Frames and perspectives in clinical nursing practice: a study of Norwegian nurses in acute care settings

The aim of this study was to investigate the nature of nurses' clinical practice in terms of what guide their clinical engagement and clinical constructions. Schön (1983) and Argyris, Putnana, and Smith (1985) have demonstrated that practitioners "see" situations differently depending on how they frame the situation. In nursing, there is a lack of knowledge regarding what kinds of frames nurses are using in their clinical work. The research question was: What frames and perspectives guide nurses' clinical constructions? The study was based on a descriptive design using a clinical field approach in an acute care setting in Norway. A theoretical sample consisted of 6 registered nurses, 3 from medical wards and 3 from surgical wards. Data were collected through participant observation and in-depth interviews with the nurses, as well as nursing documents about the patients. The results showed that the nurses' frame of reference emerged as normality, health, need, trajectory, and action. These are structured on 3 themes: (a) the patient status dimension with a set of 3 frames that are used to consider patients' current status and condition in terms of normality, health, and needs; (b) the dimension with a frame for judging patients' situational experiences in relation to hospitalization, (illness trajectory); and (c) the nurses' action referring to the frame with which nurses consider their actions. These 5 frames form a complex template with which nurses come to arrive at meanings of clinical situations and "design" or engage in their practice. The nurses are moving back and forth between these different perspectives, circulating around the individual patient or patients as a group. The nurses' practice in this setting tells about the complexity and diversity permeating the assessment, decisions, and performance of nursing care.