How do nurses in the acute surgical setting make sense of the care that they provide?

Introduction – This study seeks to explore how nurses sensemake the reality of the care they provide, including understanding the influences on how they make sense of their care. Few studies have explored how nurses sensemake the care they provide, focusing instead on how nurses understand, plan and deliver their care. Methodology – The study uses ethnomethodology to explicate how members of a particular social group, nurses in an acute hospital ward, create and maintain a sense of order in social life and how they shape, construct, and maintain their everyday worlds. To gain greater insight into the practice of caring, Sensemaking Theory (Weick, 1997) influenced the data analysis, discussion and understanding. Data collection was carried out in two surgical wards in an acute hospital, to triangulate different constructions of reality and generate a broader understanding. Methods used were the shadowing of eight nursing shifts, followed by semi-structured interviews with six registered nurses and a review of the nursing section of the hospital’s Electronic Patient Record (EPR) system. Data analysis was an iterative process, with the data collected from each phase coded to identify the key areas of understanding. Findings – The main finding is that nurses do not have one single understanding of nursing care. Instead, they construct and maintain multiple realities of care to give structure to how they deliver care. This finding suggests that nurses move seamlessly and unknowingly through these realities; this is supported by their use of specific language that they can effortlessly adopt. Dual processes of care were also identified, namely the activities involved in meeting a patient’s care needs alongside a parallel process of delivering care the nurse needs to provide. The exploration of the EPR found that the full complexity of nursing care was not appreciated or captured. In addition, the language used by nurses to create and maintain their realities was influenced by the EPR Conclusion – In appreciating the complexity of the realities of nursing care, this study has shown that nurses construct and maintain multiple realities; and that nurses have not been adequately prepared to manage these multiple realities in practice. Policy needs to reflect the work involved in managing these different realities in order to capture the quantum of nursing care required. Without this appreciation, nurses will remain ill prepared and attempts to determine the resource required will fail to reflect the complexity of care that nurses provide. Workforce planning and staffing calculation are based on a single reality, therefore underappreciating the impact and value of nursing care. The EPR focuses on capturing the physical interventions of care, and this caused frustration for the nurses using i