Critical thinking stop point 20.5

Answer to: Is the culture within the NHs toxic (DH 2013), as has been suggested, or does it facilitate compassion?

The nature of the service users in mental health services may also be a barrier, as a number of service users do not wish to accept health service provision. Some suggest it is impossible to develop trusting compassionate relationships in this situation. People who are acutely mentally ill or have a severe cognitive impairment may not see the benefits of treatments that have significant side-effects and may find it difficult to trust those people, including mental health nurses, who have coerced them into accepting the treatment.

There are also those who indicate that mental health nurses and other health care professionals need education to develop their compassionate care. Alongside this need for initial and continuing education, there is a risk of ‘compassion fatigue’ in those who do not receive adequate support and do not experience self-compassion. The need for resilience has been identified for continued work in areas that require high emotional labour to reduce burnout, but Gilbert’s theory of compassion focused therapy and model of compassion highlights the need for self-compassion. When a person has self-compassion, they show themselves understanding (self-empathy) and have sensitivity, distress tolerance and a non-judgemental regard for themselves, the need to provide compassionate care can be enhancing for wellbeing rather than draining.

There are numerous reports that indicate compassionate care is limited within the NHS from which it may be assumed that the culture is toxic for compassion.  The Care Quality Commission report 2014 to 2017, though, highlights that caring was rated as 92% good and 3% outstanding in care homes and the government continues to identify compassionate care as a core value.  Despite this, government focus remains on reducing the cost and cost efficiency within the NHS, which some people believe will reduce the opportunity for compassionate care.

Whilst some types of compassionate care can take more time (incurring more money), there are behaviors that nurses can undertake to increase compassionate care without increasing the time needed.  Techniques such as brief, ordinary and effective communication.