Compassion: Use it or lose it?: A study into the perceptions of novice nurses on compassion: A qualitative approach

BackgroundNurses and patients believe compassion to be one of the most important professional values. However, it is not known which factors influence compassionate behaviour in practice. There is a need for insight whether or not compassion in nursing practice flourishes or falters.ObjectivesThis study aims to explore how Dutch novice nurses perceive compassion within nursing care and gain insight in their strategies of sustaining and developing compassionate care.DesignThis study used an exploratory design, employing a qualitative approach.Data Sources14 in depth interviews with Dutch bachelor novice nurses with 0–5 years of practical experience took place.Review MethodsThematic analysis and inductive coding was used.ResultsFour themes emerged from the data. First, participants perceive compassion to be a part of their professional identity. Balancing between positive and negative environmental influences and their own perceptions was shown as a second theme. Thirdly, various strategies such as rebellion and conforming to the ideas on the workplace helped nurses to do so in daily practice. If nurses succeeded in dealing positively with various influences, a professional development was perceived over time. The fourth theme described the increased awareness of compassion and professional identity if strategies were successful. If not; insecurity, job dissatisfaction and ultimately consideration of job-retention was described.ConclusionCompassion is an essential value during the development of the professional identity of novice nurses. Dealing with meaningful emotions and experiences broadened nurses' personal awareness of compassionate care and stimulated a growth in their professional identity. Novices need support during their internships that builds empowerment and resilience in sustaining compassion. Furthermore, there is a need for role models and a corporative team spirit in order to coach novice nurses in compassionate behaviour.     

The butterfly effect of caring – clinical nursing teachers’ understanding of self‐compassion as a source to compassionate care

Scand J Caring Sci; 2013; 27; 175–183 The butterfly effect of caring – clinical nursing teachers’ understanding of self‐compassion as a source to compassionate care This study has its roots in a clinical application project, focusing on the development of a teaching–learning model enabling participants to understand compassion. During that project four clinical nursing teachers met for a total of 12 hours of experiential and reflective work. This study aimed at exploring participants’ understanding of self‐compassion as a source to compassionate care. It was carried out as a phenomenological and hermeneutic interpretation of participants’ written and oral reflections on the topic. Data were interpreted in the light of Watson’s Theory of Human Caring. Five themes were identified: Being there, with self and others; respect for human vulnerability; being nonjudgmental; giving voice to things needed to be said and heard; and being able to accept the gift of compassion from others. A main metaphorical theme, ‘the Butterfly effect of Caring’, was identified, addressing interdependency and the ethics of the face and hand when caring for Other – the ethical stance where the Other’s vulnerable face elicits a call for compassionate actions. The findings reveal that the development of a compassionate self and the ability to be sensitive, nonjudgmental and respectful towards oneself contributes to a compassionate approach towards others. It is concluded that compassionate care is not only something the caregiver does, nor is compassion reduced to a way of being with another person or a feeling. Rather, it is a way of becoming and belonging together with another person where both are mutually engaged and where the caregiver compassionately is able to acknowledge both self and Other’s vulnerability and dignity.     

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background The health-care system’s success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results The data analysis resulted in three main themes: ‘providing environmental prerequisites for safe nursing practice’, ‘uniting and integrating health-care providers’, and ‘creating an atmosphere of safe care’. Conclusion The results indicate that to facilitate providing safe care, nurse leaders should improve nurses’ working conditions, develop the nurses’ practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers’ professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.     

Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review

kokko r. (2011) Journal of Nursing Management 19, 673–682
Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review Aim This article describes the development of cultural competence among nursing students. The focus is on illuminating the learning experiences of nursing students during their exchange. Background As the world gets smaller, the demand for culturally competent nurses increases. Future nurses need to be open-minded towards international cooperation and willing to develop the quality of care from a cultural point of view. Nursing education in many countries provides an option for students to learn nursing in different cultures while taking part of their studies abroad. Methods A systematic literature search was conducted. Inductive content analysis was applied to the data consisting of empirical studies (n = 7) describing nursing students’ studies abroad. Results The process of developing cultural competence among nursing students on exchange was found to consist of three main themes, namely: (1) an increased cultural knowledge base, (2) personal growth and (3) the impact of exchange experiences on the nursing student’s own practice. Conclusions Studies abroad are a beneficial strategy for the development of future nurses’ cultural competence. Implications for nursing management Nursing is facing a crucial challenge to recruit culturally competent nurses, because an increasing number of patients are from different cultures. Nurses with experiences of studying abroad can offer employers a resource through their preparedness for culturally competent nursing.     

Supervising nursing students administering medication: a perspective from registered nurses

Aims. To explore the attitudes, experiences and opinions of registered nurses regarding supervision of undergraduate nursing students while administering medication in the healthcare setting. Background. Medication errors present a considerable risk to safety in the healthcare setting. By virtue of their role in the administration of medication, registered nurses are considered as major contributors to this problem. Undergraduate nursing students administer medication in the clinical setting, but little attention has been paid to the implications for patient safety. Design. This research was conducted using exploratory qualitative methodology. Methods. Focus group interviews were conducted with 13 registered nurses. The participants were asked to describe their experiences and opinions regarding the supervision of undergraduate nursing students. Data were analysed using the framework approach. Results. Three main themes from this work are presented in this paper: ‘standard of supervision’, ‘a beneficial experience’ and ‘preparation’. Conclusions. The participants regarded supervision as an important process in fostering student learning and ensuring safety. Preparation on the part of the healthcare facility, students and the university were essential to maximise the benefits for all concerned. Relevance to clinical practice. The ability to administer medication safely is an important skill for all registered nurses. Nursing students need the opportunity to develop these skills as part of their undergraduate educational programme. Registered nurses must supervise students in a rigorous and supportive manner to enhance learning and to promote quality care.     

Development and validation of a new instrument to measure nursing students compassion strengths: The Bolton Compassion Strengths Indicators

Despite considerable research and rhetoric on the importance of compassion in nursing, progress has been hindered by the lack of an adequate psychometric instrument to measure its multidimensional nature. This paper reports several studies conducted over three stages, to develop and validate a new instrument to measure nurses’ compassion strengths. A purposive sample of UK pre-registered nursing students studying at a University took part in this study. The eight indicators highlight the multidimensional nature of compassion. The Bolton Compassion Strengths Indicators (BCSIs) demonstrated robust psychometric properties and could provide the means by which nursing students can empower themselves, as they strive to develop their professional identity as compassionate practitioners. This new measure will also help other researchers and educators who wish to study the development of compassion strengths in nursing.     

Opening up to learning spiritual care of patients: a grounded theory study of nursing students

Aim. To determine undergraduate nursing students’ perspectives on spiritual care and how they learn to assess and provide spiritual care to patients. Background. Nursing is concerned with holistic care. Systematic teaching and supervision of students to prepare them to assist patients spiritually is a growing focus. However, there is limited consensus about the competences students need to develop and little is written related to students learning processes. Design. Grounded theory was used to identify students’ main concern and develop a substantive grounded theory. Method. Data collected during semi‐structured interviews at three Norwegian University Colleges in eight focus groups with 42 undergraduate nursing students were analysed through constant comparison of transcribed interviews until categories were saturated. Results. The participants’ main concern was ‘How to create a professional relationship with patients and maintain rapport when spiritual concerns were recognised’. Participants resolved this by ‘Opening up to learning spiritual care’. This basic social process has three iterative phases that develop as a spiral throughout the nursing programme: ‘Preparing for connection’, ‘Connecting with and supporting patients’ and ‘Reflecting on experiences’. Conclusion. Nurses need a wide range of competences to fulfil the nursing focus on holistic patient care. Nursing education should prepare students to recognise and act on spiritual cues. A trusting relationship and respectful and sensitive communication assist students to discover what is important to patients. An educational focus on spiritual and existential themes throughout the nursing programme will assist students to integrate theoretical learning into clinical practice. Relevance to clinical practice. Study participants reported seeing few role models in clinical settings. Making spiritual assessment and interventions more visible and explicit would facilitate student learning in clinical practice. Evaluative discussions in clinical settings that include spiritual concerns will enhance holistic care.     

Teaching spiritual care – a grounded theory study among undergraduate nursing educators

Aims and objectives. To explore teachers’ understanding of spirituality and how they prepare undergraduate nursing students to recognise spiritual cues and learn to assess and provide spiritual care. Background. Nursing education addresses patient care in all domains of the person. Systematic teaching and supervision of students to prepare them to assist patients spiritually is an important part of holistic care. However, few role models for spiritual care are seen in clinical practice, and limited research addresses necessary student competencies or how teachers can best facilitate this process. Design. Grounded theory was used to identify teachers’ main concern and develop a substantive grounded theory. Methods. Data collected during semi‐structured interviews at three Norwegian University Colleges in five focus groups with 19 undergraduate nursing teachers were conducted from 2008 to 2009. Data were analysed through constant comparison of transcribed interviews until categories emerged and were saturated. Results. The participants’ main concern was ‘How to help students recognize cues and ways of providing spiritual care’. Participants resolved this by ‘Journeying with Students through their Maturation’. This basic social process has three iterative phases that develop throughout the nursing programme: ‘Raising Student awareness to Recognize the Essence of Spirituality’, ‘Assisting Students to Overcome Personal Barriers’, and ‘Mentoring Students’ Competency in Spiritual Care’. Conclusion. Nursing education should prepare students to recognise and act on spiritual cues. Making spiritual assessment and interventions more visible and explicit throughout nursing programmes, in both classroom and clinical settings, will facilitate student maturation as they learn to integrate theoretical thinking into clinical practice. Relevance to clinical practice. Nursing students need role models who demonstrate spiritual care in the fast‐paced hospital environment as well as in other clinical practice settings. To model spirituality as part of nursing care can assist students to overcome their vulnerability and to safeguard ethical issues and promote patient integrity.     

Grief experiences of nurses after the death of an adult patient in an acute hospital setting: An integrative review of literature

ObjectiveThis integrative review explores current published literature examining grief experiences of nurses who work in hospital settings after the death of a patient in their care and the factors that may impact nurses experiencing grief within the workplace.BackgroundHealthcare workers such as nurses are required to be competent, skilled and resilient in preparation for the emotional variables and professional responsibilities when managing a patient death. There are publications exploring nurse’s grief experiences in palliative care, paediatric nursing or oncology settings, but to date, there is limited relevant literature identifying or exploring grief experiences of nurses working in other speciality areas in a hospital setting after the death of a patient in their care.MethodsComprehensive online database searches of CINAHL, EBSCO Host, PubMED, MEDLINE, Scopus, Joanna Briggs Institute (JBI) and Google Scholar was undertaken using key terms of articles published between 1990–2017. Screening of 317 articles resulted in 5 included for this review. Data analysis was guided by Whittemore and Knafl’s five stage process.FindingsThree main themes were identified were ‘the impact of formative death events in clinical practice’, ‘managing personal grief reactions and the factors that influenced these reactions’, and ‘the significance of colleague support when experiencing a patient death’.ConclusionPersonal grief responses displayed by a nurse after a patient has died can have both a positive and negative influence on their professional behaviour in the workplace. It also has the potential for grief complications for individual nurses, which highlights the importance of workplace support for nurses when making clinical decisions after the death of a patient.     

Appreciating the work of nurses caring for adults with intellectual disability and mental health issues

This paper presents findings from a study exploring the nurses’ experience of caring for adults with intellectual disability and mental health issues in inpatient settings. Semi structured interviews were undertaken with 13 nurses from various regions of New Zealand. Methods suggested by an Appreciative Inquiry methodology were used to explore the nurses’ positive experiences of their role. Interviews were transcribed and analysed using open coding and Leximancer (an online data mining tool) analysis to identify dominant themes in the discourse. Analysis revealed themes around ‘Contextualising behaviour’, ‘Communication’, ‘Confidence to care’ and ‘Time’. Participants reflected upon their experiences offering personal interpretations in identifying the aspects of nursing that mattered and that worked. What is shown is that nurses were able to describe a range of creative and adaptive ways of nursing in responding to numerous complex factors they faced in their roles. This suggests a strong foundation on which to advance nursing care in this field.     

Exploring compassion: implications for contemporary nursing. Part 2

A range of contemporary political and professional literature endorse the principle of compassion in nursing as a core and underpinning philosophy fundamental to the profession. However, despite pledges to ensure that compassion lies at the heart of nursing, the concept has not been clearly defined. It is evident that uncovering the true meaning is complex and challenging owing to its subjective nature. In light of this, several implications must be considered. Effective student nurse recruitment is essential to ensure that the most appropriate individuals are selected. Contemporary marketing campaigns must be implemented, and recruitment strategies developed, which consider specific values and attitudes. Service user involvement in recruitment and selection, curriculum planning and learning and teaching strategies, and post-qualification education, can enhance nurses' understanding of the patient perspective and make headway in embedding compassion as a core nursing value. Additionally, effective role modelling in practice which demonstrates high-quality compassionate nursing care is essential. Nurses must be adequately supported in the clinical environment to facilitate compassionate behaviours and clinical leadership at all levels must uphold political and professional pledges to achieve this. Consideration of these implications for practice is essential to ensure that nurses are able to respond to patients with humanity and kindness, and deliver high-quality, compassionate care to all.     

Nurse prescribers' experiences of prescribing

Background. Nurse prescribing has advanced rapidly over the previous decade and is clearly on the agenda for the future. Previous research considers nurse prescribing from the patient's perspective, the medical professions’ stance and the legal and ethical implications. However, there is a paucity of literature that explores the experiences of nurse prescribers’ within their current role. These experiences need investigating to ensure nurse prescribing is able to advance in ways that provide benefit to nurses and thus provides the impetus for the study. Aim. To explore and review nurse prescribers’ experiences of prescribing. Design methods. A purposeful sample of seven nurse prescribers currently prescribing within a West Midlands Community Trust underwent minimally structured interviews in this qualitative study. Transcribed interviews were analyzed using thematic analysis. Findings. Four themes were generated from analysis of the interviews, ‘patient centred care’, ‘benefits of nurse prescribing’, ‘support and role satisfaction’ and finally ‘prescribing difficulties’. Conclusions. Nurse prescribers’ perceive prescribing as a predominantly positive experience, frequently asserting the advantages that prescribing saves the patient and nurse time, is more convenient for the patient and increases the nurses’ autonomy and role satisfaction. However, negative experiences of restrictions to practice as a result of nurse prescribers’ formulary limitations and duplication of documentation were also described. Relevance to clinical practice. Nurse prescribing is a rapidly evolving area of practice with the potential to advance nursing roles. This research aims to provide an insight into the experiences of current nurse prescribers that may then be disseminated and applied to future practice.     

The first experiences of clinical practice of psychiatric nursing students in Taiwan: a phenomenological study

Aims and objectives. The purpose of this study is to understand the experiences of psychiatric nursing students during their first encounters with psychiatric patients in a clinical setting. The objective is to assist educational professionals in mental health to improve teaching strategies. Background. In clinical settings, student psychiatric nurses have to face complex problems and situations that can result in distress. Sometimes the student nurse will be uncertain of their own ability and this is reflected in a sense of fear on the part of some nurses. However, little research has been conducted into the first clinical experiences of such nursing students in Taiwan. Design. A qualitative phenomenological study was devised to explore what psychiatric nursing students perceived during their first experiences of clinical practice and narratives were analysed using Colaizzi’s seven‐step method. Method. A phenomenological approach and purposive sampling were used in the study. Face‐to‐face interviews were conducted to collect the data and during the process of data analysis we established epochs (bracketing) and focused on the reality of the student nurses’ experience to keep the data objective. Results. Four themes were identified: breaking the stigma of mental illness, developing a trusting relationship with the patient, gaining professional knowledge and skills and the process of student growth. Conclusion. The findings from this study demonstrate that it is important to understand the perceptions of students during their first experiences of psychiatric nursing in a clinical setting and highlight the importance of educational programs. Relevance to clinical practice. By understanding the emotional process that psychiatric nursing students may go through during their clinical practice, educators can be better able to design suitable training courses in the future.     

FIRST-YEAR nursing students’ experiences of simulation involving care of older patients. A descriptive and exploratory study

Mastering geriatric nursing skills takes time and its acquisition should start early in undergraduate nursing training. The purpose of this study is to synthesise and evaluate the learning experiences that first-year nursing students had following geriatric patient simulation and practice of clinical patient handover. Qualitative content analysis of survey comments from first-year students (n = 216) at a large university in Norway were performed. Simulation training included systematic patient observation of scenarios based on genuine geriatric cases in nursing homes and practice of clinical patient handover. Content analyses identified four generic categories: (1) ‘embodying theoretical knowledge’; (2) ‘increased awareness about one's self’; (3) ‘understanding that collaboration is needed’; (4) ‘preparing for future work life’. These themes provide evidence for students integrating geriatric theoretical knowledge with clinical skills as a result of simulation. Analysis of learning experiences shows that geriatric scenario simulation and practice of clinical patient handover are valuable instruments before entering clinical training with geriatric patients, even for novice students. The use of genuine simulation cases and instruction on the use of clinical handover instruments are effective in producing conceptual changes that prepare students for their first encounter with complex, real-world geriatric scenarios.