PubMed · 10275612
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D J Roger. 1985. Caring for fine instruments.. https://pubmed.ncbi.nlm.nih.gov/10275612/
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PURPOSE: Current thinking about "patient safety" emphasises the causal relationship between the work environment and the delivery of clinical care. This research draws on the theory of normal accidents to extend this analysis and better understand the "organisational factors" that threaten safety. DESIGN/METHODOLOGY/APPROACH: Ethnographic research methods were used, with observations of the operating department setting for 18 month and interviews with 80 members of hospital staff. The setting for the study was the Operating Department of a large teaching hospital in the North-West of England. FINDINGS: The work of the operating department is determined by inter-dependant, "tightly coupled" organisational relationships between hospital departments based upon the timely exchange of information, services and resources required for the delivery of care. Failures within these processes, manifest as "breakdowns" within inter-departmental relationships lead to situations of constraint, rapid change and uncertainty in the work of the operating department that require staff to break with established routines and work with increased time and emotional pressures. This means that staff focus on working quickly, as opposed to working safely. ORIGINALITY VALUE: Analysis of safety needs to move beyond a focus on the immediate work environment and individual practice, to consider the more complex and deeply structured organisational systems of hospital activity. For departmental managers the scope for service planning to control for safety may be limited as the structured "real world" situation of service delivery is shaped by inter-department and organisational factors that are perhaps beyond the scope of departmental management.
This is a study on nurses' work at central supply units (CSUs) with the aim of analyzing his/her social reality and transforming role in the caring process in health and nursing. It's a strategic research, with speech analysis of CSU nurses. Results show that their main activity is management, in a structured process that confirms the traditional nursing practice, having as object the coordination of medical-hospital material processing used for care. Their work is characterized by indirect care, and is instrumental not only for nurses' work, but for the work of other professionals as well. As a result, it not identified as specific nursing care, nor as care provided by the nurse. Its transforming potential upon relations and new production modes of care in health, and by the nurse, will occur first through his/her competence in the specific knowledge about CSUs than through his/her administrative skills.
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