Under the radar: The benefits of a sociological view of nurses’ ‘non-compliance’ in hospital wards at night
Under the radar: The benefits of a sociological view of nurses’ ‘non-compliance’ in hospital wards at night
This paper demonstrates how a 'sociology of healthcare safety and quality' (Allen et al., 2015) can expand understanding of staff 'non-compliance'. Following Allen (2016) it uses aspects of Actor-network theory and the concept of working practices to challenge the mainstream Quality Improvement approach of treating staff concerns as 'resistance' to be overcome. This research was part of a study exploring nurses' relative 'non-compliance' with a vital signs observation protocol at night. An Early Warning System (EWS) algorithm prescribed frequency of observations when readings deviated from a 'normal' range. Semi-structured interviews were carried out with 17 nursing staff on wards with differing levels of compliance with the protocol. An electronic device had a delegating (calculating observation intervals) and prescriptive role (informing nurses when to carry out observations). Data was used by hospital management to assess ward compliance with the protocol. Interviewees described how the use of these actants (electronic device, ward compliance targets and protocol) provided some affordances. Yet the measurement of prescribed activity as 'compliant' or 'non-compliant' with no opportunity for nurse input removed nurses' mediating role and reduced their sense of professional autonomy. However nurses' accounts of decisions not to comply suggested certain patient groups might be unintentionally under-monitored at night. It was recommended that nurses' judgements about non-compliance be incorporated into the system to restore nurses' mediating role but also highlight potential risks. This research demonstrates how a sociological approach can address staff concerns and patient safety while making visible the impact of technology on ward decision making.
102
British Sociological Association
Hope, Jo
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Recio Saucedo, A.
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Griffiths, P.
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Smith, G.
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Schmidt, P.
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13 September 2017
Hope, Jo
5d49099e-13bc-49d2-88d8-48e1ec6d25fc
Recio Saucedo, A.
d05c4e43-3399-466d-99e0-01403a04b467
Griffiths, P.
ac7afec1-7d72-4b83-b016-3a43e245265b
Smith, G.
adee1144-0354-42ec-8b09-86d5974969ea
Schmidt, P.
b966c795-a5c8-48a7-ac55-dbfbbf27f666
Hope, Jo, Recio Saucedo, A., Griffiths, P., Smith, G. and Schmidt, P.
(2017)
Under the radar: The benefits of a sociological view of nurses’ ‘non-compliance’ in hospital wards at night.
In Medical Sociology Study Group: 49th Annual Conference Programme.
British Sociological Association.
.
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Conference or Workshop Item
(Paper)
Abstract
This paper demonstrates how a 'sociology of healthcare safety and quality' (Allen et al., 2015) can expand understanding of staff 'non-compliance'. Following Allen (2016) it uses aspects of Actor-network theory and the concept of working practices to challenge the mainstream Quality Improvement approach of treating staff concerns as 'resistance' to be overcome. This research was part of a study exploring nurses' relative 'non-compliance' with a vital signs observation protocol at night. An Early Warning System (EWS) algorithm prescribed frequency of observations when readings deviated from a 'normal' range. Semi-structured interviews were carried out with 17 nursing staff on wards with differing levels of compliance with the protocol. An electronic device had a delegating (calculating observation intervals) and prescriptive role (informing nurses when to carry out observations). Data was used by hospital management to assess ward compliance with the protocol. Interviewees described how the use of these actants (electronic device, ward compliance targets and protocol) provided some affordances. Yet the measurement of prescribed activity as 'compliant' or 'non-compliant' with no opportunity for nurse input removed nurses' mediating role and reduced their sense of professional autonomy. However nurses' accounts of decisions not to comply suggested certain patient groups might be unintentionally under-monitored at night. It was recommended that nurses' judgements about non-compliance be incorporated into the system to restore nurses' mediating role but also highlight potential risks. This research demonstrates how a sociological approach can address staff concerns and patient safety while making visible the impact of technology on ward decision making.
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Under the radar: the benefits of a sociological view of nurses’ ‘non-compliance’ in hospital wards at night
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Published date: 13 September 2017
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British Sociological Association (BSA) Medical Sociology Annual Conference: 49th Annual Conference, University of York, York, United Kingdom, 2017-09-13 - 2017-09-15
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Local EPrints ID: 420773
URI: http://eprints.soton.ac.uk/id/eprint/420773
PURE UUID: e7ae1219-f376-41ce-8920-39ea466e2a77
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Date deposited: 16 May 2018 16:30
Last modified: 16 Mar 2024 04:23
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G. Smith
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P. Schmidt
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