This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real-life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role are described utilising evidence from the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future.

Re‐reading nursing and re‐writing practice: towards an empirically based reformulation of the nursing mandate

This chapter reports findings of a meta-ethnography of published qualitative research on nurses’ experiences of nurse-patient relationships in acute settings, reported in detail in Bridges et al. (2012a). Concerns are growing that modern healthcare delivery is lacking in compassion and is failing to provide the individualized care required by, for instance, older people with complex needs (Firth-Cozens and Cornwell, 2009). Promoting meaningful connections with patients in which practitioners see each patient ‘as a person to be engaged with rather than a body to do things to’ (Nicholson et al., 2010, p. 12) requires nurses and others to be able to articulate and appreciate the nature of these connections and their impact on patient outcomes, along with an understanding of the factors that can promote or inhibit therapeutic relationships. Nurses and nursing are now often portrayed as lacking in compassion and being distracted from these aspects of care (Flatley and Bridges, 2008). A range of high-profile reports in the United Kingdom into the quality of in-patient care for older people suggest that many of the reported problems centre on a lack of humanity in hospital staff, particularly nurses. While good practice does exist, we understand little about the conditions in which high-quality, compassionate in-patient care is delivered. Insight into nurses’ experiences as they engage with patients is therefore critical to understand how best to support existing good practice and to focus service improvement initiatives. This focus is of particular importance in acute settings where patient throughput, service configuration and staffing patterns reduce contact time between staff and patients. In addition, we lack understanding about how nursepatient relationships, the act of caring and engagement in therapeutic relationships impact on nurses themselves.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jan.12050

Capacity for care: meta-ethnography of acute care nurses' experiences of the nurse-patient relationship

Aims To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings. Background While primary research on nurses' experiences has been reported, it has not been previously synthesized. Design Meta-ethnography. Data sources Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO. Review methods Qualitative studies describing nurses' experiences of the nurse-patient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method. Results Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients. Conclusion The findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.

Capacity for care

Aim


A discussion of the meaning of reflexivity in research with the presentation of examples of how a model of reflexivity was used in a grounded theory research project.


Background


Reflexivity requires the researcher to make transparent the decisions they make in the research process and is therefore important in developing quality in nursing research. The importance of being reflexive is highlighted in the literature in relation to nursing research, however, practical guidance as to how to go about doing research reflexively is not always clearly articulated.


Design


This is a discussion paper.


Data sources


The concept of reflexivity in research is explored using the Alvesson and Skoldberg model of reflexivity and practical examples of how a researcher developed reflexivity in a grounded theory project are presented.


Implications for nursing


Nurse researchers are encouraged to explore and apply the concept of reflexivity in their research practices to develop transparency in the research process and to increase robustness in their research. The Alvesson and Skoldberg model is of value in applying reflexivity in qualitative nursing research, particularly in grounded theory research.


Conclusion


Being reflexive requires the researcher to be completely open about decisions that are made in the research process. The Alvesson and Skolberg model of reflexivity is a useful model that can enhance reflexivity in the research process. It can be a useful practical tool to develop reflexivity in grounded theory research.

Being reflexive in qualitative grounded theory: discussion and application of a model of reflexivity

Maternal report of young children’s eating styles. Validation of the Children’s Eating Behaviour Questionnaire in three ethnically diverse Australian samples

A ‘good enough’ nurse: supporting patients in a fertility unit

In this paper, I discuss the findings of an ethnographic study of a fertility unit. I suggest that caring as ‘emotional awareness’ and ‘non-caring’ as ‘emotional distance’ may be forms of nursing akin to Fabricius’s (1991) arguments around the ‘good enough’ nurse. This paper critiques caring theories and contributes to the debates over the nature of caring in nursing. I discuss the implications raised for nurses if patients want a practical approach to caring and do not expect an emotionally intimate relationship from nurses.

A 'good enough' nurse: supporting patients in a fertility unit.

This paper comments on feminist research and in particular the use of reflexivity in feminist ethnography. Reflexivity in ethnography is the use of self as an instrument of the data collection and the researcher's own awareness of reactions to the research data.Ethnography requires that the researchers immerse themselves in the field and act reflexively while collecting data. I will discuss how using myself reflexively as a researcher during data collection in an assisted-conception unit led me to reconsider an assumption about the methodology underpinning feminist research approaches. It has been argued that feminist research approaches are women-centred and that debates on reproductive technologies are based on the premise that males control assisted conception.My experience of undertaking a feminist ethnography has challenged these two assumptions. Reflection during and after the data collection has led me to question the aims of women-centred research in a field in which men are participants as doctor...

Reflexivity: A comment on feminist ethnography:

This paper explores the history of the concept of health environment in nursing discourse. The prompt to investigating the subject followed the national research and development (R&D) initiative se...

Helen Allan

Papers

A 'good enough' nurse: supporting patients in a fertility unit.

Reflexivity: A comment on feminist ethnography:

The health environment: A definition and conceptual framework for research and practice