A programme developed to support compassionate nursing practice has helped nurses to reconnect with the compassion that brought them into the profession
Recent national reports on NHS care failings highlight the need to support, develop and provide evidence of compassion in practice. This article describes a nurse training and leadership programme that teaches nurses to become champions of compassionate care, delivering cultural change across their teams and areas of practice.
Citation: Hall I, Nelligan M (2015) Helping nurses reconnect with their compassion. Nursing Times; 111: 41, 21-23.
Authors: Ian Hall is director of Crossley Hall Rocks Social Enterprise; Maria Nelligan is associate director of nursing, Cheshire and Wirral Partnership Foundation Trust.
- This article has been double-blind peer reviewed
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Compassion, otherwise known as intelligent kindness, should define nursing and other caring professions. It is one of the key values, known as the “6Cs”, in the Compassion in Practice Strategy for nursing in England (NHS England, 2012), which has had its two-year review (NHS England, 2014), and is also included in the Nursing and Midwifery Council’s new professional code (NMC, 2015). However, recent reports on NHS care failings, notably at Mid Staffordshire Foundation Trust and Winterbourne View care home, have revealed institutional failures leading to a lack of care, compassion and leadership (Francis, 2013; Department of Health, 2012). National recommendations in response to these reports highlight, among other things, a need to support, develop and evidence compassion in practice (Cavendish, 2013; Francis, 2013).
In response to the Francis Report, the North West Directors of Nursing Network for nine mental health and learning disability trusts began a year-long project in January 2014 to improve the quality and value of their nursing services (Francis, 2013). This included a nurse training and leadership programme to promote compassion in practice.
The Compassion in Practice Strategy for England calls for strong and effective leadership, front-line staff empowered to act as “change champions”, staff training and development and the right organisational culture to support staff to deliver and embed in the culture the 6Cs to improve patient care and the user experience (NHS England, 2012). Our project, the Heart of Leadership Programme, is about training and developing front-line nurses to fulfil their potential to deliver compassionate, patient-centred care and champion this across teams and organisations to achieve cultural change.
The programme is based on the premise that all nurses have the potential to deliver compassionate care; indeed this is often what leads them into nursing in the first place. However, increased pressures and demands on the NHS, constant organisational change and the challenge of engaging in emotionally demanding work can make it challenging to sustain compassionate care, and lead to staff stress and burnout. The increased emphasis on patient safety in the wake of the Francis report therefore needs to be balanced with support for the higher nursing skills and functions associated with compassion and person-centred care (Francis, 2013).
Many trusts have adopted the 6Cs (care, compassion, competence, communication, courage, commitment), or variants of them, as their values base or reference point for developing a culture refocused on compassion and care (NHS England, 2012). We wanted to create an educational experience within the framework of the 6Cs that was relevant to national and local Compassion in Practice initiatives, inspiring and helpful on a personal level to all nurses who attend, and which empowered them to be effective champions or leaders of cultural change across organisations and teams.
The Heart of Leadership programme aimed to:
- Take a collaborative approach with clinical and educational leads;
- Develop course content to target front-line nurses;
- Link to the national compassion agenda.
We looked at what was happening nationally and carried out a literature review. We also reviewed local initiatives promoting care and compassion across the nine mental health and learning disability trusts in the North West to understand progress and share good practice. We used this, along with established approaches to building personal insight and resilience, to develop and pilot a nurse training and leadership programme that could be rolled out across the North West. Course content included:
- Linking the national compassion agenda to areas of practice;
- Self-reflection and personal insight and how these relate to the delivery of compassionate care.
To help deliver the programme, we engaged Stephen Wright, a nurse leader in enlightened approaches to leadership development and compassionate insight. The programme included:
- Two courses: Companions in Compassion, and Soul of Leadership;
- An insight inventory tool to measure improvements in care and compassion across nursing services.
Companions in Compassion
This course teaches and inspires nurses to become leaders, or “companions in compassion”, who can develop and drive change within their areas of practice. The role is designed to link into the national Care Makers programme, a network of volunteers across England acting as ambassadors for the 6Cs across the NHS and beyond.
The five-day course teaches nurses key concepts in the delivery of compassionate care, linking it to the national compassion agenda. This includes supporting and developing compassionate practice in themselves and others, focusing practice and teams, and sharing, networking and celebrating their work as nurses through telling their own stories of compassion and care.
Soul of Leadership
This is a four-day course for new and experienced inpatient nurses, which teaches them how to develop compassionate insight in practice and recognise and develop this within their clinical environments and teams. It explores concepts and challenges in delivering compassionate care in today’s NHS, with a strong underpinning from the Compassion in Practice 6Cs philosophies. Participants are inspired to go out and be proud of their roles as nurses, innovate and develop best-practice examples and inspire others in their clinical areas.
The Insight programme, developed by Mr Wright, features in both courses and focuses on the nurse as a compassionate leader and practitioner. It helps nurses fulfil their potential for compassion using reflective and self-exploratory techniques to build confidence and resilience. It also shows nurses that understanding and being compassionate and caring of themselves is essential to being compassionate towards others (Box 1).
Box 1. Stephen Wright on the Insight programme
“The Insight work looks at what is going on in the person who is a nurse to enable them to fulfil their potential for compassion. It is the potential of all human beings to be loving and caring. So we ask what is going on in the system and in the person who is a nurse; what is preventing that compassion being set free?
The Insight programme does that safely through meditation, deep listening techniques, time for inner reflection, group work, sharing, trust-building - techniques that are common in psychotherapy and psychological teaching and spiritual groups.
People are quickly bought to tears, but it tends to be tears of recognition, and having their hearts touched. The programme helps them open their hearts within safe boundaries. Meditation techniques in particular unlock in people an understanding and awareness of ‘who I really am’. Nurses learn the difference between saying ‘I am a nurse’ and ‘I am a person who happens to work as a nurse’. This can be liberating. They look at patients and their colleagues in a different way, feel more relaxed, don’t feel they have to be in control of everything, don’t go home burned out.
Compassion is different from empathy and sympathy. If you feel what the patient is going through, but also do something about it, you transform that person’s life.
You can’t teach it or make people feel compassion, or you end up with ‘have a nice day’ nurses, doing the right things and smiling in the right way. But if nurses recognise fundamentally, ‘I’m OK in me, I am loved and safe’, they feel free to express that in the world and be around patients in a way where they feel that compassion authentically. They get it, patients get it, and it’s win: win. When nurses feel better, patients feel better. Staff are less likely to get sick and attrition rates go down.
The Heart of Leadership programme is framed in the organisational work around compassion. Through the integration of the two things we can produce a really powerful dynamic that can transform nurses and nursing for the better.”
Source: Wright video
Piloting the programme
Six of the nine trusts participated in the programme, with 23 nurses from four trusts attending Companions in Compassion courses and 63 from six trusts completing Soul of Leadership. On both courses, which ran from June to December 2014, we encountered nurses who were frustrated or shell-shocked in their roles. As front-line staff they had experienced huge changes both nationally and locally, which sometimes left them feeling bewildered and lost. The impact of recent care scandals and a new wave of Care Quality Commission inspections and regulation were foremost in everyone’s minds.
Throughout the courses we allowed nurses to explore and make sense of the current situation and reconnect to the values that had led them into nursing, and encouraged them to move forward as compassion-focused leaders. We wanted to inspire them to be proud of their roles and able to articulate to others what they did in a compassion framework. We heard many beautiful and inspiring stories of compassionate care across the North West, and saw nurses come alive explaining their work within the context of the 6Cs and gaining new energy and resilience to move forward.
To create a measure of improvements in compassion and care, we developed a questionnaire around eight themes, asking nurses about their feelings, attitudes and behaviours relating to themselves, their work and their colleagues, as well as sickness and retention rates in their teams. All 63 nurses attending Soul of Leadership completed the questionnaire before starting the course. This gave us benchmarking information that can be retested to measure the course’s impact, and is available to trusts as individualised data sets.
Notably, initial results showed nurses valued the softer traits of being kind and caring over harder skills such as being well-organised and efficient, ranking traits they found positive in their colleagues as follows:
- Kind and caring: 81%;
- Good communicator: 71%;
- Well organised and efficient: 68%;
- Happy and fun: 62%;
- Strong and decisive: 48%.
Evaluation from both the Companions in Compassion and Soul of Leadership courses showed all respondents were satisfied with the course content. Among benefits cited by participants were that the course inspired them to:
- Use the 6Cs in their practice;
- Lead on compassion, using tools such as supervision in a different way;
- Reflect on care and how to be compassionate with colleagues and services users.
One participant cited the benefits as: “Gaining a deeper understanding of myself, becoming deeply inspired, connecting with the world and human beings around me to give me a deeper understanding of the true meaning of the delivery of compassion”. Another said: “I feel we need to make positive changes to make sure staff are compassionate towards themselves - giving space and time in the workplace”.
Benefits cited for patients included:
- A grounded person caring for them;
- Nurses better able to recognise when patients are struggling;
- Staff more likely to use compassionate care over rigid rules;
- Staff staying compassionate even in stressful times.
In follow-up interviews, a number of nurses said the course was “life-changing” (Box 2). Another was inspired to develop her career by moving from a ward for older people with dementia to a community-based role supporting patients and carers.
Outcomes for trusts
At the end of each course, participants listed five initiatives they wanted to carry forward. For example, at Cheshire and Wirral Partnership Foundation Trust:
- Staff nurses set up group clinical supervision for healthcare assistants focusing on the 6Cs;
- Clinical leads on the dementia ward introduced “compassion for staff” as part of one-to-one clinical supervision;
- Heart of Leadership participants set up a peer support group to publicise their experiences;
- A consultant nurse joined a local trust Schwartz Round steering group to champion compassion and help with work improving the culture of the organisation and support staff.
Other initiatives included Calderstones Partnership Foundation Trust developing an offsite “barn” staff facility to act as a focus for its compassion and care work; and a proposal at Lancashire Care Foundation Trust to make The Harbour - a new state-of-the-art inpatient unit in Blackpool - into a beacon of good practice. Other trusts are running courses and exploring further options to support the initiative.
Work is continuing to build on the momentum generated by this project and develop a North West mental health and disability healthcare community that promotes compassion in practice. This year Cheshire and Wirral Partnership Foundation Trust has facilitated further Companions in Compassion courses, which have been attended by staff from all nine trusts. Courses have also been developed specifically for allied health professionals, with others opened up to all staff groups including healthcare assistants.
We also aim to embed compassion in practice through a values-based clinical supervision model, building on another project in the North West to promote reflective practice as well as further developing and clarifying the Companion in Compassion role and strengthening links into the national Care Maker initiative.
Implications for practice
Teaching nurses self-reflection and personal insight can increase their resilience and help fulfil their potential to deliver compassionate care. One way to create a culture of compassion is to make this part of a training and leadership programme that equips and inspires front-line nurses to champion compassionate care across teams and organisations. This is likely to be more effective than trying to impose a top-down cultural change programme.
Box 2. Participant views
Christine Turnbull, ward manager, Cheshire and Wirral Partnership Foundation Trust
“I applied to the Companions in Compassion course because I felt I was a compassionate nurse, but I wanted to be able to drive the compassion agenda forward with my team. The biggest thing I learned was you have to be compassionate towards yourself before you can actually be compassionate towards others. I hope through attending the course I’ve been able to be more reflective about myself and how I work and been able to encourage my own staff to do that.”
Natalie Larvin, nurse consultant in acute care, Cheshire and Wirral Partnership Foundation Trust
“I went on the Companions in Compassion course in the hope it would help me teach other staff about the compassion agenda. I came away feeling it was a life-changing experience. It affected the way I think and feel about the work I do and reminded me why I went into mental health nursing over 20 years ago. There isn’t a day goes by when I don’t think about the experience I had. It was very moving, emotional and spiritual in a way that is difficult to comprehend. I recommend that every nurse and healthcare assistant attends that sort of training at some point in their career.”
- Recent reports on NHS care failings highlight the need to support, develop and provide evidence of compassion in practice
- Compassion is one of the key values, known as the 6Cs, in the Compassion in Practice Strategy for nursing in England
- Teaching nurses self-reflection can increase their resilience and help them fulfil their potential to deliver compassionate care
- Nurses need to learn to be more caring of themselves as part of being caring and compassionate towards others
- Training front-line nurses to become leaders and champions of compassionate care is preferable to trying to impose cultural change
Department of Health (2012) Transforming Care: a National Response to Winterbourne View Hospital.
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: DH.
NHS England (2014) Compassion in Practice: Two Years on.
Nursing and Midwifery Council (2015) The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives.