DIRE DAWA UNIVERSITY COLLEGE OF MEDICINE AND OTHER HEALTH

SCIENCE DEPARTMENT OF ANESTHESIA

THE APPLICATION OF COMPASSIONATE AND RESPECTFUL CARE IN

DILCHORA REFFERAL HOSPITAL, DIRE DAWA,EAST ETHIOPIA; PATIENT’S
PRESPECTIVE

INVESTIGATORS;

1. HALIV G/MARIAM.…………... 1003588

2. TELILA NEGUSSE……………. R/3671/09

3. TSION YEMANE ……………… 1003608

4. YOHANNIS DEMESU…………..1003663

THIS RESEARCH PROPOSAL WILL BE SUBMITTED TO DIRE DAWA UNIVERSITY

COLLEGE OF MEDICINE AND OTHER HEALTH SCIENCE DEPARTEMENT OF
ANESTHESIA IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR BACHELOR
DEGREE IN ANESTHESIA.
Dire Dawa, Ethiopia
THE APPLICATION OF COMPASSIONATE AND RESPCTFUL CARE IN DILCHORA
REFFERAL HOSPITAL, DIRE DAWA; PATIENT’S PRESPECTIVE

ADVISORS

1 Teshome Abebe (BSc, MSc in Anesthesia)

2 Bayisa Gerbesa (BSc, MSc in Anesthesia)

December 26, 2021

DIRE DAWA , ETHIOPIA

ACKNOWLEDGMENT

First, We thank GOD almighty who helps us from the beginning until the end of writing this
proposal.

Secondly, We would like to acknowledge Dire Dawa University, department of anesthesia for
giving us this chance. And We would also like to express our sincere and heartfelt gratitude to
our advisors Mr. Teshome A. (Msc) and Mr. Bayisa G. (Msc) providing unreserved supervision,
constructive advice and encouragement throughout the course of this study.
 ABBREVIATION

CRC- Compassionate and respectful care

DRH- Dilchora Referral Hospital

USA- United states of America

WHO-world health organization

OPD- Out patient Department

JHPIEGO- Jhons Hopkins Program for International Education in Gynecology and Obstetrics

HCP- Health care providers

UK- United Kingdom

TABLE OF CONTENT
ACKNOWLEGMENT……………………………………………………………

…………...……III
ABBREVIATION……………………………………………………………………………………………………………..IV
SUMMARY.................................................................................................................................VII
DECLARATIONS.............................................................................................................................VII
1. INTRODUCTION......................................................................................................................- 8 -
1.1 BACKGROUND..................................................................................................................- 8 -
1.2 Statement of problem.....................................................................................................- 8 -
1.3 Significance of the study...................................................................................................- 9 -
2. OBJECTIVES...........................................................................................................................- 10 -
2.1 General objective............................................................................................................- 10 -
2.2 Specific objectives...........................................................................................................- 10 -
3. Literature Review………………………………………………………………………………………………………………. -11-

4. METHODOLOGY....................................................................................................................- 13 -
4.1 Study area and period....................................................................................................- 13 -
4.2 Study Design...................................................................................................................- 13 -
4.3 Sample size and Sampling technique..............................................................................- 13 -
4.3.1 Sample size...................................................................................................................- 14 -
4.3.2 Sampling technique......................................................................................................- 14 -
4.4 Population......................................................................................................................- 14 -
4.4.1 Source population........................................................................................................- 14 -
4.4.2 Study population..........................................................................................................- 14 -
4.5 Eligible criteria…………………………………………………………………………………………………………….. -14-

4.5.1 Inclusion criteria...........................................................................................................- 14 -

4.5.2 Exclusion criteria..........................................................................................................- 14 -
4.6 Variable of the study......................................................................................................- 14 -
4.6.1 Dependent variable......................................................................................................- 14 -
4.6.2 Independent variable...................................................................................................- 14 -
4.7 Data analysis & procedure..............................................................................................- 14 -
4.8 Data quality assurance....................................................................................................- 14 -
 4.9 Data dissimination plan...................................................................................................- 15 -
4.10 Ethical consideration....................................................................................................- 15 -
5. WORK PLAN AND BUDGET....................................................................................................- 16 -
5.1 work plan........................................................................................................................- 16 -
5.2 Budget............................................................................................................................- 17 -
6.REFERENCES..........................................................................................................................- 18 -
7. ANNEX..................................................................................................................................- 19 -
Annex 1: Consent form.........................................................................................................- 19 -
Annex2:questioners…………………………………………………………………..20

SUMMARY
Background: Compassionate and respectful health care is one of the basic things in health care
system because it is a means to improve and keep quality health care service. It has become a
current attention in our country and also the world. A lot has been done globally, continentally and
at national level to improve health status of the community. Despite the increasing scope and
sophistication of healthcare, the huge resources devoted to it and the focus on improvement; it is still
failing at a fundamental level. Caring and compassion, the basics of care delivery, and the human
aspects that define it seem to be under strain.

Objective: The aim of this study is to access the application of Compassionate and Respectful
care in Dilchora Referral Hospital from patient’s perspective

Method: Hospital-based cross-sectional study will be conducted. A semi-structured interview

administered questionnaire will be used to collect data from 384 participants. Epi-Data version
and Stata version 14.0 will be used for data entry and data analysis, respectively.
Work plan: The research will be conducted from Dec 29/2021- Feb 27 ,2022

Budget- It would take 1380 birr including personal and stationary

Chapter 1- Introduction
1.1 Background
Compassion involves feeling for a person who is suffering and being motivated to act to help the
suffering person. Compassion is not only felt for those who know but also for those who we do
not know. It is also including the ability to be non-judgmental, tolerate one’s own stress and
being compassionate for ourselves.(1) Compassion feeling is includes being open minded and
having motivational behaviors and struggle to decrease the suffering of others.(2) A simpler
definition is that it is ‘a deep awareness of the suffering of another coupled with the wish to
relieve it’. (3)
Patients who are shown compassion by the health professionals who care for them are more
likely to be comfortable in times of illness, pain and mental stress. People unites in the time of
the problem in which they show compassion. Compassion unites building human relationships
which can promotes both physical and mental health.(4)

Respect for persons is frequently used synonymous with autonomy. However, it goes beyond
accepting the notion or attitude that people have autonomous choice, to treating others in such a
way that enables them to make the choice. Respecting the patient’s right to self-determination—
that is, supporting decisions that respect the patient’s personal beliefs, values, and interest’s
problems.(5)
A person-centered health system is one that supports people to make informed decisions about,
and to successfully manage, their own health and care, able to make informed decisions and
choose when to invite others to act on their behalf. This requires healthcare services to work in
partnership to deliver care responsive to people’s individual abilities, preferences, lifestyles and
goals (6).

The Key components of person-centred care include compassion, dignity and respect. These may
be demonstrated via shared decision making, supporting self-management and proactive
communication (6). Compassion or feeling empathic concern and acting to ameliorate concerns,
pain, distress and suffering is fundamental to healthcare; it defines the higher purpose of our
healthcare system and humanity behind the bottom line. It challenges all of us, providers and
patients alike, to listen deeply to each other, to value each other’s experiences and expertise, and
to build effective relationships in which empathy is generously expressed among all participants.

A lot has been done globally, continentally and at national level to improve health status of the
community. Despite the increasing scope and sophistication of healthcare, the huge resources
devoted to it and the focus on improvement; it is still failing at a fundamental level. Caring and
compassion, the basics of care delivery, and the human aspects that define it seem to be under
strain.(7)
1.2 Statement of the problem
Compassion focuses on the recognition of the uniqueness of another individual, and the willingness to
enter into a relationship in which not only the knowledge but the intuitions, strengths, and emotions of
both the patient and the health care professional can be fully engaged’(9). But, despite this fact because
of increased health care need, globally it falls at the fundamental level.(8)

The Ethiopian government has already established a CRC program and initiatives of health care
services that are expanded beyond disease and death prevention activities. It must encompass
respect for patients and fundamental human rights, including respect for patients ‘autonomy,
dignity, feelings, preferences, and choice of friendship. Thus, this study aimed to assess the
provision of compassionate, respectful and caring health care services among health care
providers based on client’s perspective at Eastern Ethiopia, Dire Dawa city administration.

There is a lack of some qualities of health care providers in Dilchora referral hospital among a
WHO standard of CRC to mention some of the problems that we have observed are, providing a
compassionate care for their clients and families. A virtue which is noble quality embodied in the
character of the health care provider that indicates compassion is predicated on health care
provider virtues, and virtuous response independent of patient behavior, relatedness, or
deservedness. Relational space is another quality that must exist from health care providers to be
compassionate and respectful. In relational space the professional creates rapport between
themselves and patients so that the client recognizes need of compassionate care and involve in
the decision making. (9)
1.3. Significance of the study
Patient-centered care does not replace excellent medicine. It complements clinical excellence and
contributes to it through effective partnerships and communication (10).

Hence, the current study was aimed to assess the level of patient centered care in DRH from the
patients perspective so that it would provide insights into patients’ experience & view about the
status of patient centered care and highlights discrepancies between patients’ expectations and
reality. As a result, health professionals, health managers, administrators and policy makers will
incorporate in to their activity whilst designing strategies that could improve humanistic and
holistic approach of health care provision. The study is also supposed to motivate and engage
professionals and the scientific community in a further research endeavours particularly on the
most neglected area of patient centered care.

As we observed during our attachment in DIlchora Referral Hospital, we have noticed many
things which oppose the WHO standard of CRC health care. Therefore, If we conduct this
research especially from patients’ perspective, we think we could make a difference in the
implementation of CRC in clients that are served and awareness among health care providers in
Dilchora Referral Hospital.
Chapter 2: Literature review
Compassionate and respectful health care service is the current attention of health care system
over the world because it is a means to improve and keep quality health care service not only in
the current but also in the future. But, despite this fact because of increased health care need,
globally it falls at the fundamental level. Many studies have identified a lack of compassion,
respectful health care service in modern health care (8).
According to report of JHPIEGO, in many countries, women were mistreated when delivering in
the health facilities and unable to make choices or follow practices that put them in control of
their own experiences (11). A growing body of evidence has demonstrated that delivering CRC
improves health outcomes, increases patient satisfaction, improves adherence to treatment and
reduces malpractice claims and health care expenditure (12).
In addition, CRC health care services can help to prevent health problems and speed up recovery.
Compassion and respectful health care service can improve staff efficiency by enhancing
cooperation between individuals and teams and between patients and healthcare professionals
(13).
Without implementation of CRC health care services, it is impossible to achieve quality health
care. Despite quality health care service, implementation of CRC health care service improves
satisfaction of health care providers (11) and patients, retains staffs, decreases health
expenditure, and improves the outcome of health institution. In general speaking, a CRC health
care service has a benefit to patients, health care providers, medical students and health care
institutions (12).
In the context of Ethiopia, although many professionals are compassionate, respectful and caring,
a significant proportion of health professionals see their patients as cases and do not show
compassion; lack of respect to patients and their families was the common complaint among the
community at large and patients in particular. As a result, training of health work force on CRC
is taken as a means to improve quality health care by Federal Ministry of Health since 2017.
Although studies on implementation of CRC health care services especially after training of
health work force are inadequate, the practice of compassionate, respectful and caring health care
service is still optimal in Ethiopia (14).
Regarding patient experience about compassionate care, Louise and Milika Nottingham UK
showed that compassion was experienced by patients as caring attitude to people as people and
not as a thing. When health care providers look attentively, touch gently on your shoulder it
makes patients feel like human being. Such things show that they/health care providers/ are
caring. The clients also stressed that even though some patients behave wrongly the patience of
health care providers indicates respect for patients (15)
The review of theoretical and empirical literatures indicated that respect for clients, family, and
visitors is a fundamental human right, including respect for autonomy, dignity, feelings, choices,
and health care preferences (16).
A study from United States of America (USA) showed that 35% of health care providers have
poor listening skills (17).
In modern health care, lack of compassionate and respectful care was identified in many areas of
the world (8).
From the reports of patient complaints in Addis Ababa regarding not getting compassionate
respectful care from health care providers, use of bad language or insulting, shouting at patients,
mistreatment and hitting clients were un ethical practices by health care providers (HCPs) (18).
Chapter 3: Objectives
3.1. General objectives
 The aim of this study was to assess application of compassionate, respectful and caring
health care service at Dilchora Referral Hospital.
3.2. Specific objectives
 To assess the implementation of CRC among health care professionals
 To assess the Status of patient centered care in Dilchora Referral Hospital: Patients Perspective
Chapter 4: Methodology & Material
4.1. Study area & period
The study will be conducted at Dilchora Referral Hospitals which is found at Eastern direction of
Ethiopia from Dec 29/2021 to Feb 27/2022.

DCH serves about 1.2 million people. It provides services in clinically specialty,
ophthalmology, surgery, gynecology, and obstetrics, medicine, child and pediatrics, OPD, major
operation room and diagnostic facilities. It has a capacity of around 230 beds,3 operation theaters
and 193 health professionals in different field of study on average about six major elective
operations performed per day.

4.2. study design

Hospital-based cross-sectional study will be conducted.
4.3. Population
4.3.1. Source population
All patients who were admitted at Dilchora Referral Hospital will be sources of population.
4.3.2. Study population
All patients who were admitted at Dilchora Referral Hospital during data collection period will
be study populations.
4.4. Eligible criteria
4.4.1. inclusion criteria
Clients older than 18 years and in good health to communicate at outpatient or inpatient
departments
4.4.2. Exclusion criteria
Clients who are less than 18 years of age and clients who are not in a good health to participate
in the study
4.5. Study variables
4.5.1. Dependent variable
Implementation of CRC health care service: Good / Poor
4.5.2. Independent variables
Sociodemographic variable (sex, age, educational level, marital status, resident, occupation,
monthly income, previous hospital admission, length of hospital stays) Perception towards
Compassionate and respectful health care services

4.6. Sample size & sampling techniques

4.6.1. sample size
To generate data from clients we will perform exit interview using a single population proportion
formula,
2
( z a/ 2 ) ( p ) ( 1− p )
N=
d2
Where, a= confidentiality interval=95%
P= best estimate of population proportion (0.5%)
D= maximum acceptable difference= 5%
N= minimum required sample size
Za/2= value under standard normal table for the given value of confidentiality level= 1.96
( 1.96 ) 2 ( 0.5 ) ( 1−0.5 )
n=
( 0.052 )
n=384.16, consider 5% non-response rate =>nf= 384

4.6.2. Sampling techniques

The number of participants will be determined by patient load of the hospitals and proportionally
allocated to inpatients and outpatient departments.
4.7. Data analysis & procedure
Data will be summarized and analyzed by using SPSS Version 20; and then presented by graphs
and charts.
4.8. Data quality assurance
The quality of data will be assured by training data collectors and supervisors, carefully
designing questionnaire, monitoring the data collection process and checking completeness of
data during data collection time. In addition, pretest will be conducted to address confusing items
at Dilchora Referral Hospital.
4.9. Data dissemination plan
The final result of research will be submitted to department of anesthesia, presented on the day
of annual presentation of research.

4.10. Ethical clearance

Ethical clearance will be obtained from the Research committee of the Department of
Anesthesia, college of medicine and health science, School of Medicine, University of Dire
Dawa. Permission will be obtained from the department to conduct the research. After
explanation of aim and benefit of the study written and verbally informed consent will be
obtained from each study participant and their confidentiality will be guaranteed throughout the
study. Any personal identification of study participants will not be recorded.
Chapter 5: Work plan & Budget

5.1. Work plan

Table 1 A Gantt chart is used to shows

Activity Responsible Time outline

person
Sep Oct Nov Dec Jan Feb

Topic selection Investigator

Development of Investigator
proposal
Submission of Investigator
proposal to
advisor
Proposal Defense Advisor and
anesthesia
department
members
Data collection

Data analysis and Investigator

report

Submission of Investigator
final research
document

5.2. Budget

Table 2 budget chart out line

 No Item Amount Price
Birr Cent
1 Paper 120 240

2 Photo copy& 120 360

Printing
3 Flash Disk 1 300

4 Pen 4 40

5 Binding 1 40

6 Cost for data 400

collector

Total price 1380

References
(1) Strauss C, Taylor BL, Gu J, Kuyken W, Baer R, Jones F, et al. What is compassion
and how can we measure it? A review of de¦nitions and measures. Clinical psychology
review. 2016; 47:15–27.
 (2) Radey M, Figley CR. The social psychology of compassion. Clinical Social Work
Journal. 2007;35(3):207–14.
(3) Chochinov HM. (2007). ‘Dignity and the essence of medicine: the A, B, C and D of
dignity conserving care’. BMJ, 335, 7612): 184–187.
(4) Gilbert P. Compassion as a social mentality: An evolutionary approach. Compassion:
Routledge; 2017. p. 31–68.
(5) Caruso PM. Respect for persons: the foundational moral disposition in medicine (a
renewed physician ethos: respect for patients as persons) 2016.
(6) Debra de S, Helping measure person-centred care (2014), Evidence review.
(7) Chochinov HM. (2007). ‘Dignity and the essence of medicine: the A, B, C and D of
dignity conserving care’. BMJ, 335, 7612): 184–187.
(8) Kvangarsnes M, Torheim H, Hole T and Crawford P, (2013), Nurses’ perspectives on
compassionate care for patients with exacerbated chronic obstructive pulmonary
disease. J Allergy Ther,. 4(6): p. 1-6.
(9) Lown BA, Rosen J, Marttila J. An agenda for improving compassionate care: a survey
shows about half of patients say such care is missing. Health Affairs. 2011;30(9):1772 8
(10) Frampton S. et al (2008) patient-centered care improvement guide, Planetree, Inc.
And Picker Institute
(11) JHPIEGO (2017), Respectful Maternity care. Accssed from www.jhpiego.com
(12) Federal Democratic Repuplic Ethiopia (2017), National Compassionate, Respectful
and Caring Health Workforce Training Participants Manual. February
(13) Psychiatrist (2015), R.C.O., Compassion in care: ten things you can do to make a
difference.
(14) Berhe H, Berhe H, Bayray A, Godifay H, Gigar G, Beedemariam G. (2017), Status
of Caring, Respectful and Compassionate Health Care Practice in Tigrai Regional State:
Patients’ Perspective. International Journal,. 10(3): p. 1118.
(15) Bramley L, Matiti M. How does it really feel to be in my shoes? Patients'
experiences of compassion within nursing care and their perceptions of developing
compassionate nurses. Journal of clinical nursing. 2014;23(19-20):2790–9.
(16) Gallagher A, Li S, Wainwright P, Jones IR, Lee D. Dignity in the care of older
people–a review of the theoretical and empirical literature. BMC nursing. 2008;7(1):1–
12.
(17) Davis L. Dignity Health: Dignity Health survey ¦nds majority of Americans rate
kindness as top factor in quality health care. 2013.
(18) Wamisho BL, Abeje M, Feleke Y, Hiruy A, Getachew Y. Analysis of medical
malpractice clams and measures proposed by the health professionals ethics federal
committee of Ethiopia: review of the three years proceedings. Ethiop Med J.
2015;53(Suppl 1):1-6.
ANNEX
Annex 1: Consent form
UNIVERSTY OF DIRE DAWA COLLEGE OF MEDICINE AND HEALTH SCIENCES
DEPARTMENT OF ANESTHESIA

I_____________________________ am a student of department of anesthesia and we want to

study about the application of compassionate and respectful care in Dilchora Referral Hospital,
Patients’ perspective. Our study will improve the application of compassion and respectful care
in clients that are served and awareness among health care professionals.

I_______________________________ give my consent to participate in this medical study or

research. As long as my identity is kept secret and my autonomy is guaranteed.
Signatures

My signature below means that:

• I have read and understand this consent form.

• I have been given all the information I asked for about the medical study undergone.
• All my questions were answered.
• I agree to everything explained above.
Patient’s Signature: _______________
Date signed____________________
 ANNEX-2

QUESTIONERS
1. Sex

☐Male ☐Female

2. Residence

☐ Urban ☐ Rural

3. Religion

☐Orthodox ☐ Protestant

☐Muslim ☒others

4. Ethnicity

☐Amhara ☐Somali

☐oromo ☐others

5. Educational status

☐Not educated ☐Grade 9-12

☐Grade 1-4 ☐Collage and above

☐Grade 5-8

6. Occupational status

☐House wife ☐ student ☐House maid

☐government employee ☐daily labor
☐merchant ☐others

7. Relative wealth compared to neighbor

☐Very poor ☐Rich

☐Poor ☐Very rich
☐Medium

8. I have received compassionate and respectful care during my hospital visit form
Nurses

☐Very good ☐Good

 ☐Medium ☐Bad
☐Poor

Laboratory professionals

☐Very good ☐Poor

☐Good ☐Bad
☐Medium

Radiologists

☐Very good ☐Poor

☐Good ☐Bad
☐Medium

Doctors

☐Very good ☐Poor

☐Good ☐Bad
☐Medium

Pharmacists

☐Very good ☐Poor

☐Good ☐Bad
☐Medium

Midwifery

☐Very good ☐Poor

☐Good ☐Bad
☐Medium

Anesthetists

☐Very good ☐Poor

☐Good ☐Bad
☐Medium

9. I have received compassionate and respectful care during my hospital visit from non-clinicians

Security

☐Very good ☐Poor

☐Good ☐Bad
☐Medium
Runners

☐Very good ☐Poor

☐Good ☐Bad
☐Medium

Cleaners

☐Very good ☐Poor

☐Good ☐Bad
☐Medium

Others

☐Very good ☐BAD

☐Good
☐Medium
☐Poor

10- Categories’ and indicators of compassionate and respectful care

Compassionate yes No

Called me by my name ☐ ☐

Provided me sufficient information ☐ ☐

Has sensed my pain and suffering ☐ ☐

Respect
Communicated with me with respect ☐ ☐

Showed me respect with facial expression ☐ ☐

Maintained my privacy ☐ ☐

Plan of my care was communicated to me ☐ ☐

Care
Cared for me with motivation ☐ ☐

Provided me care with patience ☐ ☐

Cared for me without discrimination ☐ ☐

My family allowed to participate in my care ☐ ☐

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