5.9.1 Professional agency of nurses: Optionalising care (39)

Kathleen Kilstoff, Director of Undergraduate Nursing Studies, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Lindfield, NSW, Australia kathleen.kilstoff@uts.edu.au

Abstract:

Background:

Professional Agency of Nurses: Optionalising Care One of the challenges confronting nurses today is how best to manage the complexity of care required by the increasing numbers of acutely ill older people with concomitant co-morbidities being admitted into an economically constrained hospital system.

Aim:

The main aim of this study was to investigate nurses’ knowledge and attitudes in relation to how they responded to and managed the care needed by acutely ill older hospitalised patients.

Methods:

The study was developed in a constructivist framework with multiple methods of data collection (observations, interviews and review of hospital records), undertaken during 1999 and 2001. Data were analysed thematically in order to understand the constructions of nurses. Additional interrogation of the data was undertaken using Giddens’s (1984) Structuration Theory. Twenty seven registered nurses were recruited for the study by the use of purposive sampling.

Results:

The findings indicated that the nurses were knowledgeable and potentially competent in providing the standard of technical and functional care required by older adults in hospital. However, they admitted they were optionalising this care and blamed the medically oriented hospital organisations for the lack of funding for staff and resources, which impacted on their time. It was evident during the observations that this was not the case and so a very different picture began to unfold about what nurses said and what they did.

Conclusions:

The results demonstrate that the structural properties of the hospitals directed and controlled the way the nurses worked by a manipulation of ‘time and space’. The significance of this study is that through the use of Giddens’s (1984) Structuration Theory, the incongruence found between the nurses’ knowledge and their actions has been revealed.

Biography:

Following completion of her general nursing qualification, Kathleen Kilstoff commenced studies at the University of Hawaii and following her return to Australia commenced teaching in a hospital nursing program. She started lecturing in the tertiary sector when nursing education was transferred into the higher education sector in New South Wales. She has had extensive experience in nursing education in both the university and clinical settings. During this time she has developed, coordinated and taught across both undergraduate and postgraduate nursing programs, with a special interest in acute and aged care nursing. Her research interest is focused mainly on gerontological nursing and educational issues for nurses and include, the care of the cognitively impaired older adult, aromatherapy and hand massage for dementia day care clients, graduate transition, emotional intelligence and successful nurse graduate capabilities