McKinnon, J; (2017) Harnessing emotion to inform clinical practice. Doctoral thesis , UCL (University College London).

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Abstract

Background: Clinical judgement is the application of evidence to decision making in a professional healthcare setting. Studies in neuroscience (Immordino -Yang and Damassio, 2007) have shown that effective judgement and decision-making require tempered emotion to provide a guiding ‘rudder’ revealing knowing to be a feeling state. Emotional labour as a central feature of nursing practice is well documented (Gray, 2009). Theorists have identified emotions as tools for reflection (Bradbury-Jones et al. 2009), but this area of knowledge remains underdeveloped. / Aims: This thesis enquires into the existence of a commonality of emotions in nursing practice with potential as core emotion concepts arising from diverse narratives for use as tools for reflection and professional judgement. / Method: In phase one thirty-three nurses across five specialist areas talked exhaustively about the emotions they experienced while immersed in practice and the causes of these emotions. The data was collected in a London teaching hospital NHS trust and in three community NHS trusts in the East Midlands of England. Following this, in a second phase, six nurses (two supervisors and four supervisees) in a London Teaching Hospital who had not taken part in the first part of the research talked about their experience after two months and four months of using a framework for reflection consisting of seven common core concepts identified in the first research phase. In both phases the interviews were audio-taped, transcribed verbatim and the data analysed using Grounded Theory Method. / Results: The data betrayed professional movement that was characterised by person centred care in the face of complex adversity. Seven core emotional concepts were found to have commonality across practice forming an ‘emotion map’. The ‘emotion framework’ for reflection was shown to increase self awareness, inform and empower practice. / Discussion: The design is limited by the singularity of discourse and the sample size. The notion of emotional constituents of a framework for reflection opens up a new frontier in learning in which the details of an experience are the outcome of reflection on emotion rather than the reverse. The framework demonstrated ‘organic’ properties which permit a harnessing of the sense of salience that is central to human judgement. Increased credence has been given to personal knowledge and intuition.

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