ESRC DTC CASE 2015 APPLICATION FORM
Principal Supervisor:
Second Supervisor:
External Organisation
Contact:
Project Title:
Project Start Date:
Dr Ruth Parry
Health Sciences (SHS)
Professor Alison Pilnick
Sociology and Social Policy (SSSP)
Nottingham University Hospitals NHS Trust (NUH Trust)
Dr Joanne Cooper, Head of Nursing & Midwifery Research, Senior
Research Fellow. Dr Cooper will also act as Associate supervisor
Dignity and Compassion in Practice: an audio and video based
study with advanced nurse practitioners
1 October 2015
Background:
High quality staff-patient communication is central to compassionate, effective healthcare and
is emphasised in many policies. However, there has been limited progress towards generating
robust evidence about the precise structure and functioning of healthcare communication. In
particular, it is unclear how policy imperatives such as ‘dignity’ and ‘compassion’ are actually
talked into being in practice. This impedes both implementation of policy and development of
effective interventions. Conversation analysis – an approach that relies on audio and video
recordings of real life healthcare interactions - is making rapid advances in generating robust
evidence, though these mostly centre upon doctor patient communication in US primary-care.
This PhD will be a conversation analytic study, supervised by specialists Parry and Pilnick, with
vital clinical and policy input from Cooper. Nurses’ extensive role in healthcare contrasts with
the paucity of robust research on their communication conducted to date, and the lack of
empirical grounding for the communication skills training they receive. The working
relationships forged will lead to further collaborative research on nurse communication.
Aims
 In the context of healthcare of older people, to identify and analyse the largely tacit
communication strategies through which compassionate care is accomplished, and through
which obstacles to compassionate care are circumvented.
 To design communication teaching resources based on recordings of real life practice
Objectives
 To recruit to the project up to six senior nurses and advanced nurse practitioners working in
healthcare of older people at Nottingham University Hospitals NUS Trust
 To collaboratively design a protocol for a conversation analytic study of their, and their
colleagues interactions with older people in everyday healthcare activities
 To record up to fifty healthcare encounters involving nurse practitioners and older people
who have capacity to consent to participation (at least some of these episodes will be
video-recorded, audio-recording will be used when sensitivities of participants require this)
 To identify, collate, and analyse in detail at least 80 episodes from the recordings wherein
compassionate care is at issue. Final determination of the kinds of episodes analysed will
depend on consultation with healthcare and patient and public involvement colleagues, but
we anticipate including a focus on episodes where patients are asked to participate in
healthcare related activities they are likely to find emotionally or physically difficult.
 To generate training resources for healthcare staff and trainee learning events. These will
have a similar design to those being developed by Parry in her externally funded research –
including her NIHR fellowship. Some of them will be submitted to the ‘e learning for health’
resources curated by Health Education England.
Design
Conversation analytic study. This inductive qualitative sociological approach analyses social
interaction, focusing on verbal and bodily conduct and its social consequences. Intensive
comparative analysis of multiple episodes allows identification and explication of recurrent
patterns and their consequences, sometimes with associated quantitative analysis. The
approach has its roots in sociology, and draws on insights from linguistics and psychology.
Parry and Pilnick have written methods texts and conducted empirical studies, and are at the
forefront of recent moves to make conversation analytic perspectives and methods more
available to clinical audiences. Pilnick’s and Parry’s funded work has investigated ways through
which aspects of healthcare policy (e.g. non-directiveness, autonomy, planning for end of life)
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can be talked into being during care giving, and also the interactional reasons for apparent
failures to implement aspects of policy. This work has informed the design of this study.
Between 6 and 8 nurse practitioners. The intention is to recruit four trainee or qualified
advance nurse practitioners in healthcare of older people (tasked with both practice
development and hands on care) alongside up to 4 senior nurses known to Cooper and with
keen interests in advancing compassionate care, implementing policies in the difficult world of
the NHS, and developing their research capacity and capability. Up to 50 patients receiving
inpatient care in NUH healthcare of older people wards. We will exclude patients who do not
have capacity to consent because different procedures need to be in place, and different
communication skills are involved in their care. Up to fifty recordings will be made; our
previous work indicates this will be feasible in the ward environments, will allow multiple crosscase comparisons, and is similar to other successful studies in which we have been involved.
Outputs
PhD thesis, Publications in peer reviewed sociology and clinical journals. Digitally-based
resources housed alongside related communication training resources developed by Parry
Timeline
We ask for a 1+3 award in order for initial completion of the MARM first. MARM year:
Research training, protocol development. Develop working relationships with nurse
practitioners. Year one: Consolidate relationships, negotiate access, conduct literature review
of observational research on compassion in healthcare, finalise research protocol, NHS ethics
and governance approvals. Year two: Data collection, analysis. Year three: Finalise analysis.
Write for thesis and publications. Develop training resources.
Research training environment
SHS hosts a multicultural, multidisciplinary doctoral community (around 100 students) who
actively participate in a vibrant research culture, attending regular School seminars, studentled events, professional development training and doctoral research days. There are custombuilt office facilities. Formal, documented supervision meetings are held at least 10 times per
year, with robust annual review processes. Parry leads a team of researchers who meet
approximately fortnightly during term times for conversation analytic data sessions; these
provide specific training, ideas sharing and peer-networking. PhD students conducting
conversation analytic research including those supervised by Parry and Pilnick attend. Also, the
student will have access to SSSP’s training environment. Around 60 PhD students form an
integral part of the School, coming together each week for PGR seminars which provide
opportunities to present their developing research, hear about others’ research, and address
issues common across the PhD process, such as writing skills. This student’s work would
contribute to the interests of the School’s research group on Health and Social Care, providing
further opportunities for intellectual stimulation and cross-fertilization of ideas. NUH training
opportunities are described in the next section.
Project partner: Cooper will contribute to formal supervision sessions. She will broker
relationships with potential nurse participants and champions, and with NUH research
infrastructure. The student will attend the regular nursing and midwifery research strategy
group, and have access to NUH’s mentorship programme for aspiring clinical academics. They
will join Cooper on senior nurse time out days with external training providers, and be
embedded within the broader HCoP research team, including medics, AHPs and nurses, giving
access to service and research leaders within the field.
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