Innovation
Redesigning a module to make compassionate care more explicit.
We invited a range of participants, including lecturers, senior nurses in compassionate care, students and charge nurses to participate in an action meeting that explored key compassionate elements that needed to be integrated into the module. The participants reflected on what mattered to patients and families in the acute admission to hospital, key elements that nurses need to consider, and how care provision during this acute time can be not only safe and effective but also compassionate (directed by themes and data gathered through the Leadership in Compassionate Care Programme (LCCP) – see below).
We examined this in the context of the teaching and assessment materials including patient scenarios used within the module. The key elements discussed were mapped against key themes drawn from data generated in the clinical sites as part of the wider LCCP. These are as follows:
- a deliberate welcome and a smile costs nothing
- helping to connect
- knowing how people are feeling, acting and responding
- knowing the little things that matter
- being kept in the loop
- consider the implications of giving compassionate relationship centred care
- being open and real about expectations
The above themes illustrated by relevant patient or carer quotes were incorporated into the module teaching and assessment materials both in the online theory and in the practical and written assessments. Stories about patient and family experiences of care that reflected these themes were also recorded and made available to students as podcasts to make their learning more alive and focused. Students were encouraged to reflect on the stories and to consider the meaning of compassionate care, what matters to patients and relatives and how they can use this knowledge to influence their caring practice.
Within the practical sessions key themes were used to influence the simulated patient scenarios. Instructions for the actor patients were altered, for example we asked them to challenge the students when they used jargon and to ask them to explain what they were doing, whether it was likely to hurt them etc. The purpose was to get the students thinking about how the patient might feel in their situation and all the things that we, as health professionals, can take for granted.
In a supportive and safe environment the students practice was challenged and as the module progressed and they continued to engage in the online theoretical materials, listened to the stories and reflected on the experiences of others, and to engage in the simulated patient scenarios, their awareness of compassionate care increased.
We invited the actors to feed back how they felt while the students were caring for them in the emergency room following, for example, a road traffic accident or waking up in hospital after collapsing in a wine bar. Research tells us that the “debrief” is where a significant part of learning takes place (Arafeh et al 2010), and during this the students discussed their care practice and those of their peers and related this to experience in clinical placement.
The module has two components of assessment – a practical component where, working in pairs, the students demonstrate a systematic patient assessment, and a written exam. The students were awarded marks for demonstrating aspects of compassionate care in each. Themes and data from the programme informed the marking criteria.
Reference:
Arafeh, J., Hansen, S., Nicols, A. 2010. Debriefing in simulated-based learning: facilitating a reflective discussion. The Journal Of Perinatal & Neonatal Nursing 24 (4), 302-
What prompted innovation?
- The Leadership in Compassionate Care Programme (LCCP) is an action research programme that seeks to examine the concept of compassionate care in hospital and community settings and to develop key processes and indicators that will facilitate NHS Lothian and Edinburgh Napier University (Scotland) to embed compassionate care in practice and education.
- As part of this lecturing staff within the SNM&SC are committed to embedding compassionate care within the nursing and midwifery programmes. (For more information on the wider programme see the website www.napier.ac.uk/CompassionateCare).
- Patient, relative, staff and student stories gathered within clinical practice as part of programme were made available for staff to use within LTA. How to utilise this rich resource in a meaningful way was, however, a challenge. Emerging themes from the project suggested that compassionate care could be provided consistently across settings and situations—even in the emergency room.
- As module leader for a blended learning module that teaches acute illness and deterioration using simulated practice I decided to reshape the module in order to make compassionate care more explicit and assess it.
What makes innovation different?
- Learning through listening to and reflecting upon the experiences of service users and staff provides invaluable insight for students. This can be built on during the simulated patient scenarios.
- Incorporating LTA about aspects of compassionate care, demonstrated through simulated practice appears to be new.
- Simulated practice provides an opportunity for the students to apply their learning in practice. Immediate feedback from actor patients, peers and teaching staff during the “debrief” allows for significant learning about current knowledge and skills, in addition to areas for development.
Changes in practice
Students indicate an intention to alter their approach to patients and relatives as a result of their learning. There is however a need to evaluate this further. It is anticipated that this will be undertaken as a research project within the School and may include data gathered at Curtin University Perth (WA).
Impact
- Student, staff and actor evaluation
- Shared practice with Curtin University Perth Western Australia
Dissemination
- School of Nursing Midwifery and Social Care LTA Action Day 2010
- NHS Lothian and Edinburgh Napier University Inaugural International Conference on Compassionate 2010. Workshop: Personal narratives made available as podcasts: A resource for nurse education
- International symposium for Compassionate Greenwich Care 2011: Embedding compassionate caring elements into an UG nursing module
- Enhancing Practice Conference Belfast 2010: Making compassionate nursing practice explicit within the pre-registration curriculum: Two educational practice developments
- Publication: Adamson, E., Dewar, B. ( 2011) Compassion in the nursing curriculum: making it more explicit. Journal of Holistic Healthcare, 8, 3. pp.42-45