A project developed in partnership between an NHS board and a university has focused on promoting the importance of compassionate care in nursing practice
Elizabeth Adamson, MSc, BSc, SCM, FHEA, RGN, is lecturer; Linda King, MSc, BSc, Cert Ed, RNT, RGN, is lecturer; Janis Moody, MSc, MA, PG Cert Ed, FHEA, RMN, RGN, is lecturer; Anne Waugh, MSc, BSc, Cert Ed, RNT, FHEA, SRN, is senior teaching fellow and school director of academic quality; all at Edinburgh Napier University.
Adamson, E. et al (2009) Developing a nursing education project in partnership: leadership in compassionate care. Nursing Times; 105: 35, early online publication.
The prominence of the caring dimension has never had such a high profile in healthcare practice before.
As a result of this, the Leadership in Compassionate Care Project has evolved. A unique feature is the partnership between Edinburgh Napier University and NHS Lothian. Engaging with and helping qualified and student nurses to value and promote the delivery of compassionate care is a primary focus of the project.
This article outlines key policy drivers, the project’s four main strands, and the aims, processes and perceived impact on practice.
Keywords: Compassion, Compassionate care, Caring dimension
- This article has been double-blind peer-reviewed.
Background and political drivers
Over the last decade, there has been an increasing emphasis on the caring dimension in healthcare in policy, practice and research. This is particularly evident in policy documents emphasising the importance of person-centred care (for example, The Scottish Government, 2007; Scottish Executive, 2006a; 2006b; Department of Health, 2003). It is apparent from these documents and a number of recent national projects that compassionate care is considered fundamental to nursing practice.
The importance and centrality of compassion in nursing has therefore gained increasing prominence as a result of these many policy drivers. However, alongside this, an immense diversity of views has emerged in attempting to define or conceptualise caring, which has tended to increase its elusiveness (Schantz, 2007). Basset (2002) suggested that many authors believe that ‘care is the central and unifying core in nursing’ and argued it is vital for nurses to understand this.
Nevertheless, it is evident from nursing literature that there are difficulties in defining both caring itself and the idea of compassionate care. Compassion has been called the prelude to caring, and caring has been described as the essence of nursing (Beauchamp and Childress, 2009). Care has also been described as ‘a human trait, an affect, a moral imperative, an interpersonal interaction, or as a series of therapeutic interventions’ (Lavoie et al, 2006). But what does this tell us about delivering compassionate care in practice?
While research can be found on the subject of caring in general, less is available on the subject of compassionate nursing practice and what nurses and student nurses understand this to be and how they take this into practice settings.
This was one of the main catalysts which led to the conception of the Leadership in Compassionate Care Project. In particular there was a need to understand what compassionate care means both for patients and nurses, and how we could help students and registered nurses throughout NHS Lothian deliver such care.
A unique feature of this project was forging a strong partnership between Edinburgh Napier University and NHS Lothian.
It is apparent from recommendations made in various policy documents that person-centred care is expected to be a fundamental feature of nursing practice. It is imperative that patients’ individual experience of care is the best that it can be, and meets their particular needs.
Attree (2001) found that aspects of care which patients valued in their relationships with nurses included open communication, kindness, concern, sensitivity and time spent with them. Patients rated dignity and privacy highly, and being included in decision-making processes was also important to them.
Delivering holistic nursing care can, however, be challenging as the many pressures in clinical settings continue to increase. According to Goodman (2004), patients tend to judge the quality of technical aspects of care indirectly by evidence of healthcare professionals’ interest and concern for their health and welfare. Thus, for patients, how care is delivered is often as important as the nature of the treatment itself.
It is evident from the literature that patients welcome compassionate care and it influences their perception of the quality of care provided (Henderson et al, 2007; Goodman, 2004; Attree, 2001; Lothian and Philip, 2001). But patients’ experiences indicate that compassionate care cannot always be taken for granted (NHS Confederation, 2008).
Initially the project team explored the meaning of compassionate care. A number of broad aims were identified and from this a project plan emerged. Fig 1 shows the relationship between the project aims, strands and those who would benefit. The plan provided a useful guide for the team as the project evolved and also an effective tool to help in communicating aspects of the project to others.
Vital to the success of the project development was the working partnership between the university and nursing staff in the NHS. Scott (2008) suggested that close partnerships between education and practice can cultivate a caring culture in healthcare. This was achieved on a number of levels in both organisations and included NHS senior nurses and university lecturers participating in the project working group. It was also considered vital that project development information reached all stakeholders, and therefore routes of dissemination included roadshows, newsletters, email and face-to-face conversations.
As the project evolved, four strands emerged:
- Influencing nurse education by embedding the principles of compassionate care in the curriculum;
- Supporting newly qualified nurses;
- Facilitating the development of leadership skills;
- Identifying beacon wards as centres of excellence in compassionate care.
Influencing nurse education
A priority was to influence education through embedding person-centred, compassionate nursing practice in the nursing and midwifery programmes. This strand involved reviewing module descriptions and curriculum content to ensure the integration of person-centred, compassionate care as a theme.
A questionnaire was used to elicit nursing students’ views of compassionate care in their programme of study. Their understanding of compassionate care was also explored. This information provided a baseline from which to build on and to ensure that compassionate care became a living theme that was threaded through all teaching materials and student learning activities.
Identifying beacon wards
The areas initially chosen to champion compassionate nursing practice were named beacon wards. Aspects of their good practice would be identified with the aim of sharing this with other clinical areas.
A list of desirable criteria for the beacon wards was developed. This focused on the following three key areas:
- Caring environment – initiatives demonstrating holistic and person-centred care;
- Evidence of collaborative and effective team working – good ward communication and efficient team organisation and use of resources;
- Evidence of staff development – mentorship and preceptorship training and student evaluation.
All clinical areas in NHS Lothian interested in becoming part of the project were asked to present a portfolio to showcase their ward/clinical area. The project team provided support and guidance on portfolio development. The portfolio enabled staff to reflect on their ‘caring practices’ and highlighted many patient-centred initiatives.
Eighteen portfolios were presented from a wide range of adult nursing specialties; six were short-listed. Members of the project team, including the director of nursing and a senior academic from Edinburgh Napier University, visited the areas.
Following an in-depth selection process, four clinical areas were chosen for the initial programme of development work and awarded ‘beacon status’.
Aims of beacon wards
The project team identified a number of broad aims for the beacon wards:
- Develop an understanding of compassionate care from the perspective of patients, families and healthcare staff;
- Identify a ‘working definition’ of compassionate care;
- Develop key principles of compassionate nursing practice;
- Develop standards/best-practice statements for compassionate care;
- Identify a practice development approach that would enable change and enhance compassionate nursing practice;
- Provide undergraduate nursing students on placement in the beacon wards with exposure to compassionate care project developments;
- Ensure that all relevant experiences are studied, developed and shared with others so that best practice can be rolled out across NHS Lothian;
- Feed back learning from work in the beacon wards into the nursing undergraduate programme.
Four senior nurses in compassionate care were appointed with one based in each of the beacon wards. They helped staff to identify the structures and processes which enabled compassionate nursing practice to be consistently delivered.
Development opportunities for newly qualified nurses
Research by O’Brien-Pallas et al (2006) and Evans (2001) showed that many newly qualified nurses lack confidence and find their work environment challenging; this affects their ability to provide compassionate care. It is evident that holistic nursing care requires commitment, confidence and competence to demonstrate a compassionate approach to care-giving.
The aim of this strand is to provide ongoing support for all newly qualified nurses working in NHS Lothian during their first year in practice. The DH (2008) linked confidence with the ability to care. In addition, Carter et al (2008) found the presence of a supportive peer culture is pivotal to creating and sustaining caring practices.
Our approach to supporting newly qualified nurses in practice involved a series of study days. Four took place in the first year and their content incorporated dynamic learning opportunities such as the use of role-modelling and drama. This drew on the findings of Harrison (2006), who suggested that incorporating artistic methods into nurse education can be an effective way of developing compassion.
Leadership skills development for registered nurses
This strand offers leadership development to nurses interested in taking forward a practice initiative focusing on compassionate care in their clinical area, such as protecting patient mealtimes. By adopting an inclusive approach, all members of the multidisciplinary team could be involved. McCormack and Garbett (2001) supported this, as they found that development initiatives were most effective when staff took ownership.
Facilitated action learning was planned to enable personal and professional development by providing the opportunity to reflect on practice issues and explore solutions. Study days were also organised to facilitate practice development skills that could then be used to help nurses to implement and evaluate their change in practice.
Table 1 sets out the aims, processes and the anticipated impact on practice.
The planning and development stages of the Leadership in Compassionate Care Project were vital to realising its vision and aims. This was ultimately based on a unique working partnership between education and practice.
The project continues to evolve and it is evident that awareness has been raised at different levels in educational and practice settings about the nature of compassionate care and delivering this in practice.
The impact of the various strands in terms of delivering the project vision and the potential this has to transform practice will continue to become apparent and be reported as it progresses.
Several national projects have recently emerged with a common aim of individualising patient experience. It is hoped the findings from the Leadership in Compassionate Care Project will have a positive impact on nursing practice nationally and internationally.
Table 1. Aims, processes and anticipated impact on practice
|Principal processes||Impact on practice|
|Create confident, competent and compassionate leaders|
Ø Ensure that compassionate nursing practice is embedded in pre-registration nursing programmes
Ø Maintain the university and NHS partnership and through this ensure that compassionate care is promoted in both clinical practice and the university setting
Ø Ensure that learning and initial findings continually inform the evolving project
Ø Share the vision for compassionate nursing practice at every opportunity
Ø Confident leaders who are able to champion compassionate nursing practice
Ø Registrants who are caring and competent
Ø Satisfied patients
|Aims||Process||Impact on practice|
|Embed compassionate nursing practice in all pre-registration programmes|
Ø Encourage student-centred learning is encouraged
Ø Provide students with decision-making skills
Ø Review the personal development tutor role to enhance the personal and professional support offered to students
Ø Lecturers promote person centeredness and compassionate care in all interactions
Ø Lecturers make caring practices explicit in all teaching sessions and reflective activities
Ø Supportive and nurturing relationships are developed with all new university students throughout the programme
Ø Offer pastoral support for students through an independent advisor
Ø Build student/teacher relationships and supportive networks
Ø Offer mentor/buddy systems – where established students befriend new students and help them to settle into university
Ø Nurses and midwives who demonstrate delivery of care that:
|Build partnership with NHS colleagues|
Ø Seek agreement about the project vision
Ø Design joint working on sub-projects to influence and enhance the delivery of compassionate care
Ø Set up regular meetings to maintain effective communication between education and practice
Ø A unified approach to care delivery
Ø The development of common goals and values in both practice and education
|Evaluate and learn|
Ø Ongoing evaluation of the project through focus group discussions
Ø Feedback from students using satisfaction questionnaires
Ø Shared learning between key stakeholders
Ø Gaps in delivery of compassionate care identified
Ø Measures taken to address these
Ø The meaning of compassionate care made more explicit
|Share the vision nationally and internationally|
Ø Network within higher education institutes and practice areas locally, nationally and internationally (newsletter, website)
Ø The organisation of an international conference to share good practice
Ø Dissemination of project findings through publication
|Ø The establishment of good practice in compassionate nursing practice|
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