PHARMACY LEVEL III

NTQF Level -III

Learning Guide #02
Providing Compassionate,
Unit of Competence: - Respectful and Caring
Service
Providing Compassionate,
Module Title: - Respectful and Caring
Service
LG Code: HLT PHS3 M01 Lo1-LG2
TTLM Code: HLT PHS3 TTLM 0919v1

LO 2: Applying humanistic care to clients

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 The Caring, Respectful and Compassionate
Information Sheet-1 health workforce
CONTENT-1
Instruction Sheet Learning Guide #02
This learning guide is developed to provide you the necessary information regarding the following
content coverage and topics –
 The Caring, Respectful and Compassionate health workforce
 Patients feeling and emotions
 Patients/clients innate needs
 Recognizing patient's responsibilities and medication experience
 Ensuring safety of medications
This guide will also assist you to attain the learning outcome stated in the cover page. Specifically,
upon completion of this Learning Guide, you will be able to –

understood and implemented Patients concern
 Consider Patient and clients feelings and emotions

 addressed and communicated Patients innate needs

Learning Instructions:
1. Read the specific objectives of this Learning Guide.
2. Follow the instructions described below 3 to 6.
3. Read the information written in the information “Sheet 1, Sheet 2, Sheet 3 and Sheet 4, ” in
page 3, 16, 18 and 23 respectively.
4. Accomplish the “Self-check 1, Self-check t 2, Self-check 3 and Self-check 4” ,---” in page 9, 14,
16 and 21 respectively

2.1. Introduction to Compassionate, Respectful and Caring (CRC)

Compassion (ሩህሩህ)

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
Is a feeling of deep sympathy and sorrow for the suffering of others accompanied by a strong
desire to alleviate the suffering? Therefore, we can say it is being sensitive to the pain or
suffering of others and a deep desire to alleviate the suffering.
 To be optimally effective in clinical medicine, every health professional without exception should
be technically excellent and practice with compassionate care. However much technical
advances in medicine are beneficial to patients, no person who is ill should have to suffer the
indignity of a technically competent but uncaring doctor, nurse, or other staff member. Good
medical practice has been perennially captured in the phrase “the art of medicine,” which
combines scientific-technical knowledge with humanism, defined as the physician’s interest in
and respect for the patient as a person experiencing illness.
 Too many patients experience de-humanizing and impersonal treatment, so much so that this is
now a crisis within healthcare systems, proving destructive not only for patients, but for
professionals, families and the systems themselves.
 Compassion lies at the intersection of empathy (in this case, understanding patients’
concerns) and sympathy (feeling patients’ emotions). A health professionals’ care without
compassion cannot be truly patient-centered. Compassionate care addresses the patient’s
innate need for connection and relationships and is based on attentive listening and a desire to
understand the patient’s context and perspective.

Figure: Dr. Catherine Hamlin with fistula clients. Hamlin Fistula Ethiopia, Addis Ababa: /www.hamlinfistula.org/

Respectful (ተገልጋይንየሚያከብር)


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

The action meanings of the word respect are:-

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  Pay attention to
 Honoring
 Avoiding damage e.g. insulting, injuring
 Not interfering with or interrupting
 Treating with consideration
 Not offending
Caring (ተንከባካቢ)
Caring is an intensification of the affective dimension of empathy in the context of significant suffering.
It is coupled with effective interventions to alleviate that suffering.
Compassionate, respectful and caring (CRC) - means serving patients, being ethical,
living the professional oath, and being a model for young professionals and students. It’s a
movement that requires champions who identify with their profession and take pride by
helping people

Historical Background of CRC

Compatin is a Latin word meaning to ‘suffer with’, and as a word it has been with us a long time. Having
said that as a word it is not easy to conceptualize and to say whether it is always good, or whether it is
sometimes bad.

The term compassion has long association with most major religions and philosophies and taught to
include a number of virtues, such as empathy, sympathy, kindness, respect, and perhaps most
importantly, actually taking some kind of ‘action’.

Compassionate Care within the healthcare setting has received much attention globally; following
concerns that healthcare often fails at a fundamental level. Work is in place at a multi disciplinary level
to utilize and integrate this concept. The role and importance of a compassionate approach was
brought to the forefront in the UK, with the release of the Francis Report. This report, which gained
international attention, was based on an inquiry into devastating events at Mid-Staffordshire Hospital
and finding that for many patients the most basic elements of care were neglected.

Looking into the Ethiopian context there are many professionals who are compassionate,
respectful and caring with the required skills needed. However, a significant proportion of
health professionals see patients as just ‘cases’ and do not show compassion, lack of
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 respect to patients and their families was the common complaint among the community at
large and patients in particular .

Characteristics of CRC Health Professionals

CRC health professionals have the following four essential characteristics:

1. Considerpatientsashumanbeingswithcomplexpsychological,socialandeconomicne
eds and provide person-centered care with empathy;

2. Effectivecommunicationwithhealthcareteams,interactionswithpatientsandotherhea
lth professionals over time and across settings;

3. Respect for and facilitation of patients’ and families,’ participation in decisions

and care.

4. Takeprideinthehealthprofessiontheyareinandgetsatisfactionbyservingthepeoplean
d the country.

Benefit of CRC

Table 1.The benefits and beneficiaries of Compassionate and Respectful Care

Benefi Who How

ciaries

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  When health professionals are compassionate, patients are less anxious
First  Adherence to medical advice and treatment plans
 Compassionate care correlates positively with both prevention and disease
management. Diabetic patients, for example, demonstrate higher self-
Patients
management skills when they self-report positive relationships with their
providers
 Hostile emotional states in patients delay the healing processes
 Quality of health professionals –patient communication with increased
physical functioning, emotional health and decreased physical symptoms of
pain in patients
Second Health  Health care Professionals satisfaction with their relationships with patients
Professio can protect against professional stress, burnout, substance abuse and even
nals suicide attempts
 Burnout is strongly associated with poorer quality of care, patient
dissatisfaction, increased medical errors, lawsuits and decreased
expressions of compassion
 Participation in a mindful communication associated with short-term and
sustained improvement in well-being and attitudes associated with patient
care
 A major predictor of patient loyalty
 When health professionals are compassionate, they achieve earlier and
more accurate diagnoses because the patient is better able to reveal
information when he or she feels emotionally relaxed and safe
 Respect from the client/patients
 Health professionals will find their work more meaningful and gratifying
Third Students  Good role modeling is essential for students
 Increased motivation to be CRC health professionals

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Fourth Health  Patient satisfaction will rise
care  Quality of health care will be improved
facilities  Lower malpractice suits
 Staff will be more loyal to their hospital or health care system
 Patient adherence to treatment will rise
 Resources can be conserved
 Greater employee satisfaction and reduced employee turnover.
National Strategy And Approaches For CRC
The development of caring, respectful and compassionate health workers requires a multi-pronged
approach in order to make CRC as a culture, self-driven inner motive and a legacy that the current
generation of practitioners leaves to their successors.
 Reforming the recruitment of students for health science and medicine programs.

 Improving the curriculum of the various disciplines.

 Ownership and engagement of the leadership at all levels of the system.

 Inspirational leadership that aims to create an enabling environment.

 National, regional and facility level ambassadors.

 An advocacy campaign through mass media will also be launched to project positive images of
health professionals.

 Patients and the general public will also be engaged in this movement.

 An annual health professional recognition event will be organized

 Putting in place a favorable legislative framework to reinforce CRC which would include
regulation on patients’ rights and responsibilities (PRR)

 Measurement of health care providers on CRC

 Comprehensive projects will be designed.

 Conducting national assessment related to CRC.

 provision of continuous CRC trainings.

 Engagement and ownership of professional associations

Self-Check -1 Written Test

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Directions: Answer all the questions listed below. Use the Answer sheet provided in the next
page:
Multiple choose
1. Who is benefited from compassionate, respectful and caring (CRC) service?
A. Patients C. Health care facilities
B. Health professionals D. All
2. _____ is/are the action meanings of the word respect.
A. Interfering C. Damage
B. Offending D. Honouring
3. Which of the the following is false about National Strategy And Approaches For CRC?
A. Improving the curriculum of the various disciplines
B. Conducting national assessment related to CRC.
C. Block of continuous CRC trainings.
D. Engagement and ownership of professional

Short Answer Questions

4. What is CRC?

Note: Satisfactory rating - 4 points Unsatisfactory - below 4 points

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Info/Author: answers.
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Answer Sheet
Score = ___________
1. __________
2. __________ Rating: ____________

3. __________
4.
a. _____________________
b. _____________________
c. _____________________

Name: _________________________ Date: _______________

Information Sheet-2 Patients feeling and emotions

CONTENT-2

Elements of compassionate care

According to researches the key elements of compassionate care has seven categories, each contains theme and
subthemes.
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1. Virtue

It is described as ‘‘good or noble qualities embodied in the character of the health

care provider. Specifically, patients felt compassion stemmed from virtues of
genuineness, love, honesty, openness, care, authenticity, understanding, tolerance,
kindness, and acceptance. Compassion is predicated on health care provider
virtues, independent of patient behavior, relatedness, or deservedness.

2. Relational space:
 Relational space is defined as the context and content of a compassionate
encounter where the person suffering is aware of and is engaged by, the virtues
of the health care provider. The intent and depth of the health care provider-
patient relationship was a defining feature of compassion, extending beyond
simply acknowledging and understanding the needs of the patient to relating to
them as a fellow human being and actively engaging their suffering.

The category of relational space comprised two themes.

 Patient awareness which describes the extent to which patients intuitively knew or initially
sensed health care provider capacity for compassion.
 Engaged care giving which refers to tangible indicators of health care provider compassion in
the clinical encounter that established and continued to define the health care provider-patient
relationship over time
3. Virtuous Response

It is the “Enactment of a virtue toward a person in suffering,’’ and it is both an individual category and an
overarching principle of care that functions as a catalyst to the three core categories of compassionate care
giving: ‘‘seeking to understand, relational communicating, and attending to needs’’ The category of
virtuous response contains three broad themes within it:
 Knowing the person refers to the extent to which healthcare providers approached their patients as persons
and view their health issues and suffering from this point of view.
 Seeing the person as priority involves healthcare providers’ ability to priorities patient needs,
setting aside their own assumptions and healthcare system priorities in the process.
 Beneficence refers to healthcare providers wanting the best for the patient, informing the three
more targeted core categories of compassionate care giving.

4. Seeking to Understand
Seeking to understand refers to healthcare providers trying to know the patient as a person
and his or her unique needs. Health care providers’ first act is to know and prioritize the
patient as a person by pursuing a deeper understanding of the person and his or her unique
illness experience to better diagnose the patient. Being seen as a disease, rather than a
person living with a disease, is experienced subtlety and infrequently. When patients are
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 seen as mere diseases, however, this has a detrimental effect on the relationship between
the caregiver and well-being of the patient. The need to understand a person’s desires and
tailor his or her care is identified by most patients as a fundamental feature of compassion.
 Seeking to Understand the needs of the Person
 Relational Communication

5. Relational Communication
The category of relational communication is an important element of compassion identified
by patients consisting of verbal and nonverbal displays conveyed by the healthcare
provider’s engagement with the person suffering. There are four specific themes and
associated subthemes that convey compassion within clinical communication:
Demeanor(‘‘being’’): refers to the disposition of healthcare provider that is conveyed through
nonverbal communication, such as body language, eye contact, tone of voice, posturing and
expressions. Demeanor is closely related to ‘‘patient awareness’’ within the category of
‘‘relational space’’. It is more sensory-based and contextual to clinical communication.

Affect (‘‘feeling for’’): describes the extent to which healthcare providers actively connects with
their patients’ emotions; as well as their influence over the process. In relation to compassion,
affect is characterized by vulnerability and action, requiring healthcare providers to enter the
relational space and position themselves; to be in the ‘‘patient’s shoes’’ as clinical information is
being shared.

Behaviors (‘‘doing for’’): associated with relational communication and the use of interpersonal
skills in clinical communication, which convey compassion. Compassion- related behaviors vary
in expression; behaviors share a commonality that distinguish them from general caring of
health care providers to give not only of themselves as a professional but as a person. The
primary behaviors associated with relational communication is described by patients as
showing respect; physical displays of caring; and listening and supportive words.

Engagement (‘‘being with’’): refers to the degree to which patients feel healthcare providers are
actively present in the clinical encounter.

- The first aspect of engagement is attentiveness through nonverbal actions (e.g. sitting versus
standing at the patient’s bedside) and temporal indicators (e.g. communicating regularly with
patients about their needs or communicating potential health issues to other members of the
patient’s care team).
- Acknowledgment, the second essential aspect of engagement, involves recognizing the
personal impact of suffering, reflecting back to the patient, and integrating this information into
subsequent interactions.
- The final aspect of engagement is dialogue, which consists of healthcare providers
communicating clinical information accurately and sensitively, including the effective use of
silence and allowing patients to participate in the clinical conversation.
Attending to Needs
- It refers to ‘‘a timely and receptive desire to actively engage in and address a person’s multi-
factorial suffering’’.
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- Attending to patients’ needs has three interrelated themes:
Compassion-Related Needs: refers to the dimensions of suffering that patient feel
compassion: physical, emotional, spiritual, familial and financial. Compassionate healthcare
providers are those who, regardless of their scope of practice, is willing to actively attend to a
patient’s immediate needs.
Timely refers to addressing suffering in a ‘‘timely’’ manner. It has dual understanding of time,
referring to both the desire of healthcare providers to address suffering in a responsive manner
and at an opportune moment.
- The responsive dimension of time is frequently referred to as acute suffering (e.g. a pain crisis)
- The opportune aspect of time is associated with situations where healthcare providers seek to
sensitively address protracted suffering, which includes addressing existential distress or
sharing prognostic information at a time when patients are most receptive and supported to
receive it (e.g. such as breaking bad news when family is present or discussing prognostic
information over time).
Action refers to the initiation and engagement of a dynamic and tangible process aimed at
alleviating suffering. Compassion is more action.
Patient-Reported Outcomes

- The impact of compassion on patients who are suffering is profound. 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.
- These experiences have an equally enduring effect on their well-being and the care-giving
relationship, often exacerbating suffering in the process.

Self-Check -2 Written Test

Directions: Answer all the questions listed below. Use the Answer sheet provided in the next
page:

Multiple choose

1. ________is described as ‘‘good or noble qualities embodied in thecharacter of

the health care provider?
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 A. Virtue

B. Rational space

C. Virtuous Response

D. Seeking to understand

2. Which one of the following Elements of compassionate care is negative impact Patients
feeling and emotions?
A. Virtuous Response

B. Relational space:

C. Virtue

D. Seeking to Understand

E. None of the above

Short Answer Questions

3. What is Relational Communication?

Note: Satisfactory rating - 4 points Unsatisfactory - below 4 points

You can ask you teacher for the copy of the correct answers.

Answer Sheet
Score = ___________
1. __________
Rating: ____________
2. __________

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Name: _________________________ Date: _______________

Principles of compassionate care/Patients/clients innate needs

Information Sheet-3
CONTENT-3

Principles of compassionate care/Patients/clients innate needs

The universal principles of compassion will help us know one another in a more meaningful way
where we discover one another respectfully. They create the conditions that allow a person who is
suffering to experience the healing power of compassion.
1. Attention is the focus of health care provider. Being aware will allow the healthcare provider to
focus on what is wrong with a patient; or what matters most to the patient.
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2. Acknowledgement is the principle of what the healthcare professional says. The report of the
examination or reflection on the patient’s message. Positive messages of acknowledgment are
buoyant; they let someone know that you appreciate them as a unique individual.
3. Affection 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.
4. Acceptance- 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. It is the spirit of Shalom.
 The principle of acceptance is: being at peace with the way things are allows them to
change.

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 Self-
Written Test
Check -3

Directions: Answer all the questions listed below. Use the Answer sheet provided in the
next page:
Multiple Choose
1. Which one of the following Principles of compassionate care is how health care providers
affect or touch people?
A. Acceptance
B. Acknowledgement
C. Affection
D. Attention
2. The principle of acceptance is being at peace with the way things are allows them to change?
A. true
B. false

Short answer

3. Write Principles of compassionate care?

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 Note: Satisfactory rating - 3 points Unsatisfactory - below 3 points

You can ask you teacher for the copy of the correct answers.

Answer Sheet
Score = ___________
1. _____
2. _____ Rating: ____________

3. _____

Name: _________________________ Date: _______________

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 Patient rights
 Ethical and legal rationale behind ensuring informed consent is to respect the
patient’s autonomy and their right to control their own life.
 The basic idea of personal autonomy is that everyone’s actions and decisions
are their own. Therefore, the patient has the right to get full information and
decide what happens to their own body.
 Healthcare providers should respect the right of the patient to choose
treatment and acceptor rejects the recommendation provided to him.
 This is stipulated in Codes of Ethics of different health professions,
international documents, as well as in legal documents like regulation
299/2013, directives and standards.
Patient Responsibilities

Every patient shall have the following responsibilities:

 To provide, to the best of the patient’s knowledge, accurate and complete

information regarding past medical history and issues related to the patient’s
health, including unexpected changes, to the health professional responsible
for the patient’s care.

 To follow the course of treatment and instructions proposed by the attending

clinical practitioner or to accept the consequences if treatment instructions are
refused.

 To report any changes in his/her condition or anything that appears unsafe to

the responsible health professional.

 To consider the rights of other patients and to respect their privacy.

 To respect patients’ caregivers.

 To fulfill the financial obligations as promptly as possible.

 To keep all appointments and notify health center or the appropriate person
when enable to do so.

 To observe the health center policies and procedures, including those on

smoking, alcohol or drug addiction, cellular phones, noise and visitors.
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  Be considerate of and not to abuse the health center facilities and equipment.

 Not to litter on health center premises.

 To sign on “Against Medical Advice Notice” if patient refuses the

recommended treatment or intervention.

 Be considerate of and not to abuse the health center facilities and equipment

Ensuring safety of medications

According to the American Pharmacists Association, pharmacists in all settings have
eight essential medication related responsibilities linked to improving patient safety.
 Safety action
 Ensure access to medication
 Supply medication information
 Evaluate medication appropriateness
 Improve medication adherence
 Medication management
 All patients have the:
 Right to truth
 Right to refuse treatment
 Right to know about Informed consent
 Right to privacy
 Right to get complete information concerning his diagnosis, treatment and medication
 Right to know Ethiopian medico-Legal issues (code of law)

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 Self Recognizing patient’s responsibilities and
Check -4 medication experience
Written Test

Directions: Answer all the questions listed below. Use the Answer sheet provided in the
next page:
Write true if the statement is correct or write false if the statement is incorrect
1. Patient has right to informed consent?
2. Patient have responsible to respect patients’ caregivers?
Multiple choices
3. Which one of the following is false about patient right?
A. Ethical and legal rationale behind ensuring informed consent is to
respect the patient’s autonomy and their right to control their own life.
B. The basic idea of personal autonomy is that everyone’s actions and
decisions are their own. Therefore, the patient has the right to get full
information and decide what happens to their own body.
C. Healthcare providers should respect the right of the patient to choose
treatment and acceptor rejects the recommendation provided to him
D. None of the above.
4. Accordin to responsibility of pharmacy regard on ensuring safety of medications, which
one is false.
A. Ensure access to medication
B. Supply medication information
C. Evaluate medication appropriateness
D. Improve medication adherence
E. None of the a bove

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Note: Satisfactory rating - 4 points Unsatisfactory - below 4 points

You can ask you teacher for the copy of the correct answers.

Answer Sheet
Score = ___________
1. __________
2. __________ Rating: ____________

3. __________
4. __________

Name: _________________________ Date: _______________

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 Reference
1. DiMatteo, M.R. (1994). Enhancing patient adherence to medical recommendations.
2. National CRC Manual June 2017 ethiopia
3. Dispensing of Pharmaceuticals-III | ORHB december 2017
4. Beth A. Lown, Julie Rosen and John Marttila. An Agenda For Improving
Compassionate Care: A Survey Shows About Half Of Patients Say Such Care Is
Missing. Health Affairs 30, no.9 (2011):1772-1778.
5. FDRE, Regulation No ,299/2013, Food, Medicine and Health Care Administration and
Control, Council of Ministers Regulation
6. J Med Ethics-2003-Macklin-275-80.pdf
7. J Med Ethics-2008-Molewijk-120-4.pdf
8. Harry Chambers, Harry E. Chambers Effective Communication Skills for Scientific and
Technical Professionals 2000
9. EMA, Code of Ethics for Doctors practicing in Ethiopia, 2009

10. Royal Pharmaceutical Society of Great Britain, Code of Ethics for Pharmacists and
Pharmacy Technicians, Aug, 2007

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 Prepared By
Educationa
N l LEVE Phaone
Name Region College Email
o Backgroun L Number
d
1 oromi Nagelle [email protected] 092179872
Debisa Taressa Pharmacy B a HSC m 8
oromi Nagelle 093067505
2 Tamene Galchu Pharmacy B a HSC [email protected] 5
3 Somal 091048018
Ebrahim Dawud Pharmacy A i Jigjiga HSC [email protected] 6
Alemseged 091373979
4 Workneh Pharmacy A Harari Harar HSC [email protected] 2
5 091750409
Habtamu Tarekegn Pharmacy B BGRS Pawi HSC [email protected] 4

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