Can We Teach Nursing Students to be Compassionate?
A Japanese nursing professor, Yusuke Kurebayashi, wrote about her belief that nursing competency is improved by reflecting on experiences and learning about managing uncertainty in their practice. In this context, she explains, healthcare providers’ ability to reflect on interpersonal interactions with patients “is crucial to the quality of care they provide.” In traditional process recording, during which students 
write about their interpersonal experiences caring for patients, many students have trouble finding meaning in their care, focusing more on their faults and anxiety.
The researcher introduces the concept of self-compassion, which facilitates acceptance of not only oneself but also for others. Self-compassion helps protect the caregiver from negative emotions, promotes learning motivation, and protects individuals against negative effects. Self-compassion is strongly related to compassion for others. Dr. Kurebatashi postulates that boosting students’ self-compassion could provide a protective role when asking students to do process recording as a means of reflecting on their patient interactions.
The researcher randomly assigned students to the usual procedure for process recording (the control), and the experimental approach in which the nurse researcher taught the students about self-compassion and how to incorporate its principles into their process recordings:
- Self-kindness: extending kindness and understanding to oneself rather than harsh self-criticism and judgment
- Common humanity: seeing one’s experiences as part of the larger human experience rather than as separating and isolating
- Mindfulness: holding one’s painful thoughts and feelings in balanced awareness rather than over-identifying with them
After the process recording, the researchers examined self-compassion and self-focus scores for the control and experimental groups. The students whose forms incorporated aspects of self-compassion 
had improved scores in mindfulness, a critically important skill nurses who are new to the profession need to learn. However, there was an unexpected increase in ruminative self-focus. While rumination can indicate a depressive mood, it could also simply reflect anxiety related to having writing evaluated. On the other hand, rumination and reflection can enhance mental growth.
The nurse researcher summarized her work by saying she would have benefitted from a larger group (n=35) and suggested that students may benefit from a greater emphasis on perspectives of mindfulness and why it is important for students to be compassionate toward oneself.
The
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Even though the author did not prove her initial hypothesis, we learn that teaching students about self-compassion allowed them to be more mindful in describing their interactions with their patients.
Kurebayashi Y. The Effect of Revised Process Recording on Self‐focus and Self‐compassion: A Randomised Controlled Pilot Study. Perspect Psychiatr Care.2020;1–10. https://doi.org/10.1111/ppc.12687
It is important to know that treating patients with compassion is a learned skill, just like learning how to
listen to the different sounds from the heart or take blood pressure. There is economic value in compassionate care; thus, curricula for nursing, health professions, and medical schools should include specific elements to learn and practice these critical care aspects.
The Inaugural University of Plymouth Compassion in Healthcare Education Conference
The University of Plymouth in the UK is holding a virtual conference “to promote the idea of compassion as an educational reality that both can and should be taught to healthcare students.”
This free conference, via Zoom on December 16, 2020, has been organized by Dr. Sarah Tobin. Her doctoral research has worked on defining compassion in the healthcare context and examining how compassionate behaviors and practice can be achieved. She argues that compassion is not an optional element in healthcare education, but rather, an essential element of humane care. 
You can download the agenda here
Learn more and register here.
Kudos to Dr. Tobin and her colleagues for taking the lead on helping students integrate compassionate care from the very start of their careers.
Should a Compassionate Practitioner use Email?
I, for one, could not live without being able to email my physicians. If I must play phone tag and wait for the phone to ring to get answers to my questions, I start looking elsewhere. So, I was intrigued by this study from Denmark that explores general practitioners’ perspectives on and daily experiences with email consultations with patients.
The researchers interviewed and observed 16 practitioners. The physicians reported that they perceived a potential for misinterpretation, so they felt email was unsuitable for communications about relationships, socio-emotional, and sensitive matters with patients.
However, as researchers asked additional questions, they discovered physicians who had relationships
with patients based on mutual knowledge and trust found they could effectively use email communication as a supportive communication channel. Patients felt free to express emotions, and their mood was apparent within the messages. This sharing allowed the practitioners to show interest and compassion toward the patient proactively.
The authors submitted the article for publication in May, and there is no mention of the pandemic, so the context is a general practice pre-pandemic. The researchers were interested in the effects of the governments’ digitization of medical practice that saw an increase in email from 1.3 million encounters in 2008 to 7.1 million 10 years later. These encounters corresponded with telephone consultation dropping from 14.3 million to 9 million encounters. GPs are the entry point for a system fully supported by tax dollars, at no out-of-pocket cost to patients at the time of need. Each GP has a caseload of about 1600 patients. Email communication is through the electronic medical record, and the patient is limited to messages of 500 characters.
Key findings of the study were:
Privileging face-to-face and telephone
Practitioners preferred having patients right in front of them and would rather use email for task-oriented information. Complex, emotional, and sensitive matters do not belong on email. However, an email may trigger a phone call, thus being part of an “interaction package,” handled with finesse because the practitioner and patient know each other.
Mutual knowledge as a prerequisite
Many practitioners were more open to discussing more complex matters over email exchanges with selected patients. They had to have a longstanding relationship in which they knew the patient well for this to be appropriate. One clinic had a general inbox, which practitioners found confusing; they may not have seen the patient or know what issue the patient’s limited text refers to. This format was very frustrating for the GPs compared with those who received messages directly from their assigned patients.
Supportive communication channel
For GPs who knew their patients well, email was a supportive communication channel, particularly for patients who were challenged or distressed, either regularly or because of episodic life circumstances. GPs thought reassuring messages from the providers helped relieve some of the patients’ discomfort. One GP described how he would respond to a frustrated patient with what he called “vicarious hope;” he
would validate the patient’s feelings of powerlessness and recommend an appointment at which they could make a plan to move forward.
Relationship-oriented email consultation
Some of the GPs used email communications in place of visits. A patient would write to provide an update on their condition or their well-being. Or, perhaps just checking in about how the week went. The GP then had the opportunity to respond with positive messaging to support the therapeutic relationship.
Some GPs said they got messages of appreciation that would otherwise be difficult for the patient to say face-to-face. Likewise, practitioners initiated messages to show compassion and caring for patients undergoing difficult life circumstances.
Assing Hvidt E, et al.: Not just an information-delivery tool. An ethnographic study exploring Danish GPs’ perspectives on and experiences with the relational potential of email consultation. Scand J Prim Health Care. 2020:1-10.
The
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Understandable
While primary care providers prefer face-to-face encounters (don’t we all?), once the practitioner feels comfortable in the length of time and depth of the relationship with the patient, email communication becomes less intimidating, more effective, and efficient.
