Background Despite concerns about the degree of compassion in contemporary healthcare, there is a dearth of evidence for health service managers about how to promote compassionate healthcare. This paper reports on the implementation of the Creating Learning Environments for Compassionate Care (CLECC) intervention by four hospital ward nursing teams. CLECC is a workplace educational intervention focused on developing sustainable leadership and work-team practices designed to support team relational capacity and compassionate care delivery. Objectives To identify and explain the extent to which CLECC was implemented into existing work practices by nursing staff, and to inform conclusions about how such interventions can be optimised to support compassionate care in acute settings. Methods Process evaluation guided by normalisation process theory. Data gathered included staff interviews (n=47), observations (n=7 over 26 hours) and ward manager questionnaires on staffing (n=4). Results Frontline staff were keen to participate in CLECC, were able to implement many of the planned activities and valued the benefits to their well-being and to patient care. Nonetheless, factors outside of the direct influence of the ward teams mediated the impact and sustainability of the intervention. These factors included an organisational culture focused on tasks and targets that constrained opportunities for staff mutual support and learning. Conclusions Relational work in caregiving organisations depends on individual caregiver agency and on whether or not this work is adequately supported by resources, norms and relationships located in the wider system. High cognitive participation in compassionate nursing care interventions such as CLECC by senior nurse managers is likely to result in improved impact and sustainability.

In European countries over 40% of food loss and waste occurs at the retail and consumer stages; this situation cannot be sustained and remediation is urgently needed; opportunities for change must be created. “Nudge” techniques have been shown to be effective in changing behaviour in areas related to food consumption (e.g., healthy diet), but the effectiveness of interventions using nudge techniques to change food waste behaviours remains unclear, despite a growing body of research. The aim of this review is to elucidate means to change household food waste behaviour using nudge approaches and identify priority needs for further research. Four databases, grey literature and reference lists were searched systematically to identify relevant research on nudges to change food waste behaviours. This search identified sixteen peer-reviewed research articles and two grey literature reports that were critically appraised using a critical appraisal checklist framework for descriptive/case series. Four studies deemed reliable show interventions using nudges of social norms, reminders or social norms with disclosure were effective in changing food waste behaviours at the household level, while disclosure alone, i.e., revealing environmental costs of food waste, was not. This review, unique in the application of a critical appraisal, suggests there is reliable information on the effectiveness of nudge for food waste recycling interventions when incorporating nudges of social norms, reminders or disclosure alongside use of social norms. If food waste recycling behaviour is considered an upstream measure to raise consumers’ consciousness on the amount of food waste they produce, this may have a positive impact on food waste reduction and therefore has important policy implications for food waste behaviour change at the household level.

The quality of staff-patient interactions underpins the overall quality of patient experience and can affect other important outcomes. However no studies have been identified that comprehensively explore both the quality and quantity of interactions in general hospital settings. To quantify and characterise the quality of staff-patient interactions and to identify factors associated with negative interaction ratings. Data were gathered at two acute English NHS hospitals between March and April 2015. Six wards for adult patients participated including medicine for older people (n=4), urology (n=1) and orthopaedics (n=1). Eligible patients on participating wards were randomly selected for observation. Staff-patient interactions were observed using the Quality of Interactions Schedule. 120h of care were observed with each 2h observation session determined from a balanced random schedule (Monday-Friday, 08:00-22:00h). Multilevel logistic regression models were used to determine factors associated with negative interactions. 1554 interactions involving 133 patients were observed. The median length of interaction was 36s with a mean of 6 interactions per patient per hour. Seventy three percent of interactions were categorized as positive, 17% neutral and 10% negative. Forty percent of patients had at least one negative interaction (95% confidence interval 32% to 49%). Interactions initiated by the patient (adjusted Odds Ratio [OR] 5.30), one way communication (adjusted OR 10.70), involving two or more staff (adjusted OR 5.86 for 2 staff, 6.46 for 3+ staff), having a higher total number of interactions (adjusted OR 1.09 per unit increase), and specific types of interaction content were associated with increased odds of negative interaction (p<0.05). In the full multivariable model there was no significant association with staff characteristics, skill mix or staffing levels. Patient agitation at the outset of interaction was associated with increased odds of negative interaction in a reduced model. There was no significant association with gender, age or cognitive impairment. There was substantially more variation at ward level (variance component 1.76) and observation session level (3.49) than at patient level (0.09). These findings present a unique insight into the quality and quantity of staff-patient interactions in acute care. While a high proportion of interactions were positive, findings indicate that there is scope for improvement. Future research should focus on further exploring factors associated with negative interactions, such as workload and ward culture.

Background: Concerns about the degree of compassion in health care have become a focus for national and international attention. However, existing research on compassionate care interventions provides scant evidence of effectiveness or the contexts in which effectiveness is achievable.Objectives: To assess the feasibility of implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings and to evaluate its impact on patient care.Design: Pilot cluster randomised trial (CRT) and associated process and economic evaluations.Setting: Six inpatient ward nursing teams (clusters) in two English NHS hospitals randomised to intervention (n = 4) or control (n = 2).Participants: Patients (n = 639), staff (n = 211) and visitors (n = 188).Intervention: CLECC is a workplace educational intervention focused on developing sustainable leadership and work team practices (dialogue, reflective learning, mutual support) theorised to support the delivery of compassionate care. The control setting involved no planned staff team-based educational activity.Main outcome measures: Quality of Interaction Schedule (QuIS) for staff–patient interactions, patient-reported evaluations of emotional care in hospital (PEECH) and nurse-reported empathy (as assessed via the Jefferson Scale of Empathy).Data sources: Structured observations of staff–patient interactions; patient, visitor and staff questionnaires and qualitative interviews; and qualitative observations of CLECC activities.Results: The pilot CRT proceeded as planned and randomisation was acceptable to teams. There was evidence of potential contamination between wards in the same hospital. QuIS performed well, achieving a 93% recruitment rate, with 25% of the patient sample cognitively impaired. At follow-up there were more positive (78% vs. 74%) and fewer negative (8% vs. 11%) QuIS ratings for intervention wards than for control wards. In total, 63% of intervention ward patients achieved the lowest possible (i.e. more negative) scores on the PEECH connection subscale, compared with 79% of control group patients. These differences, although supported by the qualitative findings, are not statistically significant. No statistically significant differences in nursing empathy were observed, although response rates to staff questionnaire were low (36%). Process evaluation: the CLECC intervention is feasible to implement in practice with medical and surgical nursing teams in acute care hospitals. Strong evidence of good staff participation was found in some CLECC activities and staff reported benefits throughout its introductory period and beyond. Further impact and sustainability were limited by the focus on changing ward team behaviours rather than wider system restructuring. Economic evaluation: the costs associated with using CLECC were identified and it is recommend that an impact inventory be used in any future study.Limitations: Findings are not generalisable outside hospital nursing teams, and this feasibility work is not powered to detect differences attributable to the CLECC intervention.Conclusions: Use of the experimental methods is feasible. The use of structured observation of staff–patient interaction quality is a promising primary outcome that is inclusive of patient groups often excluded from research, but further validation is required. Further development of the CLECC intervention should focus on ensuring that it is adequately supported by resources, norms and relationships in the wider system by, for instance, improving the cognitive participation of senior nurse managers. Funding is being sought for a more definitive evaluation.Trial registration: Current Controlled Trials ISRCTN16789770.Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 33. See the NIHR Journals Library website for further project information. The systematic review reported inChapter 2was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, the University of Örebro and the Karolinska Institutet.

Global society is wasting food at unsustainable levels, and unconsumed food is contributing markedly to carbon emissions. Simultaneously, food insecurity and obesity are increasingly prevalent concerns in high-income countries. This study aimed to evaluate food waste at the household level to understand relationships between discarded food, food processing and household characteristics. A sociodemographic and food security survey of householders in Hampshire (UK) was conducted alongside a seven-day photographic food waste diary. Of the total food waste from 94 participants, 87% was unprocessed, 51% was avoidable or potentially avoidable and 36% was unavoidable. Of the total food waste, 61% occurred during food preparation. Greater amounts of avoidable food waste occurred in one, three and four+ person households than in two-person households. Potentially avoidable food waste was greater in households educated to postgraduate and university degree level than others. The outcomes of this study indicate that the focus on interventions should vary demographically. Interventions that support food security, improving diet quality and saving money, while reducing avoidable and unprocessed food waste, in one, three and four+ person households during food preparation are one option. Reducing potentially avoidable unprocessed food waste is a priority in households educated to university degree level and above.