title: Distress in working on dementia wards - A threat to compassionate care: A grounded theory study.
abstract: OBJECTIVE
  Nurses and health care workers are under increasing scrutiny from the general public and other professionals over their capacity for compassion. For example, in the UK, recruitment of nurses includes assessment of compassion through 'Values Based Recruitment'. However, compassionate care can be hindered when working in very challenging and pressurised environments. The study aimed to explore the experiences of managing work pressures in front-line NHS staff caring for older adults with dementia. One aspect of the analysis was to explore the factors that facilitate or hinder self-compassion and mindfulness, since these ways of responding to extreme pressure are likely to facilitate compassion towards others.
  
  
  METHODS
  Ten front-line staff (a mixture of nurses and Health Care Assistants) from three inpatient dementia wards took part in qualitative interviews which were then analysed using constructivist grounded theory methods.
  
  
  RESULTS
  A theoretical framework was generated which highlighted the role of structural and interpersonal types of work pressure on individual responses and ways of managing pressure. A range of helpful and unhelpful strategies were employed and although many participants appreciated the importance of taking time to process and reflect on difficult emotions and experiences during work, there were significant structural and personal barriers to practicing mindfulness and self-compassion more fully. A sense of professionalism along with various organisational factors meant that much processing of difficult emotions had to take place largely out of work hours.
  
  
  CONCLUSIONS
  Recruiting staff with high levels of compassion and training compassion to existing staff are not likely to significantly improve compassionate care alone in the context of extremely challenging work environments. Rather, organisational changes need to be made to model and reward self-compassion; staff training should focus on self-compassion and mindfulness, without which compassion to others is hindered. Strong professional values which may instil in care staff a belief in not displaying emotions at work should be considered carefully by professional bodies in order to provide guidance from pre-qualification onwards about how to balance professional conduct with appropriate expression of emotion in response to extreme situations.
authors.affiliation: School of Health and Human Sciences, University of Essex, Colchester CO4 3SQ, UK. Electronic address: smcpher@essex.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: McPherson
authors.affiliation: North Essex Partnership Foundation Trust, c/o The King's Wood Centre, Colchester General Hospital, CO4 5JL, UK. Electronic address: Syd.Hiskey@nepft.nhs.uk.
authors.forename: Syd
authors.initials: S
authors.lastname: Hiskey
authors.affiliation: School of Health and Human Sciences, University of Essex, Colchester CO4 3SQ, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Alderson
mesh_terms: D000544:Alzheimer Disease / Q000451:nursing*; D004645:Empathy; D066296:Grounded Theory; D006282:Health Personnel / Q000523:psychology*; D007407:Interviews as Topic; D009726:Nurses / Q000523:psychology*; D013312:Stress, Physiological
keywords: Compassion; Dementia care; Grounded theory; Mindfulness; Nursing; Occupational health; Professionalism; Qualitative research; Self-compassion; Work stress