NURSING RITUALS IN AN ADULT ACUTE CARE HOSPITAL: AN ETHNOGRAPHY

This study examined potential nursing rituals using an ethnographic approach. The definition of ritual by DeCraemer, Vansina and Fox (1976) was used: ritual is patterned symbolic action that refers to the goals and values of a social group. Post-mortem care, admission and discharge of patients to and from the hospital, medication administration, medical aseptic practices and change of shift report were investigated. Participant observation and intensive, semi-structured interviews were the major data collection methods of the study. Nursing staff, patients and other hospital personnel were the informants. The setting of the study was 7H, an adult medical unit located in a large urban hospital. Data collection extended over a 12 month period. Results included an ethnographic description and analysis of 7H, the nursing staff and five potential ritual categories. It was determined that post-mortem care is a therapeutic nursing ritual. It was surrounded by the problems associated with the resuscitate or do not resuscitate dilemma. Post-mortem care represented, on a symbolic level, nurses\u27 continuation and gradual relinquishing of responsibility after death. The routines and procedures of 7H\u27s nursing staff did not reveal that admission or discharge procedures are nursing rituals. However, admission and discharge procedures had characteristics of patient rituals. Administration of medications is a therapeutic nursing ritual. The importance of medications and the ritual aspects of medication administration were evident as nurses made medication errors. Events examined for rituals associated with medical aseptic practices included the bath, the handling of excreta and caring for patients with infectious diseases. Of these, the bath is clearly a therapeutic nursing ritual. Change of shift report represented a transfer of responsibility from nurses going off one shift to nurses coming on the next shift and served as an arena for role socialization of nurses. Shift report is an occupational nursing ritual. The value held by 7H nurses, to do good and avoid harm, was evident as these nursing rituals were analyzed. Nurses passed on subcultural knowledge by demonstration, and by an oral tradition of information exchange