Nurse perceptions of facility influences on older adult acute care falls

Health care and nursing sometimes seem at odds when determining what is best for patient care. This study examined registered nurse (RN) perceptions of the inability to apply expert specialized knowledge of falls prevention for older adults while maintaining professional nursing standards of care and safety and complying with health care and facility policies, procedures, and bureaucratic directives. Following methods of Institutional Ethnography (IE), the study considered how institutions influenced and organized RNs’ work and social organization. The social life and organization of RNs arises in what they do and translate into their specialized knowledge. Within their particular settings and times focus remains on what is happening while coordinating social activities. The IE lens clearly illustrated the social practices that organized RNs’ everyday experiences, explicated the textual influence of priorities, transference of knowledge, organizational culture, and the environment. The study facilitated the recognition of how present day health care culture and practices influenced RNs’ work and shaped their practice reality. Participant answers to the central question and research questions identified similar recurring thematic and sub-thematic topics. The central theme was: My patients come first. The four subsequent research question themes were (a) personal expectations versus expectations of others, (b), it is all about the money, (c) lack of textual nursing knowledge, and (d) everyday anxiety, no support, and no respect. The subthemes at times indicated variations dependent on whether answered by a bedside, management or administrative RN. Those variations became the bifurcations or disjunctures unveiled by using IE