Lucy Maddox NIHR CRDF - Development of an intervention to prevent and reduce staff compassion fatigue in an at risk NHS staff group

BackgroundCompassion is vital for good patient outcomes and safe patient care. Compassion fatigue is an important phenomenon widely associated with NHS staff stress [1]. Defined as 'physical and emotional exhaustion and a pronounced reduction in the ability to feel empathy and compassion for others', compassion fatigue is associated with poorer patient care, poorer patient satisfaction [1][2], greater staff turnover and increased absenteeism [2][3]. The Francis Report [4] highlighted the devastating, sometimes fatal, effect that a lack of compassion can have on patient care. Not all healthcare staff under pressure develop problematic levels of compassion fatigue. Whilst some risk factors are understood, further work is required to understand what works for whom in which circumstances to prevent and/or reduce compassion fatigue, and which mechanisms underlie the most effective interventions [5]. There is currently no well-evidenced intervention to reduce compassion fatigue. Existing evidence focusses mainly on interventions targeting individuals, despite the most effective wellbeing interventions being co-designed and involving systems as well as individual factors [6]. Developing an intervention to prevent and/or reduce compassion fatigue in NHS staff will improve patient care and staff wellbeing. Adolescent mental health wards are a good example of a pressurised multi-disciplinary healthcare setting with acute and chronic multi-level stressors, which can be used to develop and model a new intervention. Child and adolescent mental health referrals have been rising for years and are likely to rise post-pandemic. Research question How do we reduce compassion fatigue in adolescent mental health ward staff? AimTo develop and pilot an intervention to prevent and/or reduce compassion fatigue in adolescent mental health ward staff. ObjectivesObjective 1. To map current understanding of compassion fatigue and interventions to prevent and/or reduce compassion fatigue in healthcare staff Objective 2. To develop an evidence-based, theoretically-informed and co-designed intervention to prevent and/or reduce compassion fatigue Objective 3. To pilot and refine the prototype intervention, measuring acceptability, usefulness and feasibility. MethodsThe objectives above will be fulfilled through three studies. Study 1: Systematic review of interventions aiming to prevent and/or reduce compassion fatigue in healthcare staff. Study 2: Consultation and co-design of a multi-level intervention to reduce compassion fatigue, using intervention mapping. Study 3: Pilot and iterative refinement of intervention prototype, measuring acceptability, usefulness and feasibility TimelinesThis study will be conducted part-time over 5 years from May 2021 (current MSc in Organisation Psychology completes September 2020). Anticipated impact and disseminationThis project has the potential to impact positively on patient care and NHS staff wellbeing. I will work closely with staff, ex-patients and families to create and share outputs. I will use my previous public engagement experience and draw on clinical, academic and patient networks to disseminate. Outputs will: Impact patient care and staff wellbeing directly e.g. clear plain-English articles shared with NHS England. Share findings and methodology with academic community e.g. academic papers, conference presentations (e.g. NHS Confederation Conference) and pre-registered protocols. Engage wider audiences in conversations about compassionate care and work wellbeing e.g. podcast, articles, and funding application for creative partnership.