Nurses, medications and medication error: An ethnomethodological study

Project attempts to view the administration of medication from the perspective of the clinical nurses who carry it out, in the expectation that understanding will be found in the ordinary, every-day, common-sense world of nursing practice in an acute care setting.. This thesis documents an examination of the routine administration or medications by nurses in acute care settings, a process which is normally governed by detailed institutional rules. Previous research into medication error made by nurses has produced no satisfactory results in terms of understanding how the errors occur, the ways in which errors are reported or in suggesting ways in which errors may be reduced. Ethnomethodology, a methodology which allows access to the every-day world of nursing was selected so that the common-place, taken-for-granted ways in which nurses make sense of their work was examined. This approach reveals both the activities o fnurses as they go about their regular work and the tacitly held knowledge which informs their practice. As background to the study, the policies and procedures developed for the administration of medications by nurses are described through an analysis of relevant published texts and other unpublished administrative documents.The ways in which nurses work within those policies and protocols has been explicated by the use of participant observation techniques in patient care areas, as well as by formal and informal interviews of nurses holding both clinical and administrative positions. The documentary method of Garfinkel (1968) was used to interpret the data. In this method there is a constant movement between particular incidents and general knowledge of the situation; the particular is incorporated into the general and is then used as part of the background for the analysis of further particular incidents and ideas. The interpretations were validated by returning them to the participants and asking them (and other nurses who had not been involved in the original data gathering) Is this the way it is? Both participants and others agree that the practices recorded in this study are indeed those used in nursing work in the setting of this project. The results of the analysis reveal that nurses engage in tactics: that is they take the given institutional policies and rules (the strategy) and turn them to ends (the tactics) that benefit themselves. The tactics employed by nurses may be categorised as: 1) situated and embodied logics: activities and ways of thinking which are developed to reach particular goals in practical situations; 2) redefinition of error: nurses find procedures laid down by the institution almost impossible to follow in practice. In order not to be seen to be continually making errors, they have redefined error. There is not single redefinition, but rather a set of criteria by which incidents are judged to be either error or not error. 3) A further set of tactics result in the mainten-ance of nurses' position in the social structures within which they live and work. The results of this study have implications for the definition of error in the administration of medication, for real and reported error rates and for measures to reduce and correct medication error, as well as the movement of the discipline of nursing toward the status of a profession. The study also demonstrates the effectiveness of ethnomethodology for revealing the tacitly held knowledge of nurses and the ways in which this informs practice in the real world.