Title: Development of an intervention to reduce compassion fatigue in adolescent mental health ward staff.
Funder: Health Education England

Abstract: 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.

Lay abstract: Background Compassion is recognising that someone is suffering and wanting to help them.Compassion fatigue is a reduction in capacity to feel compassion for others. Staff experiencing compassion fatigue deliver less high quality care, which can lead to devastating consequences (e.g. patient neglect and even death). Compassion fatigue is also associated with staff sickness, which is bad for staff and costly to the NHS.Compassion fatigue is associated with working in stressful, emotionally demanding situations, like NHS settings, but not everyone who is stressed experiences compassion fatigue. Estimates of compassion fatigue in healthcare staff have varied from 7% to over 80%. Medium to high levels of compassion fatigue are common in ward staff (ie. 4 in 5 staff).Compassion fatigue is a problem for healthcare staff and their patients. We don't understand why some people and not others experience compassion fatigue and we don't have a reliable way of reducing it. We need to understand how to reduce compassion fatigue in NHS staff in order to improve patient care and staff wellbeing.Adolescent mental health wards are a good place to study compassion fatigue and develop ways to reduce it. They are busy, high-pressure environments where families and young people are often upset, resources are stretched, and staff are managing high levels of patient risk of self-harm or suicide. Diagnoses of adolescent mental health problems have been rising in the UK and are likely to continue to rise post-pandemic. Staff stress is also likely to rise during and post- pandemic.AimTo co-design an intervention to reduce compassion fatigue in adolescent mental health ward staff.Plan Review research on compassion fatigue and interventions to prevent and/or reduce it in healthcare staff. Talk to ward staff, managers, commissioners, patients and families about this evidence and co-design a staff training and management toolkit intervention for wards, to reduce compassion fatigue. Test and improve the intervention, measuring how useful and well-liked it is, and how feasible it would be use it and to test it on more wards post-PhD.Input from Previous Research and Current Patient and Public InvolvementPrevious research and conversations with staff and patients from adolescent mental health wards confirm that compassionate care and compassion fatigue are important to them. Staff agree that organisational and individual factors are involved.This proposal has been improved by staff and ex-patient feedback, which suggested: PPI Research Advisory group, inclusion of ex-patient as well as current patient voices, inclusion of management level staff, intervention flexibility.Adolescent mental health ward staff, managers, commissioners, patients, and parent/carers will co-design the intervention.Staff and patients will be part of a Research Steering Group meeting once a year (a group of up to 8 researchers, staff and patients to discuss research progress and dilemmas), and a separate Patient and Public Involvement Research Advisory Group (of staff and ex-patients recruited at the beginning of the project) meeting at least 6-monthly to discuss detailed project plans e.g. ethics, question design, analysis and dissemination.I asked staff and ex-patients if the pandemic should change this research. They thought compassion fatigue is an issue which will pre-date and continue after specific pandemic-related stresses but that I should ask staff and patients about this as part of the co-design workshops.Dissemination This project has the potential to significantly impact patient care and NHS staff wellbeing. Together with staff, ex-patients and families I will share: Articles in peer-reviewed journals Articles in professional outlets A research podcast Conference presentations e.g. NHS Confederation ConferenceI will apply for extra funding to work with a creative agency to share findings and enable conversations with a wider audience.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH