This blog post was written by Ms. Leigh Chapman, an RN and current PhD Candidate at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and a doctoral fellow at The Wilson Centre. Ms. Chapman is a trainee participating on Dr. Cynthia Whitehead’s 2016 AMS Phoenix Thematic Grant .
This research project critically examines the ideals of caring and compassion in the accreditation standards for Canadian nursing and pharmacy education curricula and health care organizations. We will interrogate the accreditation standards and formal curricular documents using accepted principles and practices of critical discourse analysis (see Leveraging Accreditation Standards to Promote Compassion in Education and Practice project). Our initial work focused on analyzing nursing education accreditation documents. As a doctoral trainee on this project, this blog post captures my reflections on our work to date, vis-à-vis some of my thoughts regarding national Nursing Week 2017.
Nursing week has been a particularly introspective time for me this year. I was invited to speak about my personal and professional advocacy at various nursing week events. I also attended several events aimed at both showcasing and celebrating the nursing profession. These events made me ponder the meaning of nursing week – an entire week dedicated to one profession seems extravagant in an era of interprofessional practice and education, doesn’t it? And what is the role of this special week for nurses? Is it about celebrating the profession, highlighting nursing advocacy, or thanking nurses for their service? Perhaps it is all of the above. Regardless of my personal deliberations, the common thread that unites nurses is often seen as the desire to care, and to do so in a compassionate manner. This ideal has been articulated throughout these nursing week events, but it is not always as central to the nursing profession as some might think.
Throughout my nursing education, we often used the idiom that doctors “cure” and nurses “care”. This rather simplistic expression seemed to serve as a means of differentiating nurses from physicians, highlighting the “care” aspect of the nursing role, and also signalling characteristics about the practice of physicians that differs from that of nurses. However, surely this is not to say that nurses don’t cure and physicians don’t care! At the time, I adopted this expression unquestioningly, but looking back now, it is easy to find fault in these naïve descriptions of two very broad professions. Almost 15 years in, the complexity of both professions is much more apparent to me and I’m astutely aware of overlapping, as well as discrete roles and responsibilities. Of course caring and compassion are pivotal to both professions … or are they?
For nursing, caring and compassion are considered such fundamental professional ideals that they are often regarded as axiomatic. We assume that nurses are caring and that all nursing education documents necessarily include references to caring and compassion. In our preliminary analysis of the accreditation standards for nursing education for this project, we found a peculiar absence of the words ‘caring’ and ‘compassion’. While these words were absent from the accreditation standards, ‘compassion’ was found in 11 places elsewhere in our documentary archive (i.e. a secondary set of documents, consisting of nursing regulatory competencies as well as other formal disciplinary documents for Canadian nursing education). In its definition, ‘compassion’ was linked closely with competency. Does this imply that compassion must coexist with competency or are they synonymous? Curiously, the definition of competency included safety and ethical care/practice but not compassion. Even further still, in one document, the adjective ‘compassionate’ was connected to nurses’ ability to relieve the suffering of another, particularly someone in pain. These early analytic insights have led to more questions than answers: Is nurses’ compassion broader than this apparent link to pain and suffering? That is, are nurses only expected to be compassionate to patients who are in pain? What other types of suffering necessitate compassion? If compassion is linked to competency, does incompetence imply care that is also lacking compassion? Surely we will unearth answers to these questions as we delve deeper into the archive, and also explore pharmacy education and health care accreditation documents for references to caring and compassion.
In our dissemination of these first findings at the Nursing Leadership Network of Ontario conference, the overall project received much praise. One attendee thanked us for carrying out the project, claiming that “nursing has lost the art of the profession, by replacing it with science”. What is the essence of nursing? Is it caring? Compassion? Art? Science? Our project will touch upon some of these deep, philosophical questions as we explore caring and compassion and sometimes, the lack thereof.
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