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Title: Contextual factors that enable or disable nurses' professional practice.
Author: Norris, Margaret Kathleen.
ISNI:       0000 0001 3449 3884
Awarding Body: University of Sussex
Current Institution: University of Sussex
Date of Award: 2000
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This study explored the complex world of nursing at a time of humungous change in the delivery of health care services. The initial focus of the research was registered nurses' use of knowledge in professional practice; however this was largely displaced by contextual issues, which emerged from the data. Eraut's (1992,1994) concepts of professional knowledge informed the data generation and the analysis. A broadly qualitative approach drawing on grounded theory and constructivism provided the methodological framework and the research methods involved observation and interview. The sample comprised registered nurses undertaking a four-year part-time degree in nursing studies. Twenty-seven were observed in a variety of clinical settings: sixteen of this group were subsequently interviewed. Six of their managers were then interviewed. Data analysis followed a pattern of literal, interpretive and reflective coding and revealed a number of key issues for registered nurses working in the United Kingdom at the time of the research. The nurses fell into three categories, the survivors, the battle weary and the battle hardened; the largest group being the battle weary. The key causes of the weariness originated from organizational constraints such as low staffing levels, poor teamwork and an inability to give appropriate care to their patients. The effects of battle weariness included low morale, which affected their motivation, tearfulness and a general fatigue. The 'survivors' (a minority) were characterized by a sense of purpose and a fulfillment from their work. The contexts in which the battle weary worked were likened to a war zone with a clearly defined battlefield. Significant changes to the traditional role of the ward sister/charge nurse have left the majority of nurses in this study feeling unsupported and with a lack of clinical leadership. The nurses, often only working at 'D' or 'E' grade, frequently found themselves trying to cope with conflicts in practice with nursing colleagues, with patients and with doctors.Professional knowledge used in practice included communication and interpersonal skills, teamwork, delivering 'hands on' care to patients and coping with the ever changing demands on the nursing time. A number of recommendations are made and include an 'enabling curriculum' for educating nurses at initial and post registration level, a return of the clinical leadership role for ward sisters and charge nurses and a renewal of the focus of nursing practice.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Health care services; Nursing; Low morale