"Hanging On in There": A Qualitative Longitudinal Study Exploring Caring Values in Undergraduate Nurse Students

Purpose: Globally numbers of older people with complex long-term conditions is increasing and meeting their needs effectively, efficiently and with compassion, represents considerable challenges for financiallyconstrained health service providers. Into this context undergraduate nursing students are placed to learn and experience the art and science of nursing practice. It is of concern therefore that evidence is emerging internationally around deficits in quality of care, particularly for older people (Katz 2011; OECD 2016). Galvin and Todres 2013 amongst others have argued that in target-driven care environments, potentially care professionals can too readily lose sight of the person receiving the care by focusing on task-completion, resulting in a dehumanising culture of care. Within the United Kingdom (UK) a number of high profile examples of poor quality care (Francis 2013) resulted in a creative and forthright vision and strategy for nursing and care staff in England (Department of Health and NHS Commissioning Board 2012), recently updated following a wide consultation exercise (NHS England 2016). These focus on embedding foundational caring values in the organisational culture of the National Health Service (NHS) to ensure compassionate, competent practice. Understandably recruitment and education of nursing students has also come under scrutiny and in particular how education can contribute to a compassionate culture in healthcare. This has resulted in the implementation of values-based recruitment processes and the development and implementation of overt values-based undergraduate nursing curricula. Limited evidence exists however, concerning the impact of such approaches over time.

This paper reports on a study that evidences the impact of an education programme based on a humanising care philosophy in shaping the students’ value base as they progress from commencement to completion of their nursing degree.

Methods: The study uses a qualitative longitudinal approach to understand the beliefs and values of student nurses from the day of entry through their education programme to completion. Two cohorts of students, one year apart (commencing February 2013) were recruited, the first on an outgoing curriculum, whereas the second cohort (February 2014 start) were exposed to a new curriculum based on a humanising philosophy (Galvin and Todres 2013). This presentation reports a comparison between the two groups at completion of their programmes (a three year Honours degree leading to nurse registration/licensure). Data were collected by individual interviews at programme commencement, focus groups after their first clinical placement, at the end of their first year and second year and then individual interviews just prior to programme completion. Ethics approval was gained for the entire project. At each stage of the process, students were formally invited to participate and on-going individual consent was gained. The audio-recordings were transcribed verbatim and analysed thematically.

Results: At course commencement, there were few differences between the groups, with lay and somewhat idealistic perceptions of caring in nursing dominating. Following the first clinical placement, again both groups expressed similar perceptions, with a focus on task completion and competence and ideas about ‘caring for’ rather than ‘caring with’ being prominent. In later data sets students expressed some lack of confidence in their ability to put theory into practice, with some negative comments as to their position as students and learning to challenge poor practice. There were many commonalities expressed by both groups about the importance of knowledge, of how much they are learning about themselves and the negative effects of poor staffing on the quality of care. Students exposed to the new curriculum more clearly articulated the difference they felt from being a healthcare assistant (HCA), the authority and trust they gained as a student (as opposed to being an HCA) and they focused more readily on the patient at the centre of care rather than their own personal development. Phase 5 data collection for the second cohort has just completed at the time of writing; insights from the subsequent analysis will be incorporated in the presentation.

Conclusion: By the end of their first placement, both groups were very similar in the expression of their values and to some extent presented a rather negative view of their experiences. Students from both groups were noticeably more articulate in expressing their values particularly in relation to their placement experience, as they moved through their programme. Further comparative insights emerging from the full-set of end of programme data will be a central focus of the presentation. The audience will be invited to judge transferability of findings to their setting; whilst this paper reports on a study from one university in the UK, the insights will have resonance for other nurse education providers internationally.