Imágenes de tapa: las viñetas de La Bruja y El Torito

This subsection reviews evidence of research associated with the boundary work performed by nursing. Observational studies on work bundles are explored while case studies are used to

demonstrate how care pathways can be interpreted as facilitating communication for collaboration.

In her review of a decade of observational studies as a way to understand what it is that nurses do, Allen (2007) speaks to the work of brokering boundaries as one of the skill sets that nurses have become adept at. As integral to the bundles of work that nurses do, they are skillful in working through the flow of chaos in health care, being flexible, and facilitating boundaries as mediators.

Allen’s qualitative case study of the development of a care pathway is designed around her consideration of a care pathway as a boundary object (Allen, 2009). She posits pathways as a

boundary concept that loosely facilitates interaction and reciprocal communication interprofessionally. Pathways are framed as a space where intra and interprofessionals can come together, without

compromising their individual identities, more or less a zone of neutrality. Her descriptor of the pathway as representative of a ‘zone of agreement between social worlds’ has the potential to bring together multiple stakeholders with conflicting agendas (Allen, 2009, p. 355 ). This model represents the complexity of the social worlds and the way that position, identity and role all co-mingle to facilitate action by professionals upon the same stage. Using this concept enables a contextual scene where stakeholders from distinct groups, representing their own worlds, can come together and negotiate collaboratively without perceiving a compromise of their own unique identities. While performing for a common goal, individuals from different social worlds can retain their unique identity while contributing to the overall goal. The participants were able to align their interests with

manageable tension, span the boundaries that might otherwise separate them and do work that achieves a common goal of delivering a process for patient care.

Ethnography is implemented in a mental health unit in Canada to investigate boundary work and the political implications for nursing. Role transition is examined in the context of one ambiguous nursing

unit within an urban metropolitan hospital in Canada. It was performed with the intent to investigate the boundary work of nursing to extend their professional lines of authority as they negotiated the complex interprofessional dynamics of nursing and medicine (Salhani and Coulter, 2009). Issues with professional jurisdiction framed the way that intra and interprofessional conflict was experienced, with tension between medical and non-medical professionals but also within professional nursing structure. Tension was demonstrated as feelings of being marginalized and treated ’like an outsider’ (Salhani and Coulter, 2009, p. 1226). The authors implemented a political analysis looking at roles through the lens of power struggles and the strategies used to establish jurisdiction as part of the nursing professional project. The significance of the struggle for power was led by elite nurses who were able to engage their nursing community in successful collaboration to organize and establish authority within their professional nursing boundaries. As they concluded, they offered up more questions than answers with their political analysis. What is significant is that the thought process on boundary work is engaged in by nursing and perception of how authority and power can be brokered through leadership.

Curie and colleagues performed a qualitative study examining nurses delivering genetic services (Currie et al., 2010). This work is highly relevant to the way that individuals and groups of individuals see themselves while at the same time, how they see the relations and the difference between themselves and others. The overlap to boundary work is conspicuous as this study was undertaken to examine role transition of nurses to a less boundaried position, one of increased ambiguity. Of interest, is a finding that movement into and out of traditional roles which are culturally conservative are associated with less tension while movement in and out of less bounded, novel roles may be associated with risk (Currie et al., 2010, p. 953). This finding poses a question into the relevance of what is considered traditional and the effect that the associated meaning of tradition has upon role transition. The question becomes how does the meaning of tradition impact the social mechanisms and the expectations surrounding roles. In the language of boundary work in nursing, what is considered traditional and the context of the role, impact the experience of the nursing professional structure. The perception of the social front by others and by those within the group, can affect perception of authority.

The evidence in this section illustrates the conceptualization of brokering boundaries and how it applies to nursing and the way that nursing skill sets support the social interaction of nursing and frame them as leaders for collaboration. Boundary work is applied to professional nursing roles associated with the context of power and how the dynamics of interprofessionalisation can be manipulated to impact the jurisdiction between nursing and medicine. A gap in the evidence surrounding the role illustrates the need for investigation. I identified the potential insulation of the cultural identity of this group (Merton, 1996). Hughes spoke of ‘frontiers’ as societies grow and establish new territory with connections to the old (Hughes, 2009, p. xvii). The space that these nurses are practicing in is a frontier and it is not yet established as a legitimate practice for a nurse, their social front in industry is hidden from other nurses (Goffman, 1959, 27). This study of their professional and personal experience set out to understand how these nurses see their role, their experience of career mobility, the contextual meaning of their role and their contribution within industry. The next and final section will review the literature on the theory of nursing work.

Section Five: Literature Examining the