title: Care erosion in hospitals: Problems in reflective nursing practice and the role of cognitive dissonance.
abstract: Care erosion - gradual decline in care level - is an important problem in health care today. Unfortunately, the mechanism whereby it occurs is complex and poorly understood. This paper seeks to address this by emphasising problems in reflective nursing practice. Critical reflection on quality of care which should drive good care instead spawns justifications, denial, and trivialisation of deficient care. This perpetuates increasingly poor care levels. We argue that cognitive dissonance theory provides a highly effective understanding of this process and suggest for this approach to be incorporated in all efforts to address care erosion. The paper includes a detailed discussion of examples and implications for practice, in particular the need to restore critical reflection in nursing, the importance of embracing strong values and standards, and the need for increased awareness of signs of care erosion.
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Ireland. Electronic address: jan.devries@tcd.ie.
authors.forename: Jan
authors.initials: J
authors.lastname: de Vries
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Ireland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Timmins
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003073:Cognitive Dissonance; D006801:Humans; D009736:Nursing Process; D009741:Nursing Staff, Hospital / Q000523:psychology*; D013850:Thinking
keywords: Care erosion; Cognitive dissonance; Critical reflection; Nursing; Nursing values