Fostering a caring presence and resilience among professional nurses working in primary health care

Abstract

Background: Professional nurses are given multiple roles and responsibilities and due to today’s pressured work environment of endless multi-tasking and multiple priorities, nurses run the risk that their caring presence and resilience may not come across effectively to patients and their families. Practicing caring presence improves the mental wellbeing of nurses, in which resilience is embedded, with a positive outcome of experiencing decreased stress and an enhanced capacity to cope. Purpose: The purpose of the research was to explore and describe the caring presence and resilience of professional nurses in primary health care (PHC) and how caring presence and resilience can be fostered among these nurses within the primary health care clinics around a semi-urban area in a district of the North West Province. Method: The research design selected was a qualitative, ethnographic study whereby two ethnographic methods were used namely: participant observation and semistructured interviews, supported by field notes. Data was collected from an ‘emic’ perspective and purposive sampling was done. The target population were all professional nurses working in different government clinics and stable patients who were willing to participate. The sample size was determined by data saturation. Data collection was divided into two (2) processes whereby Hyme’s acronym “SPEAKING” (which stands for the setting, participants, ends, acts, keys, instrumentality, norms and genre) was used to provide structure to the video recordings conducting a reflective practice. Semistructured interviews were conducted, transcribed word-for-word and analysed. The researcher also generated field notes to strengthen the research findings. Results: The video recordings showed that participants had the knowledge and skill to provide effective care to patients, however, due to certain factors, their caring presence was not well reflected to their patients. In the semi-structured interviews, participants were able to describe the concept of caring presence effectively, but did not seem to know the concept of resilience. Once resilience was explained, participants were able to share certain traits of resilience through their personal encounters in the workplace. Participants provided a description of challenges with recommendations on how to foster caring presence and resilience. Conclusion: PHC professional nurses have adapted to the culture in PHC, displaying unintentional non-caring behaviours in rendering care to cope under difficult working conditions. These behaviours formed a pattern among PHC professional nurses, posing a risk to displaying a caring presence. Suggested recommendations to foster caring presence and resilience include addressing stressful and poor working conditions under which PHC professional nurses work. Recommendations were also based on findings of relevant literature and the conclusions which included informing PHC professional nurses of the risks that prevent a caring presence and to apply cultural transformation to positively foster a caring presence, which would then foster resilience. Recommendations are made for nursing education as well as limitations and areas for future research.