Does the emphasis on caring within nursing contribute to nurses' silence about practice issues?

Nurses' perceptions of caring behaviors at referral hospitals in Ethiopia: A mixed-methods approach

BACKGROUND

Caring plays a vital role in nursing and serves as an indicator of quality. Nurse caring behaviors are directed towards patients' safety and wellbeing. Nurses' perceptions of caring behaviors are affected by different factors. Understanding the factors linked to how nurses perceive caring behaviors is crucial for enhancing the quality of care. The aim of this study was to examine the factors associated with nurses' perceptions of caring behaviors and gain a more comprehensive understanding.

METHODS

A multicenter sequential explanatory mixed-methods study was conducted among medical-surgical nurses at three referral hospitals in the Amhara region, Ethiopia. Quantitative data were collected using a pretested self-administered survey package including the Amharic version of the Caring Behaviors Inventory-16. Qualitative interviews using semi-structured, open-ended questions were conducted after the survey to complement and clarify the quantitative results, facilitating integrate through a connecting approach. A multiple linear regression model was used to examine the relationship between nurses' perceptions of caring behaviors and associated factors. The qualitative data was examined to find meaningful patterns using codebook thematic analysis. This method was deductive and followed the guidelines by Braun and Clarke, building on the findings from the quantitative results.

RESULTS

The overall mean of nurses' perceptions of caring behaviors was 4.75. The multiple linear regression analysis showed that female sex (b = 0.300, P = 0.004), age (b = 0.028, P = 0.001), nurse staffing (b=-0.115, P = 0.001), work-related stress (b = 0.298, P = 0.003), and job satisfaction (b=-0.254, P = 0.016) were associated with nurses' perceptions of caring behaviors. The codebook thematic analysis generated three themes, caring is universal and fundamental in nursing, impediments to provision of comprehensive care, and perception of the work conditions. The findings of the qualitative data complemented the results of the quantitative data.

CONCLUSION

Discrepancies between nurses' expectations and the actual working environment may create uncertainty in care provision and impact quality-of-care. Strategies to harmonize the nurses' working environment should consider work-related factors.

Fake kindness, caring and symbolic violence

The article starts by offering a definition of fake kindness focused on the dissociation between the behavioural components of kindness and the intent to sincerely pay some heed to the needs of others. Using the sociological theory of Pierre Bourdieu, this definition is then used to articulate how fake kindness can be conceptualized as a specific form of symbolic violence. Such a view allows explanations as to how and why the prevalence and effectiveness of fake kindness vary according to microsociological norms and values. The generic definition and conceptualization of fake kindness as a form of symbolic violence are then used to discuss how nursing's enthrallment with the concept of caring and its operationalization as a moral compass likely fosters the growth of fake kindness within the profession. In this view, the institutional enforcement of propriety and well-behaved professionalism is more likely to lead to toxic environments than to healthy workplaces. We hope that being able to understand how professional norms and institutional rules are sometimes turned into social tools to enforce obedience and existing hierarchies can empower victims of those phenomena to resist them more effectively. It might also contribute to increasing the awareness of well-meaning nurses or people in position of authority who have been socialized in environments where fake kindness is normalized.

Spirituality, Religiosity, Caring Behavior, Spiritual Care, and Personalized Care Among Student Nurses: A Descriptive Correlational Study in the Philippines

This study sought to determine the student nurses' spirituality, religiosity, caring behavior, spiritual care, and personalized care. Further, it sought to determine the relationship between spirituality, religiosity, and caring behavior in student nurses' spiritual care and personalized care. The study used a descriptive correlational design using convenience sampling to collect data from 1248 student nurses in the Philippines from December 2023 to February 2024. We collected data using the Spirituality and Spiritual Care Scale rating scale and the Caring Behaviors Inventory. The study revealed that the mean scores of the students in their "spirituality" and "religiosity" were 4.08 (SD = 0.98) and 2.99 (SD = 1.26), respectively. Student nurses had sufficient confidence and skills in spiritual care, caring behavior, and personalized care. The students' age had a weak and negative association with the students' spirituality and religiosity. Students from University A had higher levels of spirituality and religiosity than students from University B, University C, and University D. Students in the 4th year level were more religious than 3rd year students. Students who had their last clinical exposure in the Admission and emergency room reported poorer caring behaviors than those who had previous clinical exposure in the Medical-surgical ward, Obstetrics and gynecology, Intensive Care Units, and Community. There is no significant relationship between a student nurse's spiritual care and caring behavior. This trend is similar to caring behavior and personalized care. The students' age predicts their personalized care.

The relationship between self-compassion and caring behaviour in nurses: A cross-sectional study

AIM

To examine the relationship between self-compassion and caring behaviour in nurses.

BACKGROUND

Self-compassion can influence nurses' ability to cope with stress and their job performance. High levels of self-compassion may play a role in nurses' coping with compassion fatigue and burnout. This may make the concept of self-compassion in nurses an important variable for effective care.

METHODS

This is a cross-sectional study. Study data were collected between March and May 2022 from 331 nurses at a hospital in the city of Antalya, Turkey. A personal information form, the Self-Compassion Scale (SCS), and the Caring Behaviour Inventory-24 (CBI-24) were used to collect data, and the program SPSS 23.0 was used in data evaluation. Descriptive statistical methods, Pearson correlation analysis and multiple linear regression analysis were used in the analysis of data. The STROBE checklist was followed for this cross-sectional study.

RESULTS

The nurses' mean scores were 3.50 ± 0.61 on SCS and 5.21 ± 0.56 on CBI-24. A positive correlation was found between the nurses' self-compassion levels and caring behaviour. Also, the SCS sub-dimension of mindfulness, working in intensive care and working willingly in the nursing profession significantly predicted caring behaviour. These variables explain 19.4% of the variance of caring behaviour.

CONCLUSIONS

The nurses' self-compassion levels were medium and their caring behaviour was at a high level, and caring behaviour was higher in those who worked in intensive care, those who were working willingly in the nursing profession, and in those with high scores on the self-compassion sub-dimension of mindfulness.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

It is important to strengthen nurses' self-compassion skills to develop their caring behaviour. In particular, giving nurses in clinics mindfulness-based education will help them to increase their awareness concerning their own lives and to develop their caring behaviour.

Framing Unions and Nurses

Union communication and framing are important for how union members, as well as how unions as organizations, are represented. In the context of declining union density and therefore fewer direct union members, unions' daily communication material on social media may be one of the most common interactions people have with unions. This case study focuses on United Nurses of Alberta, the union for most registered nurses in Alberta, Canada, where unionization rates are among the lowest in Canada. This case study shows how United Nurses of Alberta uses two collective action frames, nurses-as-distinct and nurses-as-advocates, in their daily communication to members and the public. In creating and promoting these frames, United Nurses of Alberta draws from and pushes against the industrial relations framework under which they operate and the historical narrative of nurses as caring and self-sacrificing, which may reinforce common understandings of nursing and also limit United Nurses of Alberta's ability to represent their members.

Perceptions of caring behaviors: Experiences of nurses in Ethiopia

Caring is a universal phenomenon that influences nurse-patient interactions and feelings, forming the foundation of the nursing profession. How nurses perceive and experience caring in low-income settings is not well understood. Therefore, the purpose of this study was to explore Ethiopian nurses' perceptions and experiences of caring using a qualitative descriptive design. Individual semi-structured interviews were conducted with 13 nurses aged 28-57. Interviews were analyzed inductively using reflexive thematic analysis guided by the recommendations of Braun and Clarke. The analysis resulted in three themes: caring is the heartbeat of patient care, constraints to the provision of care, and ways to overcome constraints. The results revealed that nurses were committed to fulfilling their professional obligations and meeting patients' needs despite experiencing multiple constraints. The findings provide a comprehensive perspective in understanding nurses' experiences of caring. Their narratives demonstrate that they face constraints in their clinical practice, which limit the quality of care, including rotation and lack of resources. Cooperation between health policymakers and nurse authorities is essential for shifting the clinical environment from the prevailing traditional task-oriented approach to patient-centered care.

Examining the role of nurse executives in homecare through the lens of the Sociology of Ignorance and Critical Management Studies

This article presents a novel theoretical approach to explore nurse executives' paradoxical identity and agency of executive and nurse in homecare organizations. This complex phenomenon has yet to be well theorized or analyzed. Through a synthesis of literature, we demonstrate that Critical Management Studies, as informed by Foucault, and the Sociology of Ignorance, can create a different understanding of the complex interplay between knowledge and nonknowledge (ignorance) that positions nurse executives in both influential and precarious ways in homecare organizations. This theoretical framework has the potential to allow for the explicit exploration of nurse executives' strategic epistemic and discursive positioning and highlights hierarchal power structures within homecare organizations. We posit that this framework, that spans nursing, management and sociology disciplines, sets a different understanding of homecare organizations as epistemic landscapes, exposing institutional knowledge and ignorance dynamics that remain largely concealed and unchallenged, yet are integral to understanding nurse executives' epistemic agency.

Home Care in America: The Urgent Challenge of Putting Ethical Care into Practice

Home care is one of the fastest-growing industries in the United States, providing valuable opportunities for millions of older adults and people with disabilities to live at home rather than in institutional settings. Home care workers assist clients with essential activities of daily living, but their wages and working conditions generally fail to reflect the importance of their work. Drawing on the work of Eva Feder Kittay and other care ethicists, we argue that good care involves attending to the needs of another out of a concern for their well-being. Such care should be standard in the home care system. Yet, because of the pervasive racial, gender, and economic inequalities that the home care industry perpetuates, home care workers and their clients cannot reasonably be expected to care about each other. We endorse reforms aimed at enabling home care workers and their clients to form and maintain professional relationships that cultivate care..

ICU nurses´ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study

Background

The care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit.

Methods

This study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results

The interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’.

Conclusions

ICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.

A Foucauldian discourse analysis of media reporting on the nurse-as-hero during COVID-19

This study uses a Foucauldian discourse analysis to explore media reporting on the role of nurses as being consistently positioned ‘heroes’ during COVID‐19. In so doing, it highlights multiple intersecting discourses at play, with the caring discourse acting as a central one in negatively impacting nurses' ability to advocate for safe working conditions during a public health emergency. Drawing on media reports during the outbreak of COVID‐19 in Ontario, Canada in the spring of 2020 and on historical information from SARS, this study seeks to establish caring as a discourse and examine if the caring discourse impedes nurses' ability to protect themselves from harm. The results of this analysis explicate how public media discourses that position nurses as caring, sacrificial and heroic may have impacted their ability to maintain their personal safety as a result of the expectations put upon the nursing profession.

Being and becoming a nurse: Toward an ontological and reflexive turn in first-year nursing education

In this paper, we call for an ontological and reflexive turn in first-year nursing education. An ontological turn focuses on formation, the 'being' and 'becoming' of a nurse, and emphasizes the value of nursing knowledge. First-year nursing students often possess romanticized ideals about being a nurse that devalues the knowledge and expertise of nurses. We posit a thoughtful ontological orientation within nursing education that shifts the emphasis toward becoming skillful nurses, with expertise grounded in nursing perspectives. A focus on formation includes discussions regarding ideologies, dominant perspectives, and reflexive explorations of students' views of nursing juxtaposed with the realities of nursing practice. We propose ontologic reflexivity as an approach to consider what perspectives are prioritized (or not) within the nursing classroom. Within pedagogical dialogic spaces, ontologic reflexivity calls on educators to create opportunities for students to learn the value of nursing knowledge along with other forms of knowledge. We consider ways in which an ontological and reflexive turn within the first year of nursing education may contribute to the formation of nursing students who value nursing knowledge, are open-minded to various forms of knowledge, and possess an intentional reflexive way of being.

How nurses' use of language creates meaning about healthcare users and nursing practice

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses' use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person-centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses' compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power-laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others.

Professional nurses' experiences of caring for patients in public health clinics in Ekurhuleni, South Africa

Background

Caring for patients is the core aspect of nursing and a cornerstone of all nursing duties. Although caring is seen as a critical component of nursing delivery and an essential characteristic of nursing, there seems to be a gap between theory and practice.

Aim

The aim of this article was to explore and describe the experiences of caring for patients by professional nurses in public health clinics in Ekurhuleni.

Setting

The study was conducted in Ekurhuleni, an area east of the Gauteng Province in two public health clinics.

Methods

A qualitative, exploratory, descriptive phenomenological and contextual research design was used. In-depth, individual phenomenological interviews were conducted with eight purposefully sampled professional nurses to explore their experiences of caring for patients in public health clinics in Ekurhuleni. Data were analysed using Giorgi’s coding method.

Results

Two themes were revealed in the study findings. The first theme was the experienced empowering aspects of caring while the second theme was the experienced disempowering aspects of caring. The experienced empowering aspects of caring had two categories: empowering interpersonal experiences and the empowering experiences through client affirmation. These were identified by the participants as enabling effective caring for patients. The experienced disempowering aspects of caring also had two categories: disempowering interpersonal experiences and the disempowering experiences resulting from public health clinic system challenges. The disempowering aspects were identified by participants as disenabling effective caring for patients.

Conclusion

The study findings reveal that the professional nurses had empowering and disempowering experiences while caring for patients in the public health clinics.