Culture and the impact on nursing practice

Background: Recent UK policy literature has coined terms such ‘culture/s of care/caring/compassionate care’ as a means of reflecting desirable cultures in which high quality care can flourish. However, few primary research studies exist which explore ‘caring cultures’ or culture in relation to patient care outcomes, and those which do offer limited insight due to their methodological challenges. Therefore, research which explored culture, using appropriate methodology, in relation to patient care was lacking, and therefore became the gap which this research aimed to address. Methodology: Case study methodology was used, guided by the principles of constructivism. Two acute NHS wards were selected for cross case comparison purposes. Multiple methods were used to address the multi-level manifestation of culture. Methods included: non-participant observations, semi-structured interviews and the use of pre-existing, ward-level, quantitative data. Multiple perspectives were also sought, with a sample population inclusive of multidisciplinary staff, students, patients and relatives. Findings: Despite almost universal praise for staff as individuals, inadequate staffing was seen as a phenomenon which was directly and indirectly affecting patient care quality. This existed alongside three underlying cultural assumptions which were found at the deepest level of the culture at Wickham hospital: 1 - The professional status/power of nurses in relation to other groups, 2 - Power and the distribution of tasks and 3 - Power/autonomy of nurses. These were all interconnected through the common, taken for granted assumption of limited nurse empowerment. Conclusions: With a lack of nurse autonomy and empowerment assumed and ingrained within the culture, inadequate staffing, and its effect on patient care, was allowed to perpetuate. Therefore, culture was seen to affect patient care, albeit indirectly, through the medium of staffing. This research therefore contributes original findings to the already established relationship between staffing and patient care by proposing that this relationship may be more complex, and less linear than purely quantitative research may be able to capture.