Factors Militating against the Delivery of Compassionate Care: A Malawian Perspective

Background/Objectives: Malawi is one of the countries in the world with the worst maternal mortality rate. In view of this, women are encouraged to deliver at a health facility assisted by a skilled birth attendant. However, this initiative can only be effective when health care workers manifest a professional demeanor which conveys care and compassion to patients/clients. The objective of the study was to foster the development of compassionate care among nurses/midwives working in selected maternal and child health care clinical settings. Methods: The study employed an action research (AR) approach. Focus group discussions (FGDs) were conducted with nurse/midwives from the selected health facilities. Purposive sampling was utilized to obtain the sample of participants to the eight FGDs and thematic analysis was used to analyze the data. Results: The data collected from nurses/midwives clearly indicate that it is not possible to effectively render compassionate care under the present work conditions. The study reveals the following factors which hinder the delivery of compassionate care: severe nursing shortages, gross lack of essential supplies and equipment, negative attitudes of nurses/midwives and unsupportive leadership which demotivates nurses/midwives. Conclusion: The study reveals problems which hinder the delivery of compassionate care, and there is need to address these problems. This will enhance the effectiveness of hospital delivery by a skilled birth attendant as a safe motherhood initiative aimed at lowering the high maternal mortality rate.

Reliability and validation of the Korean Compassionate Communication Scale

Objective:The aims of this study were to develop the Korean Compassionate Communication Scale and to test its validity and reliability.Methods:The Korean Compassionate Communication Scale was developed based on English version.This study is a methodological one in its approach.Results:The Korean version of Compassionate Communication Scale contained 20 items and was divided into three factors that explained 63.4%of the total variance.This scale demonstrated excellent convergent and discriminant validity(100%),and criterionrelated validity(Global Interpersonal Communication Competence r=0.494;self-compassion:r=0.317).Internal consistency was acceptable,and Cronbach’sαof the total items was 0.85.Conclusions:This study examined The Korean Compassionate Communication Scale as an appropriate measurement of communication ability for nursing practice.Therefore,this scale suggests that the developed 20 items of the Compassionate Communication Scale can be used for therapeutic relationship and nursing education.

Prevalence and Social Demographic Factors Associated with Secondary Traumatic Stress, Burnout and Compassion Satisfaction among Nurses at Selected Teaching Hospitals in Lusaka, Zambia

Introduction: Nurses’ constant exposure to severe human suffering within constrained health care environments places them at risk for developing Secondary Traumatic Stress and Burnout. The current study therefore sought to establish the prevalence and social demographic factors associated with Secondary Traumatic Stress, Burnout and Compassion Satisfaction among Nurses working at selected Teaching Hospitals in Lusaka, Zambia. Methods: A correlational design employing a self-administered questionnaire adapted from version five of the Professional Quality of Life scale was used to collect data from 250 nurses drawn using proportional stratified sampling method. The resulting data were analyzed using version 23 of the Statistical Package for Social Sciences (SPSS). Hierarchical multiple linear regression analysis was used to identify predictors of Secondary Traumatic Stress and Burnout. Findings: Whilst the majority of respondents reported average levels of Secondary Traumatic Stress and Burnout, about a quarter reported high Secondary Traumatic Stress and Burnout scores at 23% and 26% respectively. Only 81 (32.4%) scored high on Compassion Satisfaction. Social demographic factors including;working in the main Intensive Care Unit, and being married accounted for the greatest variance in Secondary Traumatic Stress (R2 = 0.237, p Conclusion: Findings of the current study signify a need to institute measures to help nurses cope with the deleterious psychological effects of constant engagement with those in distress and to foster Compassion Satisfaction.

Comparative study of self-compassion and sense of coherence in nurses of psychiatric hospitals

Objective:Nurses,due to the nature of their job,are subjected to various forms of stress and physical and psychological injuries.Self-compassion and a sense of coherence have attracted much attention in research in recent years as having high potential for improving the health and performance of people in the workplace.The present study aimed to compare self-compassion and the sense of coherence in nurses working in psychiatric hospitals and other hospitals of Kerman University of Medical Sciences.Methods:The present study was a descriptive-comparative study of applied type conducted on 100 nurses of Shahid Beheshti Psychiatric Hospital in Kerman by the census method and 100 nurses of other hospitals of Kerman University of Medical Sciences by the stratified random sampling method.The instruments included the self-compassion questionnaire and the sense of coherence questionnaire.Data were analyzed using the Statistical Package for Social Sciences software.Results:The results of the present study showed that self-compassion and sense of coherence were higher in psychiatric nurses(39.35±7.7 and 53.02±8.01)than among other nurses(36.03±5.81 and 49.76±6.30).There was a direct and moderate relationship between a sense of coherence and self-compassion(P-value<0.005).The higher the score of compassion for oneself,the higher was the score of sense of coherence.Furthermore,the sense of coherence had a direct and weak relationship with all dimensions of self-compassion,except for the extreme imitation dimension,which showed a direct and moderate relationship to other dimensions(P-value<0.001).Conclusions:Self-compassion and a sense of coherence,as a form of self-communication,increase nurses’satisfaction and reduce nurses’job stress and,as a result,job performance is improved.

A Study on the Quality of Life of Elderly Nurses in Two Selected Elderly Care Institutions in Shandong Province

Objective: To comprehensively understand the impact of the quality of life of elderly nurses in two selected elderly care institutions in Zibo city, Shandong province, and to provide a scientific basis for improving the professional quality of life of elderly nurses. Methods: The convenient sampling method was used to investigate the professional quality of life (proQOL) questionnaire Version 5 and the self-designed demographic data of 82 elderly nurses working in two elderly care institutions. Result: From this score, it can be seen that the occupational burnout problem of elderly nursing staff in the two nursing homes is the most significant, with empathy and secondary trauma emergency at a moderate level. After controlling the demographic variables, the working hours and monthly income level had a significant impact on nurses’ job burnout. Conclusion: Due to the particularity and high intensity of elderly nurses’ work, their physical and mental health faces many challenges, which affect their quality of life. At present, efforts will be made to reduce work pressure, increase wages and benefits, and thereby improve the quality of life.

ICU护士同情心疲乏对其职业认同的影响

目的:探讨重症监护室(ICU)护士同情心疲乏对其职业认同的影响。方法:对山东省6家三级甲等综合医院的193名ICU护士进行问卷调查,了解ICU护士同情心疲乏及其职业认同现状,并探讨两者的关系。结果 :同情心疲乏中同情心满足和继发性创伤应激与职业认同呈正相关(P<0.05),与工作倦怠呈负相关(P<0.01)。职业认同总分为(98.29±16.20)分。分层回归分析显示,控制人口学变量后,继发性创伤应激、同情心满足和工作倦怠可独立预测职业认同的31.9%。结论:护理管理者应提高护士的工作满意度,缓解其同情心疲乏,从而提高护士职业认同,促进护理事业的发展。

God's Love as a Theme through the Whole Old Testament

This paper makes studies on God's love as a theme through the whole Old Testament. First the paper points out the impact of modern science and technology on people's thoughts and opinions about religions, while laying emphasis on the concept"God's love"and then the paper tracks the deep and great love through Old Testament, trying to demonstrate it in all directions.

Recurrent anal fistulae:Limited surgery supported by stem cells

AIM:To study the results of stem-cell therapy under a Compassionate-use Program for patients with recurrent anal fistulae.METHODS:Under controlled circumstances,and approved by European and Spanish laws,a Compassionate-use Program allows the use of stem-cell therapy for patients with very complex anal fistulae.Candidates had previously undergone multiple surgical interventions that had failed to resolve the fistulae,and presented symptomatic recurrence.The intervention consisted of limited surgery(with closure of the internal opening),followed by local implant of stem cells in the fistula-tract wall.Autologous expanded adipose-derived stem cells were the main cell type selected for implant.The first evaluation was performed on the 8th postoperative week;outcome was classified as response or partial response.Evaluation one year after the intervention confirmed if complete healing of the fistula was achieved.RESULTS:Ten patients(8 male)with highly recurrent and complex fistulae were treated(mean age:49years,range:28-76 years).Seven cases were nonCrohn’s fistulae,and three were Crohn’s-associated fistulae.Previous surgical attempts ranged from 3to 12.Two patients presented with preoperative incontinence(Wexner scores of 12 and 13 points).After the intervention,six patients showed clinical response on the 8th postoperative week,with a complete cessation of suppuration from the fistula.Three patients presented a partial response,with an evident decrease in suppuration.A year later,six patients(60%)remained healed,with complete reepithelization of the external opening.Postoperative Wexner Scores were 0 in six cases.The two patients with previous incontinence improved their scores from12 to 8 points and from 13 to 5 points.No adverse reactions or complications related to stem-cell therapy were reported during the study period.CONCLUSION:Stem cells are safe and useful for treating anal fistulae.Healing can be achieved in severe cases,sparing fecal incontinence risk,and improving previous scoring.

Evacuation flow of pedestrians considering compassion effect

By means of game theory, the effect of compassion mechanism on the evacuation dynamics of pedestrians from a room is studied based on a cellular automaton model. Pedestrians can choose to cooperate or defect in a snowdrift game during the movement. With the compassion mechanism, pedestrians share their payoff to the poorest peer when several pedestrians compete for the same empty cell. Simulation results show that the escape time grows with fear degree r of the snowdrift game, and the compassion mechanism will have a different effect on the system compared with the situation of a spatial game with fixed population. By payoff redistribution, the compassion can help the minor strategy to survive. When the fear degree r is large, the compassion can sustain the cooperative behavior, and spontaneously decreases the escape time. When the fear degree r is small, the compassion will decrease the cooperation frequency, and slightly increase the escape time. The phenomenon is explained by the evolution and competition of defectors and cooperators in the system. Finally, the effect of initial cooperator proportion, the effect of two exits, and the effect of ＂Richest-Following＂ strategy, and the effect of initial density are also discussed.

Bibliometric analysis about compassion fatigue based on Web of Science database

Objective: To analyze the related foreign literature about compassion fatigue (CF) and to provide the basis for further improving the level of research in this field. Methods: Based on the Web of Science core database and its own analysis function, HistCite analysis software was used to study the diploma research about CF. Results: A total of 652 paper were retrieved, the output of literature showed an increasing trend year by year. The United States ranked first, and China ranked eleventh. The “Oncology Nursing Forum” had the largest number of articles (4.0%). The main research direction was in nursing (29.6%), and the main research output was from articles (73.2%). The key words highly cited were “compassion” and “fatigue”. Figley was the author of the high-yield field, and mainly research institutions were universities. The highly cited article was entitled “Compassion fatigue: Psychotherapists’ chronic lack of self-care”. Conclusions: In recent years, the related heat of CF has been high fever. Our research in this field is still in the primary stage, and it needs to be further excavated and promoted.

Levels of vocational satisfaction,burnout and compassion fatigue of health professionals working in pediatric clinics

BACKGROUND Burnout and compassion fatigue are affecting the quality of professional life.AIM To investigate the levels of vocational satisfaction,burnout,and compassion fatigue and factors that may be related to health professionals working in children’s clinics.METHODS The study sample was in the west of Turkey.Data were collected using the questionnaire form and the quality of life scale for employees.RESULTS The findings obtained in this study showed that the level of vocational satisfaction of female health professionals and the burnout level of male health professionals were higher.The professional satisfaction of the doctors was lower than that of the nurses and midwives,and the mean score of burnout and fatigue was high.CONCLUSION Further studies are needed on this topic to help improve the factors that may affect the professional quality of life of health professionals.

Contemplative sciences:A future beyond mindfulness

Mindfulness is a psychological technique based on Eastern meditative practices that was developed in the late 1970s by Kabat-Zinn at the University of Massachusetts.Initially,there was a debate over whether it should be considered a scientific technique or labelled as part of the“new wave”practices.Today,mindfulness is omnipresent in modern societies but has suffered from merchandising and banalization,which has been strongly criticized.Despite some limitations regarding methodological aspects of mindfulness research,it is considered effective for treating many physical and psychological disorders,and even it is recommended in clinical guidelines such the British National Institute for Health and Care Excellence.During the last 2500 years,mindfulness practices have moved from Northern India across most of Asia,but their mixing with Western science and culture at the end of the 20^(th)century is considered a key event in recent history.For the first time in human history,due to globalization,the wisdom of all contemplative traditions can be shared with all human beings and assessed by science.Mindfulness practices,yoga included,are giving birth to a new field of knowledge,contemplative sciences,which go beyond mindfulness and is devoted to helping humanity to reach higher levels of happiness and mental peace.

Concept analysis of nurse burnout

Objective:To explore the concept of burnout among nurses.Through this concept analysis would expect in assisting hospital management departments in establishing supportive programmes to manage burnout of nurses.Method:Walker and Avant’s framework is adopted for the concept analysis of burnout.Results:Burnout is a syndrome that can happen among helping professions which characterized as emotional exhaustion,depersonalization,and reduced personal accomplishment.The antecedents of burnout are cognitive-competence,role overload,role conflict,lack of social support,and rewards.On the other hand,the consequences of burnout could be both personal and organizational,such as sub-clinical issues,behavioral change,absenteeism,and poor quality of care.Conclusion:The analysis of burnout on its attributes,together with antecedents and consequences(Appendix A)and presenting with case study,it may help the nurse to gain a better understanding of nurse burnout and build coping strategies.

Study on Empathy among Undergraduate Students of the Medical Profession in Nepal

Background: The incumbent of medical professional is expected to be socially responsible and emotionally empathetic along with good communication propensity to fasten the doctor-patient relationship. Whilst doctor’s proficiency to recognize a patient’s perspectives, and convey such an understanding back to the patient;in our case, the empathy and compassion level of promising medical professional is unknown in Nepal. Thus, this study aimed to analyze the compassion and empathy score of final year’s undergraduate students of four medical colleges in Nepal. Methods: Self-reported empathy measures were obtained using the Jefferson Scale of Physician-Student version. Results: The degree of empathy for the participants was 97.28 (SD = 14.44) with a median score of 96.00 and a range of 44 (min) to 133 (max). There was a significant difference on scores of the Jefferson scale of physician empathy between NMC Nepalgunj and BPKIHS (p = 0.00) and between NMC Nepalgunj and Manipal Pokhara (p = 0.00), as well as between UCMS and Manipal Pokhara (p = 0.044). These results were significant at the 95% confidence interval. Conclusions: The mean empathy score for the Nepali students is lower than medical students from developed countries but almost similar to medical students from other Asian medical students. The female Nepali medical students scored slightly higher than their male counterparts. Thus colleges have to develop academic programs to improve empathy and compassion among medical students through providing adequate time to consult with patient and faculties.

Status quo and influencing factors of comfort with touch among nursing staff in rehabilitation department:A cross-sectional study

Objective:The objective of this study is to investigate the current status of comfort with touch among nursing staff in the rehabilitation department and analyze its influencing factors.Materials and Methods:The convenience sampling method was used to select 131 nursing staff in the rehabilitation department of 3A-level hospitals in Yunnan Province,China,from March to June 2020 to conduct a questionnaire survey.Results:The nurses’comfort with touch score of 131 clinical nurses in the rehabilitation department was 58.82±4.85.Multivariate regression analysis showed that compassion fatigue(t=‒2.968,P<0.01)and occupational social support(t=2.767,P<0.01)were the influencing factors of the physical comfort of nursing staff;average monthly income(t=‒2.160,P<0.05),occupational cognitive evaluation(t=4.924,P<0.01),and secondary traumatic stress(t=2.833,P<0.01)were the influencing factors of task-oriented contact among nursing staff;marital status(t=2.656,P<0.01)and occupational social support(t=2.078,P<0.05)were the influencing factors for private nursing comfort of nurses.Conclusion:The comfort with touch among nurses in the rehabilitation department is at a medium level.Nursing managers should pay attention to their comfort with touch.In order to promote the development of medical service,hospitals should constantly improve the security and social support of nursing practitioners from the aspects of system,management,and salary performance.

Coronavirus Dynamics:The Undulating Playing Field

The goal of the paper is to conduct an exploratory review and analyses of the dynamics of the pandemic focusing on two themes:pandemic morbidity and vulnerable populations.Method:Review of literature,anecdotal evidence,and reports on the morbidity of COVID-19;including scope of its devastating effects in selected countries.Findings:The devastating effects of the coronavirus are felt across different vulnerable populations.These include the elderly,front line workers,marginalized communities,visible minorities,and more.Inadequate and sometimes conflicting remarks by“experts”have only contributed in exacerbating the confusion in the general population.However,compassion and empathy from different communities have had positive effects on mitigating some of the health outcomes like mental health and other health-related effects of the pandemic.Institutional support needs to be strengthened,especially with regard to individual risks and supply chain coordination:personal protection equipment(PPE),masks,swabs,reagents,etc.The challenge in Africa is especially daunting,because of limited and inadequate financial resources and infrastructure,as confirmed by the health budget allocations as a percentage of their respective GDP(gross domestic product).Discussion:The effects of the COVID-19 are producing unprecedented and catastrophic outcomes in many countries.These have been exacerbated by the level of unpreparedness and inadequate degrees of prevention and intervention strategies.With a few exceptions,the common and current intervention approach is driven by many unknowns including compilation of relevant reliable and compelling data sets.Vulnerable communities continue to suffer most:a situation that is highlighted in this essay as one attempt to remind institutions of their duty to provide appropriate support,including compassion and empathy to these populations.The repercussions of no or inadequate action are numerous,significant,and mind-boggling with unpredictable future outcomes and possible dire consequences.The continuous carnage caused by COVID-19 is a wake-up call reminding all stakeholders(public and private institutions)that once again the inequality infiltrating vulnerable populations needs to be effectively addressed with emphasis on affordability,improved quality of life,and an inclusive long-term strategic plan.Ubiquitous and inadequate supply chain coordination mechanisms have been a major deterrent towards mitigating the effects of this coronavirus pandemic.

Methods of Mitigating the Paradox of Compassion in the Organizational Behavior of Government Employees: A Case of Animal Protection Agencies in Taiwan

According to psychologists,for workers whose job is to help others,their quality of service is improved if they have compassion.However,compassion potentially produces the side effect of compassion fatigue,which decreases service quality.According to sociologists,professionals who must interact with animals,such as veterinarians or butchers adopt the role of a“gate-keeper”.Specifically,these professionals are troubled by the conflict between compassion and the faithful execution of the law.This conflict induces,in them,harmful behavior toward the animals.To verify these arguments,we empirically investigated government employees in a Taiwan Residents animal protection agency.Results from structural equation modeling indicate that although compassion toward animals can increase discretionary effort and mitigate ethics exhaustion,compassion fatigue weakened the factors mitigating ethics exhaustion,which increased harm toward the animals.Therefore,to relieve compassion fatigue,the workload of government employees must be reduced.

Psycho-Social Hazards for Staff in Geriatrics and Geriatric Psychiatry

Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.

The effect of compassion levels and empathic tendencies of intensive care nurses on quality of life: a cross-sectional study

Objective: This study was conducted to determine the effect of compassion levels and empathic tendencies of intensive care nurses' on quality of life. Methods: This descriptive and cross-sectional research study was completed with a total of 202 nurses. The data were collected using the Personal Information Form, Compassion Scale, Empathic Tendency Scale and Professional Quality of Life Scale. The data were analyzed using descriptive statistics, Student t test, Mann-Whitney U test, Kruskal-Wallis Test, One-way analysis of variance ( ANOVA ) , Spe a rman correlation and Multiple regression analysis. Results: As a result of multiple regression analysis, it was found that the variable of compassion ( β = - 0.263, P < 0.01) had a negative and significant effect on the quality of life of employees;and the empathic tendency ( β = 0.385, P < 0.01) variable had a positive and significant effect on the quality of life of employees. Conclusion: As the compassion levels of intensive care nurses increase, their quality of life decreases;as their empathic tendencies increase, their quality of life also increases. Psychoeducation about compassion and empathy should be given to nurses who work in intensive care units with the aim of reducing compassion fatigue.

How will the latest modifications to the CG189 NICE guidelines for obesity management likely impact clinical care?

Based on the 2019 Health Survey for England,nearly two thirds of the adult population and one third of children(aged 2-15 years)are either overweight or obese(1).In England,obesity affects 28%of adults,20%of boys and 13%of girls(1).Obesity is a chronic,often life-long disease that associates with>50 weight-related conditions,most notably type 2 diabetes mellitus(T2D),and other dysmetabolic conditions that contribute towards the metabolic syndrome and many other conditions that impact on nearly every aspect of physiology and mental functioning(2).Obesity has a huge economic burden,with government estimates indicating the current costs of obesity in the UK at£6.1 billion to the National Health Service(NHS),and£27 billion to wider society(1).Despite this,obesity remains fundamentally misunderstood and neglected.This is reflected by woeful under-funding of management strategies for obesity(despite many of these being highly efficacious),guidelines that place time-limitations on potentially effective therapies(with possible negative outcomes that stem from subsequent weight re-gain),and a prevailing fog of obesity-related stigma that seems to pervade its way throughout society like a contagion.