This article is the second in a two-part series discussing a gradual decline in standards of care, termed ‘care erosion’. The first part of this article used cognitive dissonance theory to discuss the psychosocial mechanisms involved in care erosion and focused on the nurse’s role in identifying and preventing declining standards in care. This article, part two, explores the wider involvement of individuals, organisations and nurse education in preventing care erosion, with a particular focus on reflection; mastery of nursing skills and care; supporting nursing values; and addressing denial and trivialisation of, and justifications for, substandard care.
This article is the first in a two-part series discussing declining standards of care. Many healthcare organisations, particularly hospitals, are under increased pressure to maintain standards of care while experiencing funding and staff shortages, and increasing patient numbers and demand for services. One of the main risks associated with these competing demands is a gradual decline in care standards, described as ‘care erosion’ in this article. Understanding the psychosocial mechanisms that can lead to care erosion is important in preventing its occurrence. This article uses the theory of cognitive dissonance to explain how nurses reflect on, and maintain, quality of care. If practice is suboptimal or substandard and inconsistent with nursing values, standards or regulations, nurses are likely to experience inner conflict or ‘dissonance discomfort’ and will usually attempt to reduce this feeling by enhancing the quality of care they provide. Conversely, nurses may defend, deny, trivialise or ignore substandard care. The authors suggest that this is the mechanism that leads to care erosion. This article uses three scenarios to explore the nurse’s role in care erosion. Part two of this article discusses the wider involvement of individuals, organisations and nurse education in preventing care erosion.
This article, the third and final in a series of three, discusses the implementation of spiritual care interventions by nurses. It describes how nurses can use clinical reasoning and the nursing process to implement appropriate spiritual care for patients, and outlines the competencies necessary to identify spiritual distress and meet the spiritual needs of patients. Spiritual care interventions are discussed as part of a multidisciplinary team approach to the provision of holistic care.
Assessing spirituality and the spiritual needs of patients is fundamental to providing effective spiritual care. This article, the second in a series of three, discusses the assessment of patients’ spirituality and spiritual needs in healthcare settings. Several formal spiritual assessment tools are available to assist nurses to identify patients’ spiritual needs and to determine whether they are experiencing spiritual distress. However, it may be more appropriate to assess patients’ spirituality informally, by asking open questions about their spiritual beliefs and needs. It is important for nurses to be aware of the limits of their competence in undertaking spiritual assessment and providing spiritual care, and to refer patients to the healthcare chaplain or other spiritual support personnel where necessary. The third and final article in this series will discuss spiritual care nursing interventions.
Spirituality is a complex concept that has different meanings for different people. Spiritual care is a fundamental aspect of nursing and attending to the spiritual needs of patients may improve their health outcomes. This article, the first in a series of three, explores various definitions of spirituality, and the importance of spirituality and spiritual care in healthcare settings. The second article of this series provides an in-depth exploration of the assessment of patients’ spiritual care needs, and the third and final article in this short series discusses spiritual care nursing interventions.