Jan 08, 2017
Building bridges to enhance interpersonal relationships
A community health centre team introduce mindfulness and self-compassion practices to seniors in a troubled apartment complex
Youville Centre (YC) is a nurse-managed, non-profit community health centre in the Winnipeg community of St. Vital. The centre’s staff include community health nurses and a community development coordinator, who work with groups, families and individuals on their identified health concerns. Consultation, collaboration and development of relationships are key components of this work.
In 2014, YC was approached by a tenant services coordinator (TSC) with Manitoba Housing, which provides affordable housing for individuals and families living on low incomes. She requested our assistance in dealing with bullying, intolerance, verbal/physical altercations and exclusionary behaviour occurring among the seniors in one of the apartment complexes she was responsible for. The stress experienced by those being bullied and by those witnessing such behaviour was negatively affecting their emotional and physical well-being.
We were aware of problems in this apartment complex and in others. The year before, University of Manitoba nursing students had been at YC for three months as part of a community development course. We asked them to conduct a needs assessment of seniors in the community. They conducted interviews with 236 St. Vital area residents. Nearly 30 per cent of the residents reported living with depression, 70 per cent reported moderate to severe loneliness and 22 per cent reported feeling stressed.
Initially, we suggested that zero tolerance policies for bullying could be implemented in the apartment complex, but Manitoba Housing informed us that it would not be realistic to attempt to enforce such policies.
With that understanding, the three of us formed the Building Bridges team and met with the TSC over several months. These meetings led to the development and implementation of a program to raise awareness of interventions that could improve the situation. Our goal was to reduce bullying and foster positive, supportive relationships and interactions by promoting self-compassion and compassion for others. We received funding for the project from the Winnipeg Regional Health Authority (WRHA).
We approached the residents in the apartment complex to ask if they would be interested in participating in a pilot project on helping seniors manage stress. In this informal meeting, attended by more than a dozen residents, we shared data from the needs assessment to ensure they were aware of the loneliness and stress that had been reported in their community and were open to finding ways to reduce it. The residents responded positively, and we asked for their input as we began to design the program.
We held our first Building Bridges session in October 2014 and met twice a month thereafter until the following May. The two community health nurses were the facilitators.
In the first session, participants were asked to identify the positive aspects and challenges of living in their building. They came up with very few positives other than the proximity of the building to services (i.e., a grocery store and a medical centre) in the area. The negatives on the list included bullying, gossip, intolerance, apathy and stress related to having to deal with difficult individuals. We asked participants to complete a questionnaire to assess perceptions about stress, loneliness and safety. We would ask them to repeat this activity at the end of the program.
Participants’ rankings of the difficulties they were facing guided the program content. We presented 12 two-hour sessions, each one with a focus on helping them learn effective ways to cope with challenges and empowering them to be able to intervene when bullying occurred. Each session built upon the previous one, but new participants could join at any time. Through discussion, individual and group activities, videos and role playing, the group explored the meaning of tolerance, kindness, resiliency, empathy, gratitude, inclusiveness, compassion and self-compassion, as well as how to practise these values.
On average, 13 seniors attended each session. With a grant obtained through Healthy Together Now, a WRHA community funding initiative, we were able to purchase white boards and other supplies, as well as door prizes and healthy snacks to promote participation.
In June 2015, we organized a wrap-up celebration with pizza, salads and cake. We wanted not only to celebrate the program but also to give participants an opportunity to implement what they had learned by inviting residents they had never connected with before.
While the program was in progress, the TSC reported noting positive changes in how residents interacted in the building’s communal areas; many, but not all, were program participants. More residents began to frequent these areas. The TSC reported that participants were modelling compassionate behaviours, and fewer angry altercations between residents were occurring. Participants encouraged residents to bring up health issues and other concerns with the TSC. A welcoming committee for new residents was revived. The apartment complex became a better place to live; participants sought out the TSC to ask how they could work together to meet the challenges and needs of other residents requiring assistance.
On post-program evaluation forms, many of the participants reported being pleased to have the opportunity to develop friendships and receive support from other members of the group. They acknowledged the need to demonstrate more acceptance and respect in communicating with others and said they felt more gratitude for what they have. They expressed their support for how the program material was presented and what was covered. Their questionnaire responses indicated they felt better supported and had an increased sense of safety.
We approached the Manitoba Centre for Nursing and Health Research (MCNHR), housed in the college of nursing at the University of Manitoba, to partner with us to evaluate the program. A research intern from MCNHR conducted a literature review on self-compassion and mindfulness. She was looking for evidence that raising awareness about and introducing practices of self-compassion and mindfulness promoted better interpersonal relationships. An evidence briefing she created based on her review provided support for the types of discussions and activities we used in the sessions.
Recognizing that our program could potentially benefit other communities, we asked the intern to help us develop an implementation toolkit, which would include an overview of the pilot and its goals, an introduction to the concept of self-compassion, program session outlines, lists of resources and a budget template.
Lessons learned and next steps
We were surprised at the interest shown in the meditation techniques we introduced to participants. They were open to and enthusiastic about them and asked us for guidance that would allow them to continue these practices. This response encouraged us to pursue more training in these areas ourselves.
We learned that it is beneficial to be bold about introducing concepts and activities that might be new to a particular group. At the least, these will generate lots of discussion and sharing of ideas. With the help of the research intern, we are refining the toolkit and identifying questions for participants that will capture additional data and help demonstrate program success. This work will also help us in designing other programs in the future. Our partnership with MCNHR, linking practice, theory and research, has been instrumental in evaluating and moving forward with the program.
In fall 2015, we started a Building Bridges program in another apartment complex and found we had similar results and positive feedback. We have received requests to bring the program to other housing blocks beyond our catchment area. The team is exploring how we can build capacity to offer it in other communities.