Nurses making caring work : a closet drama




Boyce, Joan Lee

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The study reveals how nurses operationalize their daily caring practices in a hospital oncology unit that is described by nursing students as having a “culture of caring”. Despite ample evidence that changes to nursing practices in hospitals are occurring, there exists a dearth of work, theoretical or otherwise, that clearly addresses what appears to be emerging as a major trend. This ethnographic study directs attention to issues and concerns related to the changes by exploring the question of how nurses sustain their daily caring practices in light of the contextual influences that support or impinge upon their daily nursing activities. The study spans over a three month period (2-3 days a week) and involves 19 registered nurses who volunteered to be participants. Participant observation and journaling are the methods used to generate data. This field study is strengthened by participants’ corroboration with the researcher. Data collection, analysis, and interpretation were conflated into a single simultaneous process. The findings are presented in the form of an artistic portrayal: termed a closet drama”. Analysis revealed nine themes of caring practices that framed a collective story of ‘caring comes first’: making connections, creating form, making do, tolerating ambiguity, committing to diversity and dealing with difference; facing the possibility of death and facing dying, thinking outside the box of strategic moves, caring for self and others, and staying the course. They are the titles for the nine acts. A discussion of the findings is included as part of the drama in a series of passages called ‘After Wards’. Practices of caring are identified as a third mode of thinking that is situational and immediate and located between the two worldviews of modernity and postmodern; certain and uncertainty. Nurses’ intentionality is aimed at building bridges of understanding between the predetermined strategies of imposed order, developed to direct patient care, and uncertainty stemming from patients’ personal understandings of health and unique responses to their current health event. The characteristics of caring practices are identified as thoughtful conversations and generative tensions as a consequence of the dialogical encounters that result in reflective understandings. Caring practices create a space for the centrality of the social in intellectual thinking where assumptions are questions, contextual influences are taken into account, and capacity building occurs at an individual and system level. Of note is that one of the themes, “making do”, resulted in nurses directing their attention in two different directions: towards their patient and towards system issues. Thus, “making-do” is seen to serve two different functions. One is that it resists the loss of different possibilities for care. The second is that it serves to maintain hegemonic norms. In the discussion related to the significance of the research, making do is identified as a fault line for the limiting of caring practices. The researcher concludes that there is a need for lens that would better enable nurses to examine the effects of contextual influences on nursing and nurses; to recognize the effects and opportunities related to changing worldviews.



nursing, oncology, patients, treatment