Dataset Information

Advancing the status of nursing: reconstructing professional nursing identity through patient safety work.

ABSTRACT:

Background

Recent decades have seen increased attention to patient safety in health care. This is often in the form of programmes aiming to change professional behaviours. Health professionals in hospitals have traditionally resented such initiatives because patient safety programmes often take a managerialist form that may be interpreted as a challenge to professional identity. Research, however, has mostly paid attention to the role of physicians. This study aims to highlight how such programmes may affect professional nursing identity.

Methods

We qualitatively investigated the implementation of a patient safety programme in Norway, paying attention to changes in nurses' practices and values. Based on purposive sampling, two group interviews, four individual interviews and five hours of observational studies were conducted in a hospital department, involving ten nurses and three informants from the hospital management. Interviews were conducted in offices at the hospital, and observations were performed in situ. All the interviews lasted from one to one and a half hours, and were recorded and transcribed ad verbatim. Data was analysed according to ad-hoc meaning generation.

Results

The following analytical categories were developed: reconstructing trust, reconstructing work, reconstructing values and reconstructing professional status. The patient safety programme involved a shift in patient safety-related decisions, from being based on professional judgement to being more system based. Some of the patient safety work that previously had been invisible and tacit became more visible. The patient safety programme involved activities that were more in accordance with the 'cure' discourse than traditional 'care' work within nursing. As a result, this implied a heightened perceived professional status among the nurses. The safety programme was - contrary to the 'normal' resistance against audit systems - well received because of the raised perceived professional status among the nurses.

Conclusions

Reconstructing trust, work, values and status, and even the profession itself, is being reconstructed through the work involved in implementing the procedures from the safety programme. Professional knowledge and identity are being challenged and changed, and what counts as good, professional nursing of high quality is being reconstructed.

SUBMITTER: Heldal F

PROVIDER: S-EPMC6591911 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesTo understand identity tensions experienced by health professionals when patient partners join a quality improvement committee.DesignQualitative ethnographic study based on participatory observation.SettingAn interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership.ParticipantsTwo patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team.Data collectionData collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019.Data analysisGhadiri's identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0).ResultsAll professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the 'caregiver-patient' relationship into a 'colleague-colleague' relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the 'good professional', challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.ConclusionThis research provides a new perspective on understanding how working in partnership with patients transform health professionals' identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals' resistance to working with patients, patients' status and remuneration, professionals' concerns toward patient 'representativeness'). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.