Policy in the hearts, minds and hands of nurses
2019
Introduction: Hospital Policies are mandated to meet
governance and accreditation requirements that aim
to support the safe provision of patient care. System
reviews and investigations consistently link contributing
factors related to policy adherence failures as key
causes of adverse events and incidents causing
patient harm. Purpose: This research study was undertaken to
explore and gain greater understanding of the everyday
experiences of nurses and how they made sense of
the relationship between hospital policy and nursing
practice. The aims of the study were to become
aware of the issues around policy, to gain greater
understanding of the problem and to discern a way
forward. Methods: A bi-phased qualitative research
methodology was undertaken in this study: a
hermeneutic phenomenological approach with ten
semi-structured in-depth interviews exploring nurse
experience of policy, and an ethnographic approach
to observing six nurses working eight-hour shifts in
medical wards in three private hospitals. This field
work supported observation of how they actually
experienced hospital policy in their everyday work, and
was followed by a reflective practice session with the
researcher to better understand these experiences. Results: Results facilitated awareness of
understanding nurses’ experience and everyday work
through thematic analysis and validated that there was
a problem with the relationship between policy and
nursing practice. This then enabled the researcher
to observe how nurses actually practiced in their
daily work in relation to policy and undertake further
thematic analysis. Conclusions: Nurses did more than act out policies
and procedures in their everyday work, they used their
knowledge, experience, skills and their community
of nursing practice to show resilience in resolving
uncertainty and ambiguity in the workplace and patient
care needs – policy existed in the hearts, minds and
hands of nurses. Vignettes emphasised the impact of
complexity on nurses’ everyday work, and described
their responses to this challenge.
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