Changes in technological and economic aspects of society have impacted on how we understand professional and client relationships. These relationships are constructed in terms of patients/users requiring care, and customers whose complaints have become a yardstick of satisfaction. A consequence of these changes is an interest in the related concepts of emotional labour and emotion work. For nurses, caring for people in illness and in health is central to their work, and it is this aspect of emotion at work that (...) distinguishes nursing from other occupational groups. This paper is concerned with emotion work in a National Health Service Direct (NHS Direct) call centre in the United Kingdom. Drawing upon theoretical perspectives from organizational psychology and sociology it focuses upon the social processes that narrate emotion events in a specific context. It is based on a qualitative study exploring the experience and emotion work of nurses working in a call centre. Issues in caring without the face‐to‐face contact using communication technology were crucial to the way nurses perceived their work. These factors contributed to nurses’ orientation to work and to the way that conflict and dissonance with expectations of callers and managers impacted on nurses’ emotion work. (shrink)

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom (...) and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect—moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians’ moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times. (shrink)

Background: Values are the basis of nursing practice, especially in making decisions about complicated ethical issues. Despite their key role in nursing, little information exists on the factors affecting their development and manifestation in nursing students. Objective: This study identifies and describes the facilitators and inhibitors of the development and manifestation of professional values based on the experiences of nursing students and instructors and nurses. Research design: Data were collected through 29 semi-structured interviews and two focus group interviews in 2013–2015 (...) and were analyzed using the conventional content analysis method of Elo and Kyngäs. Participants and research context: In total, 18 nursing undergraduates, five nursing instructors, and five nurses from Shiraz University of Medical Sciences and one of the teaching hospitals in Shiraz were selected through purposive sampling. Ethical considerations: The research was approved by the Ethics Committee of Shiraz University of Medical Sciences and the teaching hospital examined. Findings: The findings consisted of two categories: personal and environmental factors. Personal factors consisted of the two subcategories of personal stimuli (work experience and past relationships, inner beliefs and acting on values, belief in God and a divine worldview) and personal inhibitors (the lack of professional motivation and enthusiasm, negative emotions). Environmental factors consisted of the two subcategories of environmental stimuli (cooperation, order and discipline) and environmental inhibitors (unfavorable work environment, society’s negative attitude toward nursing, the violation of rights). Discussion and conclusion: Given the impact of personal and environmental factors on the development and manifestation of professional values in nursing students, it is upon the education authorities to take account of them in their planning, and nursing managers are also recommended to further address these factors in their development of a proper work environment, provision of standard facilities and removal of barriers. (shrink)

SARGENT A. Nursing Inquiry 2012; 19: 134–143 [Epub ahead of print]Reframing caring as discursive practice: a critical review of conceptual analyses of caring in nursingThis study critically examines the way in which the concept of caring is presented in the nursing literature through conceptual analytic approaches. A critical reflection on the potential consequences of representing a concept of caring as vague and ambiguous, yet central to ontology and epistemology in professional nursing is presented drawing on comparisons between the conceptual analyses (...) of caring, and of structuralist perspectives of language, and how this potentially limits scholarship in this area. A search of the literature revealed nine conceptual papers. These papers highlight the self‐referential characteristics of the concept of caring, and of analytical methods in general. It is proposed that this is the result of a systematic adherence to a rigid, structuralist view of language, whereby stable relationships between words and their meanings are assumed. An alternative perspective is offered by viewing caring as a discursive practice rather than a fixed conceptual entity, calling into question the role that the concept plays in nursing practice. A poststructuralist perspective requires caring to be perceived as a discourse of nursing that is fluid and contingent, rather than a central and guiding concept, opening up a new orientation for nursing scholarship in caring research. (shrink)

Background: Research suggests that nurses generally do not participate in ethical decision-making in accordance with ethical guidelines for nurses. In addition to completing their training, nurses need to reflect on and use ethically grounded arguments and defined ethical values such as patient’s dignity in their clinical work. Objectives: The purpose of this article is to gain a deeper understanding of how nurses deal with ethical decision-making in daily practice. The chosen research question is “How do nurses participate in ethical decision-making (...) for the patient?” Design and method: We use Gadamer’s philosophical hermeneutics as well as Kvale and Brinkmann’s three levels of understanding in interpreting the data material. Nine registered nurses were interviewed. Ethical considerations: The Ombudsman of Norwegian Social Science Data and the head of the hospital approved the investigation. The participants received both oral and written information about the study and they gave their consent. We informed the participants that the participation was voluntary and that they were free to withdraw at any point in the course of the study. The requirement of anonymity and proper data storage was in accordance with the World Medical Association Declaration of Helsinki (1964). The participants were assured that privacy, and confidentiality would be duly protected. Results: Four key themes emerged: (1) confusion in relation to professional and operational expectations of role, (2) ideal somnolence, (3) inadequate argumentation skills, and (4) compound pressure. Conclusion: Ethical ideals appear to be latent in the mindset of the participants; however, the main finding of this investigation is that nurses need to activate the ideals and apply them into practice. Furthermore, management needs to initiate professional reasoning and interdisciplinary discussions leading to common goals for patients. (shrink)

Any study of radical care needs to pay attention to the institution as a place of care. Yet, institutions have been more readily associated with failures of care than successes. We undertake close reading of the Ockenden Review of maternity services in a National Health Service hospital trust in England, concerning a large number of families that received inadequate care during pregnancy and birth, including investigations of adverse outcomes such as deaths of babies and mothers. We argue that to enable (...) better care in the institution requires a close attention to its institutional nature, particularly its scale, bureaucratic mode and functions, and the professional identities that work within it, and the ways they shape the practice of emotion. (shrink)

Background: In order to prove their commitment to the nursing profession, nurses need to base their professional activities on certain acknowledged values. Although a large number of studies have addressed professional values in nursing, only a few studies are available on the identification and comparison of nurses’, nursing students’, and nursing instructors’ understanding of such values. Objective: The study aims to compare nurses’, nursing students’, and nursing instructors’ perception of nursing professional values. Research design: In this descriptive-comparative study, data were (...) collected using Weis and Schank’s Nurses’ Professional Values Scale–Revised. The data were analyzed using the SPSS statistical software (v 22). Participants and research context: A total of 299 nurses, 341 nursing students, and 100 nursing instructors from multisite, 20 different wards from 3 university hospitals and associated nursing schools located in the cities of Shiraz, Fasa, and Jahrom in Fars province, participated in 2016. Ethical considerations: The Institutional Review Board of the researchers’ primary university has verified that the study complies with research ethics. Findings: The total mean scores of the nurses’, nursing students’, and nursing instructors’ perception were found to be 4.23 (0.44), 3.92 (0.50), and 4.34 (0.35), respectively, in the domain of justice—this domain was the subjects’ top priority—and 3.40 (0.56), 3.29 (0.49), and 3.55 (0.36), respectively, in the domain of activism—this domain was attached the least importance by the subjects. There were significant differences across the three groups’ perception in all of the dimensions of professional values ( p < 0.001). Discussion: The three study groups’ overall mean scores fall within the range of relatively important or important. Several studies show the same results, but there are still controversies in this regard. Conclusion: There is need for plans to increase nurses’ awareness of certain professional duties and improve their professional performance in all areas alongside their care duties. (shrink)

This paper will explore the relationship between Mezirow's concept of reflexivity and Bourdieu's theory of habitus in order to develop a more robust framework within which critical reflection can take place. Nurse educators have sought to close the theory practice gap through the use of critical reflection. However, we are not convinced that this has produced the depth and quality of reflection required. Furthermore, the contexts in which critical reflection takes place is often sidelined or erased so that the whole (...) impetus in the literature is to educate nurses in reflection rather than empower nurses to understand the complex circumstances and barriers that obstruct critical reflection. This paper argues that the reason for this position is that nurse education does not always acknowledge the role that personal and cultural values systems have on reflective practices. The literature search was undertaken using CINHAL and MEDLINE. Keywords included: values systems, habitus, and critical reflection. Inclusion criteria were determined by the theoretical approach and included seminal texts, from as far back as 1956, to identify key themes. Although critical reflection is a potentially powerful way of enhancing care it has often failed to do so. It is suggested that this is because nurse educators have frequently used models of reflection without considering the impact that student's personal values systems has on their perceptions of care and subsequently care delivery. The purpose of this paper is to promote deeper levels of reflection and is part of a programme of research aimed at developing a more robust approach to reflection in educational practice. (shrink)

Values‐based practice is deemed essential for healthcare provision worldwide. In England, values‐based recruitment methods, such as multiple mini interviews (MMIs), are employed to ensure that healthcare students’ personal values align with the values of the National Health Service (NHS), which focus on compassion and patient‐centeredness. However, values cannot be seen as static constructs. They can be positively and negatively influenced by learning and socialisation. We have conceptualised students’ perceptions of their values over the duration of their education programme as a (...) ‘values journey’. The aim of this hermeneutic longitudinal focus group study was to explore the ‘values journey’ of student nurses and midwives, recruited through MMIs, across the 3 years of their education programme. The study commenced in 2016, with 42 nursing and midwifery students, originally recruited onto their programmes through multiple mini interviews. At the third and final point of data collection, 25 participants remained. Findings indicate that students' confidence, courage and sense of accountability increased over the 3 years. However, their values were also shaped by time constraints, emotional experiences and racial discrimination. We argue that adequate psychological support is necessary as healthcare students embark on and progress through their values journey, and propose a framework for this. (shrink)

A report suggests that United States’ army officers may engage in dishonest reporting regarding their compliance procedures. Similarly, nurses with espoused high ethical standards sometimes fail to live up to them and may do so while deceiving themselves about such practices. Reasons for lapses are complex. However, multitudinous managerial demands arising within ‘technical and instrumental rationality’ may impact on honest decision‐making. This paper suggests that compliance processes, which operates within the social structural context of the technical and instrumental rationality manifest (...) as ‘managerialism’, contributes to professional ‘dishonesty’ about lapses in care, sometimes through ‘thoughtlessness’. The need to manage risk, measure, account, and control in order to deliver efficiency, effectiveness, and economy (technical rationality) thus has both unintended and dysfunctional consequences. Meeting compliance requirements may be mediated by factors such as the ‘affect heuristic’ and ‘reflexive deliberations’ as part of the ‘structured agency’ of nurses. It is the complexity of ‘structured agency’ which may explain why some nurses fail to respond to such things as sentinel events, a failure to recognize ‘personal troubles’ as ‘public issues’, a failure which to outsiders who expect rational and professional responses may seem inconceivable. There is a need to understand these processes so that nurses can critique the context in which they work and to move beyond either/or explanations of structure or agency for care failures, and professional dishonesty. (shrink)

The aim of this paper is to re‐examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults of loyalty (...) toward those institutions, while the concept of emotional labour is used to re‐examine nursing's high valuing of “caring” and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change. (shrink)

Most current management systems of healthcare institutions correspond to a model of market ethics with its demands of competitiveness. This approach has been called managerialism and is couched in terms of much‐needed efficiencies and effective management of budgetary constraints. The aim of this study was to analyse the decision‐making of nurses through the impact of health institution management models on clinical practice. Based on Foucault's ethical theory, a qualitative study was conducted through a discourse analysis of the nursing records in (...) a hospital unit. The results revealed that the health institution standardises health care practice, which has an impact on professional and patient autonomy as it pertains to decision‐making. The results of this research indicate that resistance strategies in the internal structures of health organisations can replace the normalisation and instrumentalisation of professional practice aimed at promoting patient self‐determination. (shrink)

This paper argues that insights into infant emotional development, particularly the capacity to engage with rupture and repair, can be applied to the understanding and promotion of flourishing in later life, individually and socially. Starting with the Queen’s visit to the Republic of Ireland as an example of successful social repair after rupture that enables flourishing, the paper goes on to outline some relevant psychological theory that undergirds this. It then considers some of the practical relevance and problems that apply (...) to rupture and repair in the contemporary world, particularly the world of health care, Amidst the inevitable messiness of life, flourishing and growth can only be achieved with the kind of flexibility implied by creating repair in the face of rupture. (shrink)

The purpose of this contemporary history study is to analyse nursing strategy documents produced by NHS Trusts in England in the period 2009–2013, through a process of discourse analysis. In 2013 the Francis Report on the Mid-Staffordshire NHS Foundation Trust was published. The Report highlighted the full range of organisational failures in a Trust that valued financial efficiency over patient care. The analysis that followed, however, dwelt heavily on the failings of the nurses. Nursing strategy documents at that time served (...) to set the future direction for NHS Trusts, prescribing specific value frameworks for each nursing workforce. However, the values chosen frequently conflicted with each other pitting nursing values against a managerial trope. It is argued that documents provided a response to wider NHS concerns and high-profile failures in care, particularly the Francis Report, paying lip service to staff engagement whilst maintaining a corporate focus. Nursing values were placed firmly within a managerialist discourse, one that has needed to be re-evaluated in the current Covid-19 pandemic. Wider implications of the research suggest discussion of value conflict may be beneficial within nursing education and a truly local approach to strategy creation would potentially promote staff buy-in to strategy documents. (shrink)

Background: Ethics is a founding component of the nursing profession; however, nurses sometimes find it difficult to constantly adhere to the required ethical standards. There is limited knowledge about the factors that cause a committed nurse to violate standards; moral disengagement, originally developed by Bandura, is an essential variable to consider. Research objectives: This study aimed at developing and validating a nursing moral disengagement scale and investigated how moral disengagement is associated with counterproductive and citizenship behaviour at work. Research design: (...) The research comprised a qualitative study and a quantitative study, combining a cross-validation approach and a structural equation model. Participants and research context: A total of 60 Italian nurses (63% female) involved in clinical work and enrolled as students in a postgraduate master’s programme took part in the qualitative study. In 2012, the researchers recruited 434 nurses (76% female) from different Italian hospitals using a convenience sampling method to take part in the quantitative study. Ethical considerations: All the organisations involved and the university gave ethical approval; all respondents participated on a voluntary basis and did not receive any form of compensation. Findings: The nursing moral disengagement scale comprised a total of 22 items. Results attested the mono-dimensionality of the scale and its good psychometric properties. In addition, results highlighted a significant association between moral disengagement and both counterproductive and citizenship behaviours. Discussion: Results showed that nurses sometimes resort to moral disengagement in their daily practice, bypassing moral and ethical codes that would normally prevent them from enacting behaviours that violate their norms and protocols. Conclusion: The nursing moral disengagement scale can complement personnel monitoring and assessment procedures already in place and provide additional information to nursing management for designing interventions aimed at increasing compliance with ethical codes by improving the quality of the nurses’ work environment. (shrink)

Student nurses’ professional development arises through socialisation in nursing knowledge, values and behaviours. Students are expected to demonstrate compassion; however, compassion is a complex concept, one that creates emotional challenges. A grounded theory study was undertaken to explore student nurse socialisation in compassionate practice. In-depth interviews were undertaken with 19 students in the north of England during 2009–2010, and their concerns and concern management emerged. Students expressed several concerns, one being their emotional vulnerability and uncertainty of the emotional requirements for (...) compassionate practice. A core category of ‘balancing future intentions’ was identified: that students managed feelings of vulnerability and uncertainty through balancing their intentions towards and away from engagement in compassionate practice, depending upon perceived impact on their emotional well-being. The findings are discussed in relation to emotional labour and moral distress, and courage, resilience and self-compassion are explored as a means to enable sustainable compassionate practice. (shrink)

Background: New graduate transition into the workforce is challenging and can involve managing ethical tensions. Ethical tensions cause new graduates to doubt their capabilities due to their lack of experience. To support new graduates, we need to know what these ethical tensions are. Objectives: To explore the ethical tensions perceived to occur in practice for new graduate health professionals. Research design: This qualitative systematic review involved a search of five databases (Medline, EMBASE, AMED, CINAHL and Scopus) which resulted in the (...) retrieval of 3554 papers. After the two-phased screening process, eight studies were identified that met the inclusion criteria and had rich data on the review question. Articles were read several times, critically appraised and analysed through thematic analysis. Ethical considerations: No ethical approval was required for the systematic review. The review was conducted following well-established reporting guidelines enabling transparency and rigour. Findings: Studies originated from Australia, United States, Iran and China. One study included speech pathologists and seven were with nurses. Four themes included the following: (1) enduring an unknown workplace culture that generates uncertainty without support for new graduates; (2) being vulnerable because of distress from bullying, exclusion and being a scapegoat; (3) constraining systems and institutional restrictions that cause dilemmas; and (4) experiencing disillusionment from lost ideals about ethical practice. Discussion: This review has brought to light the vulnerability of new graduates to negative workplace culture and collegial incivility. In addition, new graduates are subjected to ethical tensions created by institutional constraints which can create dilemmas and uncertainties through practice that does not align with what they anticipated. Conclusion: Understanding ethical tensions experienced by new graduates enables provision of informed support. There needs to be considerable cultural change for orientation and socialisation of new graduates to enable them to learn and manage ethical tensions. (shrink)

The espousal of organizational values with an expectation of primarily positive consequences in leadership, employee performance and organizational change has often been recognized as overly simplistic, but giving a more complete and critical account of the interrelations between values and behaviour has proven challenging. This article describes a balanced and integrated positive, ambivalent and negative (PAN) approach. The use of this PAN approach is described in the case of a health care organization. Evidence is given from a survey of 96 (...) staff perceptions of their current organizational values, staff evaluations of their colleagues’ demonstration of the organization’s espoused values and content analysis of 35 ‘memorable moments’ regarding what staff had experienced. Using the PAN framework in this case suggests a picture of staff reporting experiences as 50–30–20, respectively, for the PAN approach. The implications of this framework for leadership, employee performance and organizational change are discussed. (shrink)