Using the Repertory Grid Technique to explore the experience of compassion by mothers in a Mother and Baby Unit

Wittkowski, A., Hare, D.J. & Gillham, R. (accepted by Midwifery on 7 April 2019)

Abstract

Despite differences between Mother and Baby Units (MBUs) and other inpatient psychiatric

settings, research has not yet explored the nature and value of compassionate care offered by

MBU staff despite the increasing importance of compassion in healthcare. This novel study

investigated the experience of compassionate care by fifteen mothers admitted to a MBU in

England using the Repertory Grid Technique. Our findings indicated that these women

perceived their MBU care as compassionate. Compassion was central to nursing care and

clearly implicated in women’s recovery from mental illness. Additionally, other staff

characteristics were important to mothers, including how effectively MBU staff coped with

stressful situations, staff flexibility in their care approach and how they adhered to

professional boundaries. It is important to facilitate the expression of compassion which

partially depends on the personalities and training of staff and the cooperation of service

managers in fostering compassionate care.

Keywords: Compassion; inpatient care; mothers; nursery nurse; psychiatric nurse.

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INTRODUCTION

Women comprise 45.6% of the inpatient mental health population in the UK (Health and

Social Care Information Team, 2014). In the UK and USA, approximately 2/3rds of women

with mental health problems are mothers (Howard, et al., 2001; Nicholson, et al., 2001).

Although there are specific female mental health issues, particularly during the perinatal

period (Nicholson and Henry, 2003), services are predicated on the presumption that service

users are male and not parents (Oyserman et al., 2000). UK National Institute of Health and

Clinical Excellence guidelines (NICE, 2014) states that women requiring inpatient treatment

during pregnancy or in the first year postpartum should be admitted with their child to a

Mother and Baby Unit (MBU) that focus on the parenting skills and women’s mental health

(Gillham and Wittkowski, 2015; Wittkowski and Santos, 2017). In MBUs, service users have

the dual roles ‘patient’ and ‘mother’, caring for their infants while working on their own

recovery.

Despite such provision, policy implementations are rarely tailored to this population.

The UK National Health Service (NHS) published a directive for nurses and midwives

outlining a renewed emphasis on compassionate nursing (NHS, 2012), which was extended

in the NHS Constitution (NHS, 2013) such that all staff should provide and receive

compassion considered central to perceived care quality. This prioritisation of compassion is

also contained in the codes of ethics for nurses of the American Nurses Association (2015)

and the Canadian Nurses Association (2008). Compassion in the NHS Constitution is defined

thus:

We ensure that compassion is central to the care we provide and respond with

humanity and kindness to each person’s pain, distress, anxiety or need. We search for

the things we can do, however small, to give comfort and relieve suffering. We find

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time for patients, their families and carers, as well as those we work alongside. We

do not wait to be asked, because we care. (NHS, 2013, p. 5).

Compassion therefore has a quasi-mandatory status within the NHS, appearing in the value

statements of many NHS Trusts and as a key element in ‘values-based recruitment’.

Research into compassion from staff in the mental health field (Cheng and Tse, 2015)

highlights the relationship between staff compassion and recovery from mental health

problems (Spandler and Stickley, 2011). Negative correlations between staff compassion and

depression symptoms have also been demonstrated (Pauley and McPherson, 2010). Studies

exploring service user expectations of mental health nurses indicate compassion as a valued

personal characteristics (Bee et al., 2008).

Given the differences between MBUs and other settings, and the dual role of the

service users, it is likely that mothers have distinctive needs and/or develop different

relationships with nurses. To date, no research has explored service-user perspectives of the

role of nurses working in a MBU nor on the role of compassion within such settings. The

current study therefore explored others in a MBU construe nursing staff and nursing in the

context of the aforementioned drive for compassionate care.

METHODOLOGY

A Repertory Grid technique based upon Personal Construct Theory (PCT; Kelly, 1955) was

used to investigate the participants subjective interpretations of their experiences. PCT

proposes that people hold theories about the world that change as they experience the world

and test their hypotheses. This process of construing allows people to interpret and predict

the behaviour of other people and the world. The Repertory Grid interview elicits the bipolar

constructs, along which people base their interpretations of the behaviour of others and

which collectively form their construal of the world. Repertory Grid technique has previously

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been used in research examining staff perspectives of mothers (Blundell et al., 2012) and this

method enables the construct of compassion to be explored widely, without making

assumptions about its nature or relative importance in comparison to other aspects of care.

Moreover, the same techniques have been employed with service users with a range of

presentations including depression (e.g. Feixas et al., 2008), personality disorders (e.g.

Golynkina and Ryle, 1999), affective disorders (e.g. Böker et al., 2000) and treatment

preferences in physical health care (e.g. Rowe et al., 2005; Schaffalitzky et al., 2009).

A further reason for the use of the repertory grid technique to examine this topic

instead of a more conventional form of qualitative methodology, such as thematic analysis,

was the ability to go beyond describing the service users’ experiences and views and to

subject these to a systematic analysis without introducing researcher bias. This facility

necessarily comes at the price of increased complexity but as noted above, such an approach

yields more and richer objective data relating to subjective experience.

Participants

Seventeen mothers (39.5%) were recruited from a total of 43 admissions to a MBU in the

UK, all of whom were eligible for participation. Mothers had to be considered psychiatrically

well enough to take part on the same criteria as those used to judge readiness for overnight

leave (e.g. not posing a significant risk to self or others). Unfortunately due to resource and

time constraints, it was not feasible in the current study to involve those mothers who were

not fluent in English. The repertory grid method used in the current study is not language

specific and the primary issue was the unavailability of translator/interpreter support.

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The Mother and Baby Unit

The unit provides inpatient care for mothers requiring psychiatric treatment who are pregnant

or up to one year post-partum. Most mothers are admitted with psychotic or mood disorders.

The 10-bedded unit is staffed by psychiatric and medical staff, psychiatric and nursery

nurses, and a clinical psychologist providing routine psychiatric care, brief individual

psychological interventions, mother-baby activities, occupational therapy and psychosocial

interventions (Wittkowski and Santos, 2017).

Materials

The Brief Symptom Inventory (BSI; Derogatis, 1993): 53-item-questionnaire covering a

range of psychiatric symptoms. Items were rated according to how distressing each symptom

was over the past seven days. Responses were then scored providing information on nine

subscales (Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression,

Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism) as well as several global

indices (Global Severity Index, Positive Symptom Distress Index, Positive Symptom Total).

The widely used BSI is normed on large samples, including female psychiatric inpatients.

Previous research has used the BSI with women in the postpartum period (e.g. Vigod et al.,

2010). This measure was used to provide an overview of participants’ presentation,

considering their varied diagnoses and symptom experiences.

Procedure

Participants completed a semi-structured Repertory Grid interview, lasting 45-90 minutes.

After providing informed consent, they were presented with six elements and asked to think

of nursing staff that fitted each element category: 1) nurse with whom you have a good

relationship, 2) nurse with whom you have a bad relationship, 3) nursery nurse, 4)

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psychiatric nurse, 5) ideal nurse, and 6) worst possible nurse. Four further elements relating

to the participant were included: 7) yourself before you had children, 8) yourself now, 9) your

ideal future self, and 10) your ideal future self as a mother. Element categories refer to the

specific people or ideas that constructs will be generated in reference to.

Constructs were generated using the triadic opposite method (Caputi and Reddy,

1999). When presented with three elements, participants were asked how two were similar to

each other and different from the third. They were then asked to generate the opposite pole of

the construct, resulting in bipolar constructs. Participants described each pole in detail,

providing behavioural descriptions; for example, describing particular instances of the

construct pole or how it would be noticed by an outside other. This process was repeated

with random element combinations until the participant could not generate any further

constructs. Most participants self-reported reaching this stage, or began to generate

constructs already included. When this occurred with at least two triads, they were

considered to have generated all possible constructs. After indicating their preferred pole of

each construct, they ranked each element along the construct from the most preferred to the

least. During a second interview, participants were presented with the repertory grid biplot: a

visual representation of their grid. They also completed the BSI, before receiving a small

voucher and thank you card. This procedure was agreed following consultation with

members from the University Community Liaison Group. Full ethical approval was granted.

Data analysis

Demographic data of participants and non-participants were analysed using the Statistical

Package for the Social Sciences version 22 (IBM SPSS). The repertory grid analysis package

Idiogrid version 2.4 (Grice, 2008) was used to analyse the remaining data. Standardised

Euclidean distances were calculated to assess which elements were most similar to and most

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different from each other. Elements have an expected distance of 1.00 and were considered

‘similar’ if the inter-element Euclidean distance was less than 0.50 and ‘different’ if greater

than 1.50 (Winter, 1992). Principal Components Analysis of each repertory grid plotted the

relationships between constructs and between elements (biplot). Eigenvalues, or the

percentage variance accounted for by each principal component, were calculated. The

eigenvalue for the first principal component is a measure of the tightness of the construing;

the higher the eigenvalue, the less complex and more tight the construing (Winter, 1992).

Finally, Generalized Procrustes Analysis (Grice and Assad, 2009) was conducted to collate

the construals of all of the elements across participants. This led to a group biplot with each

element construed. Content analysis was completed using the Classification System for

Personal Constructs (CSPC; Feixas et al., 2002). There were seven main categories: moral

(judgements about moral values such as kindness, generosity, fairness etc.), emotional

(degree of emotionality, emotional attitude towards life), relational (types of relationships

and way of relating), personal (aspects of personality, character or ways of being not

captured by the previous three), intellectual and operational (skills, abilities, knowledge),

values and interests (ideological, religious or distinct values as well as diverse interests), and

other. Each category also had a number of subcategories. The reliability of the CSPC is very

high, with a lamba index (Perreault and Leigh, 1989) of λ = 0.956, comparable to

standardised and normed scales (Feixas et al., 2002).

Further analysis was undertaken via visual inspection of the biplot to identify

constructs that appeared to characterise each element. This involved examining each

individual biplot to ascertain the relative position of each of the given set of elements to each

pole of the idiosyncratic constructs and noting which pole of which construct any given

element was closest to. These constructs, which were regarded as the ‘defining construct’ for

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any given element, were then categorised according to whether or not they were congruent

with the notion of compassion, as defined with in the NHS constitution.

RESULTS

N=17 mothers participated in the study, of whom N=15 completed the repertory grids during

their inpatient stay at the MBU. Two ended the interview due to tiredness, despite attempts to

offer alternative appointments. One of the 15 participants was unavailable for follow-up and

did not complete the BSI. The sample size was based on previous repertory grid studies (e.g.,

Blundell et al., 2012; Hodgkinson et al., 2016).

Twenty-six mothers admitted to the unit in the study period did not take part: seven

refused, four were discharged before an interview could be arranged, six were considered too

unwell during their admission, six did not speak English fluently and had no available

interpreter, and three had no reason recorded for why they did not choose to participate.

There was no significant difference between the participants and the non-participants in

maternal or infant age, diagnosis, marital status, previous admissions or number of children

(Table 1). Non-participants had a wider range of ethnic backgrounds primarily due to non-

availability of interpreters. The participants reported a higher rate of previous interventions.

However, it is possible that intervention use by the non-participant sample was under-

reported in clinical records, whereas the participant sample provided this information

themselves. The demographic information of the participants is presented in Table 2. Infants

of participants with psychosis were substantially, but non-significantly, younger than those of

participants with mood disorders, implying participants with psychosis were available to

participate earlier in motherhood than those with mood disorders.

INSERT TABLE 1 AND 2 ABOUT HERE

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Group and individual biplots

Biplots were computed individually as well as for the group. Figure 1 shows the group biplot.

The elements the ideal nurse and nurse with whom you have a good relationship were

grouped closely with the psychiatric nurse and nursery nurse. The similarity of these nursing

staff elements implies that they were not clearly differentiated by the participants. In contrast,

the elements yourself before you had children and yourself now were consistently positioned

towards the negative ends of the same constructs in the group biplot, indicating that these

were construed very differently from nursing staff. Finally, both ideal future selves were

construed together and closely to the construct pole ‘warm’, which related to being

supportive without being condescending. The nurse with whom you have a bad relationship

was not included in this analysis due to only ten participants utilising this element. The

analysis can only include elements used by all participants, and a number of participants did

not include this element because they struggled to construe this even hypothetically.

INSERT FIGURE 1 ABOUT HERE

Figures 2 and 3 show the biplots for Participants 1 and 15 respectively. These participants

illustrate the diversity of construing. Participant 15 had only five tightly construed constructs

(Eigenvalue=91.2%). In contrast, Participant 1 had seven constructs which were used in a

more differentiated way (Eigenvalue=60.8%). The nursery nurse and psychiatric nurse were

construed as more dissimilar by Participant 1 (Euclidean distance=0.77) than Participant 15

(Euclidean distance=0.26). Elements relating to the self were also construed differently:

Participant 15 construed herself before she had children similarly to herself now (Euclidean

distance=0.38), contrasting with Participant 1 who rated herself now more negatively than

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herself before she had children (Euclidean distance=1.05). On average 7.23 construct poles

were elicited, with a range of three to 10 across the participants.

INSERT FIGURES 2 AND 3 ABOUT HERE

Similarity of elements

Generally, the two positive nurse elements, the nurse with whom you have a good

relationship and the ideal nurse, tended to be construed fairly similarly to the nursery (mean

Euclidean distance=0.83, 0.71 respectively) and psychiatric nurses (mean Euclidean

distance=0.63, 0.62 respectively). The psychiatric nurses and nursery nurses were also

distinct from the more negative elements of the worst possible nurse (mean Euclidean

distance of 1.23 and 1.18 respectively) and the nurse with whom you have a bad relationship

(mean Euclidean distance of 1.14 and 1.04 respectively). This pattern of being grouped close

to the positive elements and away from the negative elements implies that nursery and

psychiatric nurses were generally well regarded by participants.

The difference between nursery nurses and psychiatric nurses was highly variable,

with Euclidean distances ranging from 0.23 to 1.06. The lack of distances over 1.50 implies

no one saw these two elements as significantly dissimilar.

Content analysis

Of the 111 constructs elicited, the majority were ‘relational’ (n=45) and the remaining

constructs mostly related to ‘emotional’ (n=23) or ‘personal’ (n=19) categories, with a

further 13 in the ‘moral’ category (Table 3). The ‘intellectual and operational’ category,

which could be seen to refer to job knowledge and skill, contained only six constructs. These

included the nursing staff’s apparent capability or ability to cope, and their intelligence, the

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latter related to lived experience and relational skills rather than academic knowledge per se.

The three constructs within ‘values and interests’ describe an interest in children and being

child-focused. Each of these was central in construing nursery nurses as different from

psychiatric nurses.

INSERT TABLE 3 ABOUT HERE

The individuality of construing was highly apparent during the content analysis. For

example, several participants used the word ‘caring’ to describe the positive pole of a

construct. For some, ‘caring’ related to their emotional approach to life, describing someone

non-judgemental and open-minded. For others, ‘caring’ was a personal characteristic,

describing someone motivated to try their best for people. Lastly, ‘caring’ was a relational

style, describing people who listen and try to help. This highlights that the detailed

descriptions of the constructs were important, as individual words held different meanings

for each participant.

Key constructs for nursing staff elements

Of the influential constructs poles describing the six nursing staff elements, the majority

were consistent with the compassion definition (NHS, 2013). The compassion constructs

included wanting to help people because they genuinely care about them rather than doing

only what was required without caring. Also consistent with compassion was nursing staff

being seen to prioritise mothers over other tasks even when they were busy. Finally, there

were constructs around relating to mothers and giving them a sense of hope. The more

negative nursing elements tended to cause participants to feel like they were ‘in the way’.

This relational style made participants feel worthless or intrusive and these nurses were

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experienced as lazy and judgemental. For example, Participant 5 offered the following

compassion-related construct (paraphrased for readability):

Extravagant – a nurse who goes above and beyond in helping and does the little

things to help:

Pathetic – a nurse who is lazy and doesn’t do anything, making service users feel

they are not worth being in the company of or that they don’t belong.

As well as the constructs consistent with a compassion definition, there were a number which

appeared to relate to flexibility. First there were those describing nurses sharing personal

anecdotes, although within appropriate professional boundaries. Additionally, there was a

cluster relating to nurses adhering to rules and prescribed roles with little flexibility to

respond to individuals. This was perceived by the participants as nurses being overly

regimented in their work and was described by Participant 17 (paraphrased for readability):

Sharing – a nurse who shares something of themselves within appropriate boundaries

which makes service users feel comfortable:

Guarded – a nurse who maintains a wall between themselves and the service user by

remaining purely professional and not giving information about themselves. This

knocks the confidence of the service user.

Within the remaining influential constructs, ideas of coping and balance featured. This

referred to nurses being confident and capable, with a reassuring sense of being in control.

Participant 16 described this [paraphrased for readability]:

Act – a nurse who is content and stays calm and happy despite stress and pressures,

they are balanced and do not get ‘thrown’ by bad days:

React – a nurse who is reactive and easily frustrated and struggles to reflect before

experiencing emotions.

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The concept of coping was most influential in the construing of psychiatric nurses and was

less dominant for nursery nurses. The only role-related influential constructs described

nursery nurses, specifically their interest in caring for and prioritisation of children.

Key constructs for participant elements

Participants construed four elements relating to the self, including past, present and two

future selves. The content of the most relevant constructs was slightly different, as the

constructs were spread more evenly across the ‘moral’, ‘emotional’, ‘relational’ and

‘personal’ domains. For nursing staff, they tended to cluster more into two of the

‘emotional’, ‘relational’ or ‘personal’ domains. However, compassion remained key to the

constructs describing the different facets of the self. There were potentially fewer

compassion domains for yourself now, yourself before you had children and ideal future self

than for ideal future self as mother. This difference could be taken as indicating compassion-

related constructs were more salient when construing those elements with an explicit caring

role. Put simply, compassion appeared more likely to be ascribed to particular people based

on their perceived behaviour, which may or not be congruent with their actual job roles and

responsibilities.

DISCUSSION

This was the first study to explore the experience of compassion by mothers admitted to a

MBU and the first Repertory Grid study to focus on the construal of staff by service users.

The findings indicate a relatively consistent construing of elements by the participants.

Nursery and psychiatric nurses were considered similar to each other and generally clustered

together with the ideal nurse and the nurse with whom you have a good relationship. It is

important to note that whilst commissioners and nursing staff themselves may perceive these

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as distinct roles, service users generally do not, which may lead to misunderstandings of

nursing behaviour by service users particularly if nursing staff adhere rigidly to their

particular roles. The worst possible nurse was construed as similar to the nurse with whom

you have a bad relationship, yourself now and yourself before you had children. Constructs

relating to compassion, as defined by the NHS Constitution (2013), did feature across all of

the nursing staff elements and there was some indication that compassion defined the

elements with caring roles more than those without explicit caring roles.

The content analysis revealed that few of the constructs were related to job skill or

knowledge, with an emphasis instead on personal characteristics. This is consistent with

Blundell et al.’s (2012) research exploring the construing of mothers by nursing staff on the

MBU, which noted that few of the constructs related to symptom experiences being mainly

focused on relationships, interpersonal characteristics and social abilities. One possible

interpretation of this finding is for both nursing staff and service users, the role of the

individual as nurse or service user may be less important than personal characteristics and

relational style, although this is speculative and requires further investigation. Other research

exploring the views of service users has also emphasised the value placed on personal

qualities such as compassion and genuine curiosity (Bee et al., 2008; Gunasekara et al.,

2014). The only constructs relevant to job role were those regarding nursery nurses

prioritising children. Whilst these distinguished nursery nurses from psychiatric nurses, only

three participants provided such constructs. Therefore, an overall distinguishing factor was

identified but was not widespread on an individual level.

Several participants remarked on the relationship between certain constructs,

specifically compassion constructs, and their recovery. Participants described that they felt

better when being looked after by someone they perceived to genuinely care about them.

Thus, when a nurse was interested in them, asking about areas of their life and experiences

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outside of mental health, and involving them in life on the ward, the mothers felt more

welcomed. Participant 13 summarised this well:

Obviously being here it’s completely different to being at home, but if someone is

friendly with you and welcoming and like ‘do you want a brew’ and this, and try to

make you feel as homely as you can, then it does, I think it helps you to get better to

be honest.

Therefore, the experience of compassionate care offered by nursing staff was associated with

better recovery; an opinion echoed in other service user research (Gunasekara et al., 2014;

Stewart et al., 2015) as well as with the recovery literature (Spandler and Stickley, 2011).

Limitations

Only 39.5% of those admitted during the recruitment window participated in the research,

but this reflected the severity of illness (e.g., psychosis) and the often brief window between

granting overnight leave and discharge; average admission to MBUs can be 7 weeks, ranging

from 4 to 12 weeks (Wittkowski and Santos, 2017). Recruitment was also hindered by the

lack of available interpreters: the sample included only one participant who was not fluent in

English. Admission rates of non-English speaking service users were unexpectedly high

during the recruitment period and therefore the magnitude of this difficulty could not have

been anticipated. It is plausible that these service users, for whom communication with the

staff was largely non-verbal, experienced compassion differently from their English-speaking

counterparts. Finally, several participants experienced the interview as tiring, struggling

towards the end when element rankings were completed. This probably relates to the effects

of postnatal sleep deprivation, mental health problems and sedative medication. Whilst the

research team monitored this and offered breaks as appropriate, it is possible the rankings

were less considered than they could otherwise have been. In retrospect, the length of the

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repertory grid interview, ranging from 45-90 mins, could also have been a contributory factor

and this should be considered when undertaking further studies of this nature.

Implications for nursing care

For nursing staff working in MBUs, the results provide a picture of the behaviours and

characteristics valued by service users. Many were consistent with the NHS Constitution and

therefore unsurprising; for example, the importance of non-judgemental, approachable staff

who genuinely care. More surprising was the preference for role flexibility. Role flexibility

had several strands. First, flexibility referred to not adhering too tightly to rules, instead

acting in the best interests of the service user at all times. Second, this flexibility related to

professional boundaries. Most participants noted some knowledge of the nursing staff, for

example, whether or not they were a mother. These pieces of personal information and

shared stories seemed important to the service users, maybe because it helped them to

understand nursing staff and therefore relate to them better. Being willing to step out of role

slightly and share some personal information was both noted and valued by service users, so

may be a valuable engagement strategy for staff.

Additionally, there were constructs relating to emotional balance. These described

being able to cope with chaotic situations without becoming overwhelmed, which generated

a calm ward atmosphere and gave service users confidence in the nursing staff. This

emotional balance included separating work and home life and remaining calm and in control

on the ward even if life outside of work was chaotic. This highlights the value of learning

skills in emotional coping, such as relaxation or anxiety management. It also emphasises the

value of professional boundaries. Thus, whilst sharing personal information may promote

engagement, this needs to not impinge on the perceived ability to cope.

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Finally, the current study explored compassion from a self-other perspective, in terms

of nursing staff being compassionate towards service users. However, the other important

characteristics (work-life balance, strengths in emotional coping, etc.) imply a level of self

compassion. The NHS Constitution (2013) goes further than this, explicitly referring to staff

experiencing compassion themselves. Within the NHS currently there are many potential

barriers to this, particularly with austerity measures placing increasing pressure on services

and managers. This means many acts of compassion, such as having time for someone or

focusing on the relationship not just the tasks, are difficult if not impossible to prioritise. The

pressures may also influence the ability of staff to practice self-care.

Wider implications

As well as direct implications for nursing staff, there are further implications for those

responsible for recruitment and quality assessment. Specifically, this research supports the

move towards values-based recruitment. Whilst competence in the tasks of nursing is

required, the results indicate weighting ought to be given to interpersonal style and

characteristics. Although compassion was one of those valued characteristics, the ability to

cope in stressful environments could be considered equally important. The findings also

suggest that managers should encourage and facilitate nursing staff spending time with their

service users, even for conversations or activities that may appear mundane. It can be

difficult to evidence these activities as important, despite not typically being stated in care

programmes, they appear helpful in facilitating recovery. The valued flexibility in tasks and

boundaries will need to be both allowed and monitored to ensure appropriate boundaries are

maintained. Furthermore, managers may consider their team composition and skill set, to

ensure they have strengths in coping with stressful situations and are resourced to grow these

further. Some of those findings may be applicable to other nursing settings; however some

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elements are more specific to MBUs, including the role of the nursery nurse and the value of

information such as whether or not the nurse is a parent themselves.

Further research

As the first study in this field, this research raises questions which require further

investigation. Many participants talked about certain experiences, such as being regarded

non-judgementally or talking freely with staff, as helping them to recover. Future research

should further investigate this relationship between compassion experiences and recovery.

Whilst there is already a literature base relating to this, none was identified assessing this

relationship in the context of a MBU (Gillham and Wittkowski, 2015). Studies should also

make every effort to include service users who do not speak English. Research should

address what behaviours or characteristics of other staff members, such a psychiatrists or

psychologists, are regarded by inpatients as supporting recovery. Finally, this research

indicates that it is possible to complete in-depth qualitative research with this group. Some

flexibility is required around the needs of the infant and the attention spans of the participant;

however, it remains possible to acquire rich data using this methodology.

Conclusions

This study sought to explore the experience of compassion by mothers admitted to a MBU.

Compassion emerged as a central principle in the construing of nursing staff by service users,

having a defining role in each nursing staff element. Service users associated this experience

of compassion, or the lack thereof, with their recovery and progress on the ward.

Additionally, characteristics relating to the ability to cope with stressful situations also

emerged as a key concept. These results underlie the importance of nursing staff having time

to focus on individuals, not just to complete tasks. In summary, this research has shown that

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compassion is central to service user construing of nursing staff on a MBU and perceived by

them to relate to their recovery progress.

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Table 1: Comparison between participants and non-participants

CharacteristicsParticipants

(N=17)Non-participants

(N=26)Analysis

Maternal age (years) 29.24 (6.38) 27.92 (4.28) t=-0.746 (df=25.395), p= 0.463

Infant age (weeks) 13.59 (12.16) 16.08 (9.64) t=0.678 (df=34), p= 0.503

Previous admissions

Yes

No

1.41 (1.54)

10 (58.8%)

7 (41.2%)

0.92 (2.19)

10 (38.5%)

16 (38.5%)

t=-0.798 (df=41), p= 0.429

χ2= 1.713 (df=1), p= 0.191

Previous treatment

Yes

No

14 (87.5%)

2 (12.5%)

15 (57.7%)

11 (42.3%)

χ2= 4.118 (df=1), p= 0.042

Number of children 2.24 (1.39) 1.92 (1.16) t=-0.928 (df=41), p= 0.359

Ethnicity

White British

White European

African

White and Black Caribbean

Asian

South American

Unknown

12 (70.6%)

2 (11.8%)

0

1 (5.9%)

1 (5.9%)

1 (5.9%)

0

8 (30.8%)

4 (15.4%)

7 (26.9 %)

0

4 (15.4%)

0

3 (11.5%)

χ2= 10.343 (df=4), p= 0.035

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Table 2: Demographic characteristics of the participants

CharacteristicTotal sample (N=17)

Mean (SD) Range Number (%)

Maternal age (years) 29.24 (6.38) 19-38

Infant age (weeks) 13.59 (12.16) 2-35

Child gender

Male

Female

Unknown (unborn)

11 (64.7%)

5 (29.4%)

1 (5.9%)

Relationship status

Married

Cohabiting

Separated/divorced

Single

Engaged

6 (35.3%)

6 (35.3%)

2 (11.8%)

2 (11.8%)

1 (5.9%)

Ethnicity

White British

White European

White and Black Caribbean

Asian

South American

12 (70.6%)

2 (11.8%)

1 (5.9%)

1 (5.9%)

1 (5.9%)

Education

No qualifications

GCSEs / O Levels

A Levels / BTEC

Apprenticeship

1 (5.9%)

3 (17.6%)

6 (35.3%)

1 (5.9%)

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University degree

Other

3 (17.6%)

3 (17.6%)

Employment

Unemployed

Maternity leave

Home duties

Part-time

Full-time

3 (17.6%)

4 (23.5%)

5 (29.4%)

3 (17.6%)

2 (11.8%)

Social services involvement – Yes 7 (41.7%)

Number of children 2.24 (1.39) 1-6

Previous treatment – Yes 14 (87.5%)

Previous admissions

Yes

No

1.41 (1.54) 0-4

10 (58.8%)

7 (41.2%)

BSI scores (N=14)

Global Severity Index

Positive Symptom Distress Index

Positive Symptoms Total

49.86 (8.64)

49.50 (8.80)

50.71 (8.50)

38-64

37-62

36-64

Diagnosis

Bipolar affective disorder

Schizophrenia

Puerperal psychosis

Psychosis (other)

Depression

3 (17.6%)

2 (11.8%)

1 (5.9%)

3 (17.6%)

8 (47.1%)

Days lapsed between interview and admission (N=16)

29.69 (28.83) 6-101

26

27

Table 3: Classification System for Personal Construct (CSPC) analysis categories

Category Number of constructs (%)

Moral 13 (11.7%)

Altruist-egoist

Respectful-judgemental

Sincere-insincere

9 (69%)

1 (8%)

3 (23%)

Emotional 23 (20.7%)

Visceral-rational

Warm-cold

Optimist-pessimist

Balanced-unbalanced

4 (17%)

8 (35%)

5 (22%)

6 (26%)

Relational 45 (40.6%)

Extroverted-introverted

Pleasant-unpleasant

Tolerant-authoritarian

Peaceable-aggressive

Sympathetic-unsympathetic

Trusting-suspicious

Interested-not interested

18 (40%)

4 (9%)

4 (9%)

2 (4%)

14 (31%)

1 (2%)

2 (4%)

Personal 19 (17.1%)

Strong-weak

Hard-working-lazy

Decisive-indecisive

Flexible-rigid

Mature-immature

Self-acceptance-self-criticism

2 (11%)

8 (42%)

3 (16%)

1 (5%)

3 (16%)

2 (11%)

28

Intellectual 6 (5.4%)

Intelligent-dull

Capable-incapable

3 (50%)

3 (50%)

Values and Interests 3 (2.7%)

Specific interests 3 (100%)

Existential 2 (1.8%)

Growth 2 (100%)

Total 111 (100%)

29

30

Figure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group BiplotFigure 1: Group Biplot

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Figure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 BiplotFigure 2: Participant 01 Biplot

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Figure 3: Participant 15 Biplot

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