UK pre-registration healthcare students are expected to raise a care concern about
unsafe situations whilst in clinical practice. The UK’s NHS is in the midst of a
change to an open, honest and transparent culture which responds to a
professional’s concern about patient care, to improve safety and prevent harm.
Central to this change is improving the experience of registered healthcare
professionals whose decision to raise a care concern is influenced by the
organisational culture; this can create a difficult moral choice. The experience of
nursing students who decide to raise a care concern has received little attention,
and this study sought to explore this under-researched area.
A literature review was undertaken which identified that the experience of nursing
students who had raised a care concern had not been previously examined. To
guide this study, Clarke Moustakas’ (1994) transcendental phenomenological
methodology was used to explore nursing students’ lived experience of raising a
care concern. Ten nursing students with experience of raising a care concern in
clinical practice voluntarily participated in the study. Open interviews conducted
between December 2016 and October 2017 were audio recorded and transcribed,
exposing individual narratives of raising a care concern in clinical practice. The
transcripts were analysed to produce a composite description which summarises
nursing students’ lived experience, reflecting four themes or essences: 1) patient
centred concern; 2) deciding how to act; 3) having emotional strength; and 4)
feedback and support. These typify what it is like for nursing students to raise a care
concern whilst in clinical practice.
The findings were critically examined and suggest that compassion may motivate
nursing students to act when faced with an unsafe situation, seeking to stop patient
harm and suffering. Recognising this moral motivation, students described the
relevance of emotional strength when dealing with the emotionally complex
experience of facing difficult situations, with feedback and support providing comfort
plus moral and emotional satisfaction.
This study also explores the implications for professional practice, specifically the
impact upon future teaching and learning approaches to facilitate nursing students’
ability to detect and act upon unsafe situations; providing listening opportunities to
support students in clinical practice; and valuing nursing students who raise a care
concern as role models and local clinical leaders. Recommendations include a new
national campaign to improve the likelihood of nursing students raising care
concerns and updating UK professional guidance
