DELIVERING COMPASSIONATE CARE

Introduction 

Introducing the requirements and key concepts being covered in the assignment

This assignment aims to undertake a critique of the contemporary literature exploring the delivery of compassionate and spiritual care within the context of nursing. The author of this assignment works as a critical care nurse, therefore, will reflect compassionate care into her current role. Where possible due to limited research, the assignment will briefly relate to the provision of compassionate care during the current COVID- 19 pandemic (World Health Organization, 2020).

The assignment will also provide a critical analysis of the factors underpinning compassionate care, values, attitudes, and beliefs. In addition, the tools, techniques, and strategies to create a culture of compassionate care will also be critiqued. The principles themes within the main factors that will be explored include spiritual care, compassion fatigue, the Francis report, Schwartz rounding, self-compassion measuring compassion, Compassion in Practice and Healthcare Quality strategy.

Delivery of compassionate and spiritual care

A contemporary vision of compassionate care, based on historic events

Critically understand the concept of delivering compassionate (*including spiritual) care.

From reviewing the literature compassionate care can be difficult to define as it is often viewed as being subjective to each individual (Hewison and Sawbridge, 2016). A study conducted by Curtis (2015) explored patient’s views on compassionate care. One theme that arose from the study was that patients believed that compassion was a sense of empathising with their situation. Nevertheless, Straughair (2012) describes compassion as nursing excellence and captures two distinctive concepts, which include understanding and engaging with the suffering of others, and a virtuous response aimed at addressing suffering and facilitating healing through knowledge and practice. Despite the absence of a universal definition, a recurring theme emerges from the reviewed literature to define compassion, which is understood to involve recognition and mitigation of suffering (Roze des Ordons et al., 2019). Furthermore, it is noted by Banafsheh et a.l (2019) and Day (2015) compassion is more than just necessary care, it involves respecting and maintaining a patient’s dignity, showing kindness, and recognising other personal characteristics.

Furthermore, Jones et al (2016) argue that compassionate care is not only about relieving a patient’s suffering; it should be seeing the person within the patient. According to Crawford et al. (2014) a nurse can create a genuine relationship with their patient by understanding and fulfilling a patient’s needs. Literature by Gillick (2020) indicate compassionate nurses encourage greater disclosure by the patients about their symptoms, concerns and behaviour, thereby are significantly more effective in providing treatment, thus increasing patient satisfaction. Furthermore, Sinclair et al. (2016) states there is a strong link between compassionate care and higher levels of patient and family satisfaction. Thereby contributing to more effective healing and higher compliance levels, thus resulting in better use of resources and even lower costs.

The linkage between nurses and the delivery of compassionate care is not new, dating back to the work of Florence Nightingale in the 18th century (Bivins, Tierney and Seers, 2017). Florence Nightingale believed, good nurses were good people who acquired individual virtues and attributes in their character, one of which was compassion (Bradshaw, 2011). Furthermore, Fairman and Lynaugh (1998) state critical care nursing is a specialty that was established in 1950 by the American Association of Critical Care Nurses. Additionally, the same authors state that they developed the standards of care to educate nurses entering the field. In current times, these efforts continue to guide the education and clinical competence of critical care nurses to deliver compassionate care (Munro and Hope, 2019).

In recent years, increased focus has been put on providing compassionate care in nursing, particularly following inquiries into sub-optimal healthcare care practices, such as the Francis Report (Francis, 2013) and the Vale of Leven Hospital Investigation (MacLean, 2014). A recent public inquiry carried out by Francis (2013), documented the severe failings and lack of compassionate care at Mid-Staffordshire hospital that lead to the appalling and unnecessary suffering to many patients (Newdick and Danbury, 2015). The findings from the inquiry found a growing body of evidence that there has been a general decline in care and specifically compassionate care. Conversely, the Nursing and Midwifery Council (2015) standards reflect many of the issues that happened in the Francis (2013) report; therefore, the code had to be re-written, raising standards and bringing about the changes in culture. From the report (Francis 2013), it can be said that the delivery of compassionate care is paramount to providing safe, effective, person-centered care and is now commensurate with The Code (NMC, 2018). Gillen (2014) notes that the Vale of Leven hospital had inadequate facilities and an absence of leadership and reduced nursing care that led to many patients’ death. As a result, Straughair (2012) argues that professional and political drivers have re-endowed the concept of compassionate care as a critical component of contemporary nursing care.

                                           Spiritual care

In comparison to compassionate care, spiritual care is also unique to each patient as it involves dealing with how patients perceive life and death by exploring their values, beliefs, and meanings of life (Ferrell and Munevar, 2012). Rushton (2014) notes that being compassionate is a necessity to fulfill the spiritual needs of a patient because of the mutual empathy demonstrated between nurse and patient. According to Ho et al. (2018), spiritual care is an essential element of high-quality health care, specifically for critically ill patients, as spirituality can be a fundamental component in the way patients cope when they are critically unwell. Clarke (2013), suggests spiritual people are likely to have a more optimistic perspective and a better quality of life. For instance, Jones (2013) asserts patients living with cancer who find consolation in their faith and spiritual beliefs were more content with their lives, were happier, and suffered less pain by giving patients inner peace and enhancing patient’s healing. Likewise, O’Brien (2018), suggests people who have regular spiritual practices tend to live longer in comparison to those who are not spiritual.

Despite most critical care nurses being knowledgeable and well- trained in providing physical and curative care, Abuatiq (2015) argues that many critical care nurses feel ill-equipped to deliver adequate spiritual care. As, referrals to chaplains with specialised knowledge and spiritual care skills are often made in this environment since nurses may lack the training to provide spiritual care and may be uncomfortable with this aspect of the practice (Bone et al., 2018). Furthermore, a qualitative study carried out by Cavendish et al’s.(2006) explored the nursing role in spiritual care. The authors reported that spiritual care was not considered the nursing role, indicating patients perceive spirituality and compassionate care as separate entities provided by different health care professionals. Moreover, Neville (2020) states during this current pandemic the way patients die in hospitals have significantly changed due to visitor restrictions and the wearing of personal protective equipment (PPE); adversely impacting the delivery of compassionate care. For these reasons, it is therefore, imperative that nurses can adapt to a patient’s end-of-life by being able to provide sufficient spiritual care (Aitkin, Marshall and Chaboyer, 2020). This could be further supported by Ferrell and Paice (2019), who state it is paramount that nurses can demonstrate a holistic approach when attending to the suffering of a patient’s physical, emotional, and spiritual needs; in doing so, it is ultimately delivering compassionate care.

The reviewed research has identified the positive and negative effects while fostering a culture of compassionate care, further validating the significance of compassionate and spiritual care as a fundamental component of person-centered-care (Savel and Munro, 2014).  Nevertheless, it is emphasised by Roberts and Machon (2015) that attitudes, values, and beliefs also further influence the delivery of compassionate care.

Values, Attitudes and beliefs: Impact on the delivery of compassionate care

Factors impacting on the delivery of compassionate care
Individual, organisational and political factors impeding/facilitating the effective delivery of compassionate care Critically review and contextualize the attitudes, values and beliefs which may impact upon the delivery of compassionate care

According to McSherry, McSherry, and Watson (2012) organisational culture is a complex concept that reflects the values, attitudes, and beliefs that underpin the facilitation of compassionate care. Furthermore, healthcare organisations must have influential, compassionate leaders to cultivate a compassionate culture that promotes clinical excellence in employee engagement and staff morale (Haslam, 2015). As the authors, West et al. (2017) suggest that leadership is the most significant factor in creating a positive organisational culture. Furthermore, Horsburgh and Ross (2013) state, supportive environments facilitate compassionate care, however it is also noted that practioners remain accountable for their practice. According to Nightingale (2018), compassion should be essential in healthcare, but nursing is the only truly compassionate profession. It is therefore essential that other professions focus on improving this.

Evidence from a study carried out by Coffey et al. (2019) suggests that compassionate care programs have a positive effect on clinical leadership in creating a culture of compassionate care. The positive effects noted by Saab et al. (2019) are improved job satisfaction, a heightened sense of well‐being, and increased pride in the nursing profession. However, the participants in Coffey et al. (2019) study included representatives of managerial and senior positions. This could be a limitation as managers and senior staff are less likely to have direct patient care than nurses in frontline clinical leaders who are more likely to be involved in direct patient care. However, Smith et al. (2017) argue that compassionate care programmes should apply to both senior and junior staff in facilitating and implementing change to promote a culture of person-centered compassionate based care. Additionally, the Scottish Government (2017) notes that a positive culture helps staff feels valued and thereby enhances their practice; in comparison to a negative culture, where nurses may feel undervalued and may discourage them from speaking out about poor standards of care.

Values

According to Samuriwo et al. (2017) values-based nursing is the top agenda for the NHS, as values underpin all aspects of professional nursing practice. Furthermore, compassion is a value inherent in the NHS, (The Patient Rights Scotland Act 2011), and The Code (NMC, 2018), as it informs individual nurses of the conduct, attitudes, and expectations of their peers, the nursing profession, and the broader community expect of them. Furthermore, values can be de described by Baillie and Black (2015) as various nursing principles such as altruism, integrity, justice, and human dignity; that serve as a framework for ethics, professional practice, and evaluation. Schmidt and McArthur (2018) indicate that values are fundamental convictions of what is right, good or desirable, and inspire social and professional behaviour. However, while Nutall and Pezaro (2020), agree that values, determine one’s behaviors and convictions, they see these values as being learned rather than innate. According, to Tetley et al. (2016), nursing values intensify as nurses evolve and face new challenges

Beliefs

Moreover, according to Medes (2018), being culturally competent also plays a pivotal role in facilitating compassionate care. Papadopoulos (2019) states that being culturally competent involves having the knowledge, attitudes, and skills of cultural beliefs, allowing practitioners to provide adequate health care. Additionally, the same author states that culturally competent compassion is not something we are born with as he states that neuroscientists have recently discovered that our brains can develop it. Furthermore, Mendes (2018) states that cultural competency is a popular and recognised approach to improve the provision of health care to ethnic minorities and to reduce ethnic health disparities. The efficient provision of healthcare services by providers and organisations meets patients’ cultural, social, and linguistic needs.  Furthermore, Christiansen et al. (2015) state that consideration of patients’ cultural beliefs regarding how their care should be provided may help mitigate cultural barriers. A study conducted by the same author demonstrated the detrimental effect on the nurse-patient relationship when a nurse’s values and beliefs ……XXXX…… Kaihlanen, Hietapakka, and Heponiemi (2019) noted many types of interventions for practitioners to become more culturally aware, such as training sessions and workshop programs.

Attitudes

Our actions are thought to express through our attitudes; therefore, professional behaviours are viewed as professional attitudes (Maio, Haddock, and Verplanken, 2015). In recent years research on health professionalism has emphasised the significance of assessing observable behaviours as evidence of attitudes (Price, 2015). However, findings from high-profile cases such as the Mid-Staffordshire report (Francis, 2013) indicate that behaviour cannot always be credible for identifying professional attitudes. Kennedy et al. (2017) further support this as the author’s state behaviour cannot always reflect an individuals’ true attitudes, as the individual may behave in a caring way towards a patient; still, underneath, they may feel ambivalent or negative towards them. Furthermore, a study conducted by McConnell (2015) demonstrated that prejudicial beliefs about patients were transferred during the handover from one nurse to another and that attitudes of colleagues towards patients were influenced by poor communication and stereotypical label such as labelling a patient as ‘difficult.’ Consequently, impeding the delivery of compassionate care. The Code (NMC, 2018) states that nurses should be a model of integrity and leadership for others to aspire to.   Similar research carried out by Pope (2012) discovered that if nurses held the attitude of patients being ill, the patient would take on the patient-dependent role, consequently impacting their rehabilitation and day to day function. However, it could be argued that that it is dependent on what level of care the patient requires. As research carried out by Wunsch et al. (2015) state, critical care patients require the highest level of care; therefore, being dependent on the nurse for rehabilitation is paramount to enhancing a patient’s outcome.

The research conducted by McConnell’s (2015) and Pope’s (2012) suggests the need for positive role models and excellent leadership to influence attitudes and behavioural change, to create a culture of compassionate care. As attitudes that are filtered down from the organisation to the team affect the individual; likewise, an individual can influence the attitudes of a team and organisation (Straughair, 2012).

                                 Organisational barriers

Henderson and Jones (2017) have shown that organisational barriers can impede a nurse’s ability to provide compassionate care. As Baughan and Smith (2013) notes, unsupportive environments, excessive workload, and inadequate staffing contribute to compassionate fatigue. Compassion fatigue is not a new concept in nursing; Figley, (1995) first defined it as a unique form of burnout.

Furthermore, Ledoux (2015) states compassion fatigue can occur due to exposure to one case or can be due to a multifaceted combination of emotional, physical, and spiritual depletion consequently, impeding the delivery of compassionate care. The weakening effects of compassionate fatigue upon a nurse can then lead to a lack of empathy, therefore, significantly impacting a patient’s overall care, by delaying healing, thus leading to a more extended hospital stay. Some recent stressors reported by Shanafel, Ripp, and Trockel (2020) include the global shortage of PPE, wearing PPE for prolonged periods, and the risk of being exposed to COVID-19 at work and potentially transmitting the virus to others.

Mol et al. (2015) and Urden et al. (2015) note that providing nursing practice in the critical care department challenges the fundamentals of delivering compassionate care because of increasing technology and requiring comprehensive skills in specialised life-sustaining medical therapies. Vega and Hayes (2019) and Sacco et al. (2015) argue that compassion fatigue is prevalent in critical care settings, as critical care nurses are exposed to ethical decision making, observing the continuous suffering of patients, and end-of-life issues that lead to moral distress. However, Valizadeh et al. (2018) argue that stressors are subjective to different areas and that XXXXXX. Furthermore, a study conducted by Bray et al., (2013) found that compassion fatigue was more prevalent in younger nurses with less experience than older nurses who were experienced. Bramley and Matiti, (2014) identified that patients believe that if nurses could observe they are un-compassionate behaviour, it may motivate them to improve and be more compassionate.

Tools and Specialist Technique: that facilitate compassionate care 

Critically analyse the range of tools and special techniques that facilitate the effective delivery of compassionate care.  Tools and techniques to provide/promote compassionate care Enabling health professionals to deliver compassionate care Examples of how this is being done or could be achieved

As mentioned previously, prolonged exposure to human distress induces work-related stress unless there are tools and techniques in place such as Schwartz round and self-compassion for promote compassionate care (Leamy et al. 2019). According to Farr and Barker (2017), the Schwartz round is an evidence-based interdisciplinary discussion to support healthcare staff to share their thoughts and feelings. Furthermore, Adamson et al. (2018) state it is an innovative method of reducing work-related stress to provide care for professionals, so that practitioners can, in turn, provide compassionate care. The Francis (2013) report further praises the Schwartz round by identifying the rounds as a potential innovation to bring staff together. Williams (2017), states that participants who attended the rounds reported to have increased insights into patient care’s emotional and social aspects and increased feelings of compassion towards patients. Furthermore, Flanagan et al. (2019) note that work-related stressors were reduced by attending the rounds as staff felt more supported.

Despite the mentioned benefits of attending Schwartz round, McCarthy et al. (2020) are critical of the rounds since their study found that there were few self-reporting participants, fewer regular attenders were recruited than desired, and after completing the rounds, it was not possible to observe staff. Farr and Barker (2017) assert that rounds are not to be used for problem-solving or providing advice but to reflect. According to Horton-Deutsch and Sherwood (2017) and Adamson and Dewar (2015), reflection is an essential component of nursing that can enhance learning, support professional development and improve practice to evaluate and improve care. In a study conducted by Gishen et al. (2016), the participants who were medical students noted they would prefer Schwartz round instead of carrying out reflective practice assignments; the same being could be said for nursing students.

At present, Flanagan et al. (2019) state that around 200 healthcare organisations across the UK and Ireland have adopted the Schwartz rounds. However, it should be noted that there is only one NHS Scotland hospital that has utilised the Schwartz round (Point of Care Foundation, n.d.). Consequently, it seems to be a significant oversight from NHS Scotland who have not adopted this tool to create a culture of compassionate care. Furthermore, a study conducted by Taylor et al. (2018), identified that organisations who adopted the Schwartz round scored better on staff engagement than the non-adopters. Therefore, it could be said from the research that Schwartz rounds should currently be implemented in all healthcare facilities in Scotland to facilitate compassionate care.

Assignment question- Critically analyse the range of tools and special techniques that facilitate the effective delivery of compassionate care.  Tools and techniques to provide/promote compassionate care. Enabling health professionals to deliver compassionate care Examples of how this is being done or could be achieved

WRITER START FROM HERE

                                     Self-compassion

HI can you make this section more critical and expand further, please?

Heffernan et al. (2010) propose self- compassion as a technique to combat compassionate fatigue and to enhance the delivery of compassionate care. Kelly and Tyson, (2017) define self-compassion as the ability to respond to oneself with kindness and empathy in times of failure or distress. Todaro-Franceschi, (2013) argues that, unless a healthcare practitioner has compassion for oneself, they are unable to provide compassionate care to others. Besides, Chambers and Ryder (2019) emphasise that self-compassion contributes to lower burnout levels and improved productivity with stress management, thus, enhancing the delivery of compassionate care. For a nurse practitioner to develop and demonstrate genuine compassionate care to others, he or she must be first have a foundation upon which to cultivate compassion. The basis for cultivating compassion is by the individual`s ability to care for one`s own welfare as well as connecting to one`s own feelings. Generally, for a nurse practitioner to demonstrate care for others, he or she must first care for himself or herself. According to Richards (2013), self-compassionate among nurses is fundamental and benefits both patients and nurses. Apparently, many point out that for nurses, any emphasis on self-compassionate per se is a contradictory move for the compassionate care of others. Precisely, their argument is that for nurses developing genuine self-compassionate is more or less of fostering a culture of being egocentric throughout the nursing profession. Actually, some have labelled the practice of self-compassionate as ‘responsible selfishness’ but this aims at only extending the existing stigma of self-compassionate among nurses as selfish.

                                    Measuring compassionate care

There are tools designed to measure compassion, such as Compassionate Care Assessment Tool. However, there lacks a universal tool that can be consistently used across the NHS (Papadopoulos and Ali, 2016). Fogarty compassion scale have been widely used to establish the levels of compassion that is demonstrated to patients by nurses in the health care setting. With this assessment tool, a given number of patients are selected and requested to rate one nurse each (maybe one whom the patient have been attended by), specifically on the acts of compassion that was demonstrated to the patient by the respective nurse (Kret, 2011). For example, 50 patients are selected and asked to rate the acts of compassion of 50 nurses, one for each patient. Burnell and Agan (2013) created the Burnell Compassionate Care Tool with the aim of evaluating the elements of compassionate nursing care in acute health care settings. The tool combined the elements of compassion and caring in order to assess the nursing actions and behaviors that are perceived to be compassionate. Burnell and Agan (2013) aimed at observing, identifying and measuring the association between the spiritual and compassion needs of the patients and the caring behavior of nurses. Precisely, this compassionate care assessment tool was derived from the aspects of the Caring Benhaviors Inventory (CBI) and the Spiritual Needs Survey.

Furthermore, Dewer et al. (2011) suggest that it is necessary to measure compassion care as it helps recognize the benefits in compassionate practice so that these can be identified, understood, and improved. Flynn and Mercer (2013) pinpointed that though it is necessary to have the compassionate care assessment tools in place, the aspect of measuring or assessing compassion of nurses in the health care setting is somehow questionable. This is mostly due to the fact that the entire process of assessing the compassionate actions of nurses is solely left in the hands of patients, whom can be influenced by a number of aspects in rating the compassionate behaviors and actions of nurses. As a study conducted by Hunter et al. (2018), found that the participants who were nursing students, described compassionate care as ‘doing the little things,’ furthermore, they also noted that small acts of kindness could have a significant impact on the quality of care being delivered. However, the participants also stated how smiling at a patient is quantifiable (Hunter, et al 2018)? Similarly, Strauss et al. (2016) argue that compassion is the human quality of kindness; therefore, it is not a skill that can be quantified. Tierney, Seers, Reeve, and Tutton (2016) also supported Flynn and Mercer (2013) argument regarding the aspect of measuring compassionate actions of nurses.  According to Tierney, Seers, Reeve, and Tutton (2016), argued that assessing the compassion of nurses based on the smiles they put on while they are attending the health care consumers cannot be justified, since nurses are humans, and they can smile even when they are not propagating compassionate actions. Additionally, McSherry and Pearce (2018) state that most tools only measure specific aspects of compassion and lack evidence of adaptability to diverse practice settings; therefore, it is ineffective.

In addition to tools and technique to facilitate a culture of compassionate care, the development of local and national strategies also play a pivotal role in creating a culture of compassionate care.

Strategies designed to assist in the creation of a culture of compassionate care

Systematically analyse and review strategies designed to assist in the creation of a culture of compassionate care. Strategies to promote compassionate care Local/national policy, guidelines and initiatives aimed at facilitating the delivery of compassionate care and a culture of change

Following Francis (2013) influential report, the Department of Health England (DH,2012), developed the national Compassion in Practice: Nursing, Midwifery, and Care Staff: Our Vision and Strategy to facilitate a culture of compassionate Care. The strategy introduced the concept of the 6Cs: care, communication, competence, confidence, courage, and commitment. Following a review of the Compassion in Practice: Nursing, Midwifery, and Care Staff: Our Vision and Strategy (DH, 2012), a new framework for nurses, midwives, and care staff was developed ‘’Leading Change, Adding Value’’ (NHS England, 2016).

In England and Wales, the recent framework has been extensively adopted across NHS organisations. The benefit of the 6’C is that it supports nurses to regain public confidence that they have lost in the Francis report because of care failings (Francis, 2013). However, Scott (2013) asserts that failures are multifactorial, which the 6 C’s strategy fails to consider. Singleton and Mee (2017), further argue that compassion is presented as an individual element when, in fact, it is a critical element in the delivery of care. Similarly, Baillie (2016) also criticises the 6c’s as she argues that there was no requirement for another set of values and that the existing values should have been further developed instead. Furthermore, Bradshaw (2016), notes her concern that the six C’ s could be perceived as simplistic and might encourage a checklist approach to nursing.  Therefore, becomes task orientated rather than person-centered care which is not fulfilling the strategic goal. Whereas, Dewar and Christley (2013) argue that nursing is a complex profession; therefore, it should not be reduced to six words. Despite the criticism of the six C’s strategy, the aim is to conceptualise the values that underpin nursing practice and the contribution that nurses make to health care (Aitkenhead, 2018). However, it’s only possible if there’s a concerted effort to promote and incorporate the six C’s approach into nursing practice.

Moreover, In Scotland, the National Healthcare Quality Strategy (2010) was developed and places the delivery of compassionate person-centered care at the heart of its aims and clinical values. Furthermore, the strategic goal is to deliver the highest quality healthcare services to people in Scotland and ensure that the people of Scotland recognise that the NHS Scotland as amongst the best in the world (Scottish Government, 2010). Furthermore, The Patient Rights Act (Scotland) (2011) supports the Scottish Parliament’s vision for a high-quality person-centered NHS in Scotland. As it provides the legal basis requiring Scotland’s NHS to provide care that is person-centered, safe, and effective. The Nursing 2030 vision further places the theme of person-centered care as a critical value to implementing compassionate care. McSherry et al., (2018) is critical of the strategy, stating that it has not been updated in ten years; therefore, asserting the strategy fails to consider the changing nature of nursing roles. Furthermore, from reviewing the literature, there are no published results that support the healthcare quality strategy and identifies if it is an effective strategy that implements compassionate care.

However, other strategies of enhancing compassionate culture includes staff training interventions such as the need for them to show empathy, communication about spirituality and spiritual care as well as verbal interactions with patients. Nurses must have been oriented about showing compassion to their clients during the nursing educational programs. However, once they graduate, they are deemed to adopt the culture of the health facilities that they end up working at. If the health facility emphasize about the need of nurses demonstrating compassion to their patients, the latter will easily comply. It is the mandate of the nurse leadership personnel to not only enhance the culture of compassionate care, but also embracing programs that would train nurses on how to demonstrate and deliver compassionate care. Ferinia & Hutagalung (2017) suggested the use of the Peplau’s Theory of Interpersonal Relations as the starting point for nurses to demonstrate acts of compassion. This theory takes place when nurses engage in therapeutic relationships with health consumers. Precisely, nurses ought to embrace brief orientation of the patients in order for the latter to not only manage to adjust to the new environment, but also do away with fear that patients have. Additionally, proper orientation of patients helps in establishing a good rapport with them, in such a way that they can be comfortable to ask anything or communicate with the nurses freely.

Another strategy entails the nurse support interventions, which are primarily based on reducing secondary traumatic stress burnout and compassion fatigue (Flarity & Gentry, 2013). Abbaszadeh et al. (2017) argued that nurse burnout through high workloads with limited resting time does not only contribute to compassion fatigue but also the occurrence of medical errors, which are among the leading cause of death and acute and chronic disability among patients.

According to Roberts and Machon (2015), person-centered care is providing care that is responsive to individual personal preferences, needs, and values while assuring that patient values guide all clinical decisions. Patient activation also plays an essential element as evidence by Struwe, Schmaderer, and Zimmerman (2020) demonstrate that when people are supported to become more activated, they benefit from better health outcomes and improved care experiences. A local strategy adopted by Greater Glasgow and Clyde, The Pursuit of Healthcare Excellence (2019), set out its five-year strategy to implement compassionate person-centered care by providing training and education to staff facilitate person-centered care. Furthermore, a report by NHS Greater Glasgow & Clyde (2018) outlines a wide variety of approaches that are implemented to provide compassionate person-centered care, for example, The What Matters to You board? It involves bringing about a change in practice whereby healthcare workers ask what is important to the patient, rather than simply focusing on their diagnosis and past medical history (Lang, Hoey, Whelen and Price, 2017). A board is placed at the patient’s bedside. Slager et al. (2017) is critical, noting that some people do not want ‘what matters’ displayed above their bed reporting they are able to verbalise and communicate this to staff independently. Therefore, it is important to recognise that this is a choice and that information displayed needs to be with the consent of the patient.

Conclusion

It is, therefore, evident that the review has articulated the fundamental role of nurse practitioners providing spiritual and compassionate care in the modern day nursing profession. Apparently, there is little literature concerning the effective methods of delivering compassionate care during these unprecedented times of the current COVID-19 pandemic. This therefore, provides a golden opportunity of furthering the research in order to detail and recommend the best effective ways of delivering compassionate care during a health crisis.

Majority of scholars have critically explored the manner in which beliefs, attitudes, and values have impacted the delivery of compassion to both the patients and nurses themselves. More importantly, a significant literature has greatly demonstrated that nurses needs self-compassion in order for them to gain the potential of demonstrating genuine compassionate care to others. This, of course has been raised in order to counter the increasing forces that perceive self-compassionate among nurses as a trend of propagating the culture of selfishness among nurses. Consecutively, this paper has also explored the barriers to compassionate care, which serves as a wakeup call for role models and influential leaders in working collaboratively in order to create and enhance a compassionate culture. Simultaneously, the paper has pinpointed the challenges in creating and demonstrating compassionate care as detailed in the Francis report.

To enhance the culture of compassion in nursing, self-compassion and Schwartz round tools were critiqued. Among the aspects which enable the compassionate care culture to flourish includes the Health Care Quality strategy, Adding Value strategy and the Leading Change strategy. Apparently, there lacks a clear universal definition of compassionate and spiritual care, and this has led to lack of clarity when it comes to the provision of compassionate care. This has led to the inhibition of the utilization of the strategies and tools aforementioned above. There is need for further research that aims at addressing the nursing issues in order to effectively contemplate the challenges and barriers of compassion in nursing.

Consecutively, there is need for further research to be carried out in future in order to provide a standard and clear definition of compassionate care. Doing this will provide an universal and clarification of the assessment, delivery and understanding the value that the compassionate care has within the nursing profession and the health care industry as a whole. There is need to embrace measures that would help in dealing with the existing barriers in delivering compassionate care, as well as improving the facilities that are required by practitioners to enhance compassionate care in nursing profession.

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