Sarah Lake

PhD candidate

Within and between: accomplishing nursing in the acute care hospital setting

Supervisors: Trudy Rudge and Sandra West

Every day in clinical practice nurses work in complex, dynamic and uncertain situations. In the hospital setting, throughout the 24hr daily cycle of shift work, mediated by handover of patient status and progress, nurses attend to patient needs for care relevant to the course of the patient’s hospital stay. Each nurse will look after several patients for the duration of the shift so that there may be unfinished, competing and/or conflicting patient needs for care occurring simultaneously. Somehow nurses mostly address all that needs to be done for this finite period of time, handing over in-progress and planned care to the next shift. To do this they juggle and balance within individual patient’s needs for care and also between the needs for care of the several patients within the caseload i.e. they accomplish nursing.

The question of how nurses provide care has been dominated by studies of clinical decision-making, and a tacit (taken-for-granted) knowledge of nursing prioritisation of the patient need for care has now been discerned from within the extensive literature on the subject (Lake 2005). But, though available studies highlight nurses’ practical wisdom (Oberle & Allen 2001), embodied knowledge (Brykczynski 1998), embodied intelligence (Minick & Harvey 2003), and/or knowledge as action in practice (Purkis & Bjornsdottir 2006), how nurses nurse ‘within and between’, the crucial but taken-for-granted character of everyday acute care nursing, has not yet been studied. This research proposes to observe nurse participants in practice and talk with them to see how they do this.

The question for research:

How do nurses accomplish nursing within and between patients’ needs for care in acute care hospital wards?

Aims of the research:
  • To understand how patient care is prioritised by nurses working in acute care environments
  • To conduct an ethnographic study of up to ten Registered Nurse (RN) participants, observing them in daily practice and talking with them about this
  • To analyse all of the collected data using Bourdieu’s Theory of Practice (1977; 1990; 1998).

The study will contribute better understanding of how nurses prioritise patients’ needs for care when looking after several patients concurrently in dynamic situations. This has the potential to improve the way patient care is delivered in these more common settings where nurses work, particularly in relation to both patient safety and risk management.

In moving beyond the cognitive approach and exploring a new way of looking at nurse clinical decision-making in practice, the study is of international significance not only for nursing knowledge (and potentially for how this knowledge is used in practice), but also for the development of understandings about the practices of work in increasingly complex environments.