Allied Health Professions: Developing compassion and compassionate resilience in health care workers and family carers

Prof Andrew McVicar, Ann Pettit, Dr Ceri Wilson, Dr Pamela Knight-Davidson

ARU research has led to new training for health staff and practices to combat the compassion fatigue, and subsequent risk to care quality and carers' well-being, that can develop as a result of prolonged delivery of compassionate care.

Prof McVicar and his team's research has benefited health visitors, midwives, nurses and managers, private providers, voluntary sector organisations and patients - in the UK and abroad.

Their training model for improved compassion and care in health visitors has informed guidance for health visitors and midwives, and has been adopted by NHS managers, improving practitioners’ own health as well as their practice.

The PROactive Management of Integrated Services and Environment (PROMISE) initiative has improved compassionate care for mental health patients, reducing the level of physical restraint dramatically and raising patient satisfaction.

The research team

Explore ARU researchers' original work via our open access repository, ARRO

Research summary

Compassionate care enhances patient experience and increases practitioners’ resilience. Promoting carer compassion became mandatory in 2015 but how this is done has been debatable.

Ann Pettit, while at ARU, led a consultation on a national framework for compassionate resilience in practitioners, and compassionate leadership by managers. Pettit, Prof McVicar and Dr Knight-Davidson studied the promotion of self-compassion as a vehicle for better compassionate working and for boosting student heath visitors’ compassionate resilience.

They found their unique post-registration curriculum based on CMM encouraged personal compassion, reduced the risk of compassion fatigue and was capable of improving practice and practitioner health.

Dr Wilson worked on a project between ARU and the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) in which academics, mental health patients, psychiatrists, nurses, support workers and managers achieved a reduction in the physical restraint of patients with mental health problems or learning difficulties.

Interviews and focus groups with staff and patients identified what proactive care should entail on the front line, leading to an intervention strategy for a more compassionate service. It showed it was possible to reduce physical restraint by:

  • improving the practice and learning environment, making it conducive to improved compassion
  • improving communication and relationships between staff and patients
  • managing staffing by recruiting more front-line staff and freeing up more patient-facing time.
A carer sitting next to an elderly person on a sofa, showing them something on a tablet

Summary of the impact

  • New national and international guidance for compassionate service for health visitors, midwives and mental health practitioners
  • New training for health and social care workers to promote compassion and increase compassion resilience
  • Compassion on the curriculum at over 60 universities worldwide
  • Reduction in the need for physical restraint of patients
  • Improvement in patient satisfaction

Impact

Professional guidance for managers and practitioners

Prof McVicar and his team's research led to publication of key national guidelines for England by the Institute of Health Visiting (IHV) and new guidance from NHS England for midwives, commended by the Chief Nursing Officer for England.

Their intervention strategy for a more compassionate service formed the basis of the PROMISE initiative. Applied across mental health wards at the CPFT, it has made a positive change to its ethos and culture, as highlighted by the Care Quality Commission (CQC).

PROMISE was cited in recommendations in guidance to the Mental Health Act, and features as a CQC example of good practice to help mental healthcare providers improve support for patients. It has provided a significant contribution to a blueprint for compassion and dignity for mental health patients.

The success of PROMISE underpinned a Trust-wide mapping exercise that identified 200 ideas and new initiatives. Changes to practice resulted in high overall satisfaction scores across the adult inpatient wards.

PROMISE went global in 2016 and was established in South Africa, Australia, Czech Republic, and USA. It informed the main source of evidence regarding restraint in Acute Mental Health Care in the Czech Republic’s national mental health care plan in 2019.

Read more about more about guidance for managers and practitioners.

Increased compassionate practice and emotional resilience

Compassion Focused workshops in the NHS Eastern region and through private training providers trained managers, clinicians and health and social care practitioners to promote compassion and increase compassion resilience.

The training is being adopted by service managers for their staff wellbeing and CPD training, for instance into Perinatal Mental Health Service at Mid-and South Essex Partnership Trusts the Unit Manager has promoted a compassion-focused strategy for staff.

Ann Pettit’s work has been promoted by leading educationalists through an International Compassion network of over 60 universities worldwide, leading to collaboration in curriculum developments and delivery.

Dr Wilson's work with the PROMISE programme at the CPFT had a “huge” impact (stated the CQC) resulting in improved compassionate mental health management of patients with mental health problems or learning disability.

Physical intervention across the entire CPFT was reduced by 35% - and reduced further in specialist mental health care units.

  • The interventions in the Learning Disability Unit dropped by 81%, from 48 to nine between 2015/16 and 2016/17.
  • In the Psychiatric Intensive Care Unit (PICU) another 81% reduction took the numbers from 44 to eight over the same time period.
  • Reductions for prone restraints were proportionately greater. In the Learning Disability Unit, 16 prone restraints fell to zero, while in the PICU, the change was from 13 to two.
  • In 2016 and 2017, the Specialist Personality Unit and Low Secure Unit of the Cambridge & Peterborough NHS Trust were prone restraint-free for 23 and 20 (of 24) months, respectively.

The initiative was central to the Trust changing its practice of physical interventions with in-patients who have a mental health disorder or learning disability, so reducing risk to patient wellbeing.

Overall patient satisfaction % scores measured in the high 80s, with 96% of patients identifying changes in physical restraint positively affecting respect and dignity. The change has been sustained. In 2015, PROMISE won the Strengthening the Foundation award from the Patient Experience Network.

Read more about more about compassionate practice and emotional resilience.

United Nations Sustainable Development Goals

We have mapped our REF 2021 impact case studies against the United Nations' Sustainable Development Goals (SDGs).

The 17 SDGs, adopted by all UN Member States in 2015, are an urgent call for action. They recognise that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests.

This case study is mapped to SDG 3: Ensure healthy lives and promote well-being for all at all ages, target 3.4.

See also

Read the full REF 2021 impact case study for UoA 3: Developing compassion and compassionate resilience in health care workers and family carers

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