PROJECT FINDINGS Appreciative enquiry into the development and evaluation of a ‘train the

trainers’ approach towards cultivating compassion

Literature review (1) Background

Compassion as a core value in the NHS Constitution, in professional codes, in the Vision and Strategy for nursing and Midwifery & Prime Minister’s Commission Report on the Future of Nursing and Midwifery.

Compassion has attracted much attention from researchers and scholars e.g. Torjuul et al (2007); Van der Cingel (2011), Curtis (2012, 2013), Gilbert (2013) & Dalai Lama (1999)

What does ‘compassion’ mean? From the Latin com (together with) and pati (to suffer) = suffering with.

Involves emotion, such as empathy or sympathy, and a rational understanding of the suffering that enables identification with it - the ability to deliberately and altruistically participate in another’s suffering (von Dietze and Orb 2000).

3 components - An emotional response, rational deliberation & action.

Literature review (2) Not just about individuals…

‘Seeing the person in the patient’ (Goodrich and Cornwell 2008) – improvements in patient experiences requires co-operation and effort of all staff at 4 levels = individual, team, the institution and wider organisation. Defending Dignity: Challenges & Opportunities for Nursing (Bailey, Gallagher & Wainwright 2008) Learning from social psychology – Paley (2014) & Zimbardo – The Lucifer Effect – apples & barrels – See TED talk ‘What makes people go wrong?’ Infinite capacity to be kind or cruel (See https://www.youtube.com/watch?v=-IVHoeUGiVg )

Literature review (3) Emotional labour & compassion

As Nouwen et al (1982: 4 cited in Von Dietze & Orb 2000: 169) write:

Compassion asks us to go where it hurts,

to enter into places of pain, to share brokenness, fear, confusion and anguish. Compassion challenges us to cry out with those in misery, to mourn with those who

are lonely, to weep with those in tears. Compassion requires us to be weak with the weak, vulnerable with the vulnerable,

and powerless with the powerless. Compassion means full immersion into the

condition of being human.

Compassion fatigue & self-compassion Gilbert (2009:xxi):

If they started, to feel self-kindness or

compassion it could ignite feelings of grief.

Birnie et al (2010), drawing on the work of Neff

(2003:224) suggest that:

Self-compassion entails three fundamental

components: (1) extending kindness and

understanding to oneself rather than harsh self-

criticism and judgment, (2) seeing one’s

experiences as part of the larger humanity rather

than as separating and isolating; and (3) holding

one’s painful thoughts and feelings in balanced

awareness rather than over-identifying with

them.

Self-compassion is ‘a foundation for

compassionate care’ (Mills et al 2015).

1. Shifts in perspectives

(i) Self-compassion

(ii) Compassion towards others

(iii) The Impact on Practice

(iv) The project itself

2. Project Implementation Enablers

(i) Voluntariness

(ii) Positive leadership

(iii) Integration

4. Value of resources

(i) Toolkit

(ii) Confidence

(iii) Individual creativity

3. Project Implementation Inhibitors

(i) Scepticism

(ii) Leadership gaps

(iii) Missed opportunities for integration

(iv) Organisational factors

CULTIVATING COMPASSION

Project Themes &

Sub-themes

Cultivating Compassion Project Themes and Sub-themes

THEME 1 – SHIFTS IN PERSPECTIVES

Sub-themes - Self-compassion; Compassion towards others; & The Impact on Practice – See Executive Summary

The project itself – Shift from ‘Compassion Awareness Training’ to ‘Cultivating Compassion’

I think getting away from awareness was good you know, whereas ‘cultivating’ feels a bit like a social network and we are all

coming together as a community

Shift from compassion as exclusively towards the patient to encompass the self and others.

The potential to cascade compassion throughout the organisation.

THEME 2 – PROJECT IMPLEMENTATION ENABLERS

Sub-themes - Voluntariness; Positive leadership; & Integration - See Executive Summary

I am really lucky, my team are really positive and so they do it .

It was felt that the additional monthly support meetings from the project team were unnecessary: We meet regularly and share what we are

doing in the compassion project

I want to add the compassion activities to the sign-off mentor training. I think I have a

little bit of space there because there is room for compassion being shown to

students when they are struggling.

THEME 3 – PROJECT IMPLEMENTATION INHIBITORS Sub-themes – Scepticism;

Leadership gaps; Missed opportunities for integration; & Organisational factors - See Executive Summary

Some participants expressed concern that recognising acts of compassion may be seen as patronising:

You don’t know, someone might take it the wrong way. I don’t know. Who are you to be saying that to me? Would you expect something less from

me?

Yet, this participant revealed that they had:

never thought to compliment somebody’s compassion before

I’ve heard that within our services , within our trust ‘You’re not looking after us’, you know and that makes people less likely to then take on an

initiative that’s about being compassionate because they feel it’s not demonstrated by those

that are meant to be our leaders.

THEME 4 – VALUE OF RESOURCES

Sub-themes – Toolkit; Confidence; & Individual creativity - See Executive Summary

Thoughts from training days:

• Encourage reflective practice – thought regarding how I engage with others.

• Person-centred approach. • Needing to take time. • The workshop made me realise

that I as an individual and members of my team are already compassionate but do not realise it.

• How we as a team make time for ourselves and others within the team.

Conclusions

• The project supports the importance of self-compassion and team compassion and an

organisational culture that is receptive to compassion.

• This was recognised as a welcome shift in perspective on compassion by most participants.

• Discourse on workforce development on compassion needs to be supported from the inside of

NHS organisations.

• Outside imposed models can be greeted with scepticism.

• The train the trainer model also requires systems embedded support.

• There is also a need for named leadership positioned in various levels of the organisation to

initiate, support and evaluate toolkit activity.

• A need to integrate compassion activities with existing training initiatives and suggest the need for

staff support systems to enhance resilience and manage the stresses of high demand working.

Recommendations

• Increase awareness among leaders in healthcare organisations of the importance of demonstrating commitment to compassion in their everyday leadership activity;

• Utilise a bottom-up approach , alongside strong leadership – practitioners told us that they would have benefited from fuller engagement with the project at an earlier stage. This proved successful in one of the organisations;

• Integrate learning approaches with existing ethics and values-based developments -– the organisations we worked with already had a wide range of values-based activity in place however it was not possible to engage with these at an earlier stage due to challenges in some organisations;

• Engage with organisational leadership to negotiate time and space for staff to participate in self-compassion and receive recognition for compassion towards patients, families and colleagues;

• Explore ways to disseminate the Toolkit to the NHS workforce more widely;

• Expand the concept of compassion to a fuller engagement with ethical values (for example, justice, respectfulness and courage) and professionalism in staff development activities; and

• Be informed by scholarship & research in relation to topics such as moral distress, ethical climate & moral resilience.

Thank You to You for Listening & to:

• Health Education Kent, Surrey & Sussex who funded the project;

• Trust colleagues who worked with us on the project as compassion leads and participants;

• Laurence Leng who assisted with photography for the digital stories;

• Felix Gonzales who assisted the team with the design of the digital stories; and

• A great project team