A barrier to clinical effectiveness: the etiquette of district nursing

Abstract

Objectives the following paper addresses the etique tte of district nursing, which, it is argued, is a manifestation of the profession's non-challenging occupational culture and a barrier to clinical effectiveness. Etiquette describes courtesy rules that are applied, often unthinkingly, to facilitate smooth social interaction. Although good working relationships are essential to ‘teamwork’, there are circumstances under which patient care can suffer if politeness becomes an overriding aim. Design the data for this paper are taken from a larger ethnographic study of district nursing work. Participant observation spanned 13 days, and 50 semi-structured interviews were conducted. Setting three community trusts in North West England. Participants 37 district nurses, grades G, H and one F, were observed and interviewed. Analysis the data were analysed by constant comparative analysis until no new themes arose. Findings the findings presented here address the problem faced by the nurses of perceiving that a colleague's care was out of date, or otherwise inappropriate, and of how they dealt with this. In such circumstances, the rule of etiquette was usually that the patient's care would not be challenged, although whether the issue would be subsequently raised with the nurse concerned was attributed to a number of factors. The implications of etiquette in the workplace are addressed. Conclusions the paper concludes by suggesting that a more formal set up for clinical peer review may be a useful platform to move discussion about patient care onto a more professional footing.