Proposing implementation strategies to enhance compassionate nursing care of complex patients: an exploratory sequential mixed methods research design

Abstract

Background: Complex patients have multiple, ongoing health conditions, often with limited resources, and are frequent recipients of health and social care services. Complex patients experience discrimination and are often shown a lack of compassion from nurses and other health professionals which negatively impact their care experiences and health outcomes. Missing in the practice literature are the strategies to guide much needed improvements in the compassionate nursing care of complex patients. Purpose: The purpose of this doctoral dissertation was to enhance understanding of the indicators of, and barriers to, compassionate nursing care delivery and to propose implementation strategies with potential to promote compassionate nursing care of complex patients. Methods: An exploratory sequential mixed methods design was conducted comprised of a qualitative phase, an instrument development phase, and a quantitative phase. The qualitative phase enabled identification of indicators and barriers based on interviews with 23 individuals with experiences as complex patients. Barriers were then mapped to implementation science frameworks in the instrument (i.e., a Q-sort survey) development phase to identify relevant domains and integration functions, and to choose implementation strategies for the survey concourse. The Q-sort survey was then electronically distributed during the quantitative phase to over 140 nursing, health, and compassion care experts, out of which 32 responded and ranked the strategies. Principal component analysis determined highest ranked strategies. A five-factor solution was generated using Varimax rotation. Merging technique confirmed the rankings before strategies were subsequently operationalized using an implementation science specification framework, followed by development of an implementation plan. Results: Participants identified six indicators of compassionate nursing care—nurses who are: sensitive, aware, positive, nonjudgmental, empathic, and altruistic. Barriers were categorized under knowledge, intentions, skills, social influences, behavioural regulation, reinforcement, emotion, and environmental context and resources. The final operationalized implementation strategies included: organize clinician implementation team meetings, involve patients and families, modelling, implementation facilitation, and ongoing consultation with stress experts. Conclusions: Implementation strategies made specific for practice contexts are urgently needed to effect change at provider, managerial and organizational levels to improve compassionate care experiences of complex patients. One promising approach are alliances between health professionals and patient and family groups to design, plan, and implement strategies to improve compassionate nursing care.