Care erosion in hospitals: Problems in reflective nursing practice and the role of cognitive dissonance


This paper by de Vries and Timmins (e-copy 2015) use cognitive dissonance theory as an explanatory model to provide educators with ways of addressing decline in care levels.  The authors discuss the environment were care erosion begins, how it gradually creeps into practice and the consequences of the failure of a lack of reflective processes and self-correction. De Vries and Timmins advocate for more than critical reflection to ensure that care erosion can be averted. Using Cognitive dissonance theory to more fully explain how critical reflection works to prevent care erosion, the authors describe a process of justifications to explain the inconsistencies and uncomfortable feelings generated when there is a mis-match between values and satisfactory care of patients. The insidious spiral of deficits occurs each time a violation of care happens. The authors provide examples including potential for cross-infection when a lack of handwashing occurs between patients and is justified by environmental factors such as lack of sink or alcohol rub nearby.

De Vries and Timmins (2016) describe three focal points from the application of this theory to care erosion. Firstly they advocate that educators need to develop and teach critical reflection in a methodological way that includes motivation to protect their peace of mind, rather than avoid punitive action. There is a role for educators to promote better internalisation of values and standards by regular reminders and alignment with aims and ethos to motivate self-correction. The third focal point is for educators to teach crucial nursing activities to prepare nursing students to respond to reduced quality and seek rectification over justification. The authors also discuss the role of hospital management in supporting this discourse.

If you have any comments about care orosion or ways to minimise it, you are welcome to post them here. Please join us @PEPCommunity.

Comments

This post doesn't have any comments

Leave a Comment

 




  Back to all posts