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Many of the training needs and changes in practice result from the wider
political field. For example, nurses have little control over political
legislation such as the Human Rights Act 2007 (House of Lords, House of
Commons 2007) and the Health and Social Care Act (2008) which aim to
protect patients. However, there are often contradictions through policy
documents and in the economic recession with tighter budgets I wonder
how likely is staff training to be honoured? The latest political drivers focus
on infection control, risk assessment, quality care, dignity, compassion,
direct or patient centred care, patient safety, partnership and involvement
of patients including collecting illness narratives or patient stories 66 . If
nurses are unwilling to tell their own stories how will they be able to
facilitate storytelling in others as a way of improving the quality of the
service? But with a change of government these agendas may change
again. Nurses need to learn to harness policies rather than feel powerless.
By doing this reflective practice can be linked to improvements in patient
care. As the co-inquirers showed sometimes they were able to use policies
to their advantage to gain extra resources for their areas.
Perhaps, in the light of such policy directives, it is more appropriate to
consider that nurses are doing a disservice to patients by not reflecting
with them and about the care given which I have argued encourages
collaborative and relational practice. Collaborative working from my
experience in the NHS does not seem to question the power differentials
and different social and cultural capitals embodied by different professional
groups. When I carried out non participant observation at multidisciplinary
meetings, nurses were the only profession not asking questions. This
habitus is powerful in the field of the ward. Staff keeping busy reduces the
opportunity for students to have their questions answered. Pausing and
Posing Questions needs facilitating and senior staff have a role to play in
encouraging this, not in a blaming way but in an inquiring way focusing not
66 See for example: NHS Constitution 2009, High Quality Care for All DH 2008b, Patients
Association 2008, Confidence in Caring DH 2008a, Our NHS Our Future DH 2007, Point
of Care King‘s Fund 2008, Care Quality Commission 2008, Dignity in Care DH 2006,
Expert Patient 2001, The NHS Plan DH 2000, A First Class Service DH 1998
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