Theory of nebulous intentioning in acute hospital care nursing
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Date
2018
Authors
Ni Ruiseal, Aoife
Journal Title
Journal ISSN
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Publisher
University College Cork
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Abstract
Background: The research study was prompted by a realisation that nurses’ activities in their daily clinical work did not appear to be primarily determined by diagnosis of nursing needs among their patients. Aim: The aim of the study presented in this thesis was to explore the main influences on the work of clinical nurses in acute care settings. Method: A Classic Grounded Theory methodology was used because of the openness it allows for the emergence of participants’ main concerns while minimising researcher bias. The sample comprised experienced acute care nurses (n=24) from a large tertiary care hospital. Theoretical sampling and the constant comparative method of data analysis were used in accordance with Classic Grounded Theory methodology (Glaser 1978). Findings: The theory of nebulous intentioning explains the behaviours of nurses in acute care and the influences which result in them. Two sub-core categories emerged. The first is accommodating which relates to the overriding attention nurses give to wide ranging activities aimed at ensuring that the patient receives safe and cohesive care from the multidisciplinary healthcare team (MDT). The second, integrity eroding, conceptualises nurses’ attitudes towards the nursing role, some of which serve to undermine its importance in relation to other healthcare contributions. The consequence of nursing behaviours explained by the theory, is the perennial deferral of that nursing work perceived as core nursing care requiring presence and time with patients. Though nurses retain an intention to provide this care, plans are relatively vague and rarely satisfactorily achieved. Thus, influences on clinical nursing in acute care result in core nursing care largely existing as aspirational in nature; a nebulous intention. The study identifies missed organisational and MDT care as key influences on nursing behaviour. It explicates the nursing behaviours which result in the unfulfilled intention to provide core nursing care. Critically, it identifies much of what nurses do in the place of perceived core nursing care to be vital to achievement of holistic, safe patient care on behalf of the whole acute care organisation. Conclusion: The theory of Nebulous Intentioning indicates that nursing in acute healthcare contributes more to patient health and safety than is currently understood within or outside the profession. Much of this contribution is vital to the safe and holistic care of the patient and should therefore be resourced to enable this and core nursing care to occur together. Missed nursing and MDT care cannot be resolved unilaterally. They are organisational issues and require resolution at this level.
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Keywords
Accommodating , Nursing contribution , Acute hospital nursing , Nursing integrity , Deferral of nursing care , Nursing theory
Citation
Ni Ruiseal, A. 2018. Theory of nebulous intentioning in acute hospital care nursing. PhD Thesis, University College Cork.