Compassion In Practice Research Articles

The changing place of care and compassion within the English NHS: an Eliasean perspective

In the wake of the Francis Report, a public conversation has arisen in England about the place of compassion within healthcare settings, particularly regarding the causes of failures in the provision of adequate healthcare, and the desirability and possibility of fostering compassion in the NHS. A contribution to this conversation, this article takes as a starting point an oft-overlooked socio-historical phenomenon: social expectations of compassion in healthcare practice have shifted in comparison to what was the case at the NHS’s inception in 1948, so that both healthcare professionals and the public have come to perceive and expect compassion as an intrinsic component of healthcare. We argue that this expectation can be partly explained drawing on Elias’s concept of ‘functional democratisation’: as power asymmetries between different social groups (e.g. doctors and patients) have declined in recent decades, so have norms and expectations of compassionate care increased. Failures to provide compassionate care in some specific settings can also be partly understood as an outcome of a wider erosion of functional democratisation resulting from the growth in social inequality witnessed in England and much of the world since the 1970s. We thus call for addressing failures of care within healthcare settings through broader social policies.

Teaching compassionate care to nursing students in a digital learning and teaching environment

BackgroundHealthcare that is technically excellent, but without compassion, fails to meet the expectations of patients. Ample evidence about teaching compassion to nursing students in classrooms exists; however, few studies report online teaching. AimThis study explored final year nursing students’ perceptions of compassion and practising compassion before and after studying an online compassion module. MethodsAn exploratory, descriptive qualitative approach guided data collection and analysis. Students responded to open-ended questions before and after studying the module. FindingsThemes derived from the analysis: being present, acting to relieve suffering, getting the basics right, going forward. Being present for patients was evident in statements such as placing yourself in their shoes, taking time to listen carefully and doing things that mattered (e.g., using touch to convey compassion). Acting compassionately depends on communicating to understand the suffering of others and what matters. Being resilient involved getting the basics right (e.g., positive self-care and lifestyle practices, cultivating supportive networks, setting boundaries). Going forward included being mindful to act compassionately as new registered nurses and supporting colleagues. ConclusionsThis study provided new insights into how students’ new knowledge translated into compassionate action. Students described the positive impact of small acts of compassion from one nurse to another that enhanced teamwork and resilience. Recognising the critical role of compassion to patient and family outcomes, provider wellbeing, and organisational culture, these findings could be used by nurse leaders and educators to develop evidence-informed curricula to foster the practice of compassion which all nurses aspire to provide.

The Co-creation and Feasibility of a Compassion Training as a Follow-up to Mindfulness-Based Cognitive Therapy in Patients with Recurrent Depression

The aim of this study was to assess the feasibility, acceptability and preliminary effectiveness of Mindfulness-Based Compassionate Living (MBCL) as a follow-up intervention to Mindfulness Based Cognitive Therapy in adults with recurrent depression. We conducted an uncontrolled study in 17 patients with recurrent depression, in two successive groups. The first group contained novices to compassion training (N = 14); in the second group, ten of these participated again, in addition to three new participants (N = 13). The overall group contained 15 females and 2 males, aged between 37 and 71. The MBCL program was qualitatively evaluated using post-intervention focus group interviews in both groups. In addition, self-report questionnaires assessing depressive symptoms, worry and both self-compassion and mindfulness skills were administered before and after MBCL. No patients dropped out of the intervention. Average attendance was 7.52 (SD 0.73) out of eight sessions. Helpful elements were theory on the emotion regulation systems, practicing self-compassion explicitly and embodiment of a compassionate attitude by the teachers. Unhelpful elements were the lack of a clear structure, lack of time to practice compassion for self and the occurrence of the so-called back draft effect. We adapted the program in accordance with the feedback of the participants. Preliminary results showed a reduction in depressive symptoms in the second group, but not in the first group, and an increase in self-compassion in both groups. Worry and overall mindfulness did not change. MBCL appears to be feasible and acceptable for patients suffering from recurrent depressive symptoms who previously participated in MBCT. Selection bias may have been a factor as only experienced and motivated participants were used; this, however, suited our intention to co-create MBCL in close collaboration with knowledgeable users. Examination of the effectiveness of MBCL in a sufficiently powered randomised controlled trial is needed.

How Do Cultural Factors Influence the Teaching and Practice of Mindfulness and Compassion in Latin Countries?

Network for Prevention and Health Promotion in primary Care (RD12/0005/0006) grant from the Instituto de Salud Carlos III of the Ministry of Economy and Competitiveness (Spain), co-financed with European Union ERDF funds (FEDER “Una manera de hacer Europa”).

Compassion focused therapy for eating disorders: A qualitative review and recommendations for further applications

BackgroundPeople suffering from an eating disorder (ED), or more generally with eating, body image, and weight concerns, have been found to experience high levels of self‐criticism, self‐directed hostility, and shame. Furthermore, these individuals tend to have difficulties generating and activating affiliative and self‐soothing emotions.MethodsCompassion focused therapy (CFT) specifically addresses these issues, and CFT for eating disorders (CFT‐E) was designed to incorporate the development and practice of compassion for self and others into standard ED treatment programs to assist with these issues.ResultsThis article describes (1) the theoretical rationale for cultivating compassion for self and others as part of ED treatment, (2) the adaptation and incorporation of CFT‐E within ED treatment programs, and (3) a qualitative review of the current evidence base for CFT‐E.ConclusionsFinally, the article will explore recent and potential future developments in CFT‐E, and recommendations for the use of CFT‐E in clinical practice, including its application for those who present with other eating and weight concerns (such as being overweight or obese), and various modes of inpatient and community‐based delivery.

An evaluation of National Health Service England's Care Maker Programme: A mixed-methods analysis.

To investigate the impact and sustainability of the Care Maker programme across England from the perspective of those involved in its delivery. The Care Maker programme was launched in England in 2013. It aims to support the "Compassion in Practice" strategy, with particular emphasis on the 6Cs of care, compassion, competence, communication, courage and commitment. Care Makers were recruited in an ambassadorial role. The intention was to inspire individuals throughout the National Health Service in England to bridge national policy with those delivering care. A mixed methods design was chosen, but this article focuses on two of the four distinct empirical data collection phases undertaken as part of this evaluation: a questionnaire with Care Makers; and two case studies of separate National Health Service trust sites. Data were collected for this evaluation in 2015. An online questionnaire was distributed to the total population of Care Makers across the National Health Service in England. It included a combination of open and closed questions. The case studies involved semistructured telephone interviews with a range of professionals engaged with the Care Maker programme across the trust sites. Care Makers reported that participation in the programme had offered opportunities in terms of improving the quality-of-care provision in the workplace as well as contributing towards their own professional development. The Care Maker programme has supported and helped underpin the nursing, midwifery and care strategy "Compassion in Practice". This model of using volunteers to embed strategy and policy could potentially be used in other areas of clinical practice and indeed in other countries.

An exploration of the 6Cs as a set of values for nursing practice.

In 2012, after several high-profile cases of poor quality care in England and concerns about a lack of compassion and a need to refocus on values, the Department of Health in England published a new strategy for nursing, midwifery and care staff: Compassion in Practice. The strategy included the 6Cs (care, compassion, courage, communication, competence and commitment) and in the follow-on framework, produced by NHS England in 2016, the 6Cs were included again. This article explains the background to the 6Cs and highlights the other values frameworks that nurses and midwives must work within too. Nursing theorists have studied caring extensively and the earlier set of 6Cs, produced by a Canadian nurse Sister Simone Roach, is explained in the article. The meaning of the DH's 6Cs is then explored in detail with reference to previous research and nursing theory.

Palliative care professionals' care and compassion for self and others: a narrative review.

Compassion is arguably central to palliative care. However, calls for the restoring of compassionate care suggest a need for greater understanding and promotion of compassion in practice. Drawing upon the Foucauldian concept 'Care of the Self', this review explored the literature relating to palliative care professionals' self-care, self-compassion, and compassion for others. Three electronic databases were searched using identified key words. A thematic approach was used to synthesise and critically discuss the literature in the form of a narrative review. Four themes were identified: (1) importance of self-care; (2) awareness, expression, and planning; (3) dimensions of self-care; and (4) balanced compassion. Approaches to self-care practice and research focused mainly on compassion fatigue or a coping paradigm. This review highlights both the importance and multifaceted nature of palliative care professionals' self-care, in relation to self-compassion and compassion for others. Despite widespread discussion, empirical knowledge of these variables is limited. Future research could usefully explore health promotion interventions in self-care practice, or a positive psychology paradigm that encompasses compassion and self-compassion as positive emotions associated with wellbeing.

Community mental health nurses' and compassion: an interpretative approach

Introduction There is increasing emphasis in policy, research and practice in the UK and internationally on the importance of caring in health care. Compassion needs to be at the core of all healthcare professionals' practice. Recently, health care has received negative attention through media and government reports which cite a lack of compassion in care. Rationale The concept of compassion has received limited attention in community mental health nursing. Aim Based on data taken from semi-structured interviews with community mental health nurses, this paper aims to describe interpretations and perspectives of compassion to gain insight and development of its meaning. Method A naturalistic, interpretive approach was taken to the study. Semi-structured interviews with nine mental health nurses were analysed using Burnard's 14-step model of thematic analysis. Findings The research illuminates the complexity of compassion and how its practice impacts on emotional responses and relationships with self, patients, colleagues and the employing organization. Participants identified difficulties engaging with compassionate practice whilst recognizing it as a driving force underpinning provision of care. Implications for practice Mental health nurses need to be supported to work towards a greater understanding of compassionate care for clinical practice and the need for self-compassion.

Meditation-induced neuroplastic changes in amygdala activity during negative affective processing

ABSTRACTRecent evidence suggests that the effects of meditation practice on affective processing and resilience have the potential to induce neuroplastic changes within the amygdala. Notably, literature speculates that meditation training may reduce amygdala activity during negative affective processing. Nonetheless, studies have thus far not verified this speculation. In this longitudinal study, participants (N = 21, 9 men) were trained in awareness-based compassion meditation (ABCM) or matched relaxation training. The effects of meditation training on amygdala activity were examined during passive viewing of affective and neutral stimuli in a non-meditative state. We found that the ABCM group exhibited significantly reduced anxiety and right amygdala activity during negative emotion processing than the relaxation group. Furthermore, ABCM participants who performed more compassion practice had stronger right amygdala activity reduction during negative emotion processing. The lower right amygdala activity after ABCM training may be associated with a general reduction in reactivity and distress. As all participants performed the emotion processing task in a non-meditative state, it appears likely that the changes in right amygdala activity are carried over from the meditation practice into the non-meditative state. These findings suggest that the distress-reducing effects of meditation practice on affective processing may transfer to ordinary states, which have important implications on stress management.

Cultivating the compassionate self against depression: An exploration of processes of change

IntroductionCompassion and self-compassion can be protective factors against mental health difficulties, in particular depression. The cultivation of the compassionate self, associated with a range of practices such as slow and deeper breathing, compassionate voice tones and facial expressions, and compassionate focusing, is central to compassion focused therapy (Gilbert, 2010). However, no study has examined the processes of change that mediate the impact of compassionate self-cultivation practices on depressive symptoms.AimsThe aim of this study is to investigate the impact of a brief compassionate self training (CST) intervention on depressive symptoms, and explore the psychological processes that mediate the change at post intervention.MethodsUsing a longitudinal design, participants (general population and college students) were randomly assigned to one of two conditions: Compassionate self training (n = 56) and wait-list control (n = 37). Participants in the CST condition were instructed to practice CST exercises for 15 minutes everyday or in moments of stress during two weeks. Self-report measures of depression, self-criticism, shame and compassion, were completed at pre and post in both conditions.ResultsResults showed that, at post-intervention, participants in the CST condition decreased depression, self-criticism and shame, and increased self-compassion and openness to receive compassion from others. Mediation analyses revealed that changes in depression from pre to post intervention were mediated by decreases in self-criticism and shame, and increases in self-compassion and openness to the compassion from others.ConclusionsThese findings support the efficacy of compassionate self training components on lessening depressive symptoms and promoting mental health.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Innovation in preregistration midwifery education: Web based interactive storytelling learning

Backgroundthrough a critical description of the implementation of a web based interactive storytelling learning activity introduced into an undergraduate, preregistration midwifery education programme, this paper will explore how low-cost, low-fidelity online storytelling, designed using Moodle, can be used to enhance students’ understanding of compassion and empathy in practice. Samplecross sectional sample of first year undergraduate Midwifery students (n111) Methoddrawing from both research and audit data collected in an Higher Education Institution in London England, the paper presents the case for using web based technology to create a sustainable model for midwifery education. Findingsinitial results indicate that it is both the low cost and positive student evaluations of web based interactive storytelling, which make this approach to preregistration midwifery education which suggests that this approach has significant potential for learning and teaching in midwifery education in diverse settings around the world. Or how about: global relevance?.

Compassion in practice: connected, contested, conflicted, conflated and complex

Compassion in practice: connected, contested, conflicted, conflated and complex

The Journey

The Journey

The governing body nurse as a clinical commissioning group nurse leader.

Aim The aim of this study was to understand governing body nurses' perspective of their effect on, and leadership of, clinical commissioning groups (CCGs). Method Semi-structured face-to-face and telephone interviews were conducted with a sample of governing body nurses, CCG chairs and regional chief nurses. A total of 23 individuals were interviewed. Findings Governing body nurses were overwhelmingly positive about their role and believed they had a positive effect on the CCG governing body. Specifically, they provided leadership for the quality agenda and compassionate practice. Challenges experienced by some governing body nurses related to their capacity to undertake the role where this was on a part-time basis, time restraints and difficulties working with colleagues. Conclusion The role of the governing body nurse was not well defined when it was introduced, and as a result its development across CCGs has varied. Governing body nurses have used their leadership skills to advance important agendas for their profession, such as workforce redesign, new integrated care pathways and co-commissioned services.

Factors facilitating nurses to deliver compassionate care: a qualitative study.

Compassion is an important ethical foundation of all healthcare professionals especially for nursing. However, there is little understanding of factors which could help and motivate nurses to deliver compassionate care in modern healthcare practices today. Moreover, a cultural context may affect the way compassionate care is delivered by healthcare professionals. This study aimed to explore what facilitates compassionate care in daily practice from the unique perspective of Iranian nurses. This qualitative exploratory study was conducted in four hospitals. In this study, 16 nurses were selected from various wards. Data were collected by in-depth, face-to-face interviews. For data analysis, a conventional content analysis approach was used. As the most important theme, the theme 'deepening individual's capacity for compassionate care' emerged, which consisted of three categories: the personal system of values and beliefs, patient experience and positive role models of compassion. Addressing and developing nurses' capacity for compassion is possible by providing organisational support and professional education, next to recruiting nurses with a high motivation to relieve patient suffering. These recommendations would help to provide high-quality compassionate care in healthcare practices. Moreover, nurses could improve their individual capacity for compassion by following their value and belief system and by considering their colleagues as a role model of compassionate practice.

The Mindful Nurse Sheridan Carmel The Mindful Nurse 372pp £19.95 Rivertime Press 9780993324529 0993324525

This is an excellent text for nurses at any stage of their career. It takes the reader through mindful and compassionate practice step by step with the opportunity to explore individual practice at each stage.

A «aceitação» em portadores assintomáticos e sintomáticos da doença de Machado-Joseph

Machado-Joseph disease (MJD), also known as spinocerebellar ataxia type 3 (SCA3), is an autosomal dominant neurodegenerative disorder of late onset. The presence of the disease is frequently accompanied by important psychological alterations, especially in more advanced stages of the disease. The present work aims to examine the levels of acceptance, psychological well-being, family satisfaction, and self-compassion in a sample of 40 carriers of the MJD mutation, of whom 11 were asymptomatic and 29 symptomatic, as well as how these constructs were interconnected. A protocol was used that followed a retrospective design, and included a semi-structured interview and various psychological assessment scales. In asymptomatic carriers, acceptance was associated with family satisfaction, psychological well-being, and self-compassion. In the case of symptomatic carriers, acceptance proved to be significantly associated with self-compassion and psychological well-being. The results indicate that the levels of acceptance, psychological well-being, family satisfaction, and self-compassion decrease with the onset of symptoms. Data supports the importance of developing psychotherapeutic plans aimed at increasing acceptance, not only upon the appearance of symptoms, but also as a preventive approach, through psychological interventions that integrate the practice of mindfulness and compassion, not only directed at the individuals but also their family and social network.

Developing and Using a Toolkit for Cultivating Compassion in Healthcare: An Appreciative Inquiry Approach

This article describes the process of developing and evaluating a ‘cultivating compassionate care’ toolkit of evidence-based training resources designed to be cascaded through a ‘train-the-trainer’ approach in three healthcare organisations in Southern England. The purpose of the project was to develop an awareness of compassion, and to investigate how compassion can be recognised, developed, and sustained within the healthcare workforce. The study was based on appreciative inquiry and a train-the-trainer model, using focus groups to generate evidence-based training tools designed with the staff in the participating organisations. Questionnaires evaluated the first wave of Cultivating Compassion workshops delivered by trainers, while semi-structured interviews and focus groups evaluated the experiences of those using the toolkit. The findings demonstrated that a cultivating compassion toolkit, co-created with the healthcare workforce, can develop confidence in engaging in discourse on the meaning of compassionate care, and provoke a focus on self-compassion and compassion towards colleagues. Thematic analysis of interviews and focus group data with participants involved in cascading the toolkit activities revealed the value and usability of the toolkit resource, and the leadership factors influencing its implementation. We conclude that cultivating compassionate practices requires leadership to clearly articulate their values and vision for compassion, ensuring these are clearly supported and integrated throughout the organisation as part of changing culture and practices to support compassionate care. The limitation of the study was that we were unable, due to the project timeline, to measure impact of the project on patients, their families, and carers.

The emotion of compassion and the likelihood of its expression in nursing practice.

Philosophical and empirical work on the nature of the emotions is extensive, and there are many theories of emotions. However, all agree that emotions are not knee jerk reactions to stimuli and are open to rational assessment or warrant. This paper's focus is on the condition or conditions for compassion as an emotion and the likelihood that it or they can be met in nursing practice. Thus, it is attempting to keep, as far as possible, compassion as an emotion separate from both moral norms and professional norms. This is because empirical or causal conditions that can make experiencing and acting out of compassion difficult seem especially relevant in nursing practice. I consider how theories of emotion in general and of compassion in particular are somewhat contested, but all recent accounts agree that emotions are not totally immune to reason. Then, using accounts of constitutive conditions of the emotion of compassion, I will show how they are often likely to be quite fragile or unstable in practice and particularly so within much nursing practice. In addition, some of the conditions for compassion will be shown to be problematic for nursing practice. It is difficult to keep ideas of compassion separate from morality, and this connection is noticeable in the claims made of compassion for nursing and so I will briefly highlight one such connection that of the need for normative theory to give an account of the value that emotions such as compassion presume and that compassionate motivation is separate from moral motivation and may conflict with it. The fragility or instability of the emotion of compassion in practice has implications for both what can be expected and what should be expected of compassion; at least if what is wanted is a realist rather than idealist account of "should."