Academic journal article Nordic Journal of Working Life Studies

Evidence-Based Nursing in the IED: From Caring to Curing?

Academic journal article Nordic Journal of Working Life Studies

Evidence-Based Nursing in the IED: From Caring to Curing?

Article excerpt

Introduction

The article draws on a broad range of ethnographic data and explores how the nurses of a Danish Integrated Emergency Department (IED)1 are affected by and participate in quality and efficiency-leveraging initiatives in the shape of evidence-based standardization of their practice. Inspired by Bourdieu's theory of practice, it is analyzed how the inroads of new rules to practice transform the field of work, and the logics and rationalities that guide these nurses' differing responses to the changes are identified and explained.

There is currently a strong turn toward evidence-based and standardized practice in Danish hospitals (Knudsen et al., 2008). The development is characteristic of an international trend of increasing regulation of hospital services in a quest for quality and efficiency gains (Saltman et al., 1998) where medical evidence and standardization of clinical practice have come to serve as new public management (NPM) reform tools to regulate professional behavior (Nickelsen, 2009). In nursing, the uptake of evidence-based practice has spread with considerable force over the last decade, and many nurses have eagerly adopted this practice form (Boge & Martinsen, 2006; Delmar, 2005; Holmes et al., 2008; Jenkins, 2014). The turn toward medical evidence in nursing reinforces and accentuates a historical divide within the profession, which addresses the question of what counts as legitimate knowledge to inform practice, and essentially centers on what constitutes the core of nursing (Petersen, 1998; Taylor & Allen, 2007), or the nursing ethos (Apesoa-Varano, 2007; Fagermoen, 1997). This development is, however, not unproblematic, as medical evidence has increasingly come to rule out other knowledge bases to inform practice (Baumann, 2010; Boge et al., 2009; Holen, 2012), which raises questions about the capacities of the paradigm to designate one best practice (Holen, 2012; Holmes et al., 2008; Nolan & Bradley, 2008).

The article can usefully be located within a body of work, which has a critical focus on the connection between health care reform, healthcare organizations, work, and professionals. There is a tendency in the literature that the reactions and actions of healthcare practitioners to changing conditions of work are conceptualized in either monolithic terms as, for instance, "a profession under pressure," in binary related pairs either for or against changes, or as a choice between commitment to values of the profession or values of the organization. Furthermore, research in the field tends to be concentrated at either the macro or micro analytical level. For example, Hujala et al. (2014) describe how healthcare professionals get caught between a management logic and a professional logic in the wake of healthcare and NPM reforms. Likewise, Evetts (2011) links NPM to the notion of professionalism and describes how two oppositional idealtypes of organizational and occupational professionalism emerge. Nickelsen (2009) did an intervention study in a Danish hospital going through an accreditation process. He concludes that evidence-based practice divided the nursing staff in two groups, for or against accreditation. Allen and Taylor (2007) describe how nursing is split in a tension between professional and service visions of practice, and Apesoa-Varano (2007) and Mulhall (2002) put forth that nursing is caught in a dilemma between professionalism through academic knowledge and through caring. Healey (2009), Selberg (2013), and Latimer (2014) describe professions under pressure due to changes instantiated by public sector reform and NPM. Finally, Gibson (2013) discusses how NPM puts pressure on nurses to take up an enterprising identity. While this research brings valuable insight into the topic of public sector reform and the work of nurses, the ambition of this article is to contribute to the debate by exploring and refining nurses' responses in practice. Moreover, the article aims, through the connection of micro and macro analytical levels, at establishing an understanding of the dynamics and relationship between daily nursing work and the hospital as organization embedded in a context of wider societal and political forces. …

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