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Presented at the International Nursing
Symposium with the theme ‘Taking Time to Care: Cultivating Compassion in
Nursing’ organized by the Executive Administration of Nursing Services at King
Fahad Medical City, Riyadh 23-24, March 2015 by Professor Omar Hasan Kasule Sr.
MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Chairman of the Human and Medical
Ethics Committee at King Fahad Medical City, Riyadh, Saudi Arabia EM: omarkasule@yahoo.com.
Defining compassion: a dilemma
Definition of compassion is virtually impossible because it is an
inner feeling that manifests in outward action such as compassionate care and
communication[1] [2].
Compassion has inner and outward dimensions; one can exist without
the other. You can be compassionate without any visible physical manifestation.
Outward acts of compassion may be mechanical culturally-learned routines with
no underlying compassion (e.g. professional criers)
Adult patients beyond the concrete thinking stage can after a time
tell the difference between the inner dimensions (human connection) and outer
dimensions of compassion (routines)
Do we have compassion deficit?
Outer dimension of compassion
Measurement of compassion[3]
Testing for compassion[4]
Training in compassion: boot camp training[5], training[6], training
nurses to show / deliver compassion[7] [8] [9]
Environment to promote
compassionate care[12]
? Nursing programs exclude compassion[13]
Inner dimension of compassion in normal practice
Using stories to teach compassion[14]
listening to patients and watching their body language[15]
Compassion by inspiration[16]
Role of compassion in health care
Compassion part
of nursing care[17]
Compassion
reduces patient suffering[20]
If we cannot
cure let us at least offer compassion[21]
The Islamic concepts of compassion: outer dimension (level 1)
Obligation to visit the patient (wujuub ‘iyaadat al mariidh)[22]
Virtue (fadhl) and reward (ajr) of visiting the
patient[23]
Kindness (hilm)[26]
The Islamic concepts of compassion: outer dimension (level 1)
Avoiding secret conversations (najwa)[27]
Dua for the patient[28]
Encouraging the patient during the visit (tashjii’I almariiidh)[29]
The sick not visiting patients (la yurdana mumridh ‘ala musihh)[30]
Solving the needs of a brother (haajat al akh)[31]
The Islamic concepts of compassion: outer dimension (level 2)
Expressing love for others (al I’ilaam bi al hubb)[32]
Love for others what you love for yourself (yuhibbu li akhhihi
ma yuhibbu linafsihi)[33]
Good thoughts about others (husn al dhann)[34]
Recognize the rights of the elderly (‘irfan haqq al kabiir)
and compassion for the young (rahmat al saghiir)[35]
Compassion (rahmat)
The Islamic concepts of compassion: inner dimension (level 3)
Rahmat is a divine attribute. It has limited mention as a human attribute
as rahmat for parents[36]
, believers[37] [38],
and spouses[39]
Rahmat has 100 potions 99 of which are with Allah[40].
Allah’s rahmat for humans is more than a mother bird’s rahmat
for its chicks
Divine rahmat is comprehensive. Human rahmat focuses
more on the weak and needy
The Islamic concepts of compassion: inner dimension (level 3)
The highest level of this rahmat is be in the shoes of the
patient and share hopes and fears. Patient + Nurse = one emotional entity
The prophet likened mutual love (tawaadud) and mutual compassion
(taraahum) to the body as a physiological entity if any part is injured
the rest of the body responds with insomnia and fever[41].
This concept of rahmat is higher than empathy which is sharing an emotion without losing sight of the
fact that is somebody else’s emotion[42]
Barriers to
compassion
My hypothesis
is that compassion for the weak and suffering is natural. All humans even the
most wicked feel compassion for the young of humans and even animals
Lack of compassion
is due to modifiable acquired factors either in the person or in the
environment
We should look
for and remove what hampers nurses from being naturally compassionate rather
than strive to teach them to be compassionate.
Barriers to
compassion
Barriers to
nursing compassion include issues of pay and compensation[43]
[44],
work-related, personal factors, sociocultural factors
Barriers to
nursing compassion: pay, compassion for nurses
Barriers to
physician compassion include: burn-out, overload, difficult patients and
families, and complex clinical situations [45]
[46]
Compassion fatigue
Compassion fatigue and burn-out are
different but in essence have the same causes and impact
Warning signs of compassion fatigue
and burnout should be recognized early to combat fatigue[49] [50] [51]
Factors leading to compassion satisfaction
and compassion fatigue: manager support, co-worker relations, hours of work,
social support, trait anxiety, ethnicity, group cohesion, staff wellbeing [52] [53] [54] [55] [56] [57]
Combating compassion fatigue from
the inner dimension
All work is evaluated by the
underlying intentions (niyyat) that are in the inner dimension.
The stronger the niyyat the
better the work
Work is evaluated according to its
end (al ‘amal bi al khawatiim)[58]
The best of work is what is
continuous until the end (khayr al ‘amal adwamuha)[59]
Compassion deficit is mostly
weakness of the internal dimension
REFERENCES
[6] Br J Nurs.
2014 Oct 9-22;23(18):974-80..
[10] J Clin Nurs.
2014 Dec;23(23-24):3589-99..
[11] Nurse Educ
Today. 2014 Sep;34(9):1265-8.
[12] Int J Older People Nurs.
2015 Mar;10(1):48-58.
[14] Nurse Educ
Pract. 2014 Sep 19. pii: S1471-5953(14)00116-4
[15] Nurs Stand.
2014 Mar 12-18;28(28):61.
[16] Nurs Older
People. 2014 Sep;26(8):26-30.
[17] Nurs Stand.
2015 Jan 20;29(20):61.
[20] J Nurs Adm. 2014
Oct;44(10):517-24.
[22] Bukhari K23 B2
[23] Muslim K45 H40
[24] Muslim K45
Hadith No 75-77
[25] Bukhari K78 B35
[26] Tirmidhi K25
B86
[27] Bukhari K79 B45
[28] Abu Daud K20 B7
[29] Tirmidhi K26
B35
[30] Bukhari K76 B53
[31] Bukhari K2 B22
[32] Bukhari K37
B112
[33] Bukhari K2 B6
[34] Abu Daud K4 B21
[35] Tirmidhi K25
B15
[36] Qur;an 17:24
[37] Qur’an 48:79
[38] Qur’an 90:17
[39] Qur’an 42:23
[40] Bukhari K78 B19
[58] Bukhari K18 B33
[59] Bukhari K2 B32