Professional accountability and the nurse: a Heideggerian hermeneutical study

Chesterton, Lorna Elizabeth (2018) Professional accountability and the nurse: a Heideggerian hermeneutical study. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Professional accountability in nursing is considered the foundation of nursing practice and governs the individual’s professional standards and responsibilities (NMC, 2015a). The ideals contained within professional accountability are linked to clinical governance through the provision of high quality safe care delivery (Urgent and Emergency Care Review Team, 2013). Historical and contemporary government investigations have consistently highlighted a negative organisational culture in the NHS, and specifically in nursing, questioning the extent to which the ideals of professional accountability in reality impact upon patient care. In order to bridge the gap between theory and practice, this study explores how nurses experience and perceive professional accountability in their everyday working practices. The philosophy of Martin Heidegger (1927/2010) guides this Heideggerian hermeneutical approach, allowing new meanings to be uncovered. Data were collected from seven in-depth interviews with qualified nurses, working in the NHS and their analysis guided by Heidegger's (1927/2010) concept of the hermeneutic circle, a process that values the interpreter’s experience and values. Essential concepts and meanings are arranged into headings, patterns and structures, a technique underpinned by the work of van Manen (1984). This interpretive approach illustrates how historical, cultural, political and social constructs have influenced and affected nurses’ understanding, actions and meanings in relation to professional accountability in practice. The essential concepts, conceptualised through a hermeneutic lens, are culture, fear, self-protection, positive and negative collegial relationships, effects upon nursing care, management and professional accountability. A discussion of the findings then fuses together the essential concepts with contemporary literature and my own changing perceptions to conceptualise new ideas. The study findings are used to make recommendations for nursing through policy, practice, education and research. The recommendations focus on building upon areas of existing good practice to develop a positive culture in nursing, facilitated by changes in management, governance and support.