Adult nurses’ understanding and use of courage in their professional practice : Realising Courage in nursing

Background: Courage is outlined as one of the 6Cs in the nursing vision ‘Developing the culture of compassionate care’ (Cummings and Bennett, 2012) and ‘Compassion in Practice’ (CBCN and DHCHA, 2012). The framework ‘Leading Change, Adding Value’ (NHS England, 2016) also reaffirmed the requirement for courage. The rationale for this study is the dearth of research and sparse discussion exploring courage and its realization in nursing. Aim: To develop a grounded theory of nurses understanding and use of courage in their professional nursing practice. Methods: A social constructionist grounded theory approach was used. This comprised purposive sampling, data collection, coding, theoretical sampling, constant comparative analysis and clarification of categories. Following ethical approval in 2015 -2016, 12 initial unstructured interviews were undertaken with qualified nurses focused on their understanding and use of courage. Early themes were clarified using theoretical sampling with a further four semi-structured interviews. Findings and discussion: The iterative analytical process resulted in emergence of a co-constructed grounded theory of courage. The core category emerged as Realising courage. Several categories were identified contributing to the emergent theory. These are presented as pre-requisites to courage, the meaning of courage and being courageous and the consequences of being courageous in the context of adult nursing. Identified in these categories and linking them to one another were themes concerning gender, personality, socialisation and organisational culture. Conclusions: The emergent theory demonstrates that courage as a concept is social constructed. Cultural socialisation, personality, self-esteem, moral values and personal circumstances are influencing factors in realising courage, as is professional socialisation. The organisational culture is also significant and inspires or negates courage dependent on how it is perceived.