Perceptions of change to the hospital nurse's role: a gounded theory.

Abstract

This investigation set out to explore the changes affecting the role of the hospital nurse from the perspectives of nurses and doctors working on, and patients receiving treatment in, hospital wards. The aim was to examine their perceptions through qualitative methodology using the systematic method of grounded theory. Initially, eighteen nurses were interviewed, and through theoretical sampling, these were followed by interviews with seven doctors and then eight patients. All the nurses had been registered for a minimum of one year, and included general and specialist nurses. The doctors ranged from the newly qualified juniors to senior doctors with between fifteen and thirty years' experience, and worked in assorted specialties. The patients varied both in age and previous hospital experience, and these variations in all the groups provided both similarity and diversity of findings. The data were collected and analysed separately for each group. Four constructs emerged from the nurses: providing a service, drifting away from the patients, being ambitious and getting on and making choices. Four constructs emerged from the doctors: working together, retaining nursing, challenging medical power and defining the boundaries, and three from the patients' data: the changing healthcare environment, building relationships and responding to patients' needs. The findings of each group were then compared to examine their similarities and differences and to provide a framework for the evolving theory. The results demonstrate that the perceptions of each group are subject to both internal and external influences affecting the health care context. Thus, the role of the hospital nurse is perceived as remaining the same in some areas, such as a need to retain the caring role for patients, whilst in others progressing towards technological change and overlapping with the roles of doctors. It is perceived as undergoing metamorphosis and changing as a consequence of external political pressure, societal influences and nurses own developing knowledge; at the same time the role retains traditional elements, where nurses build a therapeutic relationship with patients and respond to their needs. Thus, depending on the perceptions of specific factors affecting the health care context, these influences generate metamorphosis or stasis in the role of the hospital nurse.