University of Tasmania
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A study of the relationship between hospital policy and nursing practice

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posted on 2023-05-28, 11:44 authored by Foley, CM
Introduction System reviews and investigations of adverse events and incidents in hospitals consistently identify factors related to failure to adhere to hospital policy as key causes of patient harm. Hospital policies are mandated as an important clinical governance approach to meet practice standards for nurses and hospital management, and to provide regulatory and accreditation requirements that aim to support the safe provision of patient care. Purpose This research study was undertaken to explore and gain a greater understanding of the everyday experiences of nurses and how they make sense of the relationship between hospital policy and nursing practice. The aims of this study are to identify issues regarding policy and nursing practice, describe and gain a greater understanding of the problem, and challenge existing assumptions about hospital policy and nursing practice. Methods A bi-phase qualitative research methodology was used in this study. The first phase adapted a hermeneutic phenomenological approach using ten semi-structured in-depth interviews to explore nurses' experiences of policy in one private hospital. The second phase used an ethnographic approach to observe six nurses working eight-hour shifts in medical wards in three private hospitals. Observations were undertaken of how they actually experienced hospital policy in their everyday work, followed by a reflective practice session with the researcher to better understand these experiences. Results The study's approach enabled the researcher to observe how nurses actually practice in their daily work in relation to policy. The results provided an understanding of nurses' experiences and every day work through thematic analysis across both phases, including policy meaning; practicality and workplace culture; processes; variation or non-adherence; and practice gaps, knowledge and cynicism. Vignettes further emphasised the effect of complexity on nurses' every day work and described their responses to this challenge regarding hospital policy. The analysis showed that there is a problematic relationship between hospital policy and nursing practice, as there is inconsistency between what is expected by regulators, accreditors and managers and how hospital policy is actually enacted and practiced by frontline nurses. Conclusions Nurses do not always read hospital policies as expected by regulators, accreditors and managers; however, they fulfil the requirements of the policies and procedures in their everyday work. They do this by using their knowledge, experience, skills and community of practice to resolve uncertainty and ambiguity in complex workplace settings that focus on patients' care needs. Standards of practice along with regulatory and accreditation standards are built upon the notion of nurses reading and following evidence-based policies and procedures. This study challenges the reality of this notion and proposes areas for further research in this area.


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