The twelve charge nurse managers from a busy NHS hospital in Wales shuffled into the workshop showing every sign of fatigue, stress and demoralization. Nobody made eye contact. The body language spoke of resentment and a wish to be elsewhere: attending to the thousand-and-one demands of a near-impossible job. This is the stark reality of many of our hospitals, beset with overwork, stress and no time to care. How do we even begin the conversation about compassionate caring?
Ninety minutes later, the participants noisily left the room brimming with positive energy, enthusiasm, hope, and many practical ideas for improving the quality of compassionate caring on their wards. The startled Director of Nursing declared that her nurse managers had all had a “personality transplant”. What process led to this transformation?
This event was not unique. The ‘Reawakening Purpose’ workshop has inspired participants in the UK, the USA, Australia and New Zealand. It appears to works with any mixture of health workers who have direct patient contact, including receptionists and office managers, and even a mixture of professionals and patients. Some attendees describe it as life-changing. A movie file is attached, giving an example of the kind of deeply moving stories elicited by the workshop [Additional file 1].
Additional file 1: "Gauri's Story".
2.1 The workshop process
The Reawakening Purpose workshop pairs participants and asks them to interview each other. The question is, “Tell me a story of one day you had an extraordinary connection with a patient”. The pairs swap roles at half-time then the whole group is reconvened in a circle. The facilitator remarks that the emotional process of sharing stories mirrors a daily challenge of clinical practice: how to end one emotionally charged patient encounter and then be fully present to the next patient. It’s suggested that being aware of breathing is a helpful technique and the facilitator leads the group in three synchronized deep breaths. This helps the participants become still and attentive and it role-models the quality of presence desired in patient encounters.
Attendees are then invited to share their story again – this time with the whole circle. A ‘talking object’ is used with a rule that only the person holding the object is permitted to speak. The group sits in silence until the first person picks up the object, tells their story, then places the object in the middle of the circle to wait for the next story-teller. Usually about three-quarters of the participants decide to share their story.
In every workshop we have heard profound and moving stories of compassionate caring. Many of the participants share tears. Two types of story regularly emerge: incidents from early in careers when the young health professionals were more open-hearted; and determined acts of rule-breaking to meet the deeper needs of a suffering patient.
Two nurses told us about a ventilated ICU patient who hadn’t seen daylight for three weeks. Borrowing a portable ventilator and infusion pumps, these two nurses pushed the ventilated patient down the corridors and into the garden to enjoy the sunshine. Another courageous nurse described undoing the chains and shackles of an incarcerated AIDS patient who had been imprisoned for fear of spreading the disease. A doctor described how a hug with a patient changed his practice forever.
The process of sharing stories is spell-binding. When all have finished, the facilitator draws out lessons from the stories:
Noting the way participants demonstrated skills in empathetic listening and examples of the observed body-language, such as mirrored gestures and posture.
Commenting on the experience of having someone listen deeply, without interruption, and how meaningful and healing is that experience.
Recognising the skills and strengths of the participants revealed in their stories – this has a remarkable impact on the way professionals perceive their colleagues.
Highlighting the many examples of compassionate practices that can easily be woven into the busiest day.
Reflecting how powerful it is to re-connect to the personal values and ideals that originally motivated a career in healthcare.
The workshop ends by asking each participant to name one simple compassionate practice they will use in the next day of patient care, or else teach to another. The entire workshop can be completed in 60 to 90 minutes, depending on the number of participants.