GRAND VALLEY

COLLEGE

Provide motivated ,competent

and Compassionate Service

Reduwan J. (April, 2023)

 Learning Outcomes

 LO1: Apply Professionalism and Ethical Practice

 LO2: Provide Motivated and Competent Care

 LO3: Effective Health Care Communication

 LO4: Provide Respectful Care for Clients

 LO5: Perform With Legal and Ethical Framework

 LO6: Apply humanistic (Compassionate) care to clients

 Learning Objectives

LO1: Professionalism and Ethical Practice

At the end of this Learning Outcome students
should be able to define:
– Basic concept of ethics
– Professionalism
– Professional ethics or Ethical principles
– Professional code of conducts
– Professional values
 Apply Professionalism & Ethical Practice

 Ethics come from Greek word ―ethos,‖ meaning

character or custom

 Ethics is moral principles that govern how person or

group will behave or conduct themselves

 Can be defined as branch of philosophy dealing with

Standards of conduct & Moral judgment

 It is the study of morality

 ...
Ethics is concerned:
what is right, or wrong, good or bad

rightness or wrongness of actions

base for moral reasoning and reflects of values

Ethics is professionally and publicly stated

 ...

• Ethics is collection of fundamental concepts and

principles of ideal human character

• Ethics are code of conduct agreed and adopted by

people

• It sets standard of how person should live and

interact with other people
 Professionalism

 Profession is occupation that requires special knowledge

and skilled preparation
 Profession is generally distinguished from other kinds of
occupation by:
 It requires prolonged specialized training
 It acquire body of knowledge pertinent to role to be
performed
 It need orientation for individual toward service
 ...
 Profession is an occupation that requires
 Extensive education,
 Special knowledge, and
 Skill

 Professionalism is process of becoming professional

 Occupation is a job or a career
 All professions are occupations but all occupations are
not professions
 Purposes of Professional Ethics

 To understand professional conduct

 To provide of profession's commitment to public serve

 To outline major ethical consideration of profession

 To provide general guidelines for professional behavior

 To guide profession in its self regulation

 Characteristics of a Professional
– Honest
– Skilled
– Courteous (Polite)
– Reliable
– Considerate
(caring)
– Dependable
(loyal)
– Cooperative
– Committed

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 How are you Judged as a
Professional?
– Your Communication
– Your Image
– Your Competence
– Your Manner
– Your Appearance
– Your Behavior
– Your Attitude

11
What nonverbal messages is the pharmacist sending?
 Moral

• Fundamental standards of right and wrong that

individual learn and internalize
• Often based on religious beliefs
– Behaviors according to certain traditions
– Moral is principles and rule of right conduct
– Morals are based on religious beliefs, social influence,and
group norms
 Differences b/n Moral and Ethics
Moral Ethics
1. Principles and rules of right • Formal responding process
conduct used to determine right
2. Private, and personal conduct
3. Commitment to principles & • Professionally and publicly
values is usually defended stated
in daily life •Inquiry or study of principles
4. Pertain to an individual‘s and values
character • Process of questioning &
changing, one‘s morals
• Hippocratic oath: ‖ I will use treatment
to help the sick according to my ability
and judgment but never with a view to
injury or wrong doing‖
 Code of Conduct
• A set of conventional
principles and
expectations that are
considered binding on any
person who is a member of
a particular group

16
 Ethical Principles
• Principles are basic ideas that are starting points for
understanding & working through problem
• Ethical principles assume that:
– we should respect value & uniqueness of person, and
– Consider others to be worthy of high regard
• These principles are important to uphold in all situations
• Number of core ethical principles are recognized in
healthcare setting
• These provide basis for complex decision-making by
weighing up multiple factors and consequences of care
 What are the fundamental principles of
healthcare ethics?
• Ethical principles are the foundations of ethical analysis
because they are the viewpoints that guide a decision.
• There are four fundamental principles of healthcare
ethics.
 Autonomy
 Beneficence
 Non-maleficence
 Justice
 Autonomy
• Autonomy is the promotion of
– independent choice,
– self-determination and
– freedom of action.
• Autonomy implies independence and ability to be self-
directed in one‘s healthcare.
• It is the basis of self-determination, and entitles the
patient to make decisions about what will happen to his or
her body.
• It may not be absolute right
 …

• The term autonomy implies four basic elements

– Informed consent
– Paternalism
– Compliance
– Self-determination
Autonomous person is respected
must be able to determine personal goals
has capacity to decide on a plan of action
has freedom to act upon choices
Informed Consent:
• is process by which patients are informed possible outcomes,
alternatives & risks of treatments and are required to give their
consent freely.
• It assures legal protection of patient's right to personal
autonomy in regards to specific treatments and procedures
Paternalism:
• Restricting others autonomy to protect from perceived or
anticipated harm
• Paternalism is appropriate when patient is judged to be
incompetent or to have diminished decision-making capacity
 …
Non-compliance:
• Unwillingness of patient to participate in health care
activity
• Lack of participation in regimen that has been
planned by health care professionals to be carried out
by client
• Noncompliance may result from two factors:
– When plans seem unreasonable to patient
– Patients may be unable to comply with plans for variety of
reasons including: resources, lack of knowledge, psychological and
cultural factors that are not consistent with proposed plan of care
 …
• If client becomes unable to make decision for himself/
herself, ―surrogate decision maker‖ would act on client's
behalf
• Four factors for violation of patient autonomy:
1. assume that patients have same values and goals as
themselves
2. Failure to recognize that individuals‘ thought
processes are different
3.Assumptions about patients‘ knowledge base
4. Focus on work rather than caring
• A 49 year old client with diabetic finding came
with right foot second finger gangrene to a
hospital. The surgeon decided that the finger
should be removed immediately. But the
patient refused the procedure.

• Question: How should the surgeon handle this

case?
 Beneficence

• Beneficence is the ethical principle which morally obliges

health workers to do positive and rightful things.

• It is ―doing what is best to the patient‖.

• In the context of professional-patient relationship the

professionals are obliged to always and without exception,
favor the wellbeing and interest of their patients.
 Example:

• Giving the correct and necessary information

to patients about their condition is considered
as a principle of beneficence.

• In addition, it will promote the autonomy of

patients.
 Non-maleficence:
• The principle refers to “avoid doing harm”.

• Patient can be harmed through omitting or committing

interventions.

• When working with clients, healthcare workers must not cause

injury or distress to clients.

• This principle of non-maleficence encourages the avoidance of

causing deliberate harm, risk of harm and harm that occurs
during the performance of beneficial acts.
 …
• Non-maleficence also means avoiding harm as
consequence of good.
• In these cases, the harm caused must be weighed
against the expected benefit.
• Example: Any medical error (either omission or
commission) could be considered as breaching non-
maleficence.
• If a nurse does not give a patient medication timely
and appropriately, it could be considered as
violating the principle of non-maleficence.

• If a laboratory technologist wrongly reports the

investigation result, he or she violates the principles
of ―do not harm‖ or non-maleficence.
• If a hospital finance manager could not release the
necessary finances, especially due to negligence, to
procure the drugs, equipment or any supply planned
and the patient could not get the care due to the
scarcity of the necessary material, he or she may
violate the principle of non-maleficence.
• Stopping medication i.e. causing harmful side
effects, discontinuing treatment strategy that is
not effective ????
 Justice
• Justice is fair, equitable and appropriate treatment.

• Justice refers to fair handling and similar standard of care

for similar cases; and fair and equitable resource
distribution among citizens.

• It is the basis for treating all clients in an equal and fair

way.

• A just decision is based on client need and fair

distribution of resources.
 …
• It would be unjust to make such decision based on how
much he or she likes each client.

• The rule of ―first come first serve‖ could be an

appropriate rule.

• Justice requires the treatment of all patients equally,

irrespective of their sex, education, income or other
personal backgrounds.
 Ethical Principles
• The major principles of health ethics are:
1. Respect for Autonomy (or Person)
• Respect the decisions of autonomous persons and protect
persons who lack decision-making capacity (e.g., confused
pts, mentally ill).
2. Beneficence
• Act in the best interests of patients
3. Non-maleficence
• Health professionals should not inflict harm on patients
4. Justice
• Requires that people be treated fairly; benefits and burdens
be distributed fairly within society
 2.2.Confidentiality and informed consent

• Confidentiality in healthcare ethics underlines the

importance of respecting the privacy of information
revealed by a patient to his or her health care provider,
• The limitation of healthcare providers to disclose
information to a third party.
• The healthcare provider must obtain permission from the
patient to make such a disclosure.

5/19/2023 37
 Confidentiality...
• The information given confidentially, if disclosed to
the third party without the consent of the patient, may
harm the patient, violating the principle of non-
maleficence.
• Keeping confidentiality promotes autonomy and
benefit of the patient.

5/19/2023 38
 …
 The high value that is placed on confidentiality has three
sources:
• Autonomy: personal information should be confidential, and
be revealed after getting a consent from the person
• Respect for others: human beings deserve respect; one
important way of showing respect is by preserving their
privacy.
• Trust: confidentiality promotes trust between patients and
health workers.

5/19/2023 39
 The right of patient to confidentiality

• All identifiable information about a patient's health

status, medical condition, diagnosis, prognosis and
treatment and all other information of a personal
kind, must be kept confidential, even after death.
• Exceptionally, family may have a right of access to
information that would inform them of their health
risks.

5/19/2023 40
 ...
• Confidential information can only be disclosed if
the patient gives explicit consent or if expressly
provided for in the law.

• Information can be disclosed to other healthcare

providers only on a strictly "need to know" basis
unless the patient has given explicit consent.

5/19/2023 41
 Exceptions to the requirement to maintain
confidentiality

• Many health care professionals require access to a

patient‘s health records in order to provide adequate
care
• Care providers routinely inform the family members
of a deceased person about the cause of death.
• These breaches of confidentiality are usually
justified, but they should be kept.

5/19/2023 42
 …
• to a minimum and those who gain access to
confidential information should be made aware of the
need not to spread

• Where possible, patients should be informed ahead

that such a breach might occur.

5/19/2023 43
 Ethiopia Council of ministers’ regulation 299/2013, Article 77
Professional Confidentiality

5/19/2023 44
 Disclosure of Information
 Disclosure of information is not necessarily actionable breach of
confidence
 Disclosure may be allowed under certain circumstances, when it is
requested by: patient, & it applies
 Other health practitioners (with patient‘s consent, & where information is relevant
to patient‘s care)
 Relatives in limited circumstances
 Researchers with ethics committee approval
 Court
 Media, if patient has consented; and
 Police, when HP has duty to provide information

5/19/2023 45
 Informed Consent
• Informed consent is legal document whereby a patient signs written
information with a complete information about the purpose, benefits,
risks and other alternatives before he/she receives the care intended.

• It is a body of shared decision making process, not just an

agreement.

• Patient must obtain and being empowered with adequate

information and ensure that he/she participated in their care process.

5/19/2023 46
 ...
• For consent to be valid, it must be voluntary and informed, and
the person consenting must have the capacity to make the decision

• These terms are explained below:

• Voluntary: the decision to either consent or not to consent to

treatment must be made by the person him or herself, and must not
be influenced by pressure from medical staff, friends or family.

• This is to promote the autonomy of the patient.

5/19/2023 47
 …
• Informed: the person must be given all of the
information in terms of what the treatment involves,
including the benefits and risks, whether there are
reasonable alternative treatments and the
consequences of not doing the treatment.
• This will help to avoid harm—patients may harm
themselves if they decide based on unwarranted and
incorrect information.
5/19/2023 48
 …
• Capacity: the person must be capable of giving
consent, which means they understand the
information given to them, and they can use it to
make an informed decision.

5/19/2023 49
 General principle

• You should ensure that informed consent be given by

a patient before any medical treatment is carried out.
• The ethical and legal rationale behind this is to
respect the patient‘s autonomy and their right to
control his or her life.
• The basic idea of personal autonomy is that
everyone‘s actions and decisions are his or her own.

5/19/2023 50
 Information for patients
• Effective communication is key to achieving
informed consent.

• Every adult patient is presumed to have the capacity

to make decisions about their own healthcare

• A care provider or health worker has a duty to assist

patients to make informed decisions

5/19/2023 51
 …
• A healthcare worker, should consider patients‘ individual
needs and priorities when providing information.
– patients’ beliefs, culture, occupation or other factors

• The health worker should ask a patient whether they have

understood the information they have received and if
they need more information before making a decision

5/19/2023 52
 ...
• The care provider must answer any questions the patient
might have.
• Also, the care provider must not withhold any
information necessary for the patient to make an
informed decision unless disclosure would cause the
patient serious harm
• It is not recommended to seek consent when a patient
may be stressed, sedated in advance of an intervention.
5/19/2023 53
 Health Professionals responsibility for seeking
consent

• Healthcare providers must have full understanding of

the procedure or treatment, how it is carried out and
the risks attached to it.

5/19/2023 54
 Decision making for incompetent patients
• Many patients may be incompetent to make a
decision for themselves.
• Example, include young children, individuals affected
by certain psychiatric or neurological conditions
which potentially impair their decision making
ability, and those who are temporarily unconscious or
comatose.
• These patients require substitute decision-makers.

5/19/2023 55
 Refusal of treatment

• Every adult with power to decide is entitled to refuse

medical treatment.

• The healthcare provider must respect a patient‘s

decision to refuse treatment, even if he or she
disagrees with the patient‘s decision.

5/19/2023 56
 Ethiopia Council of minister‘s regulation
299/2013, Article 52. Patient‘s informed consent

1.Medical service may not be provided without obtaining the

patient‘s informed consent

2.Not withstanding the provision of sub-article 1 of this article,

medical service may be provided to a patient without obtaining
his/her consent when:

a.The patient is unable to give his consent and such consent is

given by

5/19/2023 57
 i. A person authorized by the patient in writing to
give consent on his behalf;
ii. In the absence of a person authorized to give such
consent, the spouse, child, parent, brother, or sister
of the patient; or
iii. A person authorized to give such consent in
accordance with the law or a court order

5/19/2023 58
• 4.The health professional shall explain to the patient
who refused to get medical services, the possible risks
of his refusal on his health and shall record same in
writing

• 5.A consent given under this article shall be valid

when it is obtained from the patient or any other third
party in writing

5/19/2023 59
 Case study 2
• A 16 year-old female came to public hospital accompanied by her mother for a
complaint of absence of menses since two months. Up on examination she gave a
history of forced sex with her uncle before two months, but did not tell to anybody.
Up on evaluation, she is found to be pregnant. The physician counseled her on the
availability of medical abortion service but he needs written consent. And he also
advised her to report the incident of forced sex (i.e. rape) to the nearby legal office.
But she decided not to report the incident of forced sex. Also she did not want to
reveal her condition to her mother despite her mother insisting to know.

• Discuss on:
• -How would you manage this case?

• -How do you address the confidentiality and consent- related issues?

• -Do you report this case to the legal office?

5/19/2023 60
 Ethical issues related to patients
rights
1. Right to truth: The right of patients to know the truth
about their condition, prognosis, and treatment is an
issue between the physician and the patient
2. Right to refuse treatment: For reasons that are
sometimes known only to themselves patient may
refuse treatment even though lack of treatment may
result in their death

5/19/2023 61
 Ethical issues related to patients
rights
3. Informed consent: Patients have the right to be given
accurate and sufficient information about procedures, both
major and minor, so that their consent to undergo those
procedures is based on realistic expectations

4. Human experimentation: responsibilities and ethical

decisions are related to making sure that informed consent
is given for participation in the research experiments and
that the safety of their patients is protected
5/19/2023 62
 Health related Legal issues in Ethiopia:

1. Abortion:
– You shall dispense Medication abortion or MVA if
the physician is sure that an abortion is performed
for the purpose of saving the endangered life or
health of women
– You shall not attempt or carry out abortion
– You shall report to the concerned authorities of
criminal abortion in the absence of physician
– You have all the right not to participate in all
procedures of criminal abortion
5/19/2023 63
 Abortion:
Article 551: cases where law allows termination of
pregnancy
1. When the pregnancy is the result of rape or incest or
2. When continuance of pregnancy endangers the life
of the mother or the child or
3. Where the fetus has an incurable and serous
deformity or
4. Where the pregnant woman is physically as well as
mentally unfit to bring up the child

5/19/2023 64
 Health related Legal issues in Ethiopia:
2. Suicide
– If you are taking care of a patient with a suicidal
tendency you shall remove all items that facilitate
suicide such as sharp instruments, ropes, belts, drugs
and make sure that the outlets are graded.
3. Euthanasia
– You shall never assist; collaborate in taking life as an
act of mercy even at the direct request of the patient
or patient's relatives
5/19/2023 65
 Health related Legal issues in
Ethiopia:
Types of euthanasia
1. Active euthanasia: Is a deliberate attempt to end life.
e.g., deprivation of oxygen supply, administering an
agent that would result in death (e.g. Belgium,
Netherlands etc)
2. Passive euthanasia: allowing death by withdrawing or
withholding treatment. No special attempt will be made
to revive the patient. (e.g. Switzerland, Some states in
USA like, California, Washington)
 All forms of euthanasia are illegal except in states
where right to die status and living will exist
5/19/2023 66
 Negligence
• Failure to exercise due care, resulting in injury to
another
• The failure to exercise due care may be the omission to
perform an act that a reasonable person, would perform,
or it may be the commission of an act that a reasonable
person would not commit
• Negligence implies that the careless conduct was in
violation of a legal duty

5/19/2023 67
 What is Compassionate and Respectful Care

• Compassion

Is a feeling of deep sympathy and sorrow for the

suffering of others accompanied by a strong
desire to alleviate the suffering.

• Therefore, it is being sensitive to the pain or

suffering of others and a deep desire to
alleviate the suffering
68
 Cont’ed
• When they are receiving services at HF too many
patients experience
– de-humanizing and
– impersonal treatment

• These are a crisis for all

• Compassion lies at the intersection of :

– empathy (in this case, understanding patients‘ concerns)
and
– sympathy (feeling patients‘ emotions).

69
 Cont’ed
• A health professionals‘ care with compassion
is a truly patient-centered.

• Compassionate care addresses:

– the patient‘s innate need for connection and
relationships, attentive listening and a desire to
understand the patient‘s context and perspective.

70
 ...

Dr. Catherine Hamlin with fistula clients. Hamlin

Fistula Ethiopia, Addis Ababa:
/www.hamlinfistula.org/
 …
• ―This has broken my heart. I feel every time I
see woman affected by obstetric fistula ―how
could they do this to me, how could they do
this to this poor woman.‖

Dr Catherine Hamlin
 Respectful care

• Is the kind of care, in any setting, which supports

and promotes, and does not undermine a person‘s
self-respect, regardless of any differences.

73
 Cont...
• The action meanings of the word respect are:-
Pay attention to
Honoring
 Avoiding damage e.g. insulting, injuring
 Not interfering with or interrupting
 Treating with consideration
 Not offending

74
 Cont...
• Caring is coupled with effective interventions
to alleviate that suffering.

75
 Cont...
 Compassionate, respectful and caring (CRC) –
means:
serving patients,
being ethical,
 living the professional oath, and
being a model for young professionals and
students.

76
• It must encompass respect for patients‘ basic
human rights, including respect for
– patients‘ autonomy,
– dignity,
– feelings,
– choices, and
– preferences.
• It must include choice of companionship
wherever possible.
• All human beings are born free and equal in
dignity and rights.‘

• A three-year report of the Ethics Committee and

relevant documents in Addis Ababa showed that
39 complaints were related to death of the
patient and 15 complaints were about disability.
 ...
• 14 of the 60 claims had an ethical breach and/or
negligence

• other study also indicated that forwarding bad

words, shouting on patients, mistreatment, insulting
and hitting of clients are some of unethical practices
showed by the health professionals.
Who are the beneficiaries of CRC?

what are their benefits?

 The benefits of CRC
The benefits and beneficiaries of Compassionate and Respectful Care

81
cont...

82
Quality of Compassionate care

Brainstorming Activity:

Can compassion be trained and learned?

84
Qualities of compassion

87
 …
• Motivation:

– Making a decision to be compassionate, and

– it is the commitment to try to do something about

the compassionate care.

88
 …
• Being sensitive:
– Making an effort to become sensitive to feelings
and thoughts will heighten sensitivity to one‘s
needs.

• One must learn to notice one‘s thoughts and feelings

as they come about.

• To be sensitive means ‗openness and ability to

recognize and listen in appropriate ways‘.

89
Sympathetic:
• To be sympathetic is to be emotionally affected by
suffering of others.

• It is an emotional reaction to one‘s own and other

people‘s emotions and states (e.g. flinching when one
sees someone fall.

• It can also be expressed by the feeling of joy over the

well-being of others.

90
Empathy:
• Understanding and how one perceives one‘s feelings
and thoughts is to empathize.

• To be open and curious helps one to understand how

one feels, what one feels and why.

• It is the ability to sense feelings or concerns of others;

this often leads to compassion, which is a feeling of
concern for the sufferings or misfortunes of others.

91
Distress tolerance:
• To be open to feelings, one must accept them.

• Some examples of reactions to feelings is sometimes to be

critical, to run away from them, to hide or suppress them; but
when one is compassionate, it is easier to be open, tolerant,
accepting of different types of feelings.

• Therefore an important aspect of compassion is to learn how to

tolerate and come to terms with, become familiar with, and
less frightened of, one‘s feelings.

92
Not to condemn or judge:
• The suffering mind, for example, can be filled with condemning and
critical thoughts of one‘s self or others.

• Letting go of these negative thoughts is linked to becoming kind

and mindful; we become more aware of thoughts and feelings from
an observational point of view.

• We should not judge them, nor try to suppress them or push them
out of our minds, avoid or run away from them (this means, we have
to accept as they are). Rather, one should learn to reflect more and
not react too hastily.

93
Caring:
• Care is the ―action and activities directed towards
assisting, supporting or enabling another individual or
group with evident or anticipated needs to improve a
human condition or life way or to face death‖.

94
 Patient-Reported Outcomes

 refer to the effect of compassion on suffering, patient

well-being, and care.

• Although some patients feel that compassion directly

improves the health outcomes, compassion primarily
enhances patients‘ well-being and the quality of their
relationship with their healthcare providers.

95
 Principles of compassionate care
1. Attention : it is the focus of healthcare provider.

2. Acknowledgement :it is the principle of what the

healthcare professional says.

3. Affection: it is how healthcare providers affect or touch

people.
– Human contact has the ability to touch someone‘s life.
– It is the quality of your connection, mainly through warmth,
comfort, kindness and humor.
– Affection brings joy and healing.

96
 Cont’ed
4. Acceptance: it is the principle of being with mystery
– how you stand at the edge of your understanding or at
the beginning of a new experience, and regard what is
beyond with equanimity.

• It is the quality of your presence in the face of the

unknown, in the silence.

• Like the sun in the north at midnight, acceptance

welcomes the mysteries of life and is at peace with
whom we are and where we are, right now.
• The principle of acceptance is: being at peace with the
way things are allows them to change.

97
 Characteristics of CRC health professionals
have the following four essential chxs :

1.Consider patients as human beings with complex

psychological, social and economic needs and provide person-
centered care with empathy;

2.Effective communication with health care teams, interactions

with patients and other health professionals over time and across
settings;

3. Respect for and facilitation of patients‘ and families,‘

participation in decisions and care

4Take pride in the health profession they are in and get

satisfaction by serving the people and the country.
 Threats of Compassion
• In general, the most common threats for
compassionate care are:
 Compassionate fatigue

Unbalanced focus between biomedical model (clinical

training) and person

Stress, depression and burnout

Overall health facility context

99
 Cont’ed
• Compassion Fatigue

– Physical, emotional and spiritual fatigue or exhaustion

resulting from care giving that causes and a decline in
the caregivers‘ ability to experience joy or feel and
care for others.

• A form of burnout, a kind of ―secondary

victimization‖ what is transmitted by clients or
patients to care givers through empathetic
listening.

100
Unbalanced Focus in Biomedical Model in Clinical
Training

– Medical training and practice for healthcare

professionals are usually based on biomedical
model with little emphasis on developing
characteristics of compassion.

– Without emphasis on also the human aspect of

medicine, there is a risk that professionals detach
themselves from the patient‘s distress and personal
circumstances and ultimately mistreats the patients

101
 Stress, depression and burnout
• Evidence suggests that depression and high stress
affect the performance of staff in a variety of
ways, including problems in memory, decision-
making, concentration, as well as potentially
leading to abuse of alcohol and other drugs, and
decreases the ability to perform compassion.

• Burnout (or occupation burnout) is a

psychological term referring to general
exhaustion and lack of interest or motivation to
work.

102
 Wider health facility Context
• Attention by senior managers and health facility
boards to achieve financial balance that affects
priorities and behaviors of staff in health facility.

• If finance and other internal stakeholders are not

perceived as being primarily important, it can
have a negative effect on the whole achievement
of the health facility and hampers the value of
compassion.
103
 Addressing Threats of compassion

• Overcoming compassion fatigue:

Developing an inner compassionate self:
Focusing on creating a sense of a
compassionate self, just like actors do if
they are trying to carry out a specific role

104
 Cont’ed
• Compassion to yourself:
– This is linked to developing feelings, thoughts and
experiences focusing on self-compassion.
– Life is often very difficult and learning how to
generate selfcompassion can be helpful during
these times, particularly to help understand
emotions.
– Teaching compassion to professionals through,
training and education

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 Cont’ed
• Dealing with staff stress and burnout:
– Ways to address staff stress may include

preventive strategies, including creating regular

support groups or stress management workshops
for health professionals or suggesting taking time
outs.

– secondary strategies including counseling and

occupational health services.

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 Cont’ed
• Dealing with wider health facility context:
– As health facility scope with increasing patient
demand and higher levels of patient need, it
becomes even more important to address issues of
humanity within the process, dealing
compassionately with staff so that health facility
staff can do the same for patients.

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 Effective Health Care
Communication

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 Communication
• Communication is complex process of sending and
receiving verbal and non-verbal message

• It allows for exchange of information, feelings, needs, and

preferences

• It is the process of creating common understanding

• It is the process of sharing information

• It is the process of generating & transmitting meanings

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 Purposes of Communication

• Informing: new idea is introduced and made familiar to target

audience

• Educating: new idea is explained including its strengths and

weakness

• Persuading: audience is given convincing argument that

motivates them to take action or accept new idea

• Entertaining: attention of audience is drawn to new idea by

stimulating audience‘s emotion
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 Types of Communication
• People Communicate in variety of ways

1. Verbal Communication

• Verbal communication is exchange of information

using words and includes both spoken and written
word

• Verbal communication depends on language which is

prescribed way using words so that people can share
information effectively
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 …
• Verbal communication is used extensively when
– speaking with clients,
– giving oral reports to others,
– Counseling on medication use

• Characteristics of verbal communication:

– simple, brief,
– clear, relevant,
– well timed,
– adaptable, credible

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2. Non-verbal Communication
Non-verbal communication is exchange of information without
use of words
– It is communication through gestures,
– facial expressions,
– posture,
– body movement,
– rate of speech,
– eye contact
• Non verbal is less conscious than verbal, requires systematic
observation and valid interpretation

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 …
• It is generally more accepted than verbal
communication

• because non-verbal communication expresses more of

true meaning of message

• Therefore, you must be aware of both non verbal

messages they send and receive from clients

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facial expression matters
3. Meta or Mass Communication

• It is means of transmitting messages using mass media to large

audience that usually reaches large segment of population

• Mass media includes broadcast media (radio and television) as

well as print media (newspapers, books, leaflets and posters)

Advantage:
– Reach many people quickly to creating awareness for large people
– They are believable specially when source is a credible one
Limitation:
– One sided (linear)
– Doesn‘t differentiate target

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 Levels of Communication

1. Intra-personal Communication

• It takes place inside person

• It includes beliefs, feelings, thoughts, and justification we

make for our actions

• E.g. person look object & develop certain understanding

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2. Inter-personal Communication
• Face to face interaction between two people who are together
at same time and place
• E.g. between health extension worker and community member,
teacher and students in class
Advantage
– Two way communication
– Communication could utilize multi-channels (both verbal & non
verbal)
– Useful when topic is taboo or sensitive
Limitation
– Requires language ability of source
– Requires personal status
– Needs professional knowledge and preparation
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 …
3. Public (Group) Communication

• Face to face communication with several people and

members have common interest to work together for
common goal

• Small group is considered b/n 3-15 people to have

impact on decision making

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 1. One-way Communication
• This is linear model of communication in which
information flows from source to receiver
• There is no feed back from receiver
• It is commonly used in advertising
• Model is best used by organizations when message is
simple & needs to be communicated quickly
• There is no opportunity to clear up misunderstanding and
meaning is controlled by receiver

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 2.Two-way communication

• Message is more complex, two way communication

becomes essential
• This model of communication, information flows
from source to receiver and back from receiver to
source
• Addition of feedback allows sender to find out how
message is being received and so it can be monitored
and adapted to better suit receiver‘s needs.

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 Two way communication model

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 Components of Communication
• 1. Source (Sender)

• Originator of message

• Can be from individual, group, institution, organization

• People are exposed to communication from different source but most

likely to accept communication from person or organization that they trust

• Depending on community, trust and source credibility may come from:

– Personal qualities or actions e.g. HCWs who comes out to help people

– Qualification and training

– Person‘s natural position in family or community

– E.g. village chief or elder

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 2. Message
• Message consists of what is actually communicated idea
including actual appeals, words, pictures & sounds that you
use to get ideas
• Message will be effective if only advice presented is relevant,
appropriate, acceptable, and put across in understandable way
• Message is said to be good if it is:
– Epidemiologically correct (Evidence based)
– Affordable (Feasible)
– Requires minimum time/effort
– Realistic
– Culturally acceptable
– Easy to understand
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 3. Channel
• Channel is physical means by which message travels
from source to receiver

• Commonest types of channels are verbal, visual,

printed materials or combined audio visual and
printed materials

• Your choice of channel will depend on what you are

trying to achieve, nature of your audience, and what
resources used
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 4. Receiver (Audience)

• Person or group for whom communication is intended

• First step in planning any communication to consider
is intended audience
• Before communication, following characteristics of
audience should be analyzed
– Educational factors: can they read and write?
– Socio cultural factors: What do they believe and
feel about topic of communication?
– Patterns of communication: how people show
respect when talking to another person?
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 5. Effect and Feedback

• Effect is change in receiver‘s knowledge, attitude,

practice, or behavior

• Feedback is mechanism of assessing what has

happened on receiver after communication has
occurred

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 Communication Process

• Communication process has six steps

– Ideation
– Encoding
– Transmission
– Receiving
– Decoding
– Response

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1. Ideation: sender decide to share & develop idea or
selects information to share

• The sender need to know his/her goal and think

clearly for message to be meaning full

2. Encoding: putting meaning into symbolic form

―speaking, writing, or nonverbal behavior which is
understood manner‖

• Symbols are differ from senders personality, culture,

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3.Transmission: message must overcome obstacle to reach
receiver
4. Receiving: The receiver‘s senses of seeing and hearing are
activated as transmitted message is received
5. Decoding: The receiver define word and interpret gesture
during transmission of speech but written message allow more
time for decoding
Communication process dependent on receiver‘s
understanding of information
6. Response or feedback: sender must know that message has
been received and accurately interpreted

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 Basic Characteristics of Communication
• Communication is reciprocal and continuous process in which
both sender and receiver of messages participate
simultaneously
• Communicating person receive and send message by verbal
and non verbal ways which occurs simultaneously
• Non-verbal communication is more likely to be involuntary
since it is under less control of person
• Non verbal communication is considered as more accurate
that express true feelings and help person to understand
hidden messages
• There is proverb that says "Action speaks more than
thousands of words
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 Conversation Skills

• Control tone of your voice

• Be knowledgeable about topic of conversation
• Have accurate information
• Be flexible
• Be clear and concise
• Avoid words that may be interpreted differently
• Be truthful
• Keep open mind

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 Listening Skill

• Listening skill is skill that involves both hearing and

interpreting what is said
• It requires attention and concentration to sort out,
evaluate, and validate clue so that one understand true
meaning in what is being said
• Listening requires concentrating on client to what is being
said

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Techniques to improve listening skill

• Sit with client when communicating if possible

• Be alert, relaxed, and take sufficient time to client
• If culturally appropriate maintain eye contact with
client
• Give or pay attention to what client is saying
• Think before responding to client
• Listen client's comments

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 Barriers for Communication
• Competition for attention (noise)
• Language difference and vocabulary use
• Age difference
• Attitudes and Beliefs
• We cannot avoid or overcome all these barriers
but we have to find ways to minimizing them

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A. Competition for Attention (Noise)
• Noise is major distraction of communication which
could be:
• Physical Noise: avoidable
• Internal Noise: any physiological or psychological
state that undermine persons ability to effective
communication like illness
B. Language Difference and Vocabulary Use
• This includes language difference, vocabulary use,
and use of word that has different meaning

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C. Age Difference
• Age difference between sender and receiver is barrier to
effective communication
• For example, if sender is young inexperienced &
unknowledgeable then audience may not give proper attention
D. Attitudes and Beliefs
• Community may be misguided by health extension worker
• Cultural beliefs of people influence to accept and adopt new
idea and skill
• Beliefs of community may order foods that given to children

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 Overcome Barriers of Communication
• Sender must know his/her audience‘s
– Background
– Age and sex
– Social status
– Education
– Job/work
– Interests/needs
– Language
Messages must be
– Timely
– Meaningful/relevant
– Applicable to situation
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 Characteristics of Effective Communication

• Two way communication has been established

• All barriers have been removed

• Proper media has been chosen

• Good presentation has been made

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 …
• Interpersonal Skills
• Interpersonal skills are communication skills that
required for positive relationships between persons
• These skills are essential to establish and promote
good professional-client relationship
Some of interpersonal skills are
– Friendliness
– Openness
– Empathy
– Competence
– Consideration of client variable
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 …
Factors that facilitate positive interaction or
interpersonal communication
– Purpose of interaction
– Choosing comfortable environment
– Providing privacy
– Providing confidentiality
– Focusing on client

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 THANK U !!!
Any comment or suggestion???

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