Correcting medical decisions: a study in nurses' patient advocacy in (Finnish) hospital ward rounds.

Salla Kurhila,Inkeri Lehtimaja,Paul Drew

doi:10.1111/1467-9566.13159

Salla Kurhila, Inkeri Lehtimaja + Show 1 more

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https://doi.org/10.1111/1467-9566.13159

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Abstract

During daily hospital ward rounds, medical teams, led by doctors, assess the progress of an individual patient's health. It is widely reported in the research literature that nurses play a relatively passive role during these rounds, because although they may have valuable information about the patient's condition and progress, and indeed their role includes advocacy on behalf of their patients, nurses nevertheless can experience difficulties in participating during case constructions. Here we report an instance from a (gastro-surgical) ward round in a Finnish hospital, in which nurses played a key role in reversing a consultant's initial decision to discharge a patient. They did so not by directly challenging the consultant's opinion, but by employing indirect means to introduce their discrepant perspective: they provide descriptions and ask questions that draw attention to information that results in the doctor coming to a different assessment than theirs of the patient's condition, and a different decision about what should be done (the patient was not discharged from hospital). The encounter reported here is taken from a corpus of ward round discussions in a Finnish hospital. The method of our study is Conversation Analysis.

Highlights

This paper arises from research into ward rounds in a large Finnish hospital
The nurse and the ward sister played a significant role in the unfolding interaction with the patient and doctor; the nurse was assigned to this patient and was principally responsible for his care and monitoring his condition
Discussion: the role of nurses in correcting a consultant’s decision In this episode, a decision made during a hospital ward round to discharge a patient on the same day was corrected and changed; it came to be agreed that the patient will not be discharged, but will instead be transferred to a different ward

Summary

Introduction

This paper arises from research into ward rounds in a large Finnish hospital. In the bedside consultation that is the focus of this report, it emerged that the nurses present at the bedside had information about the patient which was initially overlooked by the consultant (known as a specialist, in US medicine). It becomes evident in this particular gastro-surgical ward round that the nurses regard the consultant’s assessment of the patient and his consequent decision to discharge as incorrect.

Results

Conclusion