Putting Safety in the Frame: Nurses' Sensemaking at Work

Area of Science:

• Nursing
• Healthcare Management
• Occupational Health and Safety

Background:

• Current patient safety policies may conflict with nurses' own safety.
• Understanding nurses' perspectives on work health and safety (WHS) is essential for reconciling patient and nurse safety.
• Ethnographic research is needed to explore the social contexts of safety in nursing.

Purpose of the Study:

• To examine how nurses construct work health and safety (WHS) in their daily practice.
• To identify the 'frames' nurses use to make decisions about safety during patient encounters.
• To challenge existing patient safety policies by highlighting nurses' safety concerns.

Main Methods:

• Ethnographic study involving 72 nurses across five Australian hospitals.
• Observation of nurses' decision-making processes during patient encounters.
• Thematic analysis to identify and categorize nurses' safety 'frames'.

Main Results:

• Nurses utilize four key frames in enacting safe practice: communicating builds knowledge, experiencing situations guides decisions, adapting procedures streamlines work, and team working promotes safe working.
• These frames are derived from nurses' contextual experiences and shape their sense-making of work.
• Nurses' frames challenge the current hierarchy that often prioritizes patient safety over nurse safety.

Conclusions:

• Recognizing nurses' safety frames is vital for developing and implementing effective WHS management strategies.
• Current policies may need revision to better integrate and support nurses' WHS.
• A deeper understanding of nurses' lived experiences can improve both patient and nurse safety outcomes.