Living nursing values: A collective case study

Abstract

<p>Distinctive humanistic values are foundational in professional nursing practice, commonly shared by members of the profession and the mainstay of how nurses act. The foundational values of the nursing discipline are balanced with clinical knowledge and technical skill. Nursing values presuppose nurses’ responsibility to nurture and protect, to heal, to cultivate healthy behaviours and attitudes, and to be present (physically and intellectually) during times of vulnerability, illness or injury. The rationale for this study came from the recognition that nursing has changed, so too have the characteristics of patients and the way healthcare is operationalised. Nurses are challenged on a daily basis to negotiate between meeting the complex needs of patients whilst addressing healthcare priorities and attending to their own personal and professional requirements. There is a growing philosophical debate about whether the healthcare climate is dehumanising health care professionals’ encounters with patients, including those of nurses, and creating a culture where enacted values are inconsistent with professionalism. The purpose of the research was to explore the values of professional nurses practicing in medical ward environments and how these values are lived in day-to-day practice. Case Study methodology was used to capture the contextual conditions of nursing values in nurses’ daily practice. Data collection was carried out in three medical wards in New Zealand; data were triangulated using observations, focus groups, interviews, burnout survey and theoretical application. The major theoretical and philosophical influences on the research, which were used to explore the data, were those of Isabel Menzies’ defences against anxiety and Edith Stein’s phenomenological theory of motivation and value. Key findings indicate that healthcare environments obstruct the enactment of humanistic nursing values stimulating value dissonance for nurses between how they want to practice and how they actually practice. Conflict arises from nurses experiencing systems that foster managerialism and cultures of anxiety. In order to cope with value dissonance, nurses enact unconscious defence mechanisms; resulting in constrained nursing practice, exhaustion, cynicism and burnout. This thesis challenges the nursing profession to acknowledge and address the visibility of nursing values in contemporary practice, as well as acknowledge the dissonance that exists between the values of nursing and the values that drive healthcare delivery. Humanistic nursing values remain important to practicing nurses. This study identifies in detail the every-day difficulties nurses face in seeking to enact their values and the managerial challenges that confront them. This information offers a trustworthy analysis of the challenges the nursing profession faces in addressing this problem. It also offers a basis for developing approaches that could strengthen nurses’ ability to enact the humanistic values they are professionally committed to provide. It is critical that any attempt to embed nursing values into clinical nursing practice is founded on a strategy that recognises and mitigates against dysfunctional organisations and organisational constraints. Drawing on findings from this thesis, it is recommended that the articulation and development of nursing values in acute clinical environments is responsive to organisational factors. Through this, the nursing community can develop, articulate and operationalise nursing values.</p>