Small acts, large workplace dilemmas – nursing and compassion in interaction : A conversation analytic study

Drewery, Rachael (2023) Small acts, large workplace dilemmas – nursing and compassion in interaction : A conversation analytic study. PhD thesis, University of Nottingham.

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High profile care failures within the UK, and the subsequent emergence of and emphasis on values-based healthcare in policy, have resulted in calls for compassion to be embedded throughout nursing practice. This attention on compassion has frequently been focused on the individual nurse, with policy suggesting that a nurse’s compassion is exhibited within and during interaction with the patient. There is however, little clarity regarding how compassion should be defined or what compassionate interaction involves.

Much of the existing research focuses on the perceptions and experiences of patients and/or healthcare professionals, concluding that compassion is an internal trait or state, which is expressed through communication practices (e.g. eye contact to display listening). However, while either conclusion leads to a recognition of the importance of communication skills, these studies provide little specificity about how compassionate interaction can be recognised or reproduced. This thesis addresses this research gap, presenting a conversation analytic study investigating how compassion is enacted within nurse-patient interaction.

Fieldwork was undertaken on hospital wards in a large teaching hospital and a reablement unit. Here twenty-seven audio- and/or video-recordings of naturally occurring interaction between advanced clinical practitioners (ACPs) and older patients were collected. These recordings were analysed using conversation analysis, and analysis focuses on three interactional phenomena:– patient problem-tellings; patient complaints; and ACP responses when there are problems hearing or understanding a patient’s talk.

The analysis identifies interactional practices nurses use to acknowledge suffering and display compassion, within specific interactional contexts. However, the findings also show that contemporary conceptualisations of compassion sometimes present nurses with interactional and institutional dilemmas, which are little acknowledged in contemporary policy and research. These dilemmas include the need to prioritise safe, effective long term care, which may alleviate greater suffering, over short-term responses that contemporary policy and research assume to be compassionate. Explicating the nuanced, micro-level interactional practices nurses use in such situations shows the sophisticated skill set nurses deploy to balance institutional and interactional needs in a complex care context.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Edgley, Alison
Pilnick, Alison
Cooper, Joanne
Keywords: Compassion; Communication skills; Nurse-patient interaction; Conversation analysis
Subjects: W Medicine and related subjects (NLM Classification) > WY Nursing
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Health Sciences
Item ID: 71949
Depositing User: Drewery, Rachael
Date Deposited: 31 Jul 2023 04:40
Last Modified: 31 Jul 2023 04:40

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