many tasks as efficiently as possible - often in situations where time and resources are limited. It would be very dangerous to rely on compassion as the motivation that ensures the necessary tasks are carried out.

“Reminders, routines and checklists ensure that crucial tasks are undertaken. But if hospitals are fundamentally under-resourced, they will fail to deliver the care that is required.”

Dr Smajdor’s paper, which will be published in the journal Clinical Ethics on September 19, describes how the problems at Staffordshire were systemic throughout the entire institution and its culture. But she said it would be “bizarre” if that particular hospital had been staffed entirely by individuals who lacked compassion.

In many ways it can actually be harmful for healthcare professionals to feel too much compassion, she concluded, because they may become deeply distressed by some of the things they witness, and are at risk of suffering burnout and fatigue, as well as becoming de-sensitised and damaged.


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Readers' comments (12)

  • michael stone

    I heard her on radio 4 this morning, and I tend to agree with Anna.

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  • sounds as this is going to be a significant and useful report.

    we can all sit round the tea table with Jane doing compassion (I guess that is where the huge bill for coffee and biscuits at the DH went last year) but it doesn't make us better or more efficient at getting the job done in saving lives and providing excellence in everything we do.

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  • At long last, after the reams of absolute cr*p spouted forth on this site about 'compassion', someone with a reasoned and factual approach on what it takes to deliver care.

    Cummings, Bennett, et al, are you listening?!

    Compassionate care starts with properly resourced healthcare settings with well trained staff in decent numbers.

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  • Anonymous | 18-Sep-2013 12:34 pm

    "Compassionate care starts with properly resourced healthcare settings with well trained staff in decent numbers."

    Exactly. Not daft acronyms written on a card.

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  • Proud to have been trained where this sensible statement comes from.

    I'm compassionate, I really do care for my patients but quite honestly I don't have the time to provide excellent care to all my patients.

    Compassion doesn't help provide that care, staffing and consideration to the dependency of patients on the wards for staffing does!

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  • compassion and basic care should come with the territory when you decide to become a nurse ,I agree there needs to be more staff on the wards and departments but if you are giving care to a patient why not do the job with compassion does that take more time ?What needs to be looked at are the amount of paperwork that is filled in then repeated over and over again.Also all the targets which are in place some targets are needed but they need to be realistic and not set by people who are not in the job of healthcare

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  • Anonymous | 18-Sep-2013 8:53 pm

    But you are assuming that the notion of compassion is entirely down to the individual and that it is easily dispensed in all circumstances.

    I would consider myself to be a compassionate person. But when my kids were young and we were in situations where I was harassed, exhausted by the hundred and one directions in which I was being pulled and at the the limit of my patience from their behaviour (which was no better or worse than average children), I must have looked anything but compassionate. Did I love my kids any less? No. Did it make me a bad mum? Well, the kids seemed to have survived childhood intact and are now well balanced young adults. Did it mean that I lacked compassion? No.

    We have to get away from this idea that 'compassion' and the dispensing of it, is somehow easy in all circumstances. It excuses our bosses from their responsibility to create the environments and climates that facilitate compassionate care (which the vast majority of nurses carry out day in and day out over decades in their careers) and seeks to lay unrealistic expectations on nurses, who are only human beings.

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  • michael stone

    Anonymous | 18-Sep-2013 12:49 pm

    I am warming to Anna even more, since she has replied to the e-mail I sent to her yesterday.

    I can 'sort of see' why the training there might be good - her reply, unlike some, made sense.

    I've written before, many times, that the goverment must not be allowed to side-track the issue of 'are there enough staff' by rabbiting on about 'do nurses care enough', although Anna's point was a little different to that one.

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  • Latterlife Midwife

    What a breath of fresh air! My beliefs exactly, which I've expressed here before. No one becomes a nurse (perhaps an extremely rare one who gets rooted out, or roots oneself out, quickly) without having an interest in caring for people, i.e. compassion.

    Support a hospital, an entire health system, with proper resources that allow nurses the time and the equipment to care for patients, and they will do so, and very well, indeed. I hope the words of Dr Anna Smajdor receive the attention they deserve, but somehow I doubt they will.

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  • I am doing a research project investigating stress in nursing with PTSD. In the same way that constant exposure to combat and violence can cause behaviour changes in the armed forces, we are trying to find out if low staffing and the link to exhaustion causes a similar numbness that makes it harder to care. So far we have established statistical links but we want to quantify them. No idea if it will be published and I'm sure there are plenty of people reading this who think research is all rubbish and stating the obvious but our intent is (if we find the evidence) to use it to mobilise for action. Watch this space.

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  • We need to get away from ideas and ideals. The problem is we are stranded between a romanticised view of our profession and the reality of nursing. Nursing is a science and nothing else. We have lost decades in terms of training and education in this country in the face of booming healthcare technology. Out graduates have merely a basic understanding of the body because we have not focused on that during training. Instead we have wasted time trying to teach cultural attributes that this generation can neither relate to or portray.
    We are confusing the experience of the patient with the outcome when illnesses don't care. Illness does not care whether the practitioner is compassionate or not, the outcome is not dependent on that. More staff is the issue as each clinical area will be fundamentally different from the next, even if two wards share the same patient group. This has prevented us from systematic care. But there is a way forwards if we are practical.
    Why do we not create a team of admissions nurses who see all new patients and complete the admission booklet. One simply cannot say; this must be filled in within six hours of admission if the practitioner already has obligations to existing patients. If I were a trust manager I would have taken the path of leaast resistance, especially if I thought it were vital. Why do we not have another team of nurses to re-assess patients on the due date? Why do we expect Staff Nurses to complete 50 page DST's or. HNA's when they have clinical obligations that do not pause at any time?
    But more importantly, why do we allow compassion to be parroted about as if it was akin to having an on/off switch? We may have nurses who lack ideal personal attributes but does that affect recovery? Maybe. But should that then be applied to everyone? Being a human requires compassion. We shoud be asking ourselves why compassion is lacking and what that person needs to become compassionate rather than seeing it as a character flaw. After all it is likely they have restricted their giving of obvious compassion to preserve themselves. One size does not fit all so it is clearly pointless to say 'one shouldn't be a nurse without compassion'. That is not a solution, it is a confirmation bias. Besides, one might not find you compassionate at all, despite your best efforts. Only a fool remains happy and smiling in a war zone.

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  • Compassion again.
    As a nurse it is my default setting. If only the term was understood by those that use it as another rhetoric tool.
    Fix the staffing and perhaps it would not feel like spreading a loaf with a slither of butter?

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