The clinical application of the nursing process in selected acute care settings: a professional mirage

The nursing process is the problem solving framework purported to be used in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards its use and state that it is incongruent with nursing practice. To date, there has been no study cited that has examined it use within clinical settings to determine the substance of these claims. Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Data were obtained from semi-structured interviews with predominantly nurse clinicians (n = 27), participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. Nurses in this study experienced the basic social problem of being in a state of "Unknowing" that was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. The findings revealed several problems with the clinical application of the nursing process and illustrated that the espoused theory was unable to be clinically applied.