The ethnographic results from this study have revealed much about the construction of nurses’ professional identities. The findings in relation to the SIT concepts of group performance, and social identities have been presented in the previous two sections. The findings in relation to the third, and final concept of self-categorisation are presented in this section of the Chapter. Self-Categorisation was developed from the SIT work by Turner and Hogg (1987). There are three key insights of self-categorisation. The first is that group activity occurs because of social identity, and this is a cognitive mechanism. The second is that the self-system of the
categorisation process is context sensitive, people either see themselves as “sharing category membership with others or not” (Haslam, et al., 2012, p. 206). The last insight is that mutual social influence is based on shared social identity
The results demonstrate the significance of the cognitive construction of self, particularly to the salient nursing group. The cognitive development of salient in-group membership is of interest in developing insights into the professional identities of nurses. Examples of this will be
considered by stimuli at an inclusive level, these promote assimilation of self into the prototype (Hogg & Terry, 2000).
Insights from Interviews
This section of the ethnography draws upon the previous analysis, and further extending the findings to recognise the cognitive processes that occur in SIT to develop a specific professional nurse prototype. The senior/experienced nurses are recognised as the aspired prototype. They then reinforce the prototype, question it, when it is threatened, and promote the attributes that reinforce the prototype. This is demonstrated in the themes arising from the interviews. From
104 | P a g e the interviews there are suggestions that certain attributes make co-workers suitable to work with within the intragroup. The below quotes outline these specific attributes reinforcing the attributes of the espoused prototype.
…next I would go to Jane because we get along very well personality wise as well, and we work very well together. [II2]
We just work very well together as a team, and I trust her. [II2]
…so you know if you work with someone say like Jane, you know that you can actually go, hey can I have a hand to roll this patient or can I give you a hand with this? Let’s go, and do this together, and you just generally – there’s a fluidity about the way you work. [II2]
The attributes here that are seen as positive are willingness to help each other, having a
personality that is seen as positive, and being able to trust the co-worker to help. Cooperation is an important attribute. There is a concept of the “go to” person or resource person II2, and the use of the term “fluid team” II2
One big team where all the players work together. [II2] Helping, and relying...to achieve your goal. [II2]
This goal is then identified as taking care of patients… keeping the powers that be happy. [II2]
Attributes of the prototype include team members being responsive, and willing to assist other team members, trusted to seek their opinion, willing to be available to debrief. Part of the normative fit appears to include the ability to “be there for the team” [II2].
Another attribute is the ability to communicate issues, and ask questions.
I like that behaviour of question asking because at least then I know where they’re at, you know, as opposed to them going off doing it, and making a mistake. [II1]
The attributes of the prototype appear to very much rely on behaviours that bind the staff together as a close social unit for the eight hours of a shift. The team is seen as being successful if there is fluidity to the work.
105 | P a g e Three of the nurses interviewed individually categorise themselves very normatively with the nursing clinical unit. The one nurse who did not align closely with the unit group is the junior nurse.
When you’re new, you always feel that you have to prove yourself, and you need to show that you’re competent, and that you can manage, but I guess you need to be realistic, and say there are times that I’m just not. [IIJN] …and I’ve found since coming into the real world of nursing, and
questioning the “why” factor like a young child – why this? why that? some people felt threatened I think, and they were very different in their
approach, and their answer would be because that’s just the way we do it. [IIJN]
There is a contradiction in that the nurses who categorise themselves closely with the
normative fit of the nurse unit espouse their want for questioning as a positive attribute, and yet the experience of the junior nurse is that questioning is not welcomed. It would appear there is a much more complicated process to understand the actual normative fit.
Insights from Researcher Participant Observations, and Fieldnotes
The focus here is the observations of the development of the nursing prototype. This is observed most profoundly in the nursing group handovers. The concept of context is
particularly important within self-categorisation (Haslam, et al., 2012, p. 206). However, what is emerging from the results is the importance of the professional context as a structural, and behavioural context. Given the professional context, and construct of the two activities video recorded there appears to be a developing prototype for each of these groups that had
similarities between the two regardless of their different clinical unit contexts. The SIT concepts identify that “context in which they find themselves is defined along group-based lines”
(Haslam, 2004, p. 23), however the results indicate that there may be an influence at the higher order identity that has an impact on self-categorisation.
The professional context where the group activities occurs determined the type of interactions, and reinforced the prototype relevant for this activity to occur (see Figure 8: The Handover Space in Unit B). However, the specific space also contributes to the interactions. Self- categorisation is influenced by the professional context but would also be attributed to the structural context.
106 | P a g e The results in this section focus on the structural space where the activities occur, and their influence on the self-categorisation of the individual to the group. The two activities video recorded in Unit A are in the same room, and the two activities in Unit B are in the same room. Therefore there is a consistency in the space used for the two varying activities.
Some of the key aspects to the contextual spaces include that they are private, and away from patients, relatives, and other team members. In Unit B a key is needed to open the door during the handover activity. There is a homely aspect to both the spaces, sitting, and talking is the main activity undertaken in these spaces. Both the spaces are small which reinforce the
closeness, and therefore the opportunities to interact in conversations. Both the spaces are seen as the nurses’ domains, and therefore the allied health staff are invited in.
The meeting occurred in the nurses’ tea room. The space was quite small, and although there was room as the team was small what struck me was that this was a room designed for storing food for both patients, and staff, with a table that was really set up as dining table. There was no formality to the surrounds that you might expect for a unit meeting Video 1:. Multidisciplinary meeting. [Unit A& Video 2: Nurse-to-nurse handover Unit A fieldnotes (structure)]
These spaces are not formal meeting rooms, and they are used for informal gatherings as well as these two professional activities. These spaces are nurses’ spaces.
This part of the ward is a hub of informal activity where nurses, and other staff congregate frequently for informal conversations. What is seen is a small space that conjures up feelings of safety, and inclusion. This is different to other areas of the ward where there is a feeling of business, and often high levels of stress.[Video 1: Multidisciplinary meeting Unit A& Video 2: Nurse-to-nurse handover Unit A fieldnotes (structure)]
The qualities of this setting seemed to be the informalness, it was a bit like sitting in a kitchen, particularly once the meeting had commenced. It was not particularly tidy almost a dishevelled little room. This is generally considered a private space away from the normal work environment, where patients, and family are do not normally enter. [Video 1: Multidisciplinary meeting Unit A& Video 2: Nurse-to-nurse handover Unit A fieldnotes (structure)]
107 | P a g e This room is used as an important informal social space. Staff congregate at
their meal breaks in this space, meetings such as handover, and the multidisciplinary meeting happen here. Nursing staff use the space for informal conversations. Speaking with patients, and relatives does not occur in this room. Food for patients is sometimes stored in the fridge but it is unusual for patients to access this room. [Video 1: Multidisciplinary meeting Unit A & Video 2: Nurse-to-nurse handover Unit A fieldnotes (structure)]
The pictures of the spaces reinforce the informality. In relation to the cognitive perspective of self-categorisation the reinforcement of the nursing identity as salient is profound given the identity of these spaces are entirely the nurses. The concept that contexts play an important part in self-categorisation is identified in these quotes, and pictures.
Figure 9: Unit A MDM
This space is quite different from the previous ward. The multidisciplinary meeting is held in the room that is used by the nurses as a tea room. However it’s set up is very different from Unit A. This is an oddly shaped room with insufficient space for a table (see picture). Instead there are chairs scattered around the edge of the almost triangle shaped room. There are lockers squashed on one wall two coffee tables in the middle of the room strewn with old magazines, and an old patient locker to one side that is used as an extra side table. People have to keep excusing themselves to pass others to reach the empty seats in order to sit. The nurse leading the
108 | P a g e meeting positions herself near the door, and is quite distant from the allied
health staff who sit towards the other end of the room. [Video 3: multidisciplinary meeting Unit B fieldnotes (structure)]
This room is situated in the corner of the ward, and is away from the noise of the ward. There is a window that looks out onto the street, overall it remains a nurse’s space that is not questioned, and the door is closed, and locked, and only the nurses have the pass code. This security is due to staff leaving valuables in this room, and its location in relation to the rest of the ward/unit. This however creates a very definite nurse ownership of this space as no one can enter unless allowed by a nurse from the current shift Therefore outsiders would need to be invited in. [Video 3: multidisciplinary meeting Unit B fieldnotes (structure)]
The MDM members are invited into these spaces.
The room is a quite compromised space, and the qualities of this space are more crammed than on the previous ward, particularly as there are more staff on any given shift on this ward so more staff will need to access this room, and attend the meetings. The nature of locking the door allows for complete isolation during any activities that might occur in this room. This is very clearly a defined nursing space. There are lots of artefacts on the spare walls including notices, and information not all relating to the organisation. The lack of a large table makes this roo, look more like a living room than a kitchen. [Video 3: multidisciplinary meeting Unit B fieldnotes (structure)]
This space does not seem to include elements that are related. There is no sense of the warm homely kitchen of the other ward. There is no microwave or fridge no table to amiably have a conversation at. The elements here are mainly chairs with padding making then more comfortable to sit in. This room could be likened to a living room. Again there are lockers for nurses to store their valuables in. [Video 3: multidisciplinary meeting Unit B fieldnotes (structure)]
109 | P a g e Again the space where the video is filmed is the tea room, and the cramped
slightly dishevelled room is the same as the space used in the multidisciplinary meeting. There are 10 nursing staff, and 2 nursing students in this handover. By far this is the biggest group videoed. The setting appears even more compromised with so many in this space. The staff do seem quite comfortable sitting in this space, their writing papers are either on their laps or resting on the coffee table or the patient bedside table. Again this space is locked when the door is shut, and the position of the person giving handover (ANUM) is close to the door so she is able to open it if there are any interruptions. [Video 4: Nurse-to-nurse handover Unit B fieldnotes (structure)]
These spaces have artefacts that belong to the nurses. The nurses undertake many of their informal daily activities that are away from the patients in this space.
The social aspects of this place are very similar to the previous ward. It is the informal gathering area for this unit used for eating meals in, storing valuables in lockers, and beginning, and ending the shift from this room. The use of this space clearly affects the social behaviour. This was spoken about before the video was commenced. The nurses very much feel the set up, and structure of this room allows for confidentiality, and comfort in conversation. Here the nurses of this ward identify they do not always use completely professional language away from the patients, and other staff. This space is very much owned by the nurses, and regarded as a safe place to off load some of the uncertainties that their work brings. [Video 4: Nurse-to-nurse handover Unit B fieldnotes (behaviours)]
The prototype is influenced by the social identities, and group performances of a given group, however this is context dependent. This section of the ethnography has given extensive examples of the context, and the emerging insights identify that the behaviours, and alignment to the social identity of the nurses to the nursing group is influenced by the context in which these professional activities are undertaken.
110 | P a g e Figure 10: Unit B Nurse Group Handover
Having given consideration to the influence the context has on the development of self- categorisation, the other presiding influence on the acceptance of the prototype is the recognition of the senior or experienced nurse as espousing the prototype. Examples of this include the designated seat where the senior nurse presenting the handover assumes her position; the dominance of the interactions between the two senior nurses to reinforce their place in the group. Another example is when the senior nurse takes the lead role in the
communications, and most questions are focused towards the other senior nurse who will take over, and run the following shift. There is a compliance of the remaining group to remain quiet unless they are seen as being well embedded in the group through length of time on the unit (this is referred to in the interviews around experience).Social discussion, storytelling, and humour are led by the senior nurses, and this is then a trigger for others to interact. There is an orderly way the meeting is concluded led by the nurse who will be in charge of the oncoming shift who reinforces the staff patient allocations, and affirms that the shift may now commence. In comparison to the MDM there is not an obvious focus on group cohesion but rather group interaction. Although the nurse led the meetings in both the units, looks to the other members of the team in the MDM for information, and active participation. The perception of self in this meeting is not as obviously aligned with the need to be part of this group but rather to ensure their individual information about the patients is shared, and used to plan further patient management. Clear examples of this are in the way there is an equal distribution of
communication interactions; in the types of communication where each person representing their own profession puts their perspective on patient needs forward. Further examples are the focus on the patient plan, and discharge rather than the focus on the oncoming group goals for the shift, and the dissemination of actions to individuals depending on their actual role.
111 | P a g e Therefore, what is interesting in the results is not that the multidisciplinary group is not a group but the differing normative behaviour between the two groups identifies clearly that the nurse handover is a group activity of interplay between nurses that demonstrates a prototype that sets up potential nurses to nurse interactions for the next shift. This has potential to greatly influence the self-categorisation of each nurse member in this shift group. Given the purpose of this research is to examine the professional interplay of the nurse activity, and its potential influence on professional identity comparison between these two differing groups’ offers probable insights into the differing identities of these two groups.
Shared identities in the nursing activity reinforce their identity in the nursing group, and there is significance to this as they will need to work closely as a team to achieve the overall goals of patient care that must be met in the next eight hours. The prototype of teamwork, and fun is reinforced in the nurse handover. This is seen in the video as each person behaves as is expected of them in an orderly quiet way interacting, and laughing, and being involved in storytelling only when prompted by the nurse leading the handover. This theme of teamwork, and fun is identified in the literature (Morris Thompson, et al., 2011), and also throughout the interviews. There are also suggestions that the need to belong, and therefore behave, is also evident in the videos by the way the handover is built on forming the team for the oncoming shift. The need, and necessity of belongingness has been described in relation to nursing students in the literature (Levett-Jones & Lathlean, 2009a), and this has possible implications for self-categorisation, and normative behaviours of the nursing group as a whole. If what the senior nurses identify as important behaviours within the group are seen as the prototype for each of these units, then the behaviours that are demonstrated by each of the nurse groups reinforce these in the videos.
Conclusion
The ethnography has been undertaken in accordance with the methodological plan. The findings revealed significant aspects of nurses identity, and there construction, and
maintenance within nurse group handover, and MDM. In this chapter the group performance,