The structure of nursing practice: Implications for teaching nursing process

This investigation was an explorative and descriptive analysis of the actual structure guiding professional activity in nursing practice. Professional activity was defined as consisting of the application of nursing theory and technique through rigorous instrumental problem-solving in clinical nursing practice. The model for application of nursing theory currently taught in nursing curricula is described as a sequential problem-solving framework called nursing process. The goal of this research investigation was to observe and describe the model used guiding professional behavior in actual nursing practice, and compare this on-site model to the espoused model of nursing process. Such validation offered implications for curricular modifications for nurse educator and nurse leaders as they develop realistic nursing undergraduate programs and promulgate standards of nursing practice. Qualitative methods were used to describe the on-site model of nursing practice. Content analysis, field observation and collaborative inquiry were the methods used for this investigation. Key concepts derived from content analyses of a structured interview were compared to actual observed behaviors of each research participant in clinical practice. Through collaborative inquiry, nurse participants provided descriptions and explanations for inconsistencies resulting from the comparison of the observed behavior to the analyzed initial interview. The integration of qualitative methods was designed to enhance validity of the researcher\u27s inferences and nurse participants\u27 descriptions of the actual structure guiding their behavior in clinical practice. An urban university hospital located in a large metropolitan city was the site for this investigation. Thirty-three medical-surgical registered nurses participated in this investigation. As a result of this study: (a) the on-site use of nursing process was found to be inconsistent with the nursing process framework currently taught in undergraduate curricula; (b) the guiding framework for actual nursing practice was described; (c) four implications for curricular modification were presented. The primary implication resulting from this investigation is for nurse educators, administrators and staff development departments to collaborate in designing programs which shape professional behaviors necessary for continuous inquiry in reflective practice