Respect in final-year student nurse–patient encounters – an interpretative phenomenological analysis

"This is an Version of Record of an article published by Taylor & Francis in Health Psychology and Behavioral Medicine: An Open Access Journal on 21 May 2014, available online: http://www.tandfonline.com/10.1080/21642850.2014.918513 This is an open-access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/ licenses/by/3.0/, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.Very little is known regarding health-care professionals’ understanding and experiences of respect towards patients. The study aimed to explore student nurses’ understanding and experiences of respect in their encounters with patients. Semi-structured interviews were conducted with eight final-year student nurses with practice placements across different health-care trusts in the UK. Transcripts were analysed using interpretative phenomenological analysis (IPA). Three super-ordinate themes were identified: understanding of what it means to show respect, negotiating role expectations and personal attitudes in practice, and barriers related to the performance of the nursing role. The factors identified should be investigated further and addressed as they are likely to influence patients’ experiences of feeling respected in nurse–patient interactions and subsequently their well-being and health-related behaviours.Funded by an internal University of Chester gran

Understanding self-respect and its relationship to self-esteem

The concept of self-respect has received little attention in the psychological literature and is not clearly distinguished from self-esteem. The present research sought to empirically investigate the bases of self-respect by manipulating adherence to morals together with interpersonal appraisals, or task-related competence, in hypothetical scenarios (Studies 1a and 1b) and a situation participants relived (Studies 2 and 3). Participants’ levels of state self-respect and self-esteem were measured. Studies 1-3 found main effects of adherence to morals on self-respect, with self-respect mediating the effect of adherence to morals on self-esteem, but little support for competence and interpersonal appraisals directly influencing self-respect. Self-respect uniquely contributed to anticipated/felt self-esteem alongside competence or interpersonal appraisals. The pattern of results supports the conceptualisation of self-respect as a component of self-esteem associated with morally principled conduct, distinct from performance and social self-esteem. The findings have implications for our understanding of self-esteem and moral behaviour

The value of self-respect for moral and social behaviour: Development of a trait self-respect measure

Objective: Research into self-respect is scarce, possibly because self-respect and self-esteem are often treated as interchangeable in popular culture. However, there is evidence that self-respect is a component of global self-esteem that is attached to moral, principled and honourable behaviour, highlighting its unique role in predicting moral behaviour and well-being. The paper reports on the development of the trait self-respect scale (SRS) to stimulate research into this concept. Design: Following pilot work to develop the items, cross-sectional survey and lab-based data were collected to validate the SRS. Methods: Seven convenience adult samples (total N=841) completed the SRS online or in person alongside other validated scales. One sample (N=115) also underwent lab-based tasks measuring moral self-concept and cheating. Results: Exploratory and confirmatory factor analyses supported a one-factor structure. The SRS showed good internal consistency (α>.8 in all samples), convergent and discriminant validity. It correlated significantly with self-esteem (r=.40-.61), and with agreeableness, Machiavellianism, positive norm, moral identity internalisation and symbolisation (N=121), moral-based self-esteem, self-control, number of moral trait adjectives recalled in self-related processing (N=115) and religious status (N=230), adjusting for self-esteem. It did not correlate with amount of social comparison, or with competence and social self-esteem, adjusting for self-regard. Moreover, self-respect significantly predicted forms of pro-relationship behaviour, pro-social behaviour (N=114), cheating (self-reported and observed) and well-being (N=81) over and above self-esteem. Conclusion: Findings support the need to consider trait self-respect in investigations of well-being and moral and social functioning, and contribute to debates on the value of self-esteem

Student nurses' views on respect towards service users — An interpretative phenomenological study.

Abstract/Summary Aim: To explore student nurses’ understanding and behaviours of respect towards patients in order to inform educational strategies to optimise respectful care. Background: There is a causal relationship between the perception of being treated with respect and patient satisfaction. Concerns over standards of care prompted a commissioned report into the quality of nurse education in the United Kingdom. Design: A hermeneutic phenomenological interview study was used to identify and interpret student nurses’ behaviours and understanding of respect towards patients. Setting: University health and social care faculty in the north-west of England, United Kingdom Participants: Eight third-year student nurses (adult branch), on different university sites, with practice placements across different healthcare trusts. Methods: Interviews about their understanding of respect and their behavioural intentions of respect towards patients were recorded and transcribed, then analysed using interpretative phenomenological analysis (IPA) to produce themes from the data. Findings: Three themes of relevance to nurse education were identified. Respect is a complex concept that is difficult to apply in practice. Students are not always aware of incongruence between their feelings of respect towards patients and their behaviours towards them. Role-modelling of respectful care is variable, and essential care is often learned from healthcare assistants. Discussion: Awareness of emotional responses and their relationship to patient perceptions of respect should be facilitated in theory and practice. Rehearsal of the application of respect involving emotional labour, and reflection in and on the practice of respectful care, are needed to address student learning needs. The theory-practice gap in relation to respect, variation in professional practice and the under-recognised importance of healthcare assistants in student nurse education, are barriers to the learning of respect to patients. Conclusions: Interactive education experiences are important to develop self-awareness and insight into respectful care. Mentorship in practice should encourage reflection in and on the practice of respect towards patients

The impact of a parenting guidance programme for mothers with an ethnic minority background

The current mixed-method study investigates the effects of a culturally adapted version of the International Child Development Programme (ICDP) with 135 mothers – 29 ethnic Pakistani mothers residing in Norway attending Urdu-language groups and a comparison group of 105 Norwegian mothers attending Norwegian-language groups. All mothers completed questionnaires on parenting and psychosocial health before and after attending the ICDP programme. In-depth interviews with a subgroup of 12 ethnic Pakistani mothers and 8 ethnic Norwegian mothers were analysed using thematic analysis. Before the ICDP programme, the Urdu-speaking mothers spent more time with the child, scored higher on distant child management and reported poorer mental health. Most changes over time were similar but significant for the Norwegian-speaking group only, which might imply that the minority mothers were in the process of change. In the interviews, the Urdu-speaking mothers’ emphasized enhanced communication and regulation, enhanced family relationships and life quality, whereas the Norwegian-speaking group told about increased consciousness and empowerment, and a more positive focus.Funded by the Norwegian Ministry of Children, Equality, and Social Inclusion

Evaluation of Follow-Up Effects of the International Child Development Programme on Caregivers in Mozambique

This is a non-final version of an article published in final form in Infants & Young Children, 27(2), 120-135. doi:10.1097/iyc.0000000000000006.Parenting programs have been used to good effect in many settings, yet few are systematically introduced and evaluated in developing countries. This study explores the relative long-term effect of participation in the International Child Development Programme (ICDP) in a group of caregivers in Mozambique. A quasi-experimental design was used to compare caregivers who had completed an ICDP course (n = 75) with a sociogeographically matched comparison group participants (n = 62) who had not followed any parenting program. Both groups completed a questionnaire about parenting, attitudes toward the child and the child’s behavior, self-efficacy, life quality, and mental health. The ICDP group reported better parenting skills, fewer conduct problems in their children, and better child adjustment than the comparison group, as well as a shift in physical punishment away from hitting. The ICDP group had higher self-efficacy scores, better health and life quality, and lower scores on mental health difficulties. The follow-up differences between caregivers who had and had not attended the ICDP course indicate that course attendance may result in observable benefits in parenting and mental health scores. The data are cross-sectional and the caregivers were interviewed postintervention only, and more research is therefore needed

Mothers and Fathers Attending the International Child Development Programme in Norway

Fathers are understudied in parent training studies. This study investigates whether mothers and fathers benefit equally from participating in the International Child Development Programme (ICDP) implemented as a community-wide programme in Norway in their parenting behaviour, perceived child difficulties and their psychosocial health. The questionnaire study used a pre-post design comparing 105 mothers and 36 fathers who attended a regular ICDP course. Results showed that the mothers and fathers differed on parenting behaviours prior to the course but showed similar changes, including on emotional and regulative aspects of parenting and autonomy supportive behaviours. However, only the mothers perceived a decrease in their child’s difficulties after the course while the fathers showed a greater increase in behaviours assumed to support the child’s meaning-making and in self-efficacy, and a greater decrease in anxiety after the course. ICDP courses appear to be a useful tool for supporting both mothers and fathers in their parenting role

The long-term effectiveness of the International Child Development Programme (ICDP) implemented as a community-wide parenting programme

This is an open-access article distributed under the terms of the Creative Commons Attribution Licence http://creativecommons.org/licences/by/3.0/, which permits the unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.Short-term effectiveness of the International Child Development Programme (ICDP) for parents in the general population has been studied. The aim of this paper was to investigate the longer term impact of the ICDP programme on parents looking for sustained changes 6–12 months after the programme. For this, a nonclinical caregiver group attending the ICDP programme (N ¼ 79) and a nonattending comparison group (N ¼ 62) completed questionnaires on parenting, psychosocial functioning, and child difficulties before, on completion and 6–12 months after the ICDP programme. Analyses compare changes in scores over time. The results revealed that the ICDP group showed significantly improved scores on parenting measures, less loneliness, and trends towards improved self-efficacy compared to the comparison group 6–12 months after programme completion. The ICDP group also reported that their children spent significantly less time on television and computer games and a trend towards fewer child difficulties. Key positive effects sustained over time but at a somewhat lower level, supporting community-wide implementation of ICDP as a general parenting programme. It is concluded that more intensive training with follow-up sessions should be considered to sustain and boost initial gains.Funded by the Norwegian Ministry of Children, Equality, and Social Inclusion

Nurses' experiences of communicating respect to patients: Influences and challenges

A qualitative study utilizing Interpretive Phenomenological Analysis of a sample of nursing interviews to explore the ways in which respect is conceptualized and communicated to patients.Background: Respectful care is central to ethical codes of practice and optimal patient care, but little is known about the influences on and challenges in communicating respect. Research question: What are the intra- and inter-personal influences on nurses’ communication of respect? Research design and participants: Semi-structured interviews with 12 hospital-based UK registered nurses were analysed using interpretative phenomenological analysis to explore their experiences of communicating respect to patients and associated influences. Ethical considerations: The study was approved by the Institutional ethics board and National Health Service Trust. Findings: Three interconnected superordinate themes were identified: ‘private self: personal attitudes’, ‘outward self: showing respect’ and ‘reputational self: being perceived as respectful’. Respectful communication involved a complex set of influences, including attitudes of respect towards patients, needs and goals, beliefs around the nature of respectful communication, skills and influencing sociocultural factors. A tension between the outward self as intended and perceived presented challenges for nurses’ reputational self as respectful, with negative implications for patient care. Discussion: The study offers an in-depth understanding of intra- and inter-personal influences on communicating respect, and sheds light on challenges involved, helping provide practical insights to support respectful care. Conclusion: Findings stress the need for improved conceptualisations of respect in healthcare settings to formally recognise the complex attitudinal and socially constructed nature of respect and for appropriate professional training to improve its communicatio

Influences on, and consequences of, patients' experiences of feeling respected in doctor-patient relations

This research program focused on studying patients' experiences of feeling respected and in particular the intrapersonal, interpersonal, intragroup and intergroup influences on such experiences. Consequences of feeling respected on patient outcomes were also assessed. The final chapter is a review of the literature on respect at different levels of analysis with emphasis on the example of doctor-patient relations. The second and third chapters focus on patients. With a focus on respect at the intrapersonal level, the second chapter (Study 1) explores patients' meanings of feeling respected. The third chapter (Study 2) provides support for the intrapersonal factors of expectations of the doctor and self-respect influencing respect feelings. It also tests the effect of the doctor's behaviours, an interpersonal influence, on patients' respect feelings. The fourth and fifth chapters focus on the doctor. The fourth chapter (Study 3) provides support for a model of respect as an interpersonal attitude based on the object's inherent worth as a person and respect worthy qualities embraced by the literature. The fifth chapter (Study 4) shows a salient social medical identity to be associated with deindividualization of patients but communication skills' training with individualization of patients, and thus a more respectful attitude towards patients. The sixth chapter (Study 5) shows that patients who self-categorize more strongly as traditional patients feel more respected than patients who self-categorize more strongly as consumerist patients and that respect feelings influence various patient outcomes, including illness perception, patient satisfaction and adherence to advice.EThOS - Electronic Theses Online ServiceGBUnited Kingdo