A hermeneutic phenomenological investigation of adult nurses’ concept of agency in clinical nursing care within hospital settings

Abstract

A hermeneutic phenomenological investigation was undertaken to understand nurses’ concept of agency, or power to act, in clinical nursing care within hospital settings. It examined how free or constrained nurses felt in nursing care within their scope of practice. There were questions of what constituted freedom in nursing care. Data was gathered using stories from nurses’ experiences in clinical practice. A purposive homogeneous sample of twelve nurses was used in this study; all of whom were insiders as they were involved in clinical nursing care. This made it easier for them to understand the questions asked during their stories. The main themes which emerged were experiences and responsibilities in nursing care, the ability to provide nursing care, constraints in nursing care and collaborative nursing care. The findings revealed that nursing care has changed over time, and nurses are now doing more clinical skills, but at a closer look, freedom appeared limited. Nurses were able to initiate and deliver basic nursing care; however, in some aspects of care, including extended roles, nurses needed approval from doctors first. When the findings were subjected to poiesis, the concept of agency was further compounded by the characteristics of power and authority, structuration, the cognitive empire, and colonialism. Findings were discussed against the backdrop of the existing literature and theories. What made freedom an interesting concept in nursing care was that nurses could discuss their roles, responsibilities, and clinical nursing skills they had or did, but they were unable to define nursing as it had various meanings to them. It was then difficult for them to say what was freedom. Freedom, however, was whatever the nurse saw as such. It was indicative that nurses should be allowed to develop their epistemic knowledges, deliver nursing care the way they saw appropriate and utilise clinical skills they were competent to perform.