Interruptions within the Culture of the Nursing Unit Work Environment

Abstract

Statement of the problem: Interruptions result in omissions, increased mental effort and increased total work time in controlled settings. Even though interruptions in nurses' work would seem to increase errors, consistent supporting evidence has not been provided. Inconsistent definitions, guiding frameworks, and outcome measures have resulted in a knowledge gap in how and why interruptions occur within the nursing unit. The purpose of this study was to better understand interruptions within the medical nursing unit work environment. The research question was: What within the culture of the nursing unit contributes to a work environment that is vulnerable to interruptions? Methods: A philosophical framework of symbolic interactionism and a micro ethnographic approach was used. The setting was a medical nursing unit in a large teaching hospital. Data collection included 108 hours of observation of the entire nursing unit, document review, 81 hours of individual participant observation and 9 interviews. Purposive sampling guided participant selection. Data were analyzed from unstructured field notes and interview transcripts. Definitions of interruptions and culture guided coding, categorizing, and identification of themes as data moved to higher levels of abstraction. Results: Complexity emerged as a primary theme. Interconnection, constant change and unpredictability were prevalent. Subthemes were grouped by cultural elements. Values were a) excellence in patient care and b) meeting personal needs. Beliefs were a) I have to do it all myself and b) phone calls are important. Patterns included a) changing patients, b) patient admissions, c) patient transport, and d) required resources. Normative practices included a) communicating, b) coordinating care, c) developing relationships, d) filtering, and e) adapting. Trustworthiness of findings was established. Conclusions: Interruptions are an integral part of nursing unit culture. The inherent complexity of the nursing unit suggests that complex adaptive systems is a useful framework for future research. Initiatives to improve clinical practice should investigate how cultural elements of the nursing unit contribute to interruptions. Uniformly decreasing or eliminating interruptions will disrupt current practices, such as communicating and coordinating care, that are central to nursing work. Education and training should focus on team development and identification of self-initiated and system-initiated interruptions.