Pam Smith

Student nurse socialisation in compassionate practice: A Grounded Theory study

Compassionate practice is expected of Registered Nurses (RNs) around the world while at the same time remaining a contested concept. Nevertheless, student nurses are expected to enact compassionate practice in order to become RNs. In order for this to happen they require professional socialisation within environments where compassion can flourish. However, there is concern that student nurse socialisation is not enabling compassion to flourish and be maintained upon professional qualification. In order to investigate this further, a glaserian Grounded Theory study was undertaken using in-depth, digitally recorded interviews with student nurses (n=19) at a university in the north of England during 2009 and 2010. Interviews were also undertaken with their nurse teachers (n=5) and data from National Health Service (NHS) patients (n=72,000) and staff (n=290,000) surveys were used to build a contextual picture of the student experience. Within the selected findings presented, analysis of the data indicates that students aspire to the professional ideal of compassionate practice although they have concerns about how compassionate practice might fit within the RN role because of constraints on RN practice. Students feel vulnerable to dissonance between professional ideals and practice reality. They experience uncertainty about their future role and about opportunities to engage in compassionate practice. Students manage their vulnerability and uncertainty by balancing between an intention to uphold professional ideals and challenge constraints, and a realisation they might need to adapt their ideals and conform to constraints. This study demonstrates that socialisation in compassionate practice is compromised by dissonance between professional idealism and practice realism. Realignment between the reality of practice and professional ideals, and fostering student resilience, are required if students are to be successfully socialised in compassionate practice and enabled to retain this professional ideal within the demands of 21st century nursing.

Overseas nurses’ motivations for working in the UK globalization and life politics

This article addresses the theoretical integration of macro and micro dimensions of global workforce migration, detailing overseas nurses’motivations for working in the UK. The discussion is based on focus group interviews with overseas nurses in three areas in the UK. Their motivations for migrating are contrasted with their experiences of frequently being stereotyped as economic migrants who come from poor countries to gain financial benefits. These conflicting perspectives on overseas nurses’ motivations are explored through a discussion of Bauman’s notion of global and local values, which conceptually combines issues of globalization with the migrants’ perspectives. Giddens’ concept ‘life politics’ is introduced to take further account of individuals’experiences and perspectives. Our data suggest that overseas nurses take a global, transnational perspective on life. Likewise, the simplistic understanding of overseas nurses as economic migrants appears to reflect a local perspective where the lives of individuals are seen to be confined within the borders of nation states. The analysis suggests how perspectives on migration are shaped by individuals’ values and life orientations interfacing with conditions of globalization.

Action research in health promotion

Objectives This article aims to define what is action research and where it fits in with health promotion practice, through drawing upon associated literature and personal action research experience. It also seeks to investigate the possible reasons why it is that health promotion researchers have not readily taken on the processes of action research strategies. Rationale The place of action research in health promotion programmes is an important yet relatively unacknowledged and understated activity. It has proven to be very popular with other professional groups, such as in the education, management and social sciences. In terms of health service activity, it is widely established in the fields of nursing and mental health and is beginning to establish itself in medicine. While there are a few health promotion examples to draw upon, they tend to be isolated, dated and often lie outside of the mainstream literature. It is suggested that this continuing state of affairs denies many health promotion researchers a valuable resource for managing effective change in practice. Conclusion The authors suggest that action research is both a valid and important research method for health promotion researchers, who are advised to further consider its merits in future studies. This article draws attention to the National Health Service (NHS) South West Regional Office-commissioned Our Healthier Nation: Improving the Competence of the Workforce in Health Promotion participatory action research project, as a means of promoting and validating action research strategy. The authors were all actively involved in this project.

Looking at infertility through the lens of religion and spirituality: a review of the literature

In spite of the growing body of literature that has focused on medical, psychological, social, and cultural consequences of infertility, issues such as religious and spiritual dimensions of infertility have received little attention. Considering that infertility is a multifaceted problem and results in multiple losses, we argue that health professionals need to consider all aspects of holistic care when caring for women with fertility problems. Holistic care considers not only the psychological, social and cultural needs of individuals, but also their religious and spiritual needs. Women may use their religious/spiritual beliefs to cope with crisis, and to find meaning and hope in their suffering. This article reviews the literature on religion/spirituality and infertility using Medline, CINAHL, PBSC, IBSS and ISI Web of Knowledge from 1985 to the present. It focuses on religious and spiritual care as one aspect of holistic care of women with fertility problems, and draws attention to the religious perspectives of infertility and reproductive technologies. It highlights the spiritual dimension of the infertility experience in previous research, and concludes with a discussion on the gaps in the literature and the implications of including religious and spiritual issues in infertile womens care.

Emotional labour of nursing revisited: Caring and Learning 2000.

Hochschild (1983) suggests that emotional labour involves the induction or suppression of feeling in order to sustain in others a sense of being cared for in a convivial safe place. James (1993) highlights the similarities and differences between emotion al and physical labour, with both requiring experience and skill which are subject to immediate conditions, external controls and gendered divisions of labour.

Learning About Patient Safety: Organizational Context and Culture in the Education of Health Care Professionals

Objectives This study investigated the formal and informal ways pre-registration students from medicine, nursing, physiotherapy and pharmacy learn about keeping patients safe. This paper gives an overview of the study and explores findings in relation to organizational context and culture. Methods The study employed a phased design using multiple qualitative methods. The overall approach drew on ‘illuminative evaluation’. Ethical approval was obtained. Phase 1 employed a convenience sample of 13 pre-registration courses across the UK. Curriculum documents were gathered, and course directors interviewed. Phase 2 used eight case studies, two for each professional group, to develop an in-depth investigation of learning across university and practice by students and newly-qualified practitioners in relation to patient safety, and to examine the organizational culture that students and newly-qualified staff are exposed to. Analysis was iterative and ongoing throughout the study, using frameworks agreed by all researchers. Results Patient safety was felt to have become a higher priority for the health care system in recent years. Incident reporting was a key feature of the patient safety agenda within the organizations examined. Staff were often unclear or too busy to report. On the whole, students were not engaged and may not be aware of incident reporting schemes. They may not have access to existing systems in their organization. Most did not access employers’ induction programmes. Some training sessions occasionally included students but this did not appear to be routine. Conclusions Action is needed to develop an efficient interface between employers and education providers to develop up-to-date curricula for patient safety.

Emotions at work: what is the link to patient and staff safety? Implications for nurse managers in the NHS

AIMS This paper sets the discussion of emotions at work within the modern NHS and the current prioritisation of creating a safety culture within the service. BACKGROUND The paper focuses on the work of students, frontline nurses and their managers drawing on recent studies of patient safety in the curriculum, and governance and incentives in the care of patients with complex long term conditions. METHODS The primary research featured in the paper combined a case study design with focus groups, interviews and observation. RESULTS In the patient safety research the importance of physical and emotional safety emerged as a key finding both for users and professionals. In the governance and incentives research, risk emerged as a key concern for managers, frontline workers and users. CONCLUSION The recognition of emotions and the importance of emotional labour at an individual and organizational level managed by emotionally intelligent leaders played an important role in promoting worker and patient safety and reducing workplace risk. IMPLICATIONS FOR NURSE MANAGERS Nurse managers need to be aware of the emotional complexities of their organizations in order to set up systems to support the emotional wellbeing of professionals and users which in turn ensures safety and reduces risk.

Guest Editorial: Compassion and smiles: what’s the evidence?

Compassion and smiles have been placed very firmly on the NHS agenda (Department of Health Press Release 18.06.08; John Carvel’s Guardian article 18.06.08: ‘Nurses to be rated on how compassionate and smiley they are’). Press release and article stressed the importance of nurses’ compassion and smiles to ensure patients receive good care, which in turn may aid their recovery. Although such statements are portrayed as news, research since the 1960s has shown similar trends. Revans’ (1964) research reported how high standards of morale in hospitals had a positive impact on nurses and patients. Good communication between all grades of staff was a key finding. One indicator of good communication identified in the research was the frequency with which the ward sister had contact with student nurses. In those hospitals with high morale, recruitment and retention were good while student nurse attrition, sickness rates and absenteeism were low. Patient stays were also shorter. Revans concluded that staff well-being was closely associated with that of patients. This association has been confirmed in subsequent studies and in my own research in the 1980s sisters were described as critical because of the influence they were seen to have on ‘how the students work and on the way they feel, their morale’. Patients were reported to be aware if there was a tense atmosphere on a ward, which filtered down to them and made them feel ‘unhappy whereas on other wards they’re much more relaxed’. As one patient observed ‘if staff work well with sister then the atmosphere of the ward is well’ (Smith, 1992; p. 79–80). Recent research by Borrill and West (2003) continues to report the importance of good morale among staff and the positive effects it has on patients. One of the key findings for Borrill, et al. (2003) was effective team working and the importance of good working relationships between all professional groupings. Significantly those hospitals with effective staff management, including appraisals and a higher percentage of staff working in teams showed lower patient mortality. But the components of quality care have always been elusive. Attempts to define quality of nursing care was evident in ‘The Proper Study of the Nurse’, which was commissioned by the Royal College of Nursing and supported by the then Ministry of Health. A comprehensive programme of research was set up comprising a series of studies undertaken from 1966 to 1975 to look at the nurse’s role in a variety of specialities. The programme was led by Mcfarlane (1970), who later became one of the first Professors of Nursing in the United Kingdom. One study to look at the care Journal of Research in Nursing ©2008 SAGE PUBLICATIONS Los Angeles, London, New Delhi and Singapore VOL 13 (5) 367–370 DOI: 10.1177/ 1744987108096012 GU E S T E D I TOR I A L

Provision of continued professional development for non-medical prescribers within a South of England Strategic Health Authority: a report on a training needs analysis.

AIMS This paper reports on a Training Needs Analysis for Non-Medical Prescribers commissioned by a south of England Strategic Health Authority. BACKGROUND The aim of the TNA was to inform future policy, educational provision and practice development and provide nurse managers with significant information on the perceived Continuing Professional Development (CPD) needs of the non-medical prescribers. METHODS Data were collected from a sample of 270 non-medical prescribers using an in-depth questionnaire, and telephone interviews with a purposive sample of 11 key stakeholders. RESULTS The findings report: * The qualifications that non-medical prescribers possess. * The level of confidence described by the non-medical prescribers in their role. * What non-medical prescribers identify as their present and future CPD requirements in relation to prescribing. * What education and training provision non-medical prescribers have attended in relation to their prescribing role since qualifying. CONCLUSIONS The findings suggest, first that short courses that were specific to the non-medical prescribers role were considered to be the most popular and useful. However, courses needed to be advertised well in advance. Second, training gaps were identified. IMPLICATIONS FOR NURSING MANAGEMENT Pharmacology and prescribing are rapidly changing and require regular CPD in order to keep up to date with the latest developments. Non-medical prescribing is a comparatively new innovation to the NHS, therefore those who are not medically qualified need mentorship from experienced prescribers, as well as the encouragement from nurse managers to be confident prescribers themselves and enhance patient care.

Participatory evaluation: navigating the emotions of partnerships

This paper describes the processes involved in evaluating a Sure Start programme in one inner city area. The evaluation was set up in the spirit of participatory action research in which the researchers aimed to work in partnership with key stakeholders to both enable and sustain supportive evaluative processes. The evaluation supported the aspirations espoused by the national Sure Start agenda to improve the lives of children under four, their parents and communities through an expressed commitment to partnership working. The paper draws on ethnographic reflections to describe and analyse the processes involved in setting up the evaluation over two years. Issues of trust, ambiguity and conflict associated with partnership working are explored. In particular the emotional components of relationships required to work in partnership are described as a means of managing ambiguity and conflict and promoting trust. Emotional labour is taken as a conceptual starting point to analyse the relationships and the organisational conditions required to sustain partnerships. Further psychoanalytic and sociological studies are drawn upon to aid the analysis and in particular to understand the emotional components of partnerships in the relatively uncharted waters of inner city regeneration work.