Development of the META model in relation to compassion in nursing

Introduction Compassion is an important part of nursing practice and the way in which care is delivered to patients. A number of high profile reports have highlighted the consequences of the failure to demonstrate compassionate care, with others calling for the introduction of compassion into nurse training. Background The recent reports into compassion recommend a need to create education programmes for nursing students so that they can continue to show compassionate care in practice. However, while the general literature explains the background to compassion and various ways in which this virtue can be demonstrated, it is not clear what type of training has been developed for nursing students or how effective such programmes are at teaching compassion. Aims and objectives The aim of the study was to develop a model of learning that would help nursing students understand and demonstrate the practical and emotional elements of compassion in practice. An additional aim was that the Measure Explore Try Apply (META) model would help bridge the gap between education and practice by preparing nursing students for compassion in the workplace. The main objectives were; (1) to investigate the characteristics of compassion in nursing, how compassion is taught and measured, (2) explore and validate these findings further with a series of stakeholder groups, (3) use the results of the study to create a compassion strengths model for nurses’ compassion, (4) using the compassion strengths model as a foundation develop a psychometric scale and online learning intervention to measure and teach compassion strengths, and (5) validate both interventions with a cohort of nursing students, and assess them for their individual and combined effectiveness in relation to the META model. Methods A systematic review of the literature highlighted a dearth of empirical research to support the identification of teaching and measurement of the characteristics of a compassionate nurse. As the study aimed to develop a new psychometric questionnaire, and an online scenario based learning course to help teach nursing students about compassion, a mixed methods approach underpinned by pragmatism was used. A variety of methods were included in the design of the studies. Directed content, and thematic analysis were used to explore the qualitative data. In addition, classic scale development statistics and confirmatory factor analysis methods were used to analyse the quantitative data. Findings Two major findings from this study were the development of the META model and Compassion Strengths model to support nursing students in the understanding and demonstration of compassion in practice. The Compassion Strengths model suggests that compassion is a multifaceted concept comprised of eight strengths, (1) Character, (2) Self-care, (3) Communication, (4) Connection, (5) Engagement, (6) Competence, (7) Interpersonal skills, and (8) Empathy, which are key factors in the development of a compassionate nurse. The META model proposes that nursing students can first Measure themselves on their own unique compassion strengths. Next, using the online course they can access and Explore information about each of the compassion strengths to increase their knowledge and understanding of compassion. Then, Try out what they have learned through a series of reflective scenarios. Last, students can take what they have learned and Apply it to their practice. Nursing students who engaged in the META model using the compassion strengths as a framework, developed a new understanding of how to demonstrate compassion that they were able to implement into their clinical practice with patients. Conclusion The META model, and Compassion Strengths model are two novel approaches to teaching compassion in nursing. While nursing curricula undoubtedly cover some of the compassion strengths included in this research, this study provides further empirical evidence for their importance and ways in which they can be implemented into nurse education and practice using the META model. The findings can be used to explore new avenues in the pursuit of producing nursing students with the strengths of compassion along their educational journey. The META model adds a unique contribution to knowledge. It is a novel approach to teaching that can be used as a learning tool to help students improve on specific compassion skills and help track progress over time. The results of this will not only have a positive impact on their own health and wellbeing, but that of their patients too. While this study explored the impact of both models on nursing students, the research could be applied to other healthcare students and professionals

An examination of the contribution made by the Internet in relationship-oriented retail banking

An understanding of the role the Internet can play in marketing activity is of growing interest to both academics and practitioners. The focus of the research reported in this thesis has Internet-enabled marketing as its centre. The context for this examination is that of Electronic (or Internet-enabled) retail banking. The research sought to identify, assess and evaluate the contribution of the Internet to relationship-oriented retail banking. Given the relational focus of the research it was decided that a focus on both the perspectives of bankers and retail bank customers would be accessed in order to address the research aim most effectively. Key findings from the study overall include; (i) bank branch staff have a key role in the education of their customers in order that there is continued growth in e-banking adoption, (ii) reassurance about web security is of prime importance in encouraging customers to adopt e-banking, (iii) awareness of the added value offered by e-banking needs to be generated and communicated by banks according to varying customer clusters, (iv) bank marketing communications strategies need to be refined in order to better target and help manage the perceptions of varying customer clusters with regard to the e-banking proposition, (iv) in the case bank under study a loss of face to face interaction was not seen as an inhibitor in adoption of the Internet for purchase of products of increasing complexity, (v) banks in general need to move away from a reliance on traditional segmentation approaches and adopt a more motivation driven / behaviourally -based approach to profiling customers. The thesis ends with an agenda for future research that focuses heavily on the possibilities for intemationalising the study.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Compassion for others, self-compassion, quality of life and mental well-being measures and their association with compassion fatigue and burnout in student midwives: A quantitative survey

Backgroundcompassion fatigue and burnout can impact on the performance of midwives, with this quantitative paper exploring the relationship between self-compassion, burnout, compassion fatigue, self-judgement, self-kindness, compassion for others, professional quality of life and well-being of student midwives.Methoda quantitative survey measured relationships using questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) Short Warwick and Edinburgh Mental Well-being Scale; (4) Compassion For Others Scale.Participantsa purposive and convenience sample of student midwives (n=103) studying at university participated in the study.Resultsjust over half of the sample reported above average scores for burnout. The results indicate that student midwives who report higher scores on the self-judgement sub-scale are less compassionate towards both themselves and others, have reduced well-being, and report greater burnout and compassion fatigue. Student midwives who report high on measures of self-compassion and well-being report less compassion fatigue and burnout.Conclusionstudent midwives may find benefit from ‘being kinder to self’ in times of suffering, which could potentially help them to prepare for the emotional demands of practice and study.Implicationsdeveloping, creating and cultivating environments that foster compassionate care for self and others may play a significant role in helping midwives face the rigours of education and clinical practice during their degree programm

The impact of social cognitive and personality factors on teachers' reported inclusive behaviour

Background. Inclusive education of children with intellectual disabilities is intended to maximise their educational experience within the mainstream school setting. While policy mandates inclusion, it is classroom teachers’ behaviours that determine its success. Aims. This study provided a novel application of the Theory of Planned Behaviour (TPB) in this setting. It examined the effect of TPB variables and personality on reported inclusive teaching behaviours for learners with intellectual disabilities. Sample. The sample comprised 145 primary school teachers (85% female) from mainstream schools across Scotland. Method. Participants completed a TPB questionnaire assessing attitudes (instrumental and affective), subjective norms (injunctive and descriptive norms), perceptions of control (self-efficacy and controllability) and behavioural intentions towards using inclusive strategies. The Big Five Personality Index, measuring extraversion, conscientiousness, openness, neuroticism, and agreeableness, was also completed. Teaching practices were reported two weeks later. Results. Instrumental attitudes, descriptive norm, self-efficacy and neuroticism predicted teachers’ intentions to use inclusive strategies. Further, conscientiousness had indirect effects on intentions through TPB variables. These intentions, however, did not predict reported behaviour expected by TPB. Instead, self-efficacy was the only significant predictor of reported behaviour. Conclusions. This study demonstrates the application of TPB to an educational setting and contributes to the understanding of teachers’ reported use of inclusive strategies for children with intellectual disabilities

A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses

Background: Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses.Aim: To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses.Method: Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout. Participants: A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study.Results: Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout. Conclusion: High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion

Lessons learned from pre-clinical testing of xenogeneic decellularized esophagi in a rabbit model

Summary Decellularization of esophagi from several species for tissue engineering is well described, but successful implantation in animal models of esophageal replacement has been challenging. The purpose of this study was to assess feasibility and applicability of esophageal replacement using decellularized porcine esophageal scaffolds in a new pre-clinical model. Following surgical replacement in rabbits with a vascularizing muscle flap, we observed successful anastomoses of decellularized scaffolds, cues of early neovascularization, and prevention of luminal collapse by the use of biodegradable stents. However, despite the success of the surgical procedure, the long-term survival was limited by the fragility of the animal model. Our results indicate that transplantation of a decellularized porcine scaffold is possible and vascular flaps may be useful to provide a vascular supply, but long-term outcomes require further pre-clinical testing in a different large animal model

'To live and die [for] Dixie': Irish civilians and the Confederate States of America

Around 20,000 Irishmen served in the Confederate army in the Civil War. As a result, they left behind, in various Southern towns and cities, large numbers of friends, family, and community leaders. As with native-born Confederates, Irish civilian support was crucial to Irish participation in the Confederate military effort. Also, Irish civilians served in various supporting roles: in factories and hospitals, on railroads and diplomatic missions, and as boosters for the cause. They also, however, suffered in bombardments, sieges, and the blockade. Usually poorer than their native neighbours, they could not afford to become 'refugees' and move away from the centres of conflict. This essay, based on research from manuscript collections, contemporary newspapers, British Consular records, and Federal military records, will examine the role of Irish civilians in the Confederacy, and assess the role this activity had on their integration into Southern communities. It will also look at Irish civilians in the defeat of the Confederacy, particularly when they came under Union occupation. Initial research shows that Irish civilians were not as upset as other whites in the South about Union victory. They welcomed a return to normalcy, and often 'collaborated' with Union authorities. Also, Irish desertion rates in the Confederate army were particularly high, and I will attempt to gauge whether Irish civilians played a role in this. All of the research in this paper will thus be put in the context of the Drew Gilpin Faust/Gary Gallagher debate on the influence of the Confederate homefront on military performance. By studying the Irish civilian experience one can assess how strong the Confederate national experiment was. Was it a nation without a nationalism

Advanced x-ray imaging techniques in tissue engineering: a new construct assessment platform for enabling the regeneration of personalised organs

Tissue engineering (TE) holds promise for generating lab-grown patient specific organs which can provide: (1) effective treatment for conditions that require volumetric tissue transplantation and (2) new platforms for drug testing. Even though volumetric structural information is essential for confirming successful organ maturation, TE protocol designs are currently informed through destructive and 2D construct assessment tools (e.g. histology). X-ray phase-contrast computed-tomography (PC-CT) can generate non-destructive, high resolution, 3D density maps of organ architecture. In this work, PC-CT is used as new imaging tool for guiding two TE protocols currently at the in-vitro testing stage. The first (1) involves cell-repopulation of an oesophageal scaffold, with the aim of using the regenerated construct for treating long-gap oesophageal atresia, whilst for the second (2) a lung-derived scaffold is populated with islets for regenerating a pancreas, with the “repurposed” lung offering a platform for diabetes drug testing. By combing 3D images and quantitative information, we were able to perform comprehensive construct evaluation. Specifically, we assessed volumetrically: (1) the cell-distribution within the regenerated oesophagi and (2) islet integration with the vascular tree of the lung-derived scaffold. This new information was proven to be essential for establishing corresponding TE protocols and enabled their progression to more advanced scale-up models. We are confident that PC-CT will provide the novel insights necessary to further progress TE protocols, with the next step being in-vivo testing. Crucially, the non-destructive nature of PC-CT will allow in-vivo assessments of TE constructs following their implantation into animal hosts, to investigate their successful integration