Conflict, enactment, empowerment: conditions of independent therapeutic nursing intervention

The purpose of this qualitative study was to describe the use of independent therapeutic nursing interventions by registered nurses in a variety of health care delivery agencies. The process used to integrate nursing interventions into the daily routines of agencies that did not formally require their use, the conditions in which they were implemented, and the consequences of their use, were examined. Data collection methods include observations and interviews of 36 participant nurses, employed in five health care agencies, for 1 year. The organizational culture of each environment was observed and its impact on the enactment of independent therapeutic nursing interventions was evaluated. Data analysis, done by using the constant comparative method, generated a proposal of a substantive theory that integrates conditions and consequences of therapeutic nursing intervention. Intra-role conflict, the product of incompatible expectations of the professional conception of nursing and task oriented/medically controlled work environments, served as the motivating force behind strategies of enactment utilized to overcome barriers to implement therapeutic nursing interventions. As a consequence of using therapeutic nursing interventions, participants perceived empowerment in relation to clients, peers and other health care professionals.