Surgery nurses' telephone communication: a mixed methods study with a special focus on newcomers' calls

Challenging the interprofessional epistemic boundaries: The practices of informing in nurse-physician interaction

Interprofessional management of knowledge in health care settings appears to be particularly vital for the ways in which information circulates, medical decisions are taken, and nursing practices are implemented. Drawing on an extensive ethnographic fieldwork in an Italian Intensive Care Unit, this article investigates how the nurses orient to and concurrently challenge the nurse-physician epistemic boundaries by the different ways through which they perform "informing", and make it work as a diagnostic-relevant activity. Adopting an ethnographic-nurtured discursive approach to a dataset of video-recorded morning briefings, we analyze the nurses' informing contributions in terms of sequential position, turn-taking and turn design. We identify five practices of informing and show how they display different degrees of agency and differently impact on the team's "infectious diseases diagnostic reasoning". This article contributes to nurse-physician interaction studies by showing how the epistemic imbalance at play is interactionally accomplished by participants one interaction at a time. Particularly, the analysis demonstrates that the nurses actively contribute to the teamwork by a skillful management of knowledge that precedes the exercise of the physicians' epistemic and deontic rights implied in diagnosing and planning. Our findings illustrate how the nurses: a) exert their interactional agency without crossing the institutionally sanctioned epistemic and deontic boundaries to which they are observably oriented to; b) cautiously challenge the epistemic imbalance at play in nurse-physician interaction and c) actively contribute in setting the premises of the team's collective decisions. Conclusion and practical implications are proposed.

[Interprofessional collaboration between new nursing graduates and social workers: Hospital discharge planning telephone calls.]

INTRODUCTION

In hospitals, the discharge of patients needing home care or going to a care facility is planned interprofessionally, in particular via telephone calls between nurses and social workers.

CONTEXT

During discharge planning, the collaboration between a nurse and a social worker is fraught with tension. When this planning is conducted over the phone and the nurse is a new graduate, the tension can be heightened.

METHOD

Sociological study in an acute-care hospital in French-speaking Switzerland based on analyses of telephone conversations between new nursing graduates and social workers, in addition to observations, interviews and document-gathering.

RESULTS

Discharge planning is fraught with tension related to the timing of the planning and the care requested. The telephone calls are opportunities for new nurses to learn how to present cases, the procedures to follow for discharge planning, and the work logics of the individuals involved.

DISCUSSION

The study confirms the need to prepare new nurses to work with social workers on discharge planning and recommends offering training in this, both in nursing school and in the workplace.

CONCLUSION

Research documenting real work practices provides the keys to perfecting them.