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The significance of routines in nursing practice
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
Dept of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute.
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 23-24, 3513-3522 p.Article in journal (Refereed) Published
Abstract [ar]

Aim. The aim of this study was to illuminate the significance of routines in nursing practice.

Background. Clinical nursing is performed under the guidance of routines to varying degrees. In the nursing literature, routine is described as having both negative and positive aspects, but use of the term is inconsistent, and empirical evidence is sparse. In the research on organisational routines, a distinction is made between routine as a rule and routine as action.

Design. A qualitative design using a phenomenological-hermeneutic approach.

Method. Data collection from three focus groups focused on nurses’ experience of routines. Seventeen individual interviews from a previous study focusing on caring culture were also analysed in a secondary qualitative analysis. All participants were employed as ‘qualified nursing pool’ nurses.

Result. Routines are experienced as pragmatic, obstructive and meaningful. The aim of the pragmatic routine was to ensure that daily working life works; this routine is practised more on the basis of rational arguments and obvious intentions. The obstructive routine had negative consequences for nursing practice and was described as nursing losing its humanity and violating the patient’s integrity. The meaningful routine involved becoming one with the routine and for the nurses, it felt right and meaningful to adapt to it.

Conclusions. Routines become meaningful when the individual action is in harmony with the cultural pattern on which the nursing work is based. Instead of letting contemporary practice passively become routine, routines can be assessed and developed using research and theoretical underpinnings as a starting point for nursing practice.

Relevance to clinical practice. Leaders have a special responsibility to develop and support meaningful routines. One approach could be to let wards examine their routines from a patient perspective on the basis of the themes of pragmatic, meaningful and obstructive routine.

Place, publisher, year, edition, pages
Wiley , 2011. Vol. 20, no 23-24, 3513-3522 p.
Keyword [en]
culture, lifeworld, nursing practice, phenomenological-hermeneutic method, routine, ward
National Category
URN: urn:nbn:se:liu:diva-67272DOI: 10.1111/j.1365-2702.2010.03522.xISI: 000297864500027OAI: diva2:409213
Article first published online: 12 Oct. 2010Available from: 2011-04-07 Created: 2011-04-07 Last updated: 2012-01-20Bibliographically approved
In thesis
1. Tradition och horisont: vårdkulturens betydelse för vårdens praxis
Open this publication in new window or tab >>Tradition och horisont: vårdkulturens betydelse för vårdens praxis
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main aim of this thesis was to illuminate and understand aspects of care culture as a meaning–making process that influences the care praxis. In health care there is increasing recognition of the impacts on organizational culture of health-related matters. Although the factors studied affect care and nursing care, there has been little research from a caring science perspective. Care culture is understood from a hermeneutic perspective as a meaning-making process related to tradition, horizon and “bildung”. These three concepts give care a meaning cohesion that helps caregivers to orient themselves and acquire a care praxis.

Study I was an interview study with seventeen nurses working on different wards. Study II was a focus group study, and included three focus groups with 24 nurses and a secondary qualitative analysis of interviews from study I. Both studies I and II used a phenomenological-hermeneutic approach. Study III was a hermeneutic documentary analysis conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. Study III was a hermeneutic documentary analysis conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. Study IV was a case study involving 12 individual interviews and one focus group interview that included four participants. All participants were working at various levels in the municipal organization and were directly or indirectly connected to a mistreatment situation. This research also included a two-day field study and a document study. The individual interviews and focus group interviews were analyzed using a phenomenological hermeneutic approach.

The findings show that care culture can be experienced as positive and enabling of good care but also as defective and an obstacle to good care. Three different care cultures were identified: a service, a social and a motherhood culture. All cultures showed traces of caring values, but from a caring theory perspective, none of them fully demonstrated understanding of the notion of existential caring revealed as the integration of freedom and vulnerability. By studying the underlying traditions and the caregivers’ horizon, the care culture can be illuminated and understood through its expression in praxis. From gaining a comprehensive understanding, a caring ideal could open up and reflect the care culture´s boundaries. This means that ideals can have different interpretations depending on the conditions the care praxis is based on. The gap between care theory and praxis can therefore be understood to mean that the care culture does not use Bildung as a process of alienation and appropriation, resulting in no transformation of the prevailing tradition.

Care culture could be distinguished from three different perspectives. They are referred to in this thesis as the prevailing, the visionary and the critical perspective. Developing a hermeneutic concept of culture, understood as the care culture´s critical perspective, could serve as an opportunity for a reinterpretation of nursing theory´s meta-paradigm concept of environment.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 69 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1273
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-72231 (URN)978-91-7393-027-7 (ISBN)
Public defence
2011-11-29, K1, Kåkenhus, Campus Norrköping, Linköpings universitet, Norrköping, 09:00 (Swedish)
Available from: 2011-11-23 Created: 2011-11-23 Last updated: 2015-01-19Bibliographically approved

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