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The significance of routines in nursing practice

Authors

  • Patrik Rytterström,

    1. Authors:Patrik Rytterström, PhD Student, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University; Mitra Unosson, RN, PhD, Professor, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping; Maria Arman, PhD, Associate Professor, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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  • Mitra Unosson,

    1. Authors:Patrik Rytterström, PhD Student, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University; Mitra Unosson, RN, PhD, Professor, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping; Maria Arman, PhD, Associate Professor, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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  • Maria Arman

    1. Authors:Patrik Rytterström, PhD Student, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University; Mitra Unosson, RN, PhD, Professor, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping; Maria Arman, PhD, Associate Professor, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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Patrik Rytterström, PhD Student, ISV, Health University, Linköping University, Norrköping, 601 74 Sweden. Telephone: +46 11 363551.
E-mail:patrik.rytterstrom@isv.liu.se

Abstract

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.

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