Realising skilled companionship in nursing: a utopian idea or difficult challenge?

AIMS AND OBJECTIVES: The question being considered in this discussion article is whether nurses' practice can be usefully characterised in terms of skilled companionship. BACKGROUND: A nurse's role might be characterised as one of a 'skilled companion,' a concept that brings together the scientific and moral basis of nursing practice. It is this focus on integrating both 'skill' and 'companionship' characteristics of nurses' practice that largely determines their effectiveness as care providers and their specific contribution to health care outcomes. METHODS: Discursive article that invites readers to explore and arrive at a more comprehensive understanding of nurses' daily practice, one from an ethical perspective that is based on empirical data from the study of patients' caring experiences, nurses' caring experiences and nurses' ethical practice in daily care. CONCLUSIONS: Research in this era of health care highlights an important dilemma that the nursing profession is confronted with daily: realising nurses' role as a skilled companion in an environment where this concept of nursing care is discouraged, or even thwarted. Although the ethical dimension is explicitly and universally recognised as a core dimension of nursing care, research clearly highlights nurses' difficulties in translating this element into daily practice. Most disturbing in these findings is that both patients and nurses feel compelled to reach a compromise to 'survive' in this often-chaotic caring environment. RELEVANCE TO CLINICAL PRACTICE: It appears today that nurses' intrinsic strengths and potential are largely underutilised in daily practice. More than ever, the nursing profession is challenged to reflect on the future position, aspirations and responsibilities of nurses, to make clear choices, and to act accordingly. Viewing and implementing the nurse's role as one of a skilled companion promise better health care delivery in a postmodern world.