Nursing rituals: doing ethnography.

Abstract

Types of nursing rituals identified in this study include therapeutic and occupational rituals. Therapeutic rituals (Douglas, 1963, 1966, 1975; Turner, 1957, 1967, 1969) are identified as symbolic healing actions that improve the condition of patients. Occupational rituals or rituals of socialization include symbolic actions that facilitate the transition of professional neophytes into their professional role (Bosk, 1980; Fox, 1979; Zerubavel, 1979). Nursing rituals fulfill an important although not highly visible function in a nursing unit of a modern American hospital. They enable nurses to carry out caring activities for patients who are acutely or chronically ill, old, and dying. Rituals help to reaffirm values and beliefs of nurses. Explication of the implicit meanings of nursing rituals illuminates nursing for nurses and others who seek to understand nursing services. Descriptive analyses of nursing rituals direct attention to the hidden work of the hospital staff nurse, work sometimes taken for granted by professionals and the public who fail to see the many difficult, intimate, and risky aspects of nursing work and how certain ritual behavior promotes its accomplishment. Other studies on nursing ritual are needed to expand the theory of nursing ritual in this descriptive analysis, and to move it from descriptive to explanatory theory. For example, the transmission of the beliefs, rules of conduct, and customs that take place during change-of-shift report has not been extensively investigated. Neither have the more practical aspects of shift report been studied, including the types of information exchanged or the influence of shift report on planning and priority setting for the nurses who work during the ensuing shift. Also, few empirical studies examine the effects of bathing on patient outcomes, such as skin integrity, cardiac function, and comfort levels, and patient bathing preferences. This is surprising, because the bath is such an essential ritual for the nursing profession and is thought to help patients. Nursing's close association with profane materials, including excretions and secretions, has most likely affected society's perception of the role of nurse. Investigations about these influences may reveal valuable insights into some of the status problems that nurses have encountered for many years. Equally important is the association of nurses with death. Although nurses are frustrated with the intrusion of hospital technology on patients' deaths, they have not yet established themselves as standard setters for helping patients achieve tranquil deaths.(ABSTRACT TRUNCATED AT 400 WORDS)