A moral profession: Nurse educators' selected narratives of care and compassion.

BACKGROUND:: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. OBJECTIVE:: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators' selection and use of published texts and film. METHODOLOGY:: This study employed discourse analysis. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. FINDINGS:: The desire to understand others and how to care compassionately characterised educators' choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those 'deserving' often understood as the suffering person doing enough to help themselves. DISCUSSION:: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). CONCLUSION:: To feel cared about people need to feel 'visible' as though they matter. Nurses need to be alert to problems that may arise if their 'moral vision' is influenced by ideas of desert and how much the patient is doing to help himself or herself.

Understanding and meeting your legal responsibilities as a nurse.

Nurses, midwives and nursing students are legally responsible for their actions. This article discusses the legal standard of care required in relation to nursing and midwifery practice and nurses' professional standards and code of conduct. It examines how courts in the UK determine if nurses have met their duty of care and how nurses must ensure they maintain competence to provide safe care. It examines why organisational knowing - understanding the organisation in which one is employed; its people, values and how it works - is important for all nurses, regardless of their level in the organisation. It also discusses workplace incivility and its adverse effects on nurses, patient care and healthcare organisations. The article explains that if nurses are uncertain why they are doing something, they should investigate this further, because the law expects nurses to be able to justify their actions, or failure to act.

A research-based mantra for compassionate caring.

BACKGROUND: The United Kingdom introduced the Six C's strategy to help address deficits in approaching nursing care in a compassionate and caring manner. OBJECTIVE: To identify the book, article, poem, film or play that most influenced nurse educators' understanding of care and compassion and to articulate a clearer understanding of compassionate caring. DESIGN: A qualitative study applying discourse analysis to respondents' questionnaires and their nominated narrative. SETTINGS AND PARTICIPANTS: 41 nurse educators working in 5 universities in the UK (n=3), Republic of Ireland and Canada participated. 39 items (10 books, 2 journal articles, 10 poems, 15 films and 2 plays) were nominated. FINDINGS: The desire to understand others and how to care compassionately characterised choices. Three main themes emerged. Abandonment of, and failure to see, the suffering person was evident in 25 narratives. Connecting with others was shown in 25 narratives as being able to truly seeing the other person. Comforting others was supported by 37 narratives with examples of kindness and compassion. CONCLUSION: Published narratives are valuable in developing compassionate responses. An annotated list is provided with suggestions for educational uses to help develop compassionate caring in student nurses. Compassionate, caring nurses recognise that patients need them to: "See who I am; Be present with me; Do not abandon me."

Expert Nurses' Perceptions of the Relevance of Carper's Patterns of Knowing to Junior Nurses.

This study explored with expert nurses in the UK how nursing wisdom can be developed in new and junior nurses. Carper's patterns of knowing and Benner's novice-to-expert continuum formed the theoretical framework. Employing a constructionist research methodology with participant engagement in co-construction of findings, data were collected via 2 separate cycles comprising 4 consecutive sessions followed by a nationally advertised miniconference. Empirical, ethical, personal, and esthetic knowing was considered evident in junior nurses. Junior nurses in the UK seem to lack a previously unrecognized domain of organizational knowing without which they cannot overcome hegemonic barriers to the successful development of nursing praxis.

Contemporary nursing wisdom in the UK and ethical knowing: difficulties in conceptualising the ethics of nursing.

This paper's philosophical ideas are developed from a General Nursing Council for England and Wales Trust-funded study to explore nursing knowledge and wisdom and ways in which these can be translated into clinical practice and fostered in junior nurses. Participants using Carper's (1978) ways of knowing as a framework experienced difficulty conceptualizing a link between the empirics and ethics of nursing. The philosophical problem is how to understand praxis as a moral entity with intrinsic value when so much of value seems to be technical and extrinsic depending on desired ends. Using the Aristotelian terms poesis and praxis can articulate the concerns that the participants as well as Carper (1978) and Dreyfus (in Flyvbjerg, 1991) among others share that certain actions or ways of knowing important for nursing are being devalued and deformed by the importance placed on quantitative data and measurable outcomes. The sense of praxis is a moralized one and most of what nurses do is plausibly on any account of normative ethics a morally good thing; the articulation of the idea of praxis can go some way in showing how it is a part of the discipline of nursing. Nursing's acts as poesis can be a part of how practitioners come to have praxis as phronesis or practical wisdom. So to be a wise nurse, one needs be a wise person.

The effect of fluency in English on the continuing professional development of nurses educated overseas.

BACKGROUND: In the United Kingdom, many nurses who were educated overseas and are not native English speakers are undertaking continuing professional development study within their host country. This study investigated the effect of fluency in English on the teaching and learning of registered nurses undertaking continuing professional development within a health and social care faculty in a U.K. university. METHODS: A qualitative, interpretive method was used. Data were obtained through thematic analysis of semi-structured individual interviews with educators, nurses educated in the United Kingdom, and nurses educated overseas who were not native English speakers and were undertaking continuing professional development. RESULTS: Participants included six educators, six registered nurses who were educated in the United Kingdom, and six registered nurses who were educated overseas and were not native English speakers. Educators resorted to generalizations in describing nurses' teaching and learning characteristics. Classroom dynamics that impeded nurses' learning were reported. Critical thinking, academic success, and integration within the classroom were affected by the ability to research, question, and discuss new or complex continuing professional development topics in English. CONCLUSION: Fluency in academic nursing English is necessary for successful continuing professional development. Educators should use and develop strategies to encourage integration in the classroom between nurses who were educated in the United Kingdom and those who were educated overseas and are not native English speakers to support critical thinking and engagement by all participants.

Blocking Babesia bovis vaccine reactions of dairy cattle in milk.

The use of 1.16 mg/kg (one third) of the recommended dose of diminazene aceturate, administered indiscriminately to cattle on day seven of the unfrozen Babesia bovis and Babesia bigemina bivalent live blood vaccine reaction, was an infection and block treatment method of immunisation used successfully with no known adverse effect on the parasites or the development of protective immunity. Continuing with this practice after replacement of the unfrozen vaccine with deep-frozen monovalent B. bovis and B. bigemina live blood vaccines resulted in reports of vaccine failure. Laboratory investigation indicated the harmful effect of block treatment in preventing the development of durable immunity against B. bigemina as opposed to the much lesser effect it had on B. bovis. Consequently the practice was no longer recommended. A B. bovis vaccination attempt aimed at controlling the disease of dairy cows in milk (n = 30) resulted in 20% fatalities during the expected vaccine reaction period. The practice of block treating B. bovis was therefore reinvestigated, this time in a field trial using dairy cattle in milk (n = 11). Using 0.88 mg/kg (one quarter) of the recommended dose of diminazene administered on day 12 of the B. bovis vaccine reaction resulted in only two animals (n = 5) testing ≥ 1/80 positive with the indirect fluorescent antibody test (IFAT) although parasites could be demonstrated in three. In the untreated control group, by contrast, five of the vaccinated animals (n = 6) tested ≥ 1/80 positive with IFAT and parasites could be demonstrated in all. The unsatisfactory outcome obtained in this study, combined with that of the earlier investigation, indicated that there are more factors that influence successful vaccination than previously considered. It is therefore concluded that block treatment of the live frozen South African cattle babesiosis vaccines reactions is not recommended.

Changes in nurse education: delivering the curriculum.

The aim of this study is to examine changes in pre-registration nursing education through the personal accounts of nurse teachers. This paper is based on 37 in-depth interviews within a central London Healthcare Faculty. Each interview was subjected to a process of content analysis described by Miles and Huberman. The interviews took place between August 2003 and March 2004 and totalled 34.4 hours or 305,736 words. There were thirty female and seven male participants, who shared 1015 years of nursing experience, averaging at 27.4 years (min 7-max 42). These were supplemented by 552 years of teaching practice, the average being 15 years (min 0.5-max 29). This paper--delivering the nursing curriculum--identifies that the nature of nursing has changed as it has both expanded and contracted. Participants identified three major changes; the nature of nursing, selection of future nurses and the current impact that large cohorts have on our traditional model of person-centred education. The practice placements remain central to nursing education and it is the nursing role that should define the curriculum and the values of higher education should be supportive of this identity.

Changes in nurse education: being a nurse teacher.

The aim of this study is to examine changes in nursing education through the personal accounts of nurse teachers. This paper is based on 37 in-depth interviews within a central London Healthcare Faculty, which took place between August 2003 and March 2004 and totalled 34.4h or 305,736 words. There were thirty female and seven male participants, who between them shared 1015 years of nursing experience, averaging at 27.4 years (min7-max 42). These nursing years included 552 years of teaching practice, the average time being 15 years spent in a formal teaching role (min 0.5-max 29). Each interview was subjected to a process of thematic content analysis as described by Miles and Huberman. This paper identifies how nurse teachers try to combine teaching with a nursing role. The Government, the NHS, the Universities and the Nursing and Midwifery Council all articulate contradictory visions of the nurse teacher role, which raises the question of what additional value (if any) is gained from combining nursing practice and its teaching. This tension has led to a default situation where the longer a nurse works as a teacher the less likely it is that they will maintain any nursing practice.

Healthcare assistants: the new registration route.

A number of locally organised schemes now exist to help healthcare assistants access programmes leading to qualified nursing status. Although some schemes have been operating for some time, little has been done to evaluate their effectiveness. However, drawing on the literature that has addressed indicators of successful completion among entrants taking a more conventional route into nursing, it is possible to predict which individuals are most likely to complete courses and course-related factors that encourage successful completion.