Enabling the flow of compassionate care: a grounded theory study

Background: Compassion has become a topic of increasing interest within healthcare over recent years. Yet despite its raised profile, little research has investigated how compassionate care is enacted and what it means to healthcare professionals (HCPs). In a grounded theory study, we aimed to explore this topic from the perspective of people working with patients with type 2 diabetes - a long-term condition that involves repeated interactions with HCPs. Methods: Semi-structured interviews and focus groups were conducted between May and October 2015 with 36 participants, selected from a range of roles within healthcare. Data collection explored their understanding of compassionate care and experiences of it in practice. Analysis followed the constructivist approach of Charmaz, which recognises meaning as being created by the interaction of people working under specific sociocultural conditions. It moved from open to focused coding, and involved the development of memos and constant comparison. Results: Our analysis revealed that wishing to provide compassionate care, on its own, was insufficient to ensure this transpired; HCPs needed to work in a setting that supported them to do this, which underpins our core concept - the compassionate care flow. Data suggested that to be sustained, this flow was energised via what participants described as 'professional' compassion, which was associated with the intention to improve patient health and participants' role within healthcare. The compassionate care flow could be enhanced by defenders (e.g. supportive colleagues, seeing the patient as a person, drawing on their faith) or depleted by drainers (i.e. competing demands on time and resources), through their impact on professional compassion. Conclusions: This paper presents a model of compassionate care based on the notion of flow. It looks at processes associated with this concept and how compassionate care is delivered within health settings. Our new understanding of this phenomenon will help those working in healthcare, including managers and policy makers, to consider and potentially offset disruption to the compassionate care flow

Physiotherapy Following Emergency Abdominal Surgery

Physiotherapy following elective abdominal surgery has been well documented, but following emergency abdominal surgery, despite poorer outcomes and increased complication rates, physiotherapy interventions for this patient group remain largely uninvestigated. The most common complication following upper abdominal surgery is the development of a post-operative pulmonary complication (PPC). Risk factors for the development of PPCs include duration of anaesthesia, emergency upper abdominal surgery, current smoker status, respiratory comorbidities, obesity, increased age and multiple surgeries. Physiotherapy interventions aim to prevent or remediate PPCs and post-operative complications associated with the sequelae of immobility such as venothrombotic events and to facilitate recovery from surgery and a return to normal activities of daily living and function. Physiotherapy interventions after major surgery include early mobilisation and respiratory physiotherapy techniques. Respiratory therapies include deep breathing and coughing exercises, positive expiratory pressure devices, incentive spirometry and non-invasive ventilation. Early mobilisation has been demonstrated to be safe and efficacious following elective abdominal surgery and for patients who are critically ill. This chapter reviews the evidence in these populations and propose that, until further studies are available to direct care, this evidence is extrapolated to patients following emergency abdominal surgery. As abdominal surgery impacts on physical recovery and health-related quality of life, post-discharge rehabilitation programmes may improve long-term outcomes; however, rehabilitation following major cavity surgery is in its infancy. This chapter investigates post-operative rehabilitation research to date in this population in an attempt to determine the effectiveness of such programmes and make recommendations for future practice

Measuring compassionate care : views of healthcare staff

Aim: To explore healthcare professionals' views of measuring compassionate care. Method: As part of a grounded theory study participants, who were healthcare professionals involved in the care of patients with type 2 diabetes, were invited to discuss the topic of compassionate care measurement through semi-structured interviews and focus groups. Results: Measuring compassionate care was regarded as problematic because of its complex nature. Categories identified in the data that reflect this difficulty include distinguishing compassionate care from other concepts, relying on informal indicators, making the subjective objective, incorporating external influences and putting a measurement tool to use. Conclusion: Findings highlighted the complexities associated with measuring compassionate care, and how attempts to do this by managers could be problematic

Appraising the situation : a framework for understanding compassionate care

Background: Compassion in healthcare represents an ideal way of interacting with patients. It entails an active response to suffering, distress or discomfort that can be associated with people seeking health related support or treatment. However, reports from within healthcare highlight that compassionate care (CC) is not always achieved. It may be especially problematic when trying to work with a patient who seems unwilling or unable to engage with advice provided by a healthcare professional (HCP). Methods: We conducted a grounded theory study to understand the meaning of CC for HCPs working with patients with type 2 diabetes. Data were collected between May-October 2015 using focus groups and individual interviews; 36 HCPs took part in total. For the current paper, we used constant comparison to analyse data from transcripts where participants talked about working with a ‘non-adherent’ patient. Results: Analysis highlighted how appraisal of their encounter with a non-adherent patient could affect whether CC was seen as possible by participants. Therefore, we used a transactional model of emotions as a framework for understanding HCPs’ narratives. This involved a consideration of their primary appraisal of such encounters, which participants said often resulted in a sense of threat, failure and rejection. Their secondary appraisals, which centred on coping resources, included problem-focused approaches (e.g. supporting the patient to plan how to move forwards in managing their health) and emotion-focused approaches (e.g. recognising change was hard, appreciating it may not be the right time for the patient to change). These appraisals could be modified by: a) gaining experience as a HCP; b) altering what was seen as professional success; c) their connection with the patient; d) how much autonomy they had in their job. Conclusions: Our findings provide new insights and emphasise that CC in response to non-adherent patients is not determined solely by a HCP’s innate nature, but can be affected by an individual’s appraisal of this interaction and the resources he/she has available to cope. This has implications for the environment within which staff work

Flow of compassion in health care : moving beyond an individual towards a systemic focus

Background: Compassion is an underpinning construct in nursing and healthcare more generally, an ideal that is a motivating force for most of those working in this field. Nevertheless, delivering compassionate care (CC) is not always easy or achieved. Little research has investigated how it is enacted and what it means to healthcare professionals (HCPs)

Hand-written letters and photo albums linking geoscientists with school classes

Do we miss something about &laquo;traditional&rdquo; media such as handwritten letters and photography before the digital age? Some of the authors remember this age fondly, and we wanted to see if this fondness could be translated into a science dialogue project with school classes. We designed and carried out a communication process with 4 classes at different schools across Europe. During this process, each class would interact with a single scientist primarily via hand-written questions &amp; letters, and a Polaroid photo album. The scientists would make this unique, one-of-a-kind album whilst on board a research expedition in the Barents Sea. We asked the question whether this process might show any benefits to the school students involved. To answer this, we asked the students to write up their thoughts on communicating with a scientist in this way. We analysed the texts and found that most students thought the letters and polaroid albums were a &ldquo;beautiful experience&rdquo;. Others commented on how important it is to actually put pen to paper and write, since they use (almost) only digital media these days. Most importantly, the students learnt different elements of the science connected to the research expedition, but also about the scientific process in general. And, equally important, some of the students were surprised and thankful that the scientists took the time to communicate with them in such a personal way. These results could possibly have been achieved using other media, however the hand-written letters and Polaroids worked very well. They also seemed to conjure up some of the personal memories that we have about communication not so long ago. Maybe there is something to be said for slowing things down with our science communication projects and making them more personal and unique. This is something that snail-mail and making photo albums forces us to do.</p

Human-animal relationships and interactions during the Covid-19 lockdown phase in the UK: Investigating links with mental health and loneliness

BACKGROUND The Covid-19 pandemic raises questions about the role that relationships and interactions between humans and animals play in the context of widespread social distancing and isolation measures. We aimed to investigate links between mental health and loneliness, companion animal ownership, the human-animal bond, and human-animal interactions; and to explore animal owners’ perceptions related to the role of their animals during lockdown. METHODS A cross-sectional online survey of UK residents over 18 years of age was conducted between April and June 2020. The questionnaire included validated and bespoke items measuring demographics; exposures and outcomes related to mental health, wellbeing and loneliness; the human-animal bond and human-animal interactions. RESULTS Of 5,926 participants, 5,323 (89.8%) had at least one companion animal. Most perceived their animals to be a source of considerable support, but concerns were reported related to various practical aspects of providing care during lockdown. Strength of the human-animal bond did not differ significantly between species. Poorer mental health pre-lockdown was associated with a stronger reported human-animal bond (b = -.014, 95% CI [-.023 - -.005], p = .002). Animal ownership compared with non-ownership was associated with smaller decreases in mental health (b = .267, 95% CI [.079 - .455], p = .005) and smaller increases in loneliness (b = -.302, 95% CI [-.461 - -.144], p = .001) since lockdown. CONCLUSION The human-animal bond is a construct that may be linked to mental health vulnerability in animal owners. Strength of the human-animal bond in terms of emotional closeness or intimacy dimensions appears to be independent of animal species. Animal ownership seemed to mitigate some of the detrimental psychological effects of Covid-19 lockdown. Further targeted investigation of the role of human-animal relationships and interactions for human health, including testing of the social buffering hypothesis and the development of instruments suited for use across animal species, is required

The impact of the elimination diet on growth and nutrient intake in children with food protein induced gastrointestinal allergies

Background: Non immunoglobulin E (IgE) mediated allergies affecting the gastrointestinal tract require an elimination diet to aid diagnosis. The elimination diet may entail multiple food eliminations that contribute significantly to macro-and micro-nutrient intake which are essential for normal growth and development. Previous studies have indicated growth faltering in children with IgE-mediated allergy, but limited data is available on those with delayed type allergies. We therefore performed a study to establish the impact on growth before and after commencing an elimination diets in children with food protein induced non-IgE mediated gastrointestinal allergies. Methods: A prospective, observational study was performed at the tertiary gastroenterology department. Children aged 4 weeks-16 years without non-allergic co-morbidities who were required to follow an elimination diet for suspected food protein induced gastrointestinal allergies were included. Growth parameters pre-elimination were taken from clinical notes and post-elimination measurements (weight and height) were taken a minimum of 4 weeks after the elimination diet. A 3-day estimated food diary was recorded a minimum of 4 weeks after initiating the elimination diet, including also any hypoallergenic formulas or over the counter milk alternatives that were consumed. Results: We recruited 130 children: 89 (68.5 %) boys and a median age of 23.3 months [IQR 9.4-69.2]. Almost all children (94.8 %) in this study eliminated CM from their diet and average contribution of energy in the form of protein was 13.8 % (SD 3.9), 51.2 % (SD 7.5) from carbohydrates and 35 % (SD 7.5) from fat. In our cohort 9 and 2.8 % were stunted and wasted respectively. There was a statistically significant improvement in weight-for-age (Wtage) after the 4 week elimination diet. The elimination diet itself did not improve any of the growth parameters, but achieving energy and protein intake improved Wtage and WtHt respectively, vitamin and/or mineral supplements and hypoallergenic formulas were positively associated with WtHt and Wtage. Conclusion: With appropriate dietary advice, including optimal energy and protein intake, hypoallergenic formulas and vitamins and mineral supplementation, growth parameters increased from before to after dietary elimination. These factors were positively associated with growth, irrespective of the type of elimination diet and the numbers of foods eliminated.Great Ormond Street Hospital CharityGreat Ormond St Hosp Children NHS Fdn Trust, Dept Gastroenterol, London, EnglandChelsea & Westminster Hosp NHS Fdn Trust, Dept Nutr & Dietet, London, EnglandNino Jesus Univ Children Hosp, Madrid, SpainUniv Fed Sao Paulo UNIFESP, Paediat Gastroenterol, Sao Paulo, BrazilAmer Univ Beirut, Dept Nutr & Food Sci, Fac Agr & Food Sci, Beirut, LebanonUCL, Inst Child Hlth, London, EnglandUniv Fed Sao Paulo UNIFESP, Paediat Gastroenterol, Sao Paulo, BrazilWeb of Scienc

The development and validation of the Interpersonal Support in Physical Activity Consultations Observational Tool

This study describes the development and psychometric characteristics of an observational instrument that examines four aspects of interpersonal support (or lack of) provided during physical activity (PA) promotion consultations (i.e., Autonomy Support, Involvement, Structure and Interpersonal Control), as identified by Self-determination Theory (SDT). The reliability and validity of the Interpersonal Support in Physical Activity Consultations Observational Tool (ISPACOT) were examined within an exploratory randomised control trial. Recorded consultations (N = 42) conducted by qualified PA advisors (N = 14) at 13 leisure centres across the West Midlands (UK) were rated. Intra-class correlation coefficients (ICC) indicated moderate to high inter-rater reliability for overall interpersonal support (0.80), and the Autonomy Support (0.74), Involvement (0.73) and Structure (0.91) dimensions, but low reliability for Interpersonal Control (0.35). The advisors, who conducted PA promotion consultations that were rated as low in their interpersonally supportive features, were perceived by their clients as being less supportive (F(1,10) = 5.0, p &lt;.05). Ratings on the ISPACOT differentiated advisors who were trained in SDT principles and those who were not. Overall, the findings provided preliminary evidence for the reliability and convergent validity of the ISPACOT

The influence of human-animal interactions on mental and physical health during the first Covid-19 lockdown phase in the UK : a qualitative exploration

The Covid-19 pandemic presents an opportunity to explore the role of animals as sources of emotional and physical support during a period when most of the population is experiencing social and environmental challenges. We investigated how companion animal owners perceive the influence of human-animal interaction on their physical and mental health during the first Covid-19 lockdown phase in the UK, and which concerns they may have regarding their animals at this time. We also explored the impact of participants’ interaction with non-companion animals during this phase. A cross-sectional online survey of UK residents aged over 18 was conducted between April and June 2020. The final item of the survey invited open-ended free-text responses, allowing participants to describe any experiences and/or perceptions of their human-animal relationships during the Covid-19 lockdown phase. A qualitative thematic analysis of responses was undertaken. Four main themes related to the following aspects of human-animal interaction during the Covid-19 lockdown phase were identified: positive impact of animal ownership during Covid-19 (e.g. amelioration of wellbeing and mental health); concerns relating to animal ownership during Covid-19 (e.g. concerns over animals carrying the Covid-19 virus); grief and loss of an animal during Covid-19; and impact of engaging with non-companion animals during Covid-19. The findings complement and extend previous insights into the impact of human-animal interaction with both companion and non-companion animals. They also highlight the challenges of caring for an animal during the lockdown phase and indicate the need to consider the development of further targeted support strategies, such as ‘day care’ for companion animal of key workers, in this context