Compassion is one of those weird things to define (ok, for me it is, i’m not bright) that’s somewhere between being as nebulous as love to try and describe to being as tritely defined as ‘the feeling of empathy for others’.
A steady line of policy makers have said that nurses ‘must have compassion’, ‘compassion is a quality found at its highest level in nursing’ and other such things whilst not really pinning down what this particular ‘c’ word is. ‘You’ll know if you’ve got it because the people you’re treating will feed back that you’re showing it’ is one angle, and that’s where QA metrics become knackered, you can almost hear the discussions….’its not quantitative because we don’t procure it, trade it or allocate time for it, so it’s qualitative because it’s experiential but hang on we’ll be measured quantitatively on if we do it or not…arrrrgh…..!!!’
Thankfully as just the a dad of a little guy with a disability it’s more simple ; me, my little fella and my family just want the medical professions to show it on two levels ; organisationally and individually. I’d define compassion as empathy. Not sympathy. There’s a difference. If you fall down the next set of steps you’re going down and get a whole bone-showing-through-the-skin leg fracture, someone walking past giving it ‘awwww, look at THAT! That must really hurt’ would leave you feeling no absolutely no different…that’s sympathy, useless. The same person walking past and giving it ‘awww, look at THAT! That must really hurt, i’ll get you an ambulance, would you like me to stay with you’ is showing they understand and can help, that’s empathy for me, useful. The third deadly sin that shares the stage with empathy and sympathy is patronisation too which is, in my experience, what happens when people with poor emotional intelligence ‘smarts’ think they can convey empathy verbally rather than through actions…it’s a minefield. If I hear the ‘I know you must be worried about Isaac’ line once more then there’s a fair chance that i’ll turn rabid on the professional saying it, or perhaps I should respond in an equally patronising manner ‘clever boy / girl’. If you think by telling me I must be worried is helpful, when you can see it, feel it and notice it in every aspect of an interaction then you’re not exactly the Poirot of the caring professions.
Organisationally, show us your culture of compassion. I’ll give you a true anecdote ; on the day my twins were born, both straight into NICU there was no provision to put my wife into a private ward or room. No, she was left overnight on a ward with other, healthy babies around her and mum’s moaning about lack of sleep as both our boys were ill, one fighting genuinely for his life. No pathway for NICU mums? I’ve no idea, but how it felt is that there was zero empathy. Expecting us to leave the room when doctor’s are reviewing our babies? How could that not feel like an exclusive experience? Thats just two examples and i’m sure i’m not unique in being able to list a load of others. So, did I, my wife complain? Did we use the communication tree to push our thoughts up to a higher level so that they could result in better practice? No, unfortunately not. Why may that be? Well, we had bigger fish to fry at the time and still do. In fairness, if culturally it isn’t there, if leaders are’nt spending time reflecting on how care must feel, if patient experience isn’t captured contemporaneously when care is delivered then I cant see a lot of us parents with huge amounts of contact with the professions on a weekly basis taking the time to give it.
Individually, we’ve experienced true empathy from the vast, vast majority of the nurses that have looked after Isaac. Nurses who maybe don’t even realise that when they show they are thinking of his needs before we point them out that they are showing us that they are attuned to our thinking, that they care (see previous blog for my prattle about care…!) and that they genuinely have an emotional investment in what they are doing for Isaac. I’ve mentioned in talks i’ve given about the nurse who used to come in and lift the mood in NICU by singing and joking ; it seems a minor thing but she had true empathy – she knew the levels of stress and pressure in there and the need for a release. The nurses who remember Isaac when he comes back into hospital and show they know him, the ones who will point out to other nurses or doctors when something is a bad idea from a family perspective (latest example…during tracheostomy decanulation attempts when medics may say ‘stay in until tomorrow’ when we know that going home is just the same care but the nurse said it for us).
Problem is, perhaps, how do you train compassion? Cognitively the ability to think of the effect of your actions on others and ’empathise’ beyond the person immediately in front of you is a step into what Piaget would have said is formal operational thinking, and it needs some experiential reflection even in adulthood too. We all know people who never developed that capacity, and aside from those who would get into the final centiles of psychopathy testing there’s others that regrettably we’ve met in health services. ‘Has anyone ever mentioned walker-warburg syndrome to you?’ said one consultant not 5 minutes into talking to us for the first time about Isaac when he was about 5 weeks old and seriously ill, and then when we said no saying ‘oh’ then moving onto the next subject. And again, that’s just one example, a tiny one and there’s loads more. As compassion goes, it was rare as snow in the sahara in some consultations we’ve had. I genuinely think the way to train is it to nurture it through reflective discussion and perhaps having students hear someone who’s lived it, speak about experiences which fortunately more and more universities are doing.
The effect it has is that is builds unconscious barriers ; if you dont show it in the first contact with Isaac then it’s not there in our view. You may turn up the second time and have been on some ‘showing compassion’ course in the interim and be a HEP (a Highly Empathic Person) now to use parlance but it’s lost.
Anyhow, that’s my thoughts on compassion…..please, as with all the blogs have some forbearance, i’m a lay-bloke speaking about how I see things and if it’s not well written I apologise.