Compassion at the heart of well-being: an inter-disciplinary study to evaluate the effect of a meditation intervention and a positive psychology intervention on well-being and compassionate care among healthcare employees

INTERVENTION: Arm 1: Meditation intervention ‐ The training will involve 3 x 6‐hour workshops in a group setting. Training will combine psycho‐education and instruction; participant experiential exercises (ie, meditative exercises), self‐reflection, peer‐to‐peer discussion and review, and whole‐of‐group discussion and review. ‐ The meditation exercises are: deep relaxation meditation ("yoga‐nidra" practice); mindful breathing and body‐awareness; loving‐kindness meditation; other‐oriented compassion meditation; and self‐compassion meditation. ‐ Participants will receive worksheets to complete reflective exercises and take notes during the training sessions ‐ This intervention will be delivered by an experienced meditation trainer with over 10 years teaching experience. ‐ This intervention will be delivered face to face in a group ‐ The intervention will comprise 3 x 6‐hour workshops over 4 weeks (session 1 will be in week 0 of the trial; session 2 will be in week 2 of the trial and session 3 will be in week 4 of the trial). ‐ The intervention will occur in metropolitan hospitals and health‐care centres (i.e., the workplace of participant nurses) ‐ Adherence to the intervention protocol will be monitored via a third‐party research assistant with experience in participating in meditation programs, sitting in on approximately 20% of training sessions across the trial. Arm 2: Positive psychology intervention ‐ The training will involve 3 x 6‐hour workshops in a group setting. Training will combine psycho‐education and instruction; participant experiential exercises (ie, positive psychology and self‐coaching exercises), self‐reflection, peer‐to‐peer discussion and review, and whole‐of‐group discussion and review. ‐ The experiential activities in this intervention focus on the development of skills relating to: values‐clarification, strengths‐identification and goal‐setting; solutions‐focused thinking and self‐coaching; developing self‐kindness (non‐meditative), gratitude and connecting to others. ‐ Participants will receive worksheets to complete reflective exercises and take notes during the training sessions ‐ This intervention will be delivered by an experienced coach and positive psychology trainer with over 10 years teaching experience. ‐ Mode of delivery: This intervention will be delivered face to face in a group; ‐ The intervention will comprise 3 x 6‐hour workshops over 4 weeks (session 1 will be in week 0 of the trial; session 2 will be in week 2 of the trial and session 3 will be in week 4 of the trial). ‐ The intervention will occur in metropolitan hospitals (i.e., the workplace of participant nurses) ‐ Adherence to the intervention protocol will be monitored via a third‐party research assistant with experience in participating in positive psychology programs, sitting in on approximately 20% of training sessions across the trial. CONDITION: nurse compassionate care nurse well‐being PRIMARY OUTCOME: Primary Outcome 1: General well‐being as measured by the Warwick‐Edinburgh Mental Well‐being Scale Primary Outcome 2: Compassionate nursing care, measured using the Compassionate Care Scale (Fairbrother et al, under review) Primary Outcome 3: Motivation for and enactment of compassionate behaviours as measured by the Compassion Motivation and Action Scale (Steindl, Kirby, Tellegen, Filus, Seppala, and Doty, 2017) SECONDARY OUTCOME: Behavioural empathy measured by the Reading the Mind in the Eyes Test (Vellante, M., et al., 2012). ; ; These will be interviews conducted with 20 nurse/midwives (10 from each of the active arms of the study). Sample Interview Questions for semi‐structured interviews at baseline: ; ; COMPASSION ; Q area: Can you speak about your understanding of compassion? ; Burnout measured using a two‐item measure validated by West, C. P., et al. (2009) Climate of compassion adapted from the Psychological Safety Scale of Edmondson (1999) Empathy and perspective‐taking measured using the Interpersonal Reactivity Index (Davis, 1987) Ethnographic observation: We expect to also conduct a limited amount of on‐ward observation using a trained ethnographer. Our aim is to record and understand the physical processes of work and the hierarchical structure of control within the ward: what gets done, at what times, under what time pressures, the physical structure of the ward, how much flexibility nurses have in what they do and how that gets interpreted and used), and how these might affect the nurses' motivation and the patients' experience of their interaction with the nurses. What kind of spaces do the nurses have to relax, take a break, socialise with each other? Are there religious facilities provided, if so what are they? Are there any obvious sources of tension and conflict? Experiential avoidance measured using the Brief Experiential Avoidance Questionnaire (Sahdra et al, 2016) General Semi‐structured Interviews regarding compassion and wellbeing: ; What does this mean for you? ; How has this changed in the course of your career? ; Can you give me an example of you at your most compassionate? ; Q area: Thinking about your clinical work in particular, can you speak about your understanding of compassionate care? ; What is compassionate care for you? Can you give me an example? ; How would you identify compassionate care in the context of your own practice? ; How would you identify it in the context of your colleagues’ practice? ; Q area: Can you describe a time when you felt as though you were less compassionate than you wished to be towards a patient? What happened? What gets in the way of compassion towards patients? Do you feel that there are some kinds of patients who are less deserving of compassion? ; Q area: How compassionate are you expected to be towards your patients? From which directions do you sense such expectations? ; Q area: Do you find that you exercise compassion more often in your work life than in your personal life? Or is it the other way round? ; Q area: How compassionate are you to yourself? ; ; WELLBEING ; Q area: Can you speak about your understanding of well‐being? Can you describe a time when you experienced a sense of well‐being? What did you notice? What are the things in your life that are most important for your well‐being? How does your own well‐being impact on your work life? Your personal life? How is well‐being maintained and developed for you? ; Q area: How is well‐being related to compassion for you? Can you give an example? ; Q area: timeline. Can you draw for me a timeline of your career as a nurse/midwife, and then plots times when you felt most and least well‐being. What were the key events and changes that led to these changes in well‐being? What have you learned about how best to maintain your own well‐being? ; Heart Rate Variability (HRV) will be measured using state‐of‐the‐art non‐invasive devices (E4 Empatica wristband: empatica.com), as follows: ; ; 1. Participants in all three groups will be asked to wear the wristbands on baseline for six minutes (with eyes closed) ; 2. Participants will be asked to wear the wristband continuously during the training programs in the two active groups ; 3. In the mediation arm of the trial, participants will be asked to indicate the beginning and ending of meditation periods by pressing a button on the device. ; 4. Participants will be asked to wear the wristbands for six minutes (with eyes closed) at the conclusion of day three of training (active groups only) ; Interview Questions for semi‐structured interviews at four month follow up ; ; Questions for the Arm 1: ; ; The four month follow up interviews will differ in some aspects for the two groups under study. The groups will be interviewed the context of the interventions they have received. ; ; Q area: In the baseline interview, we discussed your understanding and experience of compassion. Can you speak about any changes you’ve noticed in the last 4 months regarding how you understand and experience compassion? At work? In your personal life? ; Q area: In the baseline interview, we also discussed your understanding and experience of well‐being. Can you speak about any changes you’ve noticed in the last 4 months regarding how you understand and experience well‐being? At work? In your personal life? ; ; Questions for the Arm 2: ; ; Q area: In the baseline interview, we discussed your understanding and experience of compassion. Can you speak about any changes you’ve noticed in the last 4 months regarding how you understand and experience compassion? At work? In your personal life? ; Q area: In the baseline interview, we also discussed your understanding and experience of well‐being. Can you speak about any changes you’ve noticed in the last 4 months regarding how you understand and experience well‐being? At work? In your personal life? ; Job engagement as measured by the job engagement scale (Rich, LePine, & Crawford, 2010). Job satisfaction using a single‐item measure from Judge et al (1994). Life satisfaction measured using the European Social Survey (2013) Meaningfulness of work measured by a single item from Fairbrother, Jones and Rivas (2009) Mindfulness measured using the Five Facets of Mindfulness (Short‐Form) Scale (Bohlmeijer et al., 2011) Nurse / midwife assessments of their own compassionate care in relation to a small number of patients on a given day (a dyadic measure): During your interaction with your patient, to what extent did you: ; 1. give your full attention to the patient ; 2. feel warmth towards the patient ; 3. believe that the patient deserved compassion ; 4. see this patient as having a lot in common with you ; 5. imagine how you would feel in their situation ; 6. express care and compassion through your words and actions ; 7. feel confident managing their emotional needs ; 8. manage your own emotions effectively ; Nurse and midwife responses to ethnographic interviews: This specifically ethnographic approach will seek to explore the ‘life of a nurse’ at depth using an unstructured interview approach. The main purpose of this material is to inform the research group’s overall analysis of the impact of the intervention, and to raise issues that might not be covered directly by other more formally specified measures ; Patient assessment of nurse compassionate care a dyadic measure): During your interaction with the nurse/midwife, to what extent did you feel ; 1. they gave you their full attention ; 2. they focused on your feelings (as well as your medical needs) ; 3. confident in the care you received ; 4. able to talk about your feelings or worries ; 5. felt genuinely listened to ; 6. your nurse was warm ; 7. your nurse was caring and compassionate ; Questions for Arm 1: ; Q area: What were your expectations before you started your involvement in the program? ; Q area: Can you talk about your prior knowledge/experience of meditation? ; Q area: What were your experiences when you first began the sessions? ; Q area: What were your experiences as you progressed through the sessions? ; Q area: Did anything change as time went on? If so, what did you notice? ; Patient state affect (a dyadic measure): At this moment how do you feel? Perceived stress, measured using the 4‐item version of the perceived stress scale (Cohen, Kamarck, & Mermelstein, 1983). Prosocial behaviour at work, measured using the 'helping' subscale of the organisational citizenship behaviour scale of of Podsakoff et al (1997). Psychological safety measured using a measure of the construct from Edmondson (1999). Sample Interview Questions for semi‐structured interviews post‐intervention: ; Q area: Did you meditate in between sessions? If you did, how often? How did you manage to do that? ; Q area: Can you describe things you have learned as a result of being involved in the program? ; Q area: Have you noticed any changes in your behaviours or everyday thoughts following commencement? ; Q area: Have you noticed any changes to your approach to work, or to your life in general ? ; Can you speak about any changes you’ve noticed in relation to your relationships with the patients you work with? ; ; Questions for the Arm 2: ; Q area: What were your expectations before you started your involvement in the program? ; Q area: Can you talk about your prior knowledge/experience of well‐being? ; Q area: What were your experiences when you first began the sessions? ; Q area: What were your experiences as you progressed through the sessions? ; Q area: Did anything change as time went on? If so, what did you notice? ; Q area: Can you describe things you have learned as a result of being involved in the program? ; Q area: Have you noticed any changes in your behaviours or everyday thoughts following commencement? ; Q area: Have you noticed any changes to your approach to work, or to your life in general ? ; Can you speak about any changes you’ve noticed in relation to your relationships with the patients you work with? ; Self‐compassion as measured by the Short Self‐Compassion Scale Raes et al., 2011) Social Network Analysis: Intervention participants will be asked to nominate between 5 – 10 individuals in their workplace network who are important for the work that they do. They will then be asked the following questions, referring to the quality and frequency of their interaction and compassion‐based experience regarding their perception of each of the nominated individuals: ; ; 1. Communication ‐ Please rate the relative frequency of communication you have with this individual ; ; 2. To what extent do you perceive this person to be energising in your interactions with them? ; ; 3. To what extent has this person shown compassion towards you? ; ; 4. To what extent do you perceive this person to be willing to show compassion towards staff? ; ; 5. To what extent do you perceive this person to be willing to show compassionate towards patients and their families? ; Solutions‐focused thinking using the Solutions‐Focused Inventory (Grant, et al., 2012). State affect (a dyadic measure): At this moment, to what extent do you feel: ; 1. Enthusiastic ; 2. Calm ; 3. Distressed ; 4. Angry ; 5. Sad ; State energy (a dyadic measure): Imagine that your mental, emotional, and physical energy at work is like having 3 different types of petrol tanks. At this moment, how full is your….? ; 1. MENTAL energy tank ; 2. EMOTIONAL energy tank ; 3. PHYSICAL energy tank ; (0% ‐ 100%) INCLUSION CRITERIA: Participants must be employees of NSW Health Participants must be nurses or midwives