A lonely endeavour
: clinical nurse leadership and the older unpopular patient in community settings

  • Jacqueline Metcalfe

Student thesis: Doctoral Thesis


Rationale for the Study: High quality care is high on the national agenda together with the centrality of clinical nurse leadership to achieve this The issue of the unpopular patient in nursing, as someone nurses do not enjoy caring for, is important, because when it occurs, the prejudice negatively impacts the quality of nursing care. Yet the concept of the unpopular patient has been rarely studied, and the specific experience of clinical nurse leaders, who are said to set the climate and tone of the care setting, has not previously been explored.

Aim of the study: To explore the lived experience of clinical nurse leaders leading a team caring for an older patient perceived as unpopular in community nursing settings.

Methodology/Methods: A Heideggerian hermeneutic approach was taken. Data was gathered using in-depth semi-structured audio recorded interviews with eleven female clinical nurse leaders.

Findings: Five themes which contributed to the whole interpretation; “Knowing the Unpopular Patient”, ”Being Faithful”, ”Betwixt and Between”, ”Joined at the Hip” and ”Growing into Leadership”. The visible meanings of the experience included moral distress and moral courage, and the hidden meaning was the loneliness the clinical nurse leaders seemed to experience when trying to prevent, or address, the development of the older unpopular patient.

Implications for practice and research; NHS organisations need to be aware that clinical nurse leaders may feel distressed and lonely as a result of trying to create a culture of quality care and dignity in difficult circumstances.

Original contribution to knowledge: The unpopular patient also exists in community nursing settings, and importantly, clinical nurse leaders can experience moral distress and loneliness in response to the attitudes and behaviours of their staff team as the 'wounds of clinical nurse leadership'
Date of Award2014
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorAnn Dewey (Supervisor), Karen Burnell (Supervisor) & Heather MacKenzie (Supervisor)

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