I P&C POL ICY
l Compassion has vast benefits for patients across a wide variety of conditions.
l Missed opportunities for compassion can have devastating health effects.
l Compassion can help reverse the cost crisis in healthcare.
l Compassion can be an antidote for burnout among healthcare providers.
l Forty seconds of compassion can save a life.
One study cited by the pair found that shifting from a low- to a high-scoring category of physician empathy decreased the odds of metabolic complications among diabetic patients by 41%.5
Another study6
found that homeless patients assigned to standard medical care plus compassionate contact from trained volunteers had 33% fewer emergency department visits and were twice as likely to rate their hospital experience highly. “This book shifts the debate around compassion and quality care from opinions to impact, with hard data,” commented Storr. “The authors describe compassion as ‘the wonder drug of the 21st Century’,” she continued, explaining that “empathy plus action equals compassion”. In short, it is the emotional response to another’s pain or suffering, involving an authentic desire to help. Storr went on to discuss compassion in the context of IP&C during the COVID-19 pandemic. In response to the threat posed by the virus, NHS England and PHE developed the campaign: ‘Every action counts: hierarchy of controls for IP&C’7
The hierarchy included
the following (in order): 1) Elimination, 2) Substitution, 3) Engineering Controls, 4) Administrative Controls and 5) PPE. She commented that we now need to pause and re-think the hierarchy of controls, bringing compassion into the discussion. “The video focuses on the germ – the science. It doesn’t look at the impact of those controls on the person…We need to keep this in mind and view this through the lens of compassion,” Storr asserted. “In
If you search WHO and national infection prevention guidelines, the word ‘compassion’ doesn’t appear once…The word ‘consequences’ appears once but only in relation to the consequences of healthcare-associated infection and not in terms of the consequences of what we do to prevent that infection.
the immediate ‘eye of the storm’, we saw an extreme form of ‘elimination’ in terms of people being able to see their loved ones – visits were suspended indefinitely across health and social care.”
She acknowledged that this seemed to make sense at the time and was widely accepted – it was considered an unavoidable measure to protect people from the harm of Coronavirus. However, these restrictions persisted beyond the immediate period, and this had a considerable impact, leading to harms.
The WHO has previously published guidance on ‘Managing ethical issues in infectious disease outbreaks’.9
This
guidance grew out of concern about ethical issues raised by the Ebola outbreak in West Africa in 2014–2016. It became increasingly apparent that the ethical issues raised by Ebola also mirrored concerns that had arisen in other global infectious disease outbreaks, including severe acute respiratory syndrome (SARS), pandemic influenza, and multidrug- resistant tuberculosis.
“WHO concluded, retrospectively, that some of the strategies were more extensive than necessary to address the public health crisis. The guidance reinforces the need for solidarity and reciprocity when dealing with uncertain and potentially catastrophic infections. But liberty restricting actions can be justified in those instances. However, it emphasises that ‘restrictions should be
informed by evidence, proportionate…carried out humanely and limited to the immediate crisis only’,”8,9
commented Storr.
In 2020, WHO also produced a document that focused on restrictions in long-term care. This stated: “Establish clear visiting policies that provide a balance between IP&C measures and the need for people to maintain their psychological wellbeing (enable residents to have visitors while minimising the risk of COVID-19)”.10 “The policy brief talks about prioritising the psychological wellbeing of people receiving long-term care. What seems to have happened is that the priority, in some instances, has been focused on elimination. We need to think about why it happened – why we became fixated on the top of the hierarchy of controls, and not others, which may have led to a different outcome,” she commented.
In healthcare, the initial guidance was to suspend general visiting while continuing to support compassionate visiting when needed – for example at the end of life. “It wasn’t just care homes that focused on elimination in terms of visits. While we know that hospitals will have made exceptions, the way these exceptions were implemented was highly variable and open to interpretation. What constitutes ‘end of life’ for example? There are examples where end of life was justified as days or hours rather than months – the definition was a ‘thorny issue’,” Storr continued.
Updated guidance subsequently emphasised ‘discretion’ for hospitals to define visiting arrangements. The newspapers highlighted the impact a lack of visitors had on people’s phycological wellbeing, with headlines such as “Coronavirus: No hospital visitors ‘broke mum’s spirit’ (BBC, June 2020).11 Storr also pointed out that this has also taken its toll on healthcare professionals who were placed under considerable stress. She said that compassion also needs to be extended to healthcare workers impacted by the decisions that were made, at this time, but added it should not “stop us asking questions” and challenging what has happened. “There is a huge opportunity to learn from
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WWW.CLINICALSERVICESJOURNAL.COM DECEMBER 2021
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