Invisible gorillas and red herrings: a response to Paley (2013)

Exploring Primary Healthcare Students and Their Mentors' Awareness of Mentorship and Clinical Governance as Part of a Local Continuing Professional Development (CPD) Program: Findings of a Quantitative Survey

Introduction: Previous research exploring the benefits of mentoring and the place of clinical governance in enhancing care delivery illustrated an unexplored synonymous relationship between mentors and mentees (students at undergraduate and postgraduate levels) and its potential impact on patient safety and quality of care. The significance of the research was in recognizing the importance the role of the mentor can play in raising awareness of patient safety and clinical governance principles and processes in the primary healthcare setting. Aims: Building on this preliminary research, this research aimed to explore primary healthcare workers and their mentor’s awareness of mentorship and clinical governance as part of a local Continuing Professional Development (CPD) program. Furthermore, it aimed to establish any relationship between the mentors, the mentee, and their awareness and application of clinical governance in the primary healthcare setting. Methodology: A quantitative research design using a survey was adopted. Data Collection Instrument: The researchers integrated previously validated questionnaires incorporating a Mentor Potential Scale, the Dimensions of Mentoring, and a Clinical Governance Awareness Questionnaire into a new questionnaire. This was called “Mentorship and Clinical Governance Awareness”. Sample: Convenience sample surveys were posted to complete and return to 480 primary healthcare workers undertaking post graduate study. Findings: A total of 112 completed questionnaires were included for the analysis amounting to a 23% response rate. A principle component factor analysis combining part 1— the characteristics of an effective mentor and part 2—the personality characteristics of an effective mentor identified four primary characteristics. These are: (1) “A Facilitatory Adviser”, (2) “Critically Enabling Facilitator”, (3) “A Change Facilitator”, and 4) “An Approachable Facilitator”. These newly identified characterizations according to the primary healthcare workers significantly impacted on their awareness and application of clinical governance in primary healthcare practice. Implications for primary healthcare practice and education: The newly devised questionnaire can be used to gauge the effectiveness of mentors and mentoring and how the characteristics of the role can impact on mentee’s awareness and application of clinical governance. Healthcare manager’s, leaders, and educators should focus their attention on how these newly established characteristics of the mentor can influence clinical governance awareness and application in healthcare the future.

Understanding and addressing missed care in clinical placements - Implications for nursing students and nurse educators

This paper addresses the issue of substandard care and its effects on healthcare practice. It explores some recent concerns about the problem in nursing, its potential effects on students, how it can be conceptualised and what action needs to be, by both nurses and educators to prevent it. Recent healthcare scandals have tarnished the public image of nursing, and are also likely to influence nursing students' images, expectations and experiences of nursing. While much attention has been paid to the examination of such lapses in care, and potential corrective actions, little attention has been paid to the potential or actual effect on nursing students in practice. While good resources and staffing levels are crucial to ensuring optimal nursing care, developing and encouraging nursing students' awareness of and openness about personal behaviours, reflecting critically on practice reflection and strengthening nurse educators' collaborative links with healthcare practice can all serve to positively influence care deficits.

Teaching psychology to nursing students-a discussion of the potential contribution of psychology towards building resilience to lapses in compassionate caring

Psychology is a required element in nursing education in many countries. It is particularly aimed at teaching nursing students to get a better understanding of patients, colleagues, health care organizations and themselves, and moreover to apply what they learn about psychology to optimise their care. A meaningful integration of psychology within nursing education requires an emphasis on its application in understanding aspects of care and skills development. However, its ultimate value is demonstrated when addressing problem areas in nursing and health care. In this paper the authors outline an approach to psychology education in nursing which emphasises its development as a problem solving support. An example is presented which focuses on the application of psychology to the challenge of care erosion and deficient critical nursing reflection. The discussion includes the organisational context, social pressure, social cognition, reflection and the role of inner conflict (cognitive dissonance). Nursing educators can contribute to the prevention of care erosion by a combined effort to teach awareness of psychological mechanisms, 'critical' reflection, mastery in practice, strong values and standards, and 'inoculation' against justifications of substandard care.

A critical analysis of the failure of nurses to raise concerns about poor patient care

The occurrence of poor patient care is emerging as one of the most significant, challenging, and critical issues confronting contemporary nursing and those responsible for the provision of health care more generally. Indeed, as a consequence of the increased recognition of the manner in which nurses can be implicated in the occurrence of poor patient care, there has been sustained critical debate that seeks to understand how such healthcare failings can occur and, in particular, why nurses seemingly fail to intervene, raise concerns, and effectively respond to prevent the occurrence and continuation of such poor patient care. In seeking to contribute to this critical discussion, and in contrast to those "situational explanations" that maintain that the failure to raise concerns is a consequence of the contextual factors and challenging conditions to which nurses can be subject in the clinical setting, this paper will provide a resolutely philosophical analysis of that failure. In particular, it will draw upon the work of Jean-Paul Sartre-the French philosopher generally regarded as one of the most influential thinkers of the twentieth century-in order to propose that his work can be productively recontextualized to provide a detailed, challenging, and provocative critical analysis of the occurrence and continuation of poor patient care and the role of individual nurse practitioners in such healthcare failings.

Exploring the compassion deficit debate

Several recent high profile failures in the UK health care system have promoted strong debate on compassion and care in nursing. A number of papers articulating a range of positions within this debate have been published in this journal over the past two and a half years. These articulate a diverse range of theoretical perspectives and have been drawn together here in an attempt to bring some coherence to the debate and provide an overview of the key arguments and positions taken by those involved. In doing this we invite the reader to consider their own position in relation to the issues raised and to consider the impact of this for their own practice. Finally the paper offers some sense of how individual practitioners might use their understanding of the debates to ensure delivery of good nursing care.

Care erosion in hospitals: Problems in reflective nursing practice and the role of cognitive dissonance

Care erosion - gradual decline in care level - is an important problem in health care today. Unfortunately, the mechanism whereby it occurs is complex and poorly understood. This paper seeks to address this by emphasising problems in reflective nursing practice. Critical reflection on quality of care which should drive good care instead spawns justifications, denial, and trivialisation of deficient care. This perpetuates increasingly poor care levels. We argue that cognitive dissonance theory provides a highly effective understanding of this process and suggest for this approach to be incorporated in all efforts to address care erosion. The paper includes a detailed discussion of examples and implications for practice, in particular the need to restore critical reflection in nursing, the importance of embracing strong values and standards, and the need for increased awareness of signs of care erosion.

Absent bystanders and cognitive dissonance: a comment on Timmins & de Vries

Timmins & de Vries are more sympathetic to my editorial than other critics, but they take issue with the details. They doubt whether the bystander phenomenon applies to Mid Staffs nurses; they believe that cognitive dissonance is a better explanation of why nurses fail to behave compassionately; and they think that I am 'perhaps a bit rash' to conclude that 'teaching compassion may be fruitless'. In this comment, I discuss all three points. I suggest that the bystander phenomenon is irrelevant; that Timmins & de Vries give an incomplete account of cognitive dissonance; and that it isn't rash to propose that educating nurses 'for compassion' is a red herring. Additionally, I comment on the idea that I wish to mount a 'defence of healthcare staff'.

Francis, fatalism and the fundamental attribution error: a reply to Philip Darbyshire

Philip Darbyshire has apparently gained the impression that I used 'gee-whiz' social psychology to 'absolve poor or negligent practice from any hint of personal responsibility and accountability'. In this reply, I first discuss the fundamental attribution error, which Darbyshire trivialises as the 'fundamental arrogance error' and a piece of 'linguistic puffery'. Second I examine Darbyshire's rather naive view of causation. Third, I suggest that, on a more defensible view of causality, situations as causes do not absolve nurses from 'any hint' of personal responsibility, but they do set limits to responbility, even if Darbyshire finds this morally incovenient. Finally, I argue that the focus on individual accountability should give way to a public health model of containment and prevention. I conclude with some remarks on 'outsider disbelief'.

Compassion and the fundamental attribution error: a reply to Rolfe & Gardner

In this reply to Rolfe & Gardner's critical discussion of my editorial I do two things. First, I describe the theoretical context of the Darley & Batson study. This is the situationist perspective in social psychology, which overlaps with the idea of the cognitive unconscious. Second, I defend my account of the Good Samaritan study against Rolfe & Gardner's criticisms.