Patient Involvement in the Assessment of Pre-registration Adult Nursing Students Practice

Background: Patient involvement in practice assessment was first introduced in 1996 but failed to establish itself as a routine part of nurse training. Fourteen years later, in 2010 the UK Nursing and Midwifery Council restated this requirement in response to concerns that university-based nursing education was not producing caring and compassionate nurses. This concern speaks to two enduring discourses around the professionalisation of nursing. First, there is a discourse of nursing as a caring vocation, predicated upon a model of practical, ward-based training. Second, there is a discourse of nursing that regards it as an adjunct medical profession, predicated upon technical-scientific education. Aim: To critically explore how these discourses influence and affect the contributions, involvement and subject positions associated with patients and their involvement in the summative assessment of pre-registration adult nursing students during hospital placements. Methods: This study adopted a poststructuralist logics approach that involved analysis of documentary and narrative texts. Six patients, six adult nursing students, six mentors and six nurse lecturers from one UK university and one acute hospital placement provider were interviewed using semi-structured interviews (24 in total). Hajer’s ten analytical steps guided data analysis. Findings: The empirical characterisation of patient involvement as a social logic identified three distinct sets of practices, logics of experientialisation, protectionism and systematisation. These social logics demonstrate the on-going tensions between patient and practitioner appraisals of patient involvement. The analysis of political and fantasmatic logics demonstrates how boundaries between vocation versus technical-scientific nursing are established and maintained to create a hegemonic normative frame that constitutes patient involvement as a solution to ‘fix’ nursing. Conclusion: This research demonstrates that involvement of patients in practice assessment remains largely tokenistic, in no small part due to tensions between discourses of vocational and technical-scientific nursing. It is not until these tensions are addressed that patient involvement will be able to fulfil its real potential for patients and for the nursing profession.