Reflections about experiences of compassionate care from award winning undergraduate nurses – What, so what … now what?

Ensuring robust OSCE assessments: A reflective account from a Scottish school of nursing

AIM

This paper reflects on the experience of one Scottish University in conducting a face-to-face Objective Structured Examination (OSCE) for large cohorts of student nurses. It outlines the challenges experienced and learning gained. Borton's model of reflection frames this work due to its simplicity, ease of application and cyclical nature.

BACKGROUND

The theoretical framework for the OSCE is critical thinking, enabling students to apply those skills authentically. OSCE's are designed to transfer classroom knowledge to clinical practice and offer an authentic work-based assessment.

DESIGN

Validity and robustness are key considerations in any assessment and in OSCE, the number of stations that students encounter is important and debated. We used a case-study based OSCE approach initially over four stations and following reflection, changed to one long station with four phases.

RESULTS

In OSCE examinations, interrater reliability is a necessity, and students expect equity of approach. We identified that despite clear marking criteria, marks were polarised, with students achieving high or low marks with little middle ground. Review of examination papers highlighted that although students' overall performance was good, some had failed in at least one station, suggesting a four-station approach may skew results. On reflection we hypothesised that using a one station case study-based, phased approach enabled the examiner to build up a more holistic picture of student knowledge and skills. It also provided the student opportunity to develop a rapport with the examiner and standardised patient, thereby putting them more at ease. We argue that this approach is holistic, authentic and student centred.

CONCLUSIONS

Our experience highlights that a single station, four phase OSCE is preferrable, enabling students to integrate all aspects of the assessment and provides a holistic view of clinical skills and knowledge.

Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care

Emotional support for patients is critical for achieving person-centered care. However, the literature evidences an ongoing challenge in embedding emotional support within current health services. This study aimed to investigate the strategies to embed emotional support from the perspectives of patients and clinicians. This is an exploratory qualitative study that collected data through focus group discussions (FGDs) and interviews from 11 patients, 2 carers, and 7 clinicians in the multi-disciplinary care teams in an outpatient complex and chronic care setting in New South Wales, Australia. The FGDs and interviews were recorded, transcribed, and thematically analyzed. Three main themes emerged from the experience of both the patients and clinicians: (1) warmth and kindness, (2) deep listening, and (3) social connection in the process of treatment. Clinicians’ and patients’ shared experience of these themes was key to embed emotional support in care. Practical strategies including promoting shared understanding of emotional support, enhancing provider's capability to deliver emotional support, and building patient's networking opportunities in treatment processes were discussed to facilitate emotional support in patient care and health services.

Compassion: Use it or lose it?: A study into the perceptions of novice nurses on compassion: A qualitative approach

BACKGROUND

Nurses and patients believe compassion to be one of the most important professional values. However, it is not known which factors influence compassionate behaviour in practice. There is a need for insight whether or not compassion in nursing practice flourishes or falters.

OBJECTIVES

This study aims to explore how Dutch novice nurses perceive compassion within nursing care and gain insight in their strategies of sustaining and developing compassionate care.

DESIGN

This study used an exploratory design, employing a qualitative approach.

DATA SOURCES

14 in depth interviews with Dutch bachelor novice nurses with 0-5 years of practical experience took place.

REVIEW METHODS

Thematic analysis and inductive coding was used.

RESULTS

Four themes emerged from the data. First, participants perceive compassion to be a part of their professional identity. Balancing between positive and negative environmental influences and their own perceptions was shown as a second theme. Thirdly, various strategies such as rebellion and conforming to the ideas on the workplace helped nurses to do so in daily practice. If nurses succeeded in dealing positively with various influences, a professional development was perceived over time. The fourth theme described the increased awareness of compassion and professional identity if strategies were successful. If not; insecurity, job dissatisfaction and ultimately consideration of job-retention was described.

CONCLUSION

Compassion is an essential value during the development of the professional identity of novice nurses. Dealing with meaningful emotions and experiences broadened nurses' personal awareness of compassionate care and stimulated a growth in their professional identity. Novices need support during their internships that builds empowerment and resilience in sustaining compassion. Furthermore, there is a need for role models and a corporative team spirit in order to coach novice nurses in compassionate behaviour.