How nurses in a rehabilitation unit are coping wiht differing views on the nature of knowledge

1. Good practice:
how nurses in a rehabilitation unit are coping with
differing views on the nature of knowledge
Vestfold University College
Master in health promotion
Lene Stavnar and Monica Vestå

2. Theoretical framework
• Bolman, Lee G. & Deal, Terrence E. Reframing
organizations. Artistry, Choice and Leadership
• Hanson, Anders. Workplace health promotion
• Green, Jackie & Tones, Keith. Health Promotion.
Planning and strategies
• Grimen, Harald & Terum, Lars I. Evidence based
professional practice
• Schön, Donald A. The reflective practitioner. How
professionals think in action

3. Research questions
• How can internal control systems and clinical
judgements promote good nursing practice in a
rehabilitation unit?
1. How is the internal control system in the unit organized?
2. In what way do the nurses in the unit use their clinical
judgement?
3. How do the internal control system and the clinical
judgement interact?

4. Health promotion perspectives
The settings approach
Re-orienting health service (Ottawa-charter)

5. Reseach setting
Sample:
• A municipal rehabilitation centre for hospital patients
• Informants: nurses, nurse assistants,
physiotherapist, occupational therapist, leader

6. Methods
• Observation
• Interdisciplinary workshop
• Individual interviews of six nurses

7. Data analysis
• Inductiv approach
• Main categories:
- Internal control system
- Clinical judgement

8. Codes
•Competance and experience
•Comprehension of clinical
judgement
•Course of treatment
•Documentation
•Relatives and family
•Decisions
•Targets
•Interdisiplinary collaboration
•Patient in focus
•Patient participation
•The nurse`s role
•Time
•Communication and
information
•Leadership
•Ethical perspectives
•Culture
•Quality
•Good practice
•Coordination reform
•Correct patient group

9. Results. The internal control system
•Management ensured that
employees had necessary
knowledge and competence
and that both employees and
patients participated in
practical work. Routines
adapted to rehabilitation
were used in daily activities
•The unit has systems for
identifying possible failure,
and the procedures were
regularly evaluated. Targets
were evaluated to initiate
change
•Based on clear goals and role
descriptions the activities in
the rehabilitation unit were
planned according to the
directives in the Regulations
of Internal Control
•Procedures were regularly
adjusted according to the
evaluations and
improvement s were made
Act
h
Plan
a,b
Do
c,d,e
Check
f,g

10. Results. The use of clinical judgement
• Comprehension: The combination of
theoretical knowledge, experience and
intuition
• Used continuously
• Reflection in- and over- action, both
individually and together
• Reflection on ethical values and dilemmas

11. Results. Good nursing practice based
on the interaction between the
internal control system and the nurses
clinical judgement
The nurse`s role Organizational factors
•Primary contact
•Cooperation partner
•Coordinator
•The nurse`s basic values
•Leadership
•Decisions and targets
•Good routines
•Time and resources

12. Concluding remarks
• Structural balance : The internal control system
included an appropriate distribution of top-down
and bottom-up elements. Decisions based on
experiences and clinical judgement could take
place.
• Future challenge: The internal control system will
determine the nature of the clinical judgements
and the way health professionals develop their
competence.

13. Workshop