Compassionate Care: A mixed methods study of how health care professionals and students understand and contextualise compassion within their practice

Compassionate Care: A mixed methods study of how health care professionals and students understand and contextualise compassion within their practice Dr Angela Christiansen, Dr Mary R. O Brien, Kate Zubairu,
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Compassionate Care: A mixed methods study of how health care professionals and students understand and contextualise compassion within their practice Dr Angela Christiansen, Dr Mary R. O Brien, Kate Zubairu, Dr Lucy Bray Faculty of Health and Social Care Edge Hill University Background to the study Current health policy emphasises healthcare should be safe, effective and compassionate (DH 2012, DH 2013). Key reports have demonstrated how systematic failings can lead to care that lacks compassion ( Francis Report 2013, The Ombudsman Report 2011) Nursing, Midwifery and Care Staff Vision and Strategy (2012) Schantz (2007) Compassion involves sensitivity to the distress of self and others combined with the commitment to do something about it. Dewar (2013) A barometer of the quality of the relationship between people; an emotional connection; an efforts to preserve the integrity of the individual. Organisational and cultural factors can impact significantly on these aspects of care The study aim and design 1. How do health professionals and students understand compassion and how it can be demonstrated? 2. What factors do they perceive can inhibit or facilitate them to deliver compassionate care? A sequential mixed method approach (Gerrish & Lacey 2010; Doyle et al 2009)) A self administered questionnaire completed by 155 health care professionals, 197 students Two questions ask respondents to rate statements according to their opinion Eight closed Likert-scale questions Two open ended questions -the factors that prevented/ facilitated compassionate practice Semi-structured interviews face to face (7) and telephone (7) Study participants Qualified Healthcare Professionals (n=155) Pre-registration Students (n=197) Qualified nurse 123 (34.9%) Nursing ODP 4 (1.1%) Adult 68 (19.4%) Paramedic 4 (1.1%) Child 32 (9.1%) Other post registration 6 (4.4%) MH 20 (5.7%) Counsellor 2 (0.6%) LD 5 (1.4%) Qualified AHP 10 (2.8%) ODP 2 (0.6%) Midwife 3 (0.9%) Paramedic 45 (12.8%) Social worker 3 (0.9%) Midwife 19 (5.4%) Other 6 (1.7%) Ethical approval was granted by University Faculty Ethical Committee Data analysis Structured data from questionnaires were analysed using SPSS version 16.0 to produce descriptive statistics Open data from written responses with questionnaire were subject to thematic content analysis (O Cathain & Thomas 2004) Devise coding frame to describe thematic content Assign codes to all comments Codes grouped to form themes and sub-themes Frequency of coding's were identified Interview data were transcribed, open coded and analysed using a thematic approach Data from qualitative phase used to support quantitative findings (Cresswell, 2009). Understanding of compassion in health care Response Percent Response Count Acting with empathy, warmth and respect 68.3% 110 Involving patients in their care and providing individualised care 31.1 % 50 Anticipating patients anxieties and needs and acting to prevent and minimise these 26.7% 43 Acting in a way that you would like others to act towards you 26.1% 42 Treating patients as people 14.9% 24 Recognising the distress of those in your care 13.0% 21 Acting to alleviate the distress of those in your care 13.0% 21 Meeting basic needs for physical, mental and emotional care 9.9% 16 answered question 161 Compassion can be demonstrated by Answer Options Response Percent Response Count Answer Options Respons e Percent Respons e Count active listening 56.3% 90 respecting dignity 50.0% 80 being attentive 40.6% 65 showing respect 29.4% 47 being caring 21.3% 34 being approachable 17.5% 28 spending time 17.5% 28 being patient 17.5% 28 being competent 13.8% 22 being sensitive 10.6% 17 an act of kindness 5.0% 8 being accessible 4.4% 7 offering help 3.8% 6 a warm smile 2.5% 4 a courteous manner 2.5% 4 having good humor 1.3% 2 answered question 160 Qualitative themes Theme Doing the little things Seeing the person and family Putting yourself in their shoes Example You know a little touch, just little things that go a long way. Saying has anybody brushed your teeth?, shall we give your hair a brush? little things like that to me show compassion ID1 Holding the lady s hand and just talking, just being there ID12 By taking the time to listen, doing the little things for them, making them feel good about themselves and giving them the will to get better and carry on ID 5 compassionate means that you re giving people time to express themselves and to listen to them ID7 I get to know not only the patients but their family and their background and their home circumstances and I feel that gives us a great advantage in order to be compassionate. ID1 I think the families are often left out quite a lot in compassion really and that s quite sad ID5 We try and look at people holistically and we try and look at effects on family and their home life and we try to address what s important to the patient. So it might not be what s important or what we see as important but it s what is important to them and it causes them concern ID6. for me personally it s about treating my patients and their relatives and carers as I would expect to be treated myself, or as I would treat my own family ID1 To some extent it s sort of putting yourself in their shoes and imagining how you would feel if you were sat in that bed or in that wheelchair or whatever ID2 Treating people with respect, treating them the same way you d want to be treated yourself ID8 Factors that prevent the delivery of compassionate care Themes Sub-themes Nursing students (n=102) Midwifery students (n=20 ) Paramedic students (n=44 ) Qualified nurses (n=113 ) Other HCP s (n=33 ) All student respondents (n=166 ) All qualified staff (n=146 ) Organisational factors Heavy workload (17%) 40 (24%) Staff shortages (11%) 35 (23%) Business model of (7%) 16 (10%) healthcare Time constraints (46) 76 (52%) Team factors Poor leadership or teamwork (6%) 4 (2%) Individual factors Patients or family (16%) 7 (4%) attitudes Lack of understanding (12%) 13 (8%) Personal well-being (7%) 15 (9%) Values and behaviours (7%) 7 (4%) Factors that promote compassionate care Theme Sub-themes Nursing students (n=102 ) Midwife students (n=20 ) Paramedic students (n=44 ) Qualified nurses (n=113 ) Other HCP s (n=33 ) All student respondents (n=166 ) All qualified Respondent (146) Organisational factors Adequate levels and mix of (6%) staff More time with patients (14%) 48 (34%) Team factors Individual factors Good teamwork and leadership Understanding of self and others (11%) 30 (20%) (17%) 39 (26%) Staff wellbeing (4%) 13 (8%) Values and behaviours (63 %) 75 (51%) Organisational and team factors Subtheme Time Staffing and workload Business model of health care Team factors I think time constraints can hinder because being compassionate means that you re giving people time to express themselves and be able to listen to them and if you are pushed for time then you don t have time to do that. Having time, making time, time management skills People are so busy and they re so short staffed, especially on the wards now. Having the time to just stop and ask somebody how they re feeling or just take a moment to comb their hair, I think they re so pushed. The turnover is a lot quicker now with patients isn t it? And managers want nearly 100% occupancy on beds and people just don t feel that they re being they feel like they re being rushed all the time, that there s a conveyor belt and they re just part of a system and their individual needs are not being addressed ID7 it s very much a business model and there s a lot of pressure to achieve targets and that s great if you re making tins of beans but you know you re treating people, it doesn t work like that. ID2 I think our culture is far too much, let s get the job done and let s get it done quickly. ID4. An inspirational leader who boosts morale; Good happy teammates; working in collaborative team who communicate well; I do think at its best, compassion is something that s role modelled to people ID2 A good mentor makes a massive difference ID1 junior nurses obviously always look to senior staff and if you ve got a good ward sister to follow and you think oh, you know you re sort of inspired by them then I think you take it upon yourself to practice the same as well ID5 Well I think just watching people that are compassionate like leading by example kind of thing ID5 Yeah I ve definitely learnt it from certain Paramedics that I ve worked with. I ve also learnt it off patients and so you know if they ve been compassionate to their relative or what have you or compassionate towards us for working a night shift or something. ID13 Individual factors Personal wellbeing I think if the government and the powers that be didn t keep altering things every five minutes maybe I think sometimes people just get so fed up that it makes them become a less compassionate person because they re having too much stress. ID6 Working long hours without a break, fatigue and hunger Not feeling that anyone appreciates my efforts Patient and family If somebody s abrupt or aggressive it is difficult sometimes to try and retain that compassion ID6 Family members who are overwhelming (student midwife); Difficult patients and families. Its hard to be compassionate when someone is shouting at you (paramedic student) Understanding self and others Values and behaviours If people are being aggressive or just rude it doesn t come as naturally to be compassionate but then I think you need to think why are they being rude and then as soon as that is addressed, you can often understand it s through fear or pain or anxiety and then compassion comes easier. ID4 Being aware of people s reaction to illness (student nurse) Understanding what patients are going through (student nurse) Taking time to reflect (qualified nurse) A kind and caring nature (student nurse) my family upbringing (student nurse) my own sense of right and wrong (student nurse) Doing the job I have always wanted to do Being approachable, letting patients know I am ready to talk ; being non judgemental; Developing a strong bond with my patient enables me to be sensitive to their needs. Spending time with patients in order to listen, learn and understand; being patient and able to prioritise Organisations, teams and individuals Health care practitioners and students have a clear understanding of compassionate care and agree on how it can be demonstrated. - However they also perceive a number of factors within their working and learning environments that impacts on their ability to practice in accordance with their values. Organisations shape the way health care is delivered and can either support or mitigate compassionate and patient centred workplace practices (Cole-King & Gilbert 2011) Dewar (2013) talks about the compassionate organisation that cultivates a caring and compassionate culture Growing evidence of the positive relationship between staff well-being and high quality patient care (Raleigh et al 2009) and improved patient outcomes (Pinder et al 2013) Leaders at ward level create positive emotional climates through modelling compassionate ways of being, in relation to others. They engage staff by showing authentic personal concern for them as individuals (Onyett 2012 p13 ) Dewar (2013) Compassion involves relationship-centred care. This requires personal understanding of how own emotional responses to patients can act as a barrier. Being compassionate with self requires space and support to reflect on difficult thought and feelings. Requires courage to make emotional connections and develop relationships (Dewar 2012). Schwartz Rounds are a multidisciplinary forum in which staff come together to discuss and reflect on the emotional and social challenges they are facing with the aim of improving relationships and communication among and between staff and patients (Goodrich 2012; Thompson 2013). Thank you. Dr Angela Christiansen, Dr Mary R. O Brien, Kate Zubairu, Dr Lucy Bray Faculty of Health and Social Care Edge Hill University
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