Our study published in Nursing Ethics “Ethical sensitivity and compassion in homecare – care leaders’ views” that belongs to our project “Compassion and ethical sensitivity in care”.
Link to the project and its previous publications here:
In Finland, the responsibility for organising public healthcare, social welfare and rescue services have recently been transferred to wellbeing services counties. At the time of writing, the budget and financial plan is being decided in the wellbeing services counties and is expected to be very tight when all activities are to be accommodated. Last year, when we interviewed home care leaders for our study, there were already a concern about lacking resources in home care. There was concern about home care personnel not having enough time for clients, while the number of home care clients continues to grow in line with an increasing number of elderly people in Finland. The home care leaders felt that empathic values as ethical sensitivity and compassion have a special place in home care and needs to exist in order for the care to be qualitative. A home visit by home care personnel may be the only visit that day for some of the home care clients. This makes it especially important that values such as ethical sensitivity and compassion are present in home care.
The purpose of our study was to explore home care leaders’ perceptions of ethical sensitivity and compassion associated with quality of care in home care. The data was collected through 10 in-depth-interviews with homecare leaders’ and analyzed with content analysis according to Graneheim and Lundman (2004).
Home care personnel have been singled out as one of the factors that can give older people meaningfulness in home care, and it is suggested that the performance of care has a bearing on the quality of care: as closely related to the organisation’s ethical culture this puts home care leaders in a significant role because their impact on other healthcare professionals, can affect the caregivers’ being and caring (Hemberg et al., 2021). The presence of compassion in the care of the elderly is of great importance as they are often vulnerable as a result of physical, cognitive, emotional and social factors, which can mean suffering (Kagan, 2014). Compassion is described as the heart, or the fundamental core of caring (Hemberg & Wiklund-Gustin, 2021). At an organizational level it is essential recognizing the importance of compassion in caring as otherwise compassion risks being stifled by the environment (Fotaki, 2015). Ethical sensitivity implies the emotional ability to discern ethical tensions and is a prerequisite for other ethical components such as reflection, behavior, decision-making and action (Lechasseur et al., 2018). Ethical sensitivity also includes the caregiver’s ability to interpret verbal or non-verbal behaviors in order to best identify the patient’s needs (Poikkeus et al., 2014).
The overall theme of the result in our study were that compassion provides deeper meaning and ethical sensitivity provides means for knowing how to act. This theme showed that when ethical sensitivity and compassion are present in care, the home care leaders relate that a trusting relationship between the client and the caregiver can be created. The leaders highlighted the caregivers’ approach to treatment as well as trust as co-creators of a trusting relationship where ethical sensitivity and compassion are present and saw these as important factors that can raise the quality of care. The organisation and the leaders are co-creaters to the conditions for a permissive environment where ethical sensitivity and compassion can be seen as resources.
Four subthemes were found in the study: ‘Co-creation between the caregivers’ responsiveness and the client’s needs’, ’Compassion creates a deeper understanding of the client and enables trust’, ’Ethical sensitivity and compassion are challenging, but can be strengthened through experience and support’ and ’A need to create conditions for ethical sensitivity and compassion on an organisational level’. The study showed that ethical sensitivity is a cornerstone of home care when it comes to entering another person’s home, and if the caregiver does not have the necessary conditions for this the care can suffer. Ethical sensitivity was in the study described as being open in the caring encounter to be able to discern nuances in the client and to convey and pay attention to the client’s needs with compassion. Through ethical sensitivity, clients can feel that they are being listened to, heard and allowed to decide for themselves about their own care, their home and their life, which is important for the quality of care.
According to the home care leaders, compassion conveyed with ethical sensitivity creates trust and warmth, and is consensus-based care. The caring relationship and the co-creation in care that the relationship entails make the care important for both the caregiver and the client, which also increases the value of the care. Ethical sensitivity and compassion allow the caregiver to better meet the client’s real needs in the caring encounter, which also enables quality in care.
In the study home care leaders view compassion as feeling with someone in their suffering and vulnerability. Through life experience, professional experience and support in various forms, caregivers can develop their ethical sensitivity and compassion. Several of the home care leaders pointed out that in order to have ethical sensitivity the caregivers first need to feel secure in their professional role. The study also found that the challenges in home care quickly can become mentally burdensome when it comes to balancing the professional role and dealing with feelings of compassion. More discussion and support are needed but it is difficult to put in more support measures with the current scarce resources in home care. According to the home care leaders, a lack of resources can affect the caregivers’ ability to give time, consideration and show compassion to the client, which also can create anxiety in the caregiver.
The organisation and the leader can together create a supportive environment that encourages ethical sensitivity and compassion. In addition to this being important for clients and care it can also add value to caregivers in their professional role. In the study we found that the role of the organisation is to support the well-being of the staff by meeting their needs and providing adequate resources in home care.
The study showed that if nurses fail to be sensitive and compassionate with patients, good and high qualitative home care cannot be achieved. Ethical sensitivity and compassion can be seen as resources in home care but the organisation and the care leaders need to provide the support for these to develop. This study provides an understanding of the meaning of ethical sensitivity and compassion as sources of strength and their link to quality of care in a home care context. With this study, we wish to highlight the relevance of compassion and ethical sensitivity to be presence in home care for the care to be qualitative.
Link to the article:
Blomqvist, H., Bergdahl, E. & Hemberg, J. (2022). Ethical sensitivity and compassion in homecare: care leaders´ views. Nursing Ethics. https://doi.org/10.1177/09697330221122965
Heidi Blomqvist
RN, MHS, PhD candidate in Health Sciences, Department of Caring Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland. E-mail: heidi.blomqvist@abo.fi
ID ORCId: https://orcid.org/0000-0003-1724-4290
Link to Åbo Akademi University profile: https://research.abo.fi/en/persons/heidi-blomqvist
Elisabeth Bergdahl
PhD, RN. Senior Lecturer. Örebro University: School of Health Sciences.
ORCID: https://orcid.org/0000-0003-4917-7766
Jessica Hemberg
PhD in Health Sciences, PHN, RN, Associate Professor, Senior Lecturer, Department of Caring Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland. Subject leader in pedagogical studies for teachers within Health Sciences Didactics and subject leader for leadership in health and social care. E-mail: jessica.hemberg@abo.fi
ORCID: https://orcid.org/0000-0002-0829-8249
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