Mirella Hopper 2013 Cohort

Transcription

1 Investigating the Relationships between Staff Individual Differences and Challenges to Compassion towards Patients who are detained under the Mental Health Act Mirella Hopper 2013 Cohort

2 Compassion in Healthcare Growing concerns into lack of compassionate care within healthcare system (e.g. Francis, 2013) A basic kindness, with a deep awareness of the suffering of oneself and of other living things, coupled with the wish and effort to relieve it (Gilbert, 2010) Increasing acknowledgement of individual, relational, organisational and social barriers to compassion (Campling, 2014)

3 Compassion in Research Previous research explored costs of compassion in mental health professionals (MHPs) (i.e. compassion fatigue, burnout) Fears of compassion active conflict in receiving and expressing affiliative emotions (from others, for self, for others) Existing Fears of Compassion Scale (Gilbert, McEwan, Matos & Rivis, 2011) has limited use within clinical/therapeutic relationship contexts

4 Factors Affecting Compassion Attachment security (Mikulincer, Shaver, Gillath & Nitzberg, 2005) Nurtured soothing affect regulatory system (Gilbert, 2005) Positive implicit attitudes towards caregiving (Brener, Rose, von Hippel & Wilson, 2013) Capacity for emotional intelligence (self and other) (Martos, Lopez-Zafra, Pulido-Martos & Augusto, 2013) Perceptions of deservedness, relevance and ability to affect change (Goetz, Keltner & Simon-Thomas, 2010)

5 The Current Study Research aim #1: To determine whether there is a relationship between individual differences in direct-care staff and challenges to compassion towards patients detained under Mental Health Act (1983/2007) Direct-care staff - interpersonal/affective nature of relationship, exposure to patient risk and distress, ward-based, physical interventions, staffing shortages Detained patients - risk to self/others, stigmatising attitudes, security vs. care, power inequality Research aim #2: To develop a more appropriate measure of the challenges mental health professionals experience in displaying compassionate care to patients (CCQ) Ethical approval obtained from Lancaster University FHM REC, 5x NHS R&D committees and 2x private sector research boards

6 Quantitative Methodology Two-part online survey Online questionnaire (adult attachment [ECR], professional quality of life [ProQOL], challenges to compassion [CCQ], emotional intelligence [S-PEC], explicit attitudes) Implicit Associations Test (IAT) Questionnaire completed by 104 participants Genders: 79 females, 25 males Roles: 41 support workers, 40 nurses, 23 clinical managers Ages: years Clinical experience: 1 month-48 years Settings: acute services, psychiatric intensive care units, locked rehabilitation, low and medium secure hospitals IAT completed by 21 participants Reflective of ward time-constraints?

7 Primary Results Minimal challenges to compassion in direct-care staff! Multiple regression analysis of predictors of CCQ Lower rates of compassion satisfaction Lower capacity for intrapersonal emotional intelligence Relationships with CCQ Attachment-related anxiety Support worker role Compassion fatigue Age, gender and length of experience unrelated to CCQ Factor analysis of new CCQ measure Internal reliability and validity Increasing implicit preference for detained patients with experience

8 Exploration of Findings Tension between detachment/control vs. compassion (Matthews & Williamson, 2016) Compassion satisfaction gratification obtained from caregiving Filters down from leaders and flows through teams (Campling, 2015) Role of intrapersonal emotional intelligence Compassion feeling with another (Singer & Klimecki, 2014) Self-compassion related to intrapersonal emotional intelligence (Senyuva, Kaya, Isik & Bodur, 2014) and interpersonal compassion (Gilbert, 2011) Attachment-related anxiety conflicting relational motives Insecurity increased by complex organisational systems (Braun, 2011) Support worker role Limited autonomy (Manojlovich, 2005) Physical interventions (Sequeira & Halstead, 2004)

9 Pragmatic Applications Compassion as a corrective emotional and interpersonal experience for patients (Bridges, 2006) Promoting compassion across four interrelated levels Individual Impact of staff wellbeing on quality of care provision (DoH, 2014) Compassionate culture begins with self-compassion (Cree & Rodgers, 2013) Interpersonal Mentalising to tune-in to a patient s world (Bateman & Fonagy, 2013) Organisational Social Mental health services as attachment figures (Seager, 2013) Psychologically-informed environments (PIEs) Embed compassion within training programmes (Firth & Cornwell, 2009) Reduce social inequalities and mental health stigma (MHF, 2016)

10 References #1 Bateman, A., & Fonagy, P. (2013). Mentalization-based treatment. Psychoanalytic Inquiry, 33(6), Braun, G. (2011). Organisations today: What happens to attachment? Psychodynamic Practice, 17(2), Brener, L., Rose, G., von Hippel, C. V., & Wilson, H. (2013). Implicit Attitudes, Emotions, and Helping Intentions of Mental Health Workers toward Their Clients. The Journal of Nervous and Mental Disease, 201(6), Bridges, M. R. (2006). Activating the corrective emotional experience. Journal of Clinical Psychology, 62(5), Campling, P. (2015). Reforming the culture of healthcare: The case for intelligent kindness. British Journal of Psychiatry Bulletin, 39, 1-5. Cree, M., & Rodgers, V. (2013, November 19). Personal reflections: developing our own compassionate mind as staff member: Implications for service development. Presented at Cultivating a Culture of Compassion in Healthcare: Creating Social Contexts for Compassion to Thrive Conference, Derbyshire. Department of Health. (2014). Healthcare sector staff wellbeing, service delivery and health outcomes. London: HMSO. Firth-Cozens, J., & Cornwell, J. (2009). The Point of Care Enabling compassionate care in acute hospital settings. UK: The King s Fund.

11 References #2 Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Executive Summary. Norwich: TSO. Gilbert, P. (2005). Compassion: Conceptualisations, research and use in psychotherapy. London: Routledge. Gilbert, P. (2010). The Compassionate Mind. London: Constable & Robinson Ltd Gilbert, P., McEwan, K., Matos, M., & Rivis, A. (2011). Fears of compassion: Development of three self-report measures. Psychology and Psychotherapy: Theory, Research and Practice, 84(3), Goetz, J. L., Keltner, D., & Simon-Thomas, E. (2010). Compassion: An Evolutionary Analysis and Empirical Review. Psychological Bulletin, 136(3), Manojlovich, M. (2005). Promoting nurses' self-efficacy: a leadership strategy to improve practice. The Journal of Nursing Administration, 35(5), Martos, M. P. B., Lopez-Zafra, E., Pulido-Martos, M., & Augusto, J. M. (2013). Are emotional intelligent workers also more empathic? Scandinavian Journal of Psychology, 54(5), Matthews, H., & Williamson, I. (2016). Caught between compassion and control: exploring the challenges associated with inpatient adolescent mental healthcare in an independent hospital. Journal of Advanced Nursing, 72(5), Mental Health Foundation. (2016). Stigma and Discrimination.

12 References #3 Mikulincer, M., Shaver, P. R., Gillath, O., Nitzberg, R. A. (2005). Attachment, Caregiving, and Altruism: Boosting Attachment Security Increases Compassion and Helping. Journal of Personality and Social Psychology, 89(5), Seager, M. (2013). Using attachment theory to inform psychologically minded care services, systems and environments. In A. N. Danquah & K. Berry (Eds.), Attachment Theory in Adult Mental Health: A Guide to Clinical Practice. Oxon: Routledge Senyuva, E., Kaya, H., Isik, B., & Bodur, G. (2014). Relationship between self-compassion and emotional intelligence in nursing students. International Journal of Nursing Practice, 20(6), Sequeira, H., & Halstead, S. (2004). The psychological effects on nursing staff of administering physical restraint in a secure psychiatric hospital: When I go home, it's then that I think about it. The British Journal of Forensic Practice, 6(1), Singer, T., & Klimecki, O. M. (2014). Empathy and compassion. Current Biology, 24(18), R875 R878. Whomsley, S. (2014). Compassion, organisations and leadership. Clinical Psychology Forum, 263,