Correcting medical decisions: a study in nurses’ patient advocacy in (Finnish) hospital ward rounds

Abstract

During daily hospital ward rounds, medical teams, led by doctors, assess the progress of an individual patient's health. It is widely reported in the research literature that nurses play a relatively passive role during these rounds, because although they may have valuable information about the patient's condition and progress, and indeed their role includes advocacy on behalf of their patients, nurses nevertheless can experience difficulties in participating during case constructions. Here we report an instance from a (gastro-surgical) ward round in a Finnish hospital, in which nurses played a key role in reversing a consultant's initial decision to discharge a patient. They did so not by directly challenging the consultant's opinion, but by employing indirect means to introduce their discrepant perspective: they provide descriptions and ask questions that draw attention to information that results in the doctor coming to a different assessment than theirs of the patient's condition, and a different decision about what should be done (the patient was not discharged from hospital). The encounter reported here is taken from a corpus of ward round discussions in a Finnish hospital. The method of our study is Conversation Analysis.

Patient‐activist or ally? Assessing the effectiveness of conscience and beneficiary constituents in disease advocacy fundraising

“…While prior research has made clear DAO campaigns’ importance in generating awareness and raising funds for illnesses and emphasised the central role of those suffering from the disease (and their loved ones) as advocates (Best, 2012, 2019; Ganchoff, 2004; Gunnarsson Payne & Korolczuk, 2016; Hess, 2004; Kurhila et al., 2020; Lindén, 2021; Nahuis & Boon, 2011; Ozieranski et al., 2022; Panofsky, 2011; Rose, 2013; Strach, 2016; Wong‐Rieger, 2017), little attention has been paid to the important role of outside supporters. Our study illustrates that in one major DAO active in the domain of prostate and testicular cancer—the widely prominent Movember campaign—outside supporters, or conscience constituents, played a very important role.…”

“…Edward T. Walker https://orcid.org/0000-0001-9633-4723 Tijs van den Broek https://orcid.org/0000-0002-8686-7312 Anna Priante https://orcid.org/0000-0003-1536-3755 Michel L. Ehrenhard https://orcid.org/0000-0002-5608-9628 ENDNOTES 1 Although outside our scope, DAOs are also important for raising awareness and generating policy changes (Strach, 2016), in addition to providing education (Kurhila et al, 2020).…”

“…Disease advocacy organisations (DAOs) represent a powerful force in society, raising funds for, and awareness of, a vast range of diseases (Best, 2012, 2019; Ganchoff, 2004; Gunnarsson Payne & Korolczuk, 2016; Hess, 2004; Kurhila et al., 2020; Lindén, 2021; Nahuis & Boon, 2011; Ozieranski et al., 2022; Rose, 2013; Strach, 2016). Such organised efforts influence patient access to drugs (Lindén, 2021), allocations of public research budgets (Best, 2012), provide rare condition patients with empowerment and ability to influence science (Hess, 2004; Panofsky, 2011), offer partnership between patients and care providers (Kurhila et al., 2020; Wong‐Rieger, 2017) and foment broader public engagement (ibid). DAOs often also play key roles in health social movements, drawing attention to conditions overlooked by mainstream medicine (e.g.…”

“…1 1 Although outside our scope, DAOs are also important for raising awareness and generating policy changes (Strach, 2016), in addition to providing education (Kurhila et al., 2020). …”

Untangling a complex skein on ward round terminologies, purposes, and main features through a rapid review

“…In other words, the rounding is intended to prepare, deliver, or ameliorate the care. The findings suggest three main reflections: regarding the setting, the round may be performed away from the patient whereas other required rounding should be applied at the point of care; others aimed at promoting research for example, may be implemented away or at the bedside, in all settings. regarding the time, those roundings “ensuring an effective care plan, team and environment” are performed before the delivery of the care, to set some structural and processes prerequisite to ensuring quality, such as sharing information, preparing the team, deciding the plan care, thus making the whole environment safe and effective (Kurhila et al, 2020). Those rounds aimed at “delivering tailored and timely nursing care” are performed instead when the care is delivered, as a care intervention itself, to check needs, safety issues, to implement the multidisciplinary approach or to involve patients.…”