Compassion in practice-Evaluating the awareness, involvement and perceived impact of a national nursing and midwifery strategy amongst healthcare professionals in NHS Trusts in England

An auto-ethnographic reflection on the nature of nursing in the UK during the Covid-19 pandemic

In this article I discuss the effects on the patient experience of isolation nursing during the CoronaVirus Disease (COVID)-19 pandemic. An unintended consequence of isolation nursing has been to distance patients from nurses and emphasise the technical side of nursing while at the same time reducing the relational or affective potential of nursing. Such distanced forms of nursing normalise the distal patient in hospital. I consider ways in which this new form of distanced nursing has unwittingly contributed to the continued commodification of nursing care in the British NHS. Autoethnography is used to describe and reflect on the illness experience, the experiences of caregivers and the sociocultural organisation of health care. The findings discuss three areas of the illness experience: intimate nursing care; communication; the 'distanced' patient experience.

An investigation of factors affecting compassion levels of midwives

INTRODUCTION

The profession of midwifery is seen as a genuinely individual-centric catalyst transforming compassion to care. Due to this, compassionate care should be the basis of midwives’ care, especially for those who care for women and children. This research investigated the compassion levels of midwives to determine the factors affecting them.

METHODS

This descriptive research was conducted between 10 February and 29 May 2020, with 119 midwives working in a training and research hospital in Istanbul. The data were collected using the ‘Compassion Scale’ and analyzed using the Mann-Whitney U test, Kruskal-Wallis test and logistic regression model.

RESULTS

The total mean score on the compassion scale of midwives participating in the study was found to be 71.46 ± 9.60. Sociodemographic data and vocational belongings of participants were compared with the mean scores of the compassion scale sub-dimensions. It was determined that as the age of the midwives increased, they showed more kindness and awareness of compassion (p<0.021, p<0.023, respectively). It has been determined that as the education level of midwives decreases, their compassion level also decreases and they become more insensitive (p<0.044). It was found that being married increased the kindness (p<0.023) and common humanity characteristics (p<0.032) that affect compassion. It was found that the levels of kindness (p<0.020) and awareness (p<0.048) increased for those who had children, and compassion was associated with having a child. In addition, a statistically significant relationship was found between the professional commitment and kindness of the midwives participating in the study (p<0.034). It was found that midwives’ knowledge of rules related to professional ethics increased their compassion scale scores by 1.2.

CONCLUSIONS

Midwifery is a profession with a high sense of spirituality. However, professional belonging, love of the profession and professional development positively affect midwives’ levels of compassion. Improving midwives’ feelings of belonging and their professional development will also contribute to the quality of maternal and infant health.

Making the invisible more visible: Reflections on practice-based humanising lifeworld-led research - existential opportunities for supporting dignity, compassion and wellbeing

BACKGROUND

The need for dignity and compassion in healthcare is enshrined in policy, but is often difficult to enact in practice and what is precisely meant by these concepts is unclear. In this paper, we have explored theoretical underpinnings which form the basis of a lifeworld-led approach which was used in a research study to support the humanity of service providers and users alike.

AIM

In this article, we share our analysis of what we have learnt after undertaking an innovative appreciative action research project with patients and staff in a stroke ward with the aim of exploring if a novel phenomenologically driven and philosophically derived humanising framework could be applied in health care. Following the research, we wanted to develop a theoretical understanding of the processes occurring during the research in order to provide a framework and language which could be used to support practical lifeworld developments in the future. We analysed the approach through Participatory and Appreciative Action Reflection.

FINDINGS

As researchers, we found that the approach was underpinned by four key existential principles. The first principle was recognising a mutually arising reality rather than a reality 'out there'. The second was recognising a reality which was constantly changing rather than 'fixed'. The third was recognising that we needed to work from within, as part of a human living system rather than trying to control reality from the 'outside'. Finally, we recognised that this reality could only be accessed through human knowing, including embodied knowing rather than intellectual knowing alone. These principles challenged many of the usual ways of thinking and working within research and healthcare contexts.

CONCLUSION

Understanding the processes and reality in this way gave new perspectives; enhancing our understandings and views of ourselves, what is important and most importantly what is possible in caring systems.

Staff compassion in acute mental health wards: a grounded theory investigation

BACKGROUND

Staff working on acute inpatient mental health wards face unique challenges in terms of short admissions, acuity, complexity and exposure to violence, suicide and self-harm. They experience high levels of stress and burnout, which can impact compassion.

AIM

To qualitatively explore staff's understanding and conceptualisation of the development, loss and restoration of compassion within acute inpatient environments.

METHOD

Eleven participants from a variety of professional backgrounds currently working on acute wards were interviewed. Using constructivist grounded theory, data were synthesised into theoretical categories and sub-categories.

RESULTS

A conceptual model of the facilitators and inhibitors of compassionate care was developed, based on five categories that emerged from the data: A compassionate stance; the challenges of acute wards; feeling under threat; restoring compassion; and a compassionate organisation.

CONCLUSIONS

Findings outline the process whereby staff compassion can be challenged or depleted, leading to a negative appraisal of the patient. Colleague support, knowing and understanding patients, and accessing a reflective space all supported the restoration of compassion. Staff reported lack of organisational compassion influenced their ability to maintain a compassionate stance. The importance of appropriate training and support structures is discussed, alongside recommendations to support the development of compassionate acute mental health care.

An online mindfulness intervention to enhance compassion in nursing practice: A feasibility and acceptability study with nursing students

Background

Compassion is an important component of nursing care, but public enquiries into care failures have noted that it is not always evident. Mindfulness interventions have the potential to support compassion. However, the feasibility of delivering a mindfulness intervention at scale to nursing students has not been established.

Objectives

To develop and test the feasibility and acceptability of a tailored mindfulness based online intervention to foster compassion in nursing students within clinical practice.

Design

A randomised feasibility study with a waiting list control.

Setting

A UK nursing faculty within a large university.

Participants

Post-graduate, post-registration and pre-registration nursing students (N = 77).

Methods

An online five module mindfulness based intervention (Mindful Nursing Online) was developed and tailored to support compassion in clinical nursing. The feasibility study comprised 77 participants randomised in a 2:1 ratio into an immediate access group (intervention, n = 50) or a delayed access group (waiting list control, n = 27). Data on feasibility through completion, attrition and practice rates, were collected through follow-up questionnaires at post-intervention, and 14 and 20 weeks after baseline. Acceptability data was collected through semi-structured interviews with 12 participants.

Results

Non-completion rates were high with all five modules completed by only 28% (n = 14) of participants, and three modules completed by only 46% (n = 23). The most commonly cited reason for non-completion was lack of time. However, the interview data suggested those who completed the intervention were using mindfulness techniques in practice. They described feeling less stressed on the ward, having an increased focus on patients and a greater appreciation of the importance of self-care. Evaluative feedback therefore showed that the intervention was perceived to be effective at promoting mindfulness skills and was relevant to nursing work.

Conclusion

Minimising attrition and enhancing engagement with the intervention should be the key objectives of a future study. Feedback from participants who completed the intervention indicates that a brief mindfulness intervention delivered online may support the delivery of compassionate nursing care.

Obstacles to compassion-giving among nursing and midwifery managers: an international study

AIM

To explore nursing and midwifery managers' views regarding obstacles to compassion-giving across country cultures.

BACKGROUND

The benefit of compassionate leadership is being advocated, but despite the fact that health care is invariably conducted within culturally diverse workplaces, the interconnection of culture, compassion and leadership is rarely addressed. Furthermore, evidence on how cultural factors hinder the expression of compassion among nursing and midwifery managers is lacking.

METHODS

Cross-sectional, exploratory, international online survey involving 1 217 participants from 17 countries. Managers' responses on open-ended questions related to barriers for providing compassion were entered and thematically analysed through NVivo.

RESULTS

Three key themes related to compassion-giving obstacles emerged across countries: 1. related to the managers' personal characteristics and experiences; 2. system-related; and 3. staff-related.

CONCLUSIONS

Obstacles to compassion-giving among managers vary across countries. An understanding of the variations across countries and cultures of what impedes compassion to flourish in health care is important.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Nursing mangers should wisely use their power by adopting leadership styles that promote culturally competent and compassionate workplaces with respect for human rights. Policymakers should identify training and mentoring needs to enable the development of managers' practical wisdom. Appropriate national and international policies should facilitate the establishment of standards and guidelines for compassionate leadership, in the face of distorted organizational cultures and system-related obstacles to compassion-giving.

The impact of compassionate care education on nurses: A mixed-method systematic review

AIMS

To identify, describe, and summarize evidence from quantitative, qualitative, and mixed-method studies conducted to prepare nurses and nursing students to lead on and/or deliver compassionate care.

DESIGN

Mixed-method systematic review.

DATA SOURCES

CINAHL, Medline, PsychINFO, and SocINDEX (January 2007-February 2018).

REVIEW METHODS

Papers were screened by two independent reviewers using an online screening tool and data were extracted using a standardized data extraction table. Parallel-results convergent synthesis was used to synthesize evidence from included qualitative, quantitative, and mixed-method studies. Quality appraisal and risk of bias assessment were conducted.

RESULTS

Fifteen studies were included with three main themes and six sub-themes: (a) programme impact (impact on ward-level and senior nurses and impact on nursing students and educators); (b) programme characteristics (characteristics leading to positive outcomes and characteristics leading to negative outcomes); and (c) programme implementation (implementation barriers and implementation facilitators). Compassionate care education programmes helped enhance nurses' ability to engage in reflective practice, deal with clinical challenges, and gain confidence. The importance of nurturing compassionate care delivery in nursing education was highlighted in the literature. Various nursing-level, patient-level, and organizational barriers to compassionate care delivery were identified.

CONCLUSION

The impact of compassionate care educational programmes on nurses was predominantly positive. Further evaluation of the long-term impact of these programmes on nurses, patients, and organizations is warranted.

IMPACT

Optimal delivery of compassionate care can be achieved by building organizational infrastructures that support nurses from all levels to attend education programmes and lead on compassionate care delivery.

Impact of a compassionate care leadership programme

Compassionate care delivery enhances patient satisfaction and quality of life and reduces nurse burnout. This study measured the perceptions of nursing and midwifery leaders regarding the impact of the ‘Leaders for Compassionate Care Programme’ on their personal development, learning experience, service and care delivery, programme quality, and satisfaction with the programme. Seventy-nine leaders were surveyed using the Leaders for Compassionate Care Outcomes Evaluation Questionnaire and the Leaders for Compassionate Care Evaluation Questionnaire. Participants' perceived ability to support peer learning, manage conflict, and build trust with patients increased significantly following the programme (P≤0.001). Over 80% of participants reported that they were able to apply to practice what they had learnt from the programme and reported an increase in their motivation to lead in compassionate care delivery. Various strategies are needed to improve compassionate care leadership and further research is needed to explore the long-term impact of the programme.

Compassion in nursing: Solution or stereotype?

Compassion in healthcare has received significant attention recently, on an international scale, with concern raised about its absence during clinical interactions. As a concept, compassionate care has been linked to nursing. We examined historical discourse on this topic, to understand and situate current debates on compassionate care as a hallmark of high-quality services. Documents we looked at illustrated how responsibility for delivering compassionate care cannot be consigned to individual nurses. Health professionals must have the right environmental circumstances to be able to provide and engage in compassionate interactions with patients and their relatives. Hence, although compassionate care has been presented as a straightforward solution when crisis faces health services, this discourse, especially in policy documents, has often failed to acknowledge the system-level issues associated with its provision. This has resulted in simplistic presentations of 'compassion' as inexpensive and the responsibility of individual nurses, a misleading proposal that risks devaluing the energy and resources required to deliver compassionate care. It also overlooks the need for organisations, not just individuals, to be charged with upholding its provision.