This study investigates the nature of nurses' clinical engagements and courses of action in acute-care settings in Norway. A qualitative descriptive design with a convenience sample of 6 registered nurses was used. Data were collected via participant observation, in-depth interviews during 3 full shifts for each nurse, and nursing documents about the patients. Data analyses used the method suggested by Atkinson (1992) that coalesces analyses of parts with wholes. Findings revealed that nurses' clinical engagements are multidimensional and consist of 3 sorts of activities: (a) nurses' movements and encounters with patients, (b) the process of knowing patients, and (c) clinical actions addressing patients' specific needs/requests. These activities constituted most nursing work when the nurses were providing care for hospitalized patients.
Keywords: nurses' approaches; clinical engagement; nursing practice; nurses' involvement; modes of care
The practice of nursing is multifaceted work demanding high-level skills and complex knowledge. Nursing practice involves engagement of nurses in clinical fields as agents of deliberation and enactment. Deliberation, based on mental processes, aligns with the process of estimation and discretion; enactment, based on acting, involves the mandates, laws, and regulations governing health care practices. In clinical engagements, nurses observe, assess, recognize, form ideas about, and decide on clinical situations, and produce actions accordingly. As cultural agents, nurses are socialized into ways of confronting clinical situations. Through experiences and interactions with other professionals, they assume specific ways of seeing, telling, and describing in practice, which are similar in other clinical professional practitioners (Atkinson, 1995; Lave & Wenger, 1991). Some aspects of these specific ways might dominate their practice, which may or may not be for the best for the patient, because common ways of viewing practice might stress some points and deemphasize others.
To be able to develop and improve nursing practice and reach excellence it is necessary to know what is actually going on in practice. We need descriptions of nursing practice. The closer and more in-depth knowledge we gain about this practice, the better we can act and react accordingly. Hughes (1984) asserts the importance of studying nurses' work to the maturation of nursing as a profession. Studies of nursing practice provide an understanding of nurses' work that can be used to improve nursing practice. This article looks at nursing practice and investigates the nature of nurses' clinical engagements and their course of action in acute care settings in Norway. It aims to disclose knowledge of nurses' patient-oriented activities and presents a picture of a nurse's clinical engagement.
Nursing practice is a form of human action aimed at solving another person's, that is, patient's or client's, health-related problems and providing care or help with his/her living. Nursing practice involves organized or intentional activities coordinated through nurses' deliberations about a client's situation and the clinical field (specific setting) in which both the nurse and the client are located (Kim, 1994). Deliberation by the nurse involves arriving at assessments and meanings of a clinical encounter, making decisions about the situation, and acting accordingly (Kim, 2000).
The activity of nursing has been described as direct and indirect care with more indirect care activities than direct care taking place in nursing settings (Jinks & Hope, 2000). Additional studies investigated types of nursing tasks, amount and complexity of these, and knowledge and models used in practice (Blay, Cairns, Chisholm, & O'Baugh, 2002; Coffin, 1990). Social processes embedded within the work of health care professionals have been studied to suggest that nurses' and patients' experiences in health care involve intricate, coordinated, interactive processes evolving into specific patterns (Strauss, Fagerhaugh, Suczek, & Wiener, 1984). …