Nurses' Medication Work: The Social Organization of Rule Breaking to Keep Patients Safe

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atmire.migration.oldid2900
dc.contributor.advisorWhite, Debbie
dc.contributor.advisorRankin, Janet
dc.contributor.authorDyjur, Louise
dc.date.accessioned2015-01-26T15:39:31Z
dc.date.available2015-02-23T08:00:39Z
dc.date.issued2015-01-26
dc.date.submitted2015en
dc.description.abstractPatient safety has emerged as one of the most important and widely accepted aims of contemporary health care organizations. Medication errors are common and pose potentially serious threats to the safety of patients. Consequently, initiatives to improve patient safety often target nurses’ work with medications. A plethora of research studies examine medication errors and contribute to dominant formulations that impose stringent rules thought to enhance medication safety. However, little literature has examined the materiality of medication work and few research studies are oriented to the knowledge practices of nurses. This study used an institutional ethnographic approach, grounded in nurses’ everyday experiences, to contribute a different way of knowing about medication work. The study findings revealed a disquieting disjuncture between theoretical accounts of medication work and the actual everyday practices of nurses working with medications. Nurses routinely use their professional judgment and discretion to adapt stringent rules in order to keep patients safe and accomplish medication work effectively. However necessary and sensible it may be, nursing work that does not adhere to standard practice and institutional policy may be perceived as “breaking the rules”. Rule breaking is risky for nurses, as their professional competence is scrutinized and evaluated through regulatory and theoretical frameworks that value adherence to rules as the only way to demonstrate safety. The core argument developed in this analysis is that discretion is an essential element of competent medication practice, and that framing discretionary work within a rule based discourse obscures the safety work that nurses are routinely and regularly engaged in.en_US
dc.identifier.citationDyjur, L. (2015). Nurses' Medication Work: The Social Organization of Rule Breaking to Keep Patients Safe (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/27149en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/27149
dc.identifier.urihttp://hdl.handle.net/11023/2024
dc.language.isoeng
dc.publisher.facultyGraduate Studies
dc.publisher.facultyNursing
dc.publisher.institutionUniversity of Calgaryen
dc.publisher.placeCalgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subjectNursing
dc.subject.classificationMedication Worken_US
dc.subject.classificationNursing Worken_US
dc.subject.classificationInstitutional Ethnographyen_US
dc.titleNurses' Medication Work: The Social Organization of Rule Breaking to Keep Patients Safe
dc.typedoctoral thesis
thesis.degree.disciplineNursing
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
ucalgary.item.requestcopytrue
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