Edinburgh Napier University

  Abstract
Background
Compassionate caring and dignity are key priorities in current policy and research agendas and are central to the quality of experience for patients, families and staff. Developing relationships has been identified as a key component in enabling excellence in caring to be realised in practice. However there is little evidence that identifies the processes involved in delivering compassionate relationship-centred care. This study sought to address this gap in the knowledge base.

Aims and research questions
The study’s aim was to examine and evaluate processes that enhance compassionate relationship-centred care within an older people care setting in an acute hospital. Key objectives were: to develop an understanding of the concept of compassionate relationship-centred care within the practice setting through exploring the views, perceptions and experiences of staff, patients and their families; to develop, implement and evaluate strategies that promote this concept; to examine the processes that need to be put in place to enable sustainability of these strategies; and to identify the lessons learnt to inform practice, education, policy and research. This study was part of a larger programme of work that aimed to integrate compassionate care across practice and education.

Approach and methods
My role as a senior nurse and practitioner researcher meant that I was in a unique position to be able to capture not just theoretical views of compassion but how this was enacted in practice. To do this the study used the approach of appreciative inquiry. A range of methods was used: participant observation, stories using emotional touchpoints, photo-elicitation, and group discussions to explore beliefs and values. Data were continually fedback to staff participants to involve them in analysis. An iterative and inductive process of immersion crystallization was used to analyse data.

Findings
A key finding was the development of a practice model to support practitioners to deliver compassionate relationship-centred care. This model suggests that, in order to deliver such care, people need to engage in the process of appreciative caring conversations in order to understand a) who people are and what matters to them; and b) how people feel about their experience. This in turn enables a process of working together to shape the way things are done. The findings support the notion that during these caring conversations the practitioner needs to connect emotionally, be curious, collaborative, able to compromise, considerate of others perspectives, courageous and actively celebrate when practices have worked well in order to promote compassionate relationship-centred care. This framework comprises the 7 ‘C’s of caring conversations and makes a unique contribution to the body of knowledge in providing practical guidance as to the ‘how’ of compassionate relationship-centred care.

Key outcomes of implementing this model were that people felt comfortable to express emotions, developed stronger relationships, were more consistent in delivering compassionate care practice across the team, and had a sense of learned hopefulness in the face of complex and competing demands.

Conclusions and implications
Implementation of activities in practice to support this way of working revealed that these processes are complex, often requiring the practitioner to takes risks and therefore the provision of appropriate support, facilitation and strong leadership are important factors in helping to sustain such practices. The outcomes of this research build upon the existing knowledge base by providing a practice model that specifies how to deliver compassionate relationship-centred care, and they demonstrate the impact of using appreciative approaches to facilitate improvement within health care contexts.