A Hermeneutic Study of Service Improvement Experiences in Nursing: From Student to Newly Registered Nurse

Craig, Lynn (2017) A Hermeneutic Study of Service Improvement Experiences in Nursing: From Student to Newly Registered Nurse. Doctoral thesis, Northumbria University.

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Abstract

Service improvements in healthcare can improve service provision; make cost efficiency savings, streamline services and reduce clinical errors. However, service improvement alone may not be adequate in improving patient outcomes and quality of care. Complexity of healthcare provision makes service improvement a challenge, and there is little evidence of whether service improvement initiatives change healthcare practice and improve patient care. To equip the nursing workforce with the skills necessary to make service improvements, Higher Educational Institutions (HEI) have developed courses that include service improvement within their pre-registration programmes. However, service improvement is a learned skill, which nurses need to practice in order to become competent in making improvements.

In order to explore service improvement in nursing, hermeneutic phenomenology was used to gain an understanding of the lived experiences from student to registered nurse. A purposive sample of twenty participants were selected from an adult pre-registration nursing programme, during their third year. Data was collected using semi-structured interviews in two phases; once when the participants were student nurses and 12 months later when the same participants were registered nurses. Data analysis occurred using a van Manen (1990) approach and the hermeneutic circle to facilitate interpretation and analysis of findings. Four key themes emerged from the data; service improvement in nursing; socialisation in nursing practice; power and powerlessness and challenges in changing practice. Findings showed that the participants underwent processes of professional transformation, becoming empowered and developing resilience in making service improvements from student to registered nurse. Participants achieved this by developing positive, adaptive behaviours. A new ‘Model of Self-efficacy in Service Improvement Enablement’ is presented which explains the participant’s service improvement journey. This new model has relevance for both nurse education and practice, in seeking to improve patient care through service improvements in nursing.

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