The Social Organization of Wound Clinic Work: An Institutional Ethnography

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atmire.migration.oldid4208
dc.contributor.advisorRankin, Janet
dc.contributor.authorWaters, Nicola Ruth
dc.contributor.committeememberRaffin Bouchal, Shelley
dc.contributor.committeememberEwashen, Carol
dc.date.accessioned2016-03-23T19:00:50Z
dc.date.available2016-03-23T19:00:50Z
dc.date.issued2016
dc.date.submitted2016en
dc.description.abstractThe care of wounds (broadly defined as any break in the surface of the skin) is considered a foundational component of nursing knowledge. Whilst most wounds resolve with minimal intervention, today’s aging population and rise in chronic disease have seen a rapid escalation in the number of people living with wounds that are challenging to heal. Nurses have played an integral part in initiatives to address the identified burden of chronic wounds. Efforts centred on developing evidence-based protocols intended to simplify selection of new wound-related technologies expected to improve clinical outcomes. In contrast to these expectations, anecdotal evidence, a limited number of published critiques and a recent focus in the literature on patient “wellbeing” suggest that wound care may be a contested place of nursing practice. This research interrogates the discourse of “advanced wound care” that presupposes wound healing as a linear, predictable event dependent on objective, quantifiable outcome measures. It troubles standardized approaches to wound care that require nurses to focus on physical characteristics of wounds rather than patients’ experience of living with a wound. Developed as an institutional ethnography, the study provided a way to articulate tensions that arise for nurses working in outpatient wound clinics. My analysis began in descriptions of everyday wound work. By empirically tracing links embedded in the textual records clinic nurses complete I explicate how biophysiological models organize nurses to practice as though wounds can be abstracted from the individuals living with them. This problem is amplified when translated into the algorithmic decision-making tools of an integrated health system wherein patients are managed as cases, referred to others for intervention, and provided with information to self-manage their care. I show how, as clinic nurses participate in the ruling relations of case management, their consciousness of what wound care is and how they are able to respond to their patients has been organized in line with managerial priorities. These findings call into question the foundations on which today’s wound care knowledge is built and open up for future dialogue and research the work of nurses and others committed to the care of people with chronic wounds.en_US
dc.identifier.citationWaters, N. R. (2016). The Social Organization of Wound Clinic Work: An Institutional Ethnography (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/28383en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/28383
dc.identifier.urihttp://hdl.handle.net/11023/2868
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.classificationWound Careen_US
dc.subject.classificationInstitutional Ethnographyen_US
dc.subject.classificationChronic Woundsen_US
dc.subject.classificationNurses' Worken_US
dc.titleThe Social Organization of Wound Clinic Work: An Institutional Ethnography
dc.typedoctoral thesis
thesis.degree.disciplineNursing
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
ucalgary.item.requestcopytrue
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