THE SOCIAL ORGANIZATION OF NURSES' EDUCATIVE WORK.
Contributors: Dalhousie University (Canada)
Published: 1994
Number of pages: 256
Subjects: Health Sciences, Nursing.; Education, Health.
Description: Nurses claim an educative function for nursing and have done so from the earliest days of the profession. In this study, and using the method of institutional ethnography, I analysed the social organization of nurses' educative work from the standpoint of the hospital staff nurse.

I observed the work of twelve female surgical nurses for up to three complete work shifts per nurse, interviewed each nurse twice and seven other nurses once (5 nurse managers, 1 nurse educator and 1 staff nurse), analysed periodicals and texts on patient teaching, patient instructional material, and hospital documents that nurses used in their work or that organized their work. The key question that emerged for analysis was this: How is the visibility and invisibility of educative work constructed?.

Nursing is an occupation undergoing professionalization through scientification. Nurses learn and practice teaching within a discourse that trains them to understand educative work as the systematic instruction of patients in practices to promote compliance with medical regimens, self-care, and independence from professional caregivers. Work of this sort (for example, pre-operative teaching) is visible to nurses as teaching. However, my observations revealed that nurses teach inexperienced health care workers as well as patients, and they teach both of them to participate in hospital work processes. Furthermore most of nurses' educative work emerges in the course of everyday work routines, such as measuring vital functions. Work like this is invisible to nurses as teaching until it is brought to their attention. I contend that this is because such work has the character of "women's work".

Management of nurses' educative work is exercised through documentary processes that are oriented to control of nursing labour costs, quality of nursing care and protection of the hospital against liability from inadequate nursing care. Managerial documents build in professional conceptualizations of teaching. They do not take account of the teaching nurses do to produce the smooth organization of hospital work nor to teach physicians.

The invisibility of nurses' educative work with physicians, and with patients in the domains of medical diagnosis and therapy, is organized through their subordinate location in the gender and knowledge hierarchy of the hospital. Nurses' knowledge is masked through practices of deference and referral to physician knowledge, and through other communicative and documentary practices that obscure what they know.

This study revealed the range of nurses' educative work and its organization through professionalism, managerialism and gender. The findings have implications for the training of nurses and physicians, the theory and practice of teaching in nursing, nursing unions and nursing managers.
Notes: Source: Dissertation Abstracts International, Volume: 56-08, Section: B, page: 4239.

Thesis (PH.D.)--DALHOUSIE UNIVERSITY (CANADA), 1994.

School code: 0328.