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Registered Nurses Watching Over their Patients: A Grounded Theory Study

Friday, 17 July 2009: 9:10 AM

Lee A. Schmidt, RN, PhD
Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL

Learning Objective 1: describe the process of Registered Nurses watching over their patients

Learning Objective 2: identify conditions that facilitate and hinder Registered Nurses watching over their patients.

Purpose: The purpose of this study was to generate a substantive theory of the process used by Registered Nurses in watching over patients during a workshift.  Registered Nurses are in a key position to impact patient safety and welfare due to their constant presence with patients and the importance of this role is most evident at the nurse-patient dyad level on the workshift. In previous work, patients identified being watched over as an essential component of nursing care.

Methods: The classical grounded theory method of Glaser and Strauss was used to generate a substantive theory of the process of Registered Nurses watching over their patients.  Fifteen staff Registered Nurses from inpatient nursing units were interviewed about their experiences watching over their patients, and factors that helped and hindered the watching over process. 

Results: Making Sure emerged from the data as a core category.  Making Sure involves taking responsibility for the care of the patient and being certain and in control of the patient care situation.  The process of watching over detailed in this theory includes five sequential categories: Knowing What is Going On, Being Close, Watching, Not Taking Anything for Granted, and Protecting.  Participants identified inferences drawn by patients as they experience being watched over:  Trusting and Feeling Secure.

Conclusion: This substantive theory provides understanding of the process used by Registered Nurses as they watch over their patients.  These results provide an important addition to the nursing quality and safety knowledge base. Conditions during shift report and during the workshift must be optimized to allow watching over to occur.

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