Student nurse socialisation in compassionate practice: A Grounded Theory study

Summary

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.

Introduction

Compassionate practice is an explicit expectation and a key quality indicator for nursing in the United Kingdom (UK) according to standards set within the UK Department of Health (DH) (Department of Health (DH), 2008, 2010a) and professional bodies around the world such as the UK Nursing and Midwifery Council (NMC) (Nursing and Midwifery Council (NMC), 2008, 2010), the Canadian Nurses Association (CNA) (Canadian Nurses Association (CNA), 2008), and the American Nurses Association (ANA) (American Nurses Association (ANA), 2011). Compassionate practice is also an expectation of those accessing healthcare and reports of a lack of compassion within nursing provision over recent years (Age Concern, 2006, The Patients Association, 2009) have added to concerns raised by both professional and public organisations (Department of Health (DH), 2010b; Care Quality Commission, 2011).