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U.Va. Schools of Nursing and Medicine Building a Transformational Model for Compassionate Care Worldwide

February 23, 2010 — When Dr. Monica Sharma, the former United Nations director of leadership and capacity development, led a recent two-day workshop, "Alleviating Human Suffering through Compassionate Care," she helped to lay a solid cornerstone for a burgeoning program at the University of Virginia.

The U.Va. Initiatives in Compassionate Care is a collaboration between the schools of Medicine and Nursing, and is envisioned as a transformational model for delivery of "compassionate care." The goal is "to improve the lives of those with life-threatening illnesses across the lifespan and in health care settings by transforming practice, education, research and community partnerships."

Compassionate care is not a new concept; in fact, the mission statement for the School of Nursing includes "providing high-quality and compassionate health care." Certainly many health care providers are compassionate in their practice, but the intent of the initiatives is to make such care less a matter of individual happenstance and more a systematic expectation within a supportive institutional framework, and to better meld the often technological aspects of modern health care with human needs – physical, emotional, psychosocial and spiritual.

As one expert, Cynda Rushton of Johns Hopkins University, put it, "Compassion denotes the presence of an appropriate relationship to suffering and the capacity to respond to suffering without being overwhelmed by it and to transform it in beneficial ways."

One example is that of a nurse who is able to provide highly skilled physical care for a critically ill patient while simultaneously being flexible with routines that help the family stay connected with the patient and to fulfill their commitments in the face of terminal illness. It could be a physician who offers a moment of silent prayer after giving a life-altering diagnosis, or a chaplain sitting quietly with a family grieving the impending death of a loved one.

According to Dorrie Fontaine, dean of the School of Nursing, who is directing the effort, "We intend to lead the way in guiding significant transformation in designing, developing, implementing and improving compassionate care in communities we serve now and those across the globe that will be served by our graduates. We recognize the need to create systems and methodologies to assure compassionate care and to boost resiliency for these caregivers."

Philanthropists Tussi and John Kluge have provided significant funding for the program, including creating endowed professorships in both the schools of Medicine and Nursing. The program includes the Kluge Compassionate Care Lecture Series, workshops and retreats, weekly mindfulness practices and outreach efforts that bring multidisciplinary teams to patients' homes and that engage the broader community in shaping the initiatives.

As part of the effort, Jon Kabat-Zinn, a founder of mindfulness-based stress reduction, will present a series of workshops March 11-16.

The initiative's interdisciplinary leadership team includes Fontaine; David Cattell-Gordon, director of Community Engagement and Rural Network Development at the U.Va.Health System; and Dr. Daniel Becker, Tussi and John Kluge Professor and director of the U.Va. Center for Biomedical Ethics and Humanities. Tussi Kluge plays an active role in supporting the ongoing development of the program.

The program also is guided by outside consultants. Rushton is an associate professor of nursing and pediatrics at the Johns Hopkins University schools of Nursing and Medicine and an international leader in palliative care and ethics. She is engaged in designing innovative models of practice, education and systems integration to bring heart-centered principles into the care of people with life-threatening conditions, their families and their communities.

Sharma, who led the recent workshops, serves as a consultant and facilitator. A former program director for the United Nations, she was responsible for whole-system transformations, especially in severely impoverished countries. She has worked with UNICEF on multiple levels to address the needs of children worldwide. Her extensive work on HIV/AIDS issues resulted in more than 720 initiatives with positive measurable results in 40 countries. Her continuing leadership is expected to help develop an aggressive plan to design a new approach to delivery of compassionate care at U.Va. and she was recently inducted as an honorary member of the prestigious nursing honor society, Sigma Theta Tau International.

At a Feb. 8 interdisciplinary introduction and planning session at the Harrison Institute's Byrd/Morris Room, Sharma engaged a group including experts from the U.Va. schools of Nursing, Medicine, Law, the Curry School, Darden and a corporate CEO. The following day, the group was expanded as about 60 people met in the Rotunda Dome Room in a town hall-style collaboration for implementation planning. Participants considered their deepest aspirations, identified their unique contributions, and explored how their collective talents and commitments could be leveraged toward transforming care.

Becker described the event as an experience that "prompted University and community leaders to reconsider the activist creed of 'think global and act local' to move past positions and opinions and professions to the basic human qualities that lead to change – our ability to listen to each other, find joy, remain curious, allow humor, and reinvent our commitment not only to our patients, but also to ourselves."

Though the program is growing and developing, Cattell-Gordon said he saw the event as a watershed moment. "Those two days provided us invaluable wisdom, deeply felt inspiration and substantial guidance. We hope this moment represents a strategic inflection point – a moment when we can all look back and say, 'This is when lasting change in our programs and systems in compassionate care began to occur.'"

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