Nurses’ experiences of learning to care in practice environments: A qualitative study

Introduction: Recent attention has been drawn to the absence of caring behaviours in health services globally, termed a “crisis of care” and policies are developing to address this shortfall. To obtain accounts of caring behaviours and attitudes in nursing practice and to identify how nurses manage student learning, we spoke to nurses and students in university and hospital locations across 2 NHS England Regions. Method: Using the principles of appreciative inquiry, we conducted focus groups with BSc and MSc pre-registration nursing students, mentors, link lecturers and practice educators (n = 69). Findings: Participants spoke powerfully about skilful, caring nursing practice, identifying plentiful examples of caring behaviours and attitudes. Four main themes emerged: “going the extra mile” (beyond routine policy, demanding commitment, flexibility and adaptation); time spent or invested (moderated by personal or organisational resources); caring as a personalised experience; communication practices and culture/role modelling. Discussion/conclusions: Positive caring attitudes and behaviours shown to patients, staff and work were highly valued. An ability to regulate and sustain an emotional connection with patients framed student learning. Observations of nurses who preserved caring practices amidst organisational pressures were frequently chosen by students as role models who “fight” inadequate or missed care. Theoretical links between caring and resilience are strengthened by these findings.