0% found this document useful (0 votes)
224 views15 pages

Final Research Paper

Uploaded by

api-399086837
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
224 views15 pages

Final Research Paper

Uploaded by

api-399086837
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 15

Running head: AN INTEGRATIVE REVIEW 1

An Integrative Review: The Effects of Providing Compassionate Care

Jane G. Watson

Bon Secours Memorial College of Nursing

Mrs. Holowaychuk, MSN, RN

NUR 4122: Nursing Research

October 29, 2017

I pledge: JGW
AN INTEGRATIVE REVIEW 2

Abstract

The purpose of this integrative review is to gain a better understanding of how nurses who care

for chronically ill patients perceive the effects of compassionate care while treating patients who

are at the end of life. There is currently a nursing shortage. Due to improvements in medical

technology that allow people to live longer and the fact that the baby boomer generation is

getting older, the need for nurses to care for patients with chronic illness will most likely

increase over the next few years. Therefore, it is important to understand the needs of these

nurses and equip them for success. Databases such a PubMed and Google Scholar were utilized

to obtain relevant studies. The searches yielded well over 1,000 articles. After refining the

search several times, the researcher chose five articles that fulfilled requirements set for this

topic. Although the researcher specifically sought studies that offered contrasting points of view,

the researcher was only able to locate studies within the past five years that supported the

opinion reflected in this paper.


AN INTEGRATIVE REVIEW 3

An Integrative Review: The Effects of Providing Compassionate Care

Compassionate care is a fundamental principal for nurses to establish a therapeutic

relationship with their patients. Providing compassionate care can be beneficial to both the nurse

as well as the patient. However, nurses “working in the landscape of death and dying frequently

are exposed to existential issues, psychological challenges, and emotional distress associated

with care at the end of life” (Sansó, Galiana, Oliver, Pascual & Sinclair, 2015). In 1992, Carla

Joinson coined the term compassion fatigue (CF) as a type of professional burnout specific to

caregivers who continually provide support to trauma patients. In the context of this literary

review, the “American Psychiatric Association’s definition of trauma will be used which refers

to a traumatic stressor as any event that may cause or threaten death” (Sacco, Ciurzynski,

Harvey, & Ingersoll, 2015). Therefore, nurses who routinely work with a chronically ill patient

population may be at a greater risk for developing CF. The purpose of this integrative review is

to analyze pertinent research information obtained from reliable medical journals that provide

relevant information regarding the researcher’s PICOT question, how do nurses who care for

chronically ill patients perceive the effects of compassionate care for patients nearing the end of

life? The researcher is interested in this topic as she is currently a nursing student.

Design and Research Method

This integrative review analyzes five studies that are relevant to the researcher’s PICOT

question. Two databases, PubMed and Google Scholar, were retrieved through the researcher’s

remote library access via Open Athens. Key terms used in the searches included: compassion,

compassionate care, compassion satisfaction, compassion fatigue, burnout, nurse, nurses,

nursing, healthcare, chronic, terminal, and long-term. The criteria were further refined to peer
AN INTEGRATIVE REVIEW 4

reviewed, academic journals published in English between 2012 and 2017 with full text

accessibility. The research method was limited to either quantitative or qualitative. The

researcher was able to find a significant amount of studies pertaining to the PICOT question,

how do nurses who care for chronically ill patients perceive the effects of compassionate care for

patients nearing the end of life? For the purpose of this review, two qualitative and three

quantitative studies are analyzed.

Findings and Results

The findings and results of the research articles clearly reveal a correlation between the

additional stress of caring for chronically ill patients and the risk of developing compassion

fatigue (CF). A summary of the studies selected for this integrative review is provided in Table

1 and can be found following the reference page. Four of the articles investigate compassionate

care from a healthcare provider’s point of view. One article utilizes the perception of

compassionate care through the eyes of the family members of patients that died as a result of

having dementia. Although this particular article does not directly answer the researcher’s

PICOT question, it does provide relevant information for future recommendations regarding

compassionate care in nursing. Each study was conducted by well qualified researchers and

credentials were provided. Each study obtained appropriate sample sizes for the type of study,

ethical considerations for all participants was addressed, and proper research approval was

obtained. No competing interest was noted.

This integrative review is based on the following categories that emerged as recurring

themes throughout the analysis: compassionate care, compassion fatigue, and coping strategies.
AN INTEGRATIVE REVIEW 5

Compassionate Care

As previously mentioned, caring is a fundamental part of the nursing role. Three of the

articles utilized for this integrative review mention some sort of personal fulfillment nurses

achieve by offering compassionate care. “Most palliative professionals report high levels of

satisfaction and meaning in their work and acknowledge that caring for patients facing the end of

life can be an enriching and beneficial experience” (Sansó et al., 2015, p. 201). “Although all of

the nurses interviewed indicated that providing hospice and palliative care was a privilege, each

had experienced some of the symptoms of professional compassion fatigue (PCF)” (Melvin,

2012, p. 608). “Although nurses obtain professional satisfaction from their work, their repeated

exposure to the aftermath of critical illness puts them at a high risk for compassion fatigue”

(Sacco, Ciurzynski, Harvey & Ingersoll, 2015, p. 32).

Compassion Fatigue

In this integrative review, two qualitative studies utilized in-depth interviews to gather

data. Each of the interviews lasted between 30 and 80 minutes, were recorded, and then

transcribed verbatim. In the study by Crowther, Wilson, Horton & Lloyd-Williams (2015), 40

mourning family members of deceased patients who suffered from dementia were analyzed by

unstructured narrative interviews with a grounded theory, allowing for personal experiences to

dictate the direction of the interview. Each participant was asked to rate their perceived level of

compassionate care that was provided to their family member by the nursing staff. A perception

of little compassion was noted as the staff was viewed as distant and unaffected by the

“routinization” of traumatic events (Crowther et al., 2015).

The second qualitative study evaluated in this integrative review was by Melvin who

used a phenomenological approach to obtain insight on compassionate nursing care through a


AN INTEGRATIVE REVIEW 6

semi-structured interview of six female palliative care nurses with at least 10 years of experience

in their field of nursing. The data was analyzed using a constant comparison analysis. An

inductive approach was used to develop codes, categories and patterns. “Each of the nurses

recognized the risk of professional compassion fatigue (PCF), while one of the nurses was

clearly showing signs and symptoms of PCF at the time of the interview” (Melvin, 2012, p. 610).

This participant was not rebounding from work stressors like she used to. “This finding is

consistent with previous research which suggested that when health professionals suffer with

PCF they become physically, mentally, and spiritually exhausted, yet they continue to provide

care for their patients” (Melvin, 2012, p. 610).

In addition, one quantitative study investigated the relationship between compassion

fatigue and turnover intention for nurses working in high stress areas of Korean hospitals. One

hundred and forty-two nurses were recruited by sampling who worked for tertiary hospitals with

500 beds or more. PASW 19.0 program which included one-way ANOVA, independent t-tests,

Pearson’s correlation coefficient and hierarchical regression analysis was implemented.

“Compassion fatigue and burnout were significantly correlated and they were tested as predictive

variables for turnover intention” (Sung, Seo, & Kim, 2012). Therefore, the study suggests that

gaining insight regarding compassion fatigue and providing appropriate interventions can reduce

nurse turnover and increase retention.

Coping Strategies

Of the five studies included in this integrative review, one quantitative and two

qualitative studies explore the effects of coping strategies on the perception of providing

compassionate care for chronically ill patients nearing the end of life. In the quantitative study

by Sansó, Oliver, Pascual, Sinclair & Benito (2015), 385 healthcare professionals from 13
AN INTEGRATIVE REVIEW 7

associations belonging to the largest palliative care association in Spain were assessed based on

an adapted version of the Kearney’s awareness model of self-care. The study was conducted by

gathering data from emailed surveys. Three variables of self-care that were evaluated by Sansó et

al. included physical self-care (maintaining a healthy body), inner self-care (maintaining a

healthy mind), and social self-care (maintaining healthy relationships outside of work). The

variable of awareness was measured “with the validated Spanish version of the Mindful

Attention Awareness Scale, a 15-item instrument that measures the general tendency to be aware

and conscious of one’s own experiences of daily life” (Sansó et al., 2015). The variable of

coping with death was “measured with the Coping with Death Scale, a questionnaire that

measures professionals’ competence in handling death and their knowledge concerning

preparedness for death” (Sansó et al., 2015). Data aligned with the estimated model and

supported the hypothesis that “self-care and awareness positively predicted professionals’

competence in coping with death and negatively predicted compassion fatigue and burnout”

(Sansó et al., 2015, p. 200).

In the cross-sectional quantitative study by Sacco et al., data was gathered via electronic

survey and analyzed by ProQOL, version 5, of 221 voluntary participants solicited through the

University of Rochester medical center. After thorough investigation of the participants grouped

by education level (associate, bachelors, and masters), gender (male/female), and age ranges per

decade (20s, 30s, 40s, and 50+), the overall finding of the study revealed that in general “nurses

that achieve a balance of compassion satisfaction to off-set the effects of compassion fatigue,

experience a higher professional quality of life and are less likely to leave their position” (Sacco,

2015, p. 40).
AN INTEGRATIVE REVIEW 8

In Melvin’s qualitative study, “the overarching theme that emerged was that without

adequate coping strategies, the participants were at risk of developing PCF” (Melvin, 2012, p.

608). Melvin’s coping strategies included internal personal choices such as setting professional

boundaries and exercise, as well as external support from supervisors who recognize signs of CF

and offer appropriate and timely interventions that may include a periodic change in roles

(Melvin, 2012, p. 609).

Discussion and Implications

In regard to the researcher’s PICOT question, how do nurses who care for chronically ill

patients perceive the effects of compassionate care for patients nearing the end of life, the results

from this integrative review support the fact that compassionate care can mutually benefit the

patient as well as the nurse as long as the nurse employs positive coping strategies that facilitate

self-preservation. “Most palliative professionals report high levels of satisfaction and meaning

in their work and acknowledge that caring for patients facing the end of life can be an enriching

and beneficial experience” (Sansó et al., 2015, p. 201). However, in order for those nurses to

provide compassionate care to chronically ill patients day after day, they must have appropriate

coping skills. These coping skills will assist the nurse in renewing the level of compassionate

care he or she is able to provide. “Each of the participants described the need to set professional

boundaries in order to maintain their ability to work in end-of-life care” (Melvin, 2012, p. 609).

“Palliative care professionals are privileged and challenged to find ways of using their selves

therapeutically to provide a healing presence to patients in life-threatening crises while

simultaneously providing a means for health care professionals to cope when facing frequent

losses. Palliative care professionals function as a powerful but vulnerable tool in the caring

process” (Sansó, 2015, p. 204).


AN INTEGRATIVE REVIEW 9

Limitations and Conclusion

A few limitations should be noted regarding this integrative review. First, the

researcher’s lack of experience in performing integrative reviews may skew the information

represented. Additionally, all of the studies utilized in this integrative review represent the same

point of view. Contrasting points of view were found, however the research was conducted prior

to the 5-year inclusion criteria for this assignment and therefore disregarded.

In conclusion, caring for the chronically ill can be a tremendously satisfying career. As

the average age of our population continues to increase as a result of the baby boomer generation

and the improvements in medical technology, “there is an increased incidence of chronic

diseases. Thus, the demand for medical services has increased rapidly, and the demand for

nurses has also increased consistently” (Sung et al., 2012, p. 1087). “Compassion fatigue has

emerged as a natural consequence of caring” (Crowther et al., 2013, p. 492). This integrative

review suggests that there appears to be a compassion threshold in nursing. Nurses perceive

compassionate care as beneficial up to a point. However, the stress of continually providing care

to patients that are at the end of life can become overwhelming, especially if nurses are not

utilizing positive coping strategies on a regular basis. Nurses who utilize positive coping

strategies are better equipped to handle the additional stress that caring for chronically ill patients

can present. Therefore, this integrative review supports the need to continually monitor the

compassion threshold of nurses who care for the chronically ill and support appropriate coping

strategies to enable sustainable compassionate care and decrease the risk of burnout or turnover.
AN INTEGRATIVE REVIEW 10

References

Crowther, J., Wilson, K. C. M., Horton, S., & Lloyd-Williams, M. (2013). Compassion in

healthcare-Lessons from a qualitative study of the end of life care of people with

dementia. Journal of the Royal Society of Medicine, 106(12), 492-497. doi:

10.1177/0141076813503593

Melvin, C. S. (2012). Professional compassion fatigue: What is the true cost of nurses caring for

the dying? International Journal of Palliative Nursing, 18(12), 606-611.

doi: 10.12968/ijpn.2012.18.12.606

Sacco, T. L., Ciurzynski, S. M., Harvey, M. E., & Ingersoll, G. L. (2015). Compassion

satisfaction and compassion fatigue among critical care nurses. Critical Care Nurse,

35(4), 32-42. doi: 10.4037/ccn2015392

Sansó, N., Galiana, L., Oliver, A., Pascual, A., Sinclair, S., & Benito, E. (2015). Palliative care

professionals’ inner life: Exploring the relationships among awareness, self-care, and

compassion satisfaction and fatigue, burnout and coping with death. Journal of Pain and

Symptom Management, 50(2), 200-207. doi: 10.1016/j.jpainsymman.2015.02.013

Sung, K., Seo, Y., & Kim, J. (2012). Relationships between compassion fatigue, burnout, and

turnover intention in Korean hospital nurses. Journal of Korean Academy of Nursing,

42(7), 1087-1094. doi: 10.4040/jkan.2012.42.7.1087


AN INTEGRATIVE REVIEW 11

Table 1: Qualitative/Quantitative Evaluation Tool


First Author Crowther (2013) – (APSCSG), Institute of Psychology, Health and Society, University of Liverpool, and
(Year)/Qualifications St Luke’s Hospice (p. 492)
Background/Problem There is much attention on the lack of compassion in the UK healthcare setting. (p. 492)
Statement
Conceptual/theoretical This research explores the correlation of the family’s perception of compassion and kindness to the
Framework experience of care for demented patients in their last year of life (p. 492)

Design/  Qualitative methodology informed by modified Grounded Theory and phenomenology


Method/Philosophical  In depth interview with informal caregivers of patients with dementia
Underpinnings  Unstructured narrative interview (p. 493)
Sample/ Setting/Ethical  40 voluntary participants
Considerations  Recruited from Alzheimer’s Society and Age UK organizations
 Full ethical approval (RETH/000206) was obtained (p. 493)
Major Variables Studied (and  Current experience- perceptions of provided healthcare to a close family member who died from
their definition), if appropriate dementia (p. 493)

Measurement Tool/Data  Unstructured narrative interview allowed participants to guide the conversation
Collection Method  Interviews lasted between 30 and 80 minutes
 Recorded digitally then transcribed verbatim
 Participants approved transcription (p. 493)
Data Analysis  Grounded theory reflecting personal experiences (p. 493)
Findings/Discussion  Kindness, compassion and humane were frequently used words by participants
 Caring domain is from birth to death (womb to tomb) while the medical domain is purely the
science of saving life (p. 494)

Appraisal/Worth to practice  Nurses who constantly work with dying patients can view it as routine and experience compassion
fatigue
 Bereaved family offer great insight on the perceptions of compassionate care
 Target driven care is important but family perceptions are just as important (p. 496)
AN INTEGRATIVE REVIEW Article #2 Evaluation Table 12

First Author • Sanso, PhD (2015) Department of Methodology for the Behavioral Sciences, University of
(Year)/Qualifications Valencia (p. 200)
Background/Problem • The researchers’ aim was to investigate the extent to which data from a nationwide survey of
Statement Spanish palliative care professionals supported Kearney and Weininger’s model on the
relationships among awareness, self-care, CS, CF, burnout and coping with death (p. 204)
Conceptual/theoretical • Based on previous research from Kearney and colleagues which suggests that self-awareness
Framework promotes compassion satisfaction and prevents compassion fatigue and burnout (p. 201)
Design/ • Quantitative online survey
Method/Philosophical • Included measurements of satisfaction, compassion fatigue, awareness, death exposure,
Underpinnings coping with death, and burnout (p. 201)
Sample/ Setting/Ethical • 385 healthcare professionals from 13 associations belonging to the largest palliative care
Considerations association in Spain (SECPAL)
• Inclusion criteria: currently working in palliative care setting and at least 18 yrs old (p. 202)
Major Variables Studied (and • Self-Care: physical (exercise) inner (emotional care of the mind), social (friendship)
their definition), if • Awareness: conscious of daily experiences
appropriate • Coping with death: 30 items concerning preparedness
• Professional Quality of Life: Balance of compassion satisfaction and compassion fatigue (p.
202)
Measurement Tool/Data • Due to the several variables being measured, the researchers chose path analysis instead of
Collection Method regression analysis in order to distinguish effects of one variable on another (p. 203)
Data Analysis • Path analysis was estimated using Satorra-Bentler robust corrections for standard errors and
fit indices implemented in the EQS 6.1 program for ordinal and non-normal data (p. 203)

Findings/Discussion • As hypothesized, a positive correlation between self-care, awareness and professional


quality of life was associated with compassion satisfaction and negatively associated with
compassion fatigue
Appraisal/Worth to practice • Palliative professionals are at a greater risk for CF than other healthcare workers. Positive
coping strategies are beneficial to both caregiver as well as the pt. (p. 204)
AN INTEGRATIVE REVIEW Article #3 Evaluation Table 13

First Author • Melvin (2012) Clinical Associate Professor, Department of Nursing, University of Vermont
(Year)/Qualifications (p. 606)
Background/Problem • Nurses who routinely care for dying patients are at an increased risk of developing
Statement professional compassion fatigue (PCF)- the cumulative impact of caring
• Compassion and empathy are core values of nursing (p 606-607)
Conceptual/theoretical • The researcher acknowledged that nurses are at a risk of compassion fatigue because
Framework compassion and empathy are core values of nursing and nurses who continually work with a
dying population are at an even greater risk of compassion fatigue (p. 606)
Design/ • Descriptive qualitative study
Method/Philosophical • Phenomenology (real life situations)
Underpinnings • Semi-structured interview (p. 607)
Sample/ Setting/Ethical • All participants were informed and assured anonymity
Considerations • Six female nurses purposefully selected with at least 10 yrs experience in palliative or end-
of-life care
• Experience ranged from 11-33 years
• Study was approved by the University of Vermont Human Subjects Research Com. (p. 607)
Major Variables Studied (and • Healthy coping strategies- exercise, good nutrition, relaxation, supportive supervisors, work-
their definition), if life balance
appropriate • The need to change roles periodically (p. 610)
Measurement Tool/Data • Semi-structured interview
Collection Method • Audiotaped- approximately one hour (p. 608)
Data Analysis • Audiotaped interview was transcribed verbatim
• Line-by-line process using themes generated in literature (p. 608)
Findings/Discussion • Emerging themes 1. Risk for PCF 2. Physical and Emotional Cost of Caring 3. Setting
boundaries/Healthy Coping Strategies
• Each participant had experienced some degree of PCF- One was actively in PCF (p. 608)
Appraisal/Worth to practice • The intensity from the needs of patients experiencing the end of life increases the risk of
professional compassion fatigue (PCF). This study explores the effects of PCF as well as
coping strategies adopted by nurses
• With an aging population, the demand for end-of-life care will increase (p. 610)
AN INTEGRATIVE REVIEW Article #4 Evaluation Table 14

First Author • Sung (2012) College of Nursing/Catholic University of Daega, Department of Nursing
(Year)/Qualifications Kyonbuk/Science College Chilgok-gun and Department of Med Technology
Background/Problem • Nursing is stressful. There is a worldwide shortage of nurses. Nurses who experience
Statement compassion fatigue may leave their position for a nonclinical role
Conceptual/theoretical • This research investigated relationships between compassion fatigue as a predictive variable
Framework for turnover intention

Design/ • Quantitative
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical • 142 nurses who worked for tertiary hospitals with 500 beds or more recruited by sampling
Considerations • Participants signed written agreements and were assured the information would not be used
for any other purpose
• Research was supported by the Research Grant funded by Kangwon National University.
An Ethics Committee was not discussed
Major Variables Studied (and • Compassion Fatigue: stress caused by repeatedly helping others in need
their definition), if • Burn-out: manifested symptoms of anxiety, impulsive behavior, and substance abuse
appropriate • Turnover Intention: expressed desire to leave the unit

Measurement Tool/Data • PASW 19.0 program which included one-way ANOVA, independent t-tests, Pearson’s
Collection Method correlation coefficient, and hierarchical analysis
Data Analysis • Hierarchical regression analysis used to determine if compassion fatigue was a predictive
variable for turnover intention among hospital nurses

Findings/Discussion • Positive correlation between compassion fatigue and burn out (r=0.37, p < 0.001)
• Positive correlation between compassion fatigue and turnover intension (r= 0.55 < p 0.001)
Appraisal/Worth to practice • Gaining insight regarding compassion fatigue can reduce nurse turn-over and increase
retention
AN INTEGRATIVE REVIEW Article #5 Evaluation Table 15

First Author • Sacco, RN, MS, CCRN, AGNS-BC, ACCSN-AG (2015) St. John Fisher College
(Year)/Qualifications
Background/Problem • “Compassion fatigue has been studied in other populations. This research examined the
Statement effects of compassion fatigue on nurses in a critical care setting” p. 34)

Conceptual/theoretical • “The primary purpose was to establish the prevalence of compassion satisfaction and
Framework compassion fatigue in critical care nurses in an academic medical center in western New
York State” (p. 38)
Design/ • Quantitative
Method/Philosophical • Cross-sectional study; Electronic survey emailed (p. 34)
Underpinnings
Sample/ Setting/Ethical • “221 Voluntary participants
Considerations • Anonymity granted with no participant identifiers
• Approved by the Medical Center’s Institutional Review Board” (p. 35)
Major Variables Studied (and • “Compassion satisfaction- positive feelings from helping others during traumatic situations
their definition), if • Compassion fatigue- cumulative state of frustration with a person’s work environment that
appropriate develops over a long period of time
• Professional Quality of Life - Cumulative experience of both (compassion satisfaction and
compassion fatigue)” (p. 33)

Measurement Tool/Data • “Data was grouped by participants’ education level (associate, bachelors, masters), gender
Collection Method (male/female), and age grouped by decade (20s, 30s, 40s, and 50+)
• Therefore, an effective balance in the ProQOL was achieved” (p. 38)

Data Analysis • ProQOL, version 5 (p. 34)

Findings/Discussion • “The most significant finding was the high levels of compassion satisfaction (73%) in nurses
50 years and older than among their younger colleagues (34-42%)” (p. 36)

Appraisal/Worth to practice • Nurses who achieve a balance of compassion satisfaction and compassion fatigue
experience a professional quality of life and are less likely to leave their position

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy