Compassionate care intervention for hospital nursing teams caring for older people: a pilot cluster randomised controlled trial

Gould, Lisa; Griffiths, Peter; Barker, Hannah; Libberton, Paula; Mesa‐Eguiagaray, Ines; Pickering, Ruth; Shipway, Lisa; Bridges, Jackie

doi:10.1136/bmjopen-2017-018563

Cited by 18 publications

(20 citation statements)

References 27 publications

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“…It is essential, therefore, that research instruments are developed that do not exclude this population. Observation-based measures such as QuIS hold promise here because they do not require care recipients to have the abilities to, for instance, complete a written questionnaire and they largely remove the psychological threat of rating one's own care ( Bridges et al., 2018 ; Goldberg and Harwood, 2013 ; Gould et al., 2018 ). Our recruitment strategy in this study aimed to optimise the inclusion of people with cognitive impairment, although the number recruited with cognitive impairment was low.…”

Section: Discussionmentioning

confidence: 99%

“…(1993) reported that increases in the QuIS-rated quality of interactions following a change of service location were accompanied by improvements in residents’ cognitive impairments, mood and functional capacity, providing some evidence of QuIS’ validity in relation to quality of life. Subsequent studies established the responsiveness of QuIS to changes in service quality in a range of healthcare settings ( Bridges et al., 2018 ; Brooker, 1995 ; Fritsch et al., 2009 ; Gould et al., 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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The Quality of Interactions Schedule (QuIS) and person-centred care: Concurrent validity in acute hospital settings

Bridges

Gould

Hope

et al. 2019

International Journal of Nursing Studies Advances

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Background There is a lack of consensus on how the practices of health care workers may be assessed and measured in relation to compassion. The Quality of Interactions Schedule (QuIS) is a promising measure that uses independent observers to assess the quality of social interactions between staff and patients in a healthcare context. Further understanding of the relationship between QuIS and constructs such as person-centred care would be helpful to guide its future use in health research. Objective This study aimed to assess the validity of QuIS in relation to person-centred care measured using the CARES® Observational Tool (COT™). Methods 168 nursing staff-patient care interactions on adult inpatient units in two acute care UK National Health Service hospitals were observed and rated using QuIS and COT™. Analyses explored the relationship between summary and individual item COT™ scores and the likelihood of a negative (lower quality) QuIS rating. Results As the degree of person-centred care improved, QuIS negative ratings generally decreased and positive social ratings increased. QuIS-rated negative interactions were associated with an absence of some behaviours, in particular staff approaching patients from the front (relative risk (RR) 3.7), introducing themselves (RR 3.1), smiling and making eye contact (RR 3.4), and involving patients in their care (RR 3.7). Conclusion These findings provide further information about the validity of QuIS measurements in healthcare contexts, and the extent to which it can be used to reflect the quality of relational care even for people who are unable to self-report.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Quality of Interactions Schedule (QuIS) and person-centred care: Concurrent validity in acute hospital settings

Bridges

Gould

Hope

et al. 2019

International Journal of Nursing Studies Advances

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“…Expressing compassion in a caring relationship could enhance a feeling of being trusted by another person (LoCurto & Berg, ) and compassionate training could help nurses to express their compassion towards older persons more explicitly (Adam & Taylor, ; Dewar et al, ). Although this type of training is usually for student nurses (Adam & Taylor, ), it could help more experienced nurses as it would enable them to reflect on their own behaviour (Gould et al, ). Nurses who have had this training might also be better able to assess and discuss the informal carer's attitude and behaviour towards the person.…”

Section: Discussionmentioning

confidence: 99%

“…Although this type of training is usually for student nurses (Adam & Taylor, 2014), it could help more experienced nurses as it would enable them to reflect on their own behaviour (Gould et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Trust in older persons: A quantitative analysis of alignment in triads of older persons, informal carers and home care nurses

Doekhie

Strating

Buljac-Samardžić

et al. 2019

Health Soc Care Community

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Self‐management by older persons could be influenced by the level of trust found in triads of informal carers, formal care providers and care recipient, the older person. Little research has been done on care providers’ trust in older persons. This study aims to explore the level of trust that informal carers and home care nurses have in older persons, the extent of alignment in triads and the relationship between trust in older persons and self‐management. We conducted a cross‐sectional survey study in the Netherlands, sampling 133 older persons, 64 informal carers and 72 nurses, which resulted in 39 triads. Alignment level was analysed through Intraclass Correlation Coefficient 1 scores and absolute and mean difference scores. Correlation analysis and one‐way analysis of variance measured the relationship between trust and self‐management. The results show that triads contain both alignment and misalignment. Misalignment occurs mostly when informal carers and nurses have little trust in the older person while this person views their own behaviour towards their caregivers positively. Care providers’ trust levels relate significantly to their perception of the person's ability to self‐manage, but not to the person's self‐rated ability. This could be explained by care providers not communicating their intrinsic trust in the older person to them. Trust building could be enhanced by organising discussions of mutual expectations of trust and both formal and informal care providers could benefit from compassionate assessment training, to learn how to openly express their trust in the older person.

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“…Reproduced fromGould et al 2018 120. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018.…”

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confidence: 99%

Implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings: a pilot RCT and feasibility study

Bridges

Pickering

Barker

et al. 2018

Health Serv Deliv Res

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BackgroundConcerns about the degree of compassion in health care have become a focus for national and international attention. However, existing research on compassionate care interventions provides scant evidence of effectiveness or the contexts in which effectiveness is achievable.ObjectivesTo assess the feasibility of implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings and to evaluate its impact on patient care.DesignPilot cluster randomised trial (CRT) and associated process and economic evaluations.SettingSix inpatient ward nursing teams (clusters) in two English NHS hospitals randomised to intervention (n = 4) or control (n = 2).ParticipantsPatients (n = 639), staff (n = 211) and visitors (n = 188).InterventionCLECC is a workplace educational intervention focused on developing sustainable leadership and work team practices (dialogue, reflective learning, mutual support) theorised to support the delivery of compassionate care. The control setting involved no planned staff team-based educational activity.Main outcome measuresQuality of Interaction Schedule (QuIS) for staff–patient interactions, patient-reported evaluations of emotional care in hospital (PEECH) and nurse-reported empathy (as assessed via the Jefferson Scale of Empathy).Data sourcesStructured observations of staff–patient interactions; patient, visitor and staff questionnaires and qualitative interviews; and qualitative observations of CLECC activities.ResultsThe pilot CRT proceeded as planned and randomisation was acceptable to teams. There was evidence of potential contamination between wards in the same hospital. QuIS performed well, achieving a 93% recruitment rate, with 25% of the patient sample cognitively impaired. At follow-up there were more positive (78% vs. 74%) and fewer negative (8% vs. 11%) QuIS ratings for intervention wards than for control wards. In total, 63% of intervention ward patients achieved the lowest possible (i.e. more negative) scores on the PEECH connection subscale, compared with 79% of control group patients. These differences, although supported by the qualitative findings, are not statistically significant. No statistically significant differences in nursing empathy were observed, although response rates to staff questionnaire were low (36%). Process evaluation: the CLECC intervention is feasible to implement in practice with medical and surgical nursing teams in acute care hospitals. Strong evidence of good staff participation was found in some CLECC activities and staff reported benefits throughout its introductory period and beyond. Further impact and sustainability were limited by the focus on changing ward team behaviours rather than wider system restructuring. Economic evaluation: the costs associated with using CLECC were identified and it is recommend that an impact inventory be used in any future study.LimitationsFindings are not generalisable outside hospital nursing teams, and this feasibility work is not powered to detect differences attributable to the CLECC intervention.ConclusionsUse of the experimental methods is feasible. The use of structured observation of staff–patient interaction quality is a promising primary outcome that is inclusive of patient groups often excluded from research, but further validation is required. Further development of the CLECC intervention should focus on ensuring that it is adequately supported by resources, norms and relationships in the wider system by, for instance, improving the cognitive participation of senior nurse managers. Funding is being sought for a more definitive evaluation.Trial registrationCurrent Controlled Trials ISRCTN16789770.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 33. See the NIHR Journals Library website for further project information. The systematic review reported inChapter 2was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, the University of Örebro and the Karolinska Institutet.

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Compassionate care intervention for hospital nursing teams caring for older people: a pilot cluster randomised controlled trial

Cited by 18 publications

References 27 publications

The Quality of Interactions Schedule (QuIS) and person-centred care: Concurrent validity in acute hospital settings

The Quality of Interactions Schedule (QuIS) and person-centred care: Concurrent validity in acute hospital settings

Trust in older persons: A quantitative analysis of alignment in triads of older persons, informal carers and home care nurses

Implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings: a pilot RCT and feasibility study

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