A Grounded Theory Study Exploring Patients and Nurses Perceptions of Caring.

“Health care is in crisis at the global, national and local levels, current healthcare models seem to have ignored, muted or excluded the voices of the people they were intended to serve, resulting in delivery models that do not respond to the needs of the people.” (Karpf et al 2010) p 266. Karpf et al highlight that the contemporary concern for high quality caring in healthcare is not being met and this is creating a gap between consumer expectations and care delivery systems. They go on to stress that caring needs to be defined around the primacy of the users. The first priority for anyone suffering from illness is effective, compassionate care. The NHS Constitution (Department of Health 2009) claims that the NHS touches lives in times of critical human need when caring and compassion are what matters most. This document sets out the expectations of the patient experience. Its principles include commitment to quality, individuality, respect, dignity and compassion. Watson (2004) identifies these as the core principles of caring.

The centrality of caring to nursing is evidenced through a plethora of research based evidence and theory (Watson 1979, Watson 2004, Leininger 2004, Benner and Wrubel 1989). However current evidence reveals that there is a stark contrast between the reality of care received by patients and the principles and values enacted by nurses in the modern NHS (Ombudsman’s Report 2011). The Ombudsman’s report into care of older people identified that patients experience un-necessary pain, lack of respect and less than compassionate care.  This report is supported by additional studies that highlight the gulf between the core principles of caring and the behaviours and attitudes held by nurses. For example, Bridges and Nugus (2009) found that patients suffered from a diminished sense of significance and received ageist comments from nurses. While Bridges et al (2009) found that nurses appeared to focus on technical interventions rather than relational aspects of caring. It is claimed that caring is losing it’s primacy and is under threat in the modern world (Peacock and Nolan 2000, Watson 2006) and it is claimed that domination of the medical model, outcome centred principles and technological dexterity appear to prevail in modern nursing (Nelson 2004). Watson (2009) acknowledges that nurses seem to be torn between enacting human caring values and functioning in highly technocratic institutions. Much of the current literature fails to capture the complexities of the issues at stake for example Meyer (2009) identifies the rapid throughput of patients as a rationale for reduced caring as the opportunity to create meaningful relationships is diminished, however, he fails to adequately address what counts as a meaningful relationship and does not provide evidence that patients recognise this as a core element of caring.

Quality caring is anchored in specific core values, understanding these values is the key to designing effective models of practice. Despite the strong association between nursing and caring, a tension exists for nurses as Brilowski and Wendler (2005) highlight that the nature of caring is one of the least understood ideals used by professionals. They stress that nurses have not adequately investigated a term that they use daily to motivate their actions. The problem is compounded by the complexities of healthcare itself and the cultural diversity of healthcare consumers who vary in their understanding and interpretation of core caring principles. Furthermore, Paley (2001) argues that the study of caring has not been advanced by research. Rather than enriching understanding, he claims that methodological flaws have led to the creation of endless terms that describe caring behaviours. It seems that the motivations and intentions behind caring are a neglected research domain and understanding remains partial. Radical change is needed to reverse the non-caring trend and enhance the understanding of caring principles. What is needed is a new philosophical value based approach  to practice and a theory driven model that is grounded in the views of health care professionals and healthcare consumers so that authentic caring can be practiced. By listening to and honouring the contributions of the people who operate in caring environments and receive care it is possible to develop care processes and models that respond to contemporary needs. The aim of this research is to enhance understanding of caring in order to truly come to know it, in terms of motivation and performance in order to cultivate a climate where caring can occupy a position of primacy. The study will explore perceptions of caring from the perspectives of nurses and healthcare consumers in order to bridge the gap between expectations of caring and actual provision in order to fuse the promise of care and the reality of the patient experience. Similarities and differences will be analysed in order to produce a model of caring that be used as a feasible guide for practice. Charmaz (2000) Constructivist Grounded Theory will be used as a theoretical framework.