Edinburgh Napier University

  Introduction: Students and qualified nurses often cite a motivation to care for people as their reason for entering the profession. Patients also value human connection and expect compassionate care. However, acute clinical environments do not always facilitate optimal compassion and, in many workplaces, efficiency dominates. With this in mind the study question was ‘What aspects of workplace culture hinder or facilitate person centred care?’ Method: Critical ethnography, a qualitative research methodology that aims to examine and provide a critique of culture with an emancipatory intent, was utilised. Data were collected through observation and interviews over a five month period in 2014 and were analysed reconstructively to reveal cultural meanings and expose cultural hegemony. Results: Nurses espoused individualised care delivered within a therapeutic relationship, but delivered task focused care. Constraints on nurses’ care giving behaviour included communication structures that left nurses uninformed; the requirement for measurable outcomes that promoted the efficiency discourse; and the subordinate position of nursing within the health care team. These aspects combined to leave nurses disempowered and unable to provide person centred care. Nurses did not challenge the status quo but perpetuated it through team relationships that rewarded efficiency and sanctioned inefficiency. Conclusion: Unequal power dynamics and workplace practices impact on nurses’ care giving behaviour. This knowledge can be used to generate new models for practice, specifically the development of effective communication structures and equitable partnerships within the interdisciplinary team that can help to facilitate person centred care.