title: Enabling the flow of compassionate care: a grounded theory study.
abstract: Compassion has become a topic of increasing interest within healthcare over recent years. Yet despite its raised profile, little research has investigated how compassionate care is enacted and what it means to healthcare professionals (HCPs). In a grounded theory study, we aimed to explore this topic from the perspective of people working with patients with type 2 diabetes - a long-term condition that involves repeated interactions with HCPs.
  
  
  
  Semi-structured interviews and focus groups were conducted between May and October 2015 with 36 participants, selected from a range of roles within healthcare. Data collection explored their understanding of compassionate care and experiences of it in practice. Analysis followed the constructivist approach of Charmaz, which recognises meaning as being created by the interaction of people working under specific sociocultural conditions. It moved from open to focused coding, and involved the development of memos and constant comparison.
  
  
  
  Our analysis revealed that wishing to provide compassionate care, on its own, was insufficient to ensure this transpired; HCPs needed to work in a setting that supported them to do this, which underpins our core concept - the compassionate care flow. Data suggested that to be sustained, this flow was energised via what participants described as 'professional' compassion, which was associated with the intention to improve patient health and participants' role within healthcare. The compassionate care flow could be enhanced by defenders (e.g. supportive colleagues, seeing the patient as a person, drawing on their faith) or depleted by drainers (i.e. competing demands on time and resources), through their impact on professional compassion.
  
  
  
  This paper presents a model of compassionate care based on the notion of flow. It looks at processes associated with this concept and how compassionate care is delivered within health settings. Our new understanding of this phenomenon will help those working in healthcare, including managers and policy makers, to consider and potentially offset disruption to the compassionate care flow.
authors.affiliation: Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. stephanie.tierney@warwick.ac.uk.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tierney
authors.affiliation: Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Seers
authors.affiliation: Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.|Trauma Research, Kadoorie Centre, Oxford University Hospitals NHS Foundation Trust, Coventry, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tutton
authors.affiliation: Social Science and Systems in Health, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Reeve
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004645:Empathy; D017144:Focus Groups; D066296:Grounded Theory; D006282:Health Personnel / Q000523:psychology; D006295:Health Resources; D006801:Humans; D009042:Motivation; D011369:Professional-Patient Relations; D006113:United Kingdom
keywords: Compassionate care; Focus groups; Grounded theory; Healthcare professionals; Interviews; Qualitative research; Type 2 diabetes