Creating Learning Environments for Compassionate Care

Abstract

The quality of relationships with staff is key to shaping older people's hospital experiences [1]. While the extent of problems with quality of interactions between older people and nurses on NHS hospital wards is unknown, recent reports indicate that older people frequently fail to experience positive and caring attitudes and behaviours, resulting in a perceived lack of compassion. CLECC (Creating Learning Environments for Compassionate Care) is a practice development programme that aims to promote compassionate care for older people. This study will assess the feasibility of implementing CLECC in acute hospital settings and of evaluating its impact on patient care using an experimental design and associated process and economic evaluations.Compassion is "a deep awareness of the suffering of another coupled with the wish to relieve it" [2]. Being compassionate requires "relational capacity" in practitioners, i.e. capacity to experience empathy and to engage in a caring relationship [3]. Our research shows that relational capacity can depend on ward conditions with nurses on general hospital wards reflecting lower capacity than critical care nurses, and a greater tendency to avoid relationships with patients and to burn out [4]. Previous research suggests that interventions which foster workplace learning, empathy, peer support and positive culture at ward team level may be more effective than individual interventions but we lack robust research on impact of such interventions on frontline care [5][6][7]. CLECC is a ward-based practice development programme focused on developing sustainable ward management and team practices that enhance capacity to provide compassionate care [8]. It is based on workplace learning theory with the ward itself conceptualised as learning environment and team as potential community of practice [9][10][11]. CLECC aims to create and support sustainable work-based opportunities for team dialogue, reflective learning, mutual support and role modelling.This project is a feasibility study of CLECC implementation and its evaluation. Semi-structured qualitative interviews with staff, patients and carers will be used to assess CLECC's workability and integration into existing work practices. Contextual data will also be gathered at ward level including staffing, sickness rates, agency usage, turnover and shift length. Procedures for a cluster RCT and associated economic evaluation will be piloted to inform a future main trial design, evidence on outcome measures obtained to contribute to the power calculation, risk of contamination between clusters assessed, and participation and attrition rate estimated. Outcomes to be assessed include quality of staff-patient interactions, patient evaluations of care and staff perceptions of empathy. Carer/visitor perceptions of care quality, staff wellbeing, ward climate and perceived workload will also be measured. The study will take part in two phases. Phase 1 will include six wards and follow-up of 36 months. Phase 2 will use process evaluatio...