Servicio de almacenamiento por bloques (Cinder)

Of particular interest to this research is the process individuals go through after this exposure to new or different care reality, or the phase of developing consciousness. Developing consciousness conceptualizes a phase experienced by the individual while responding to the introduction of different possible care realities. Similar to the appraisal phase of coping theory, within the developing consciousness phase the individual

becomes aware of the discrepancies between the different care realities. The result is a disparity between what the individuals understood about their care reality from their education and past experience and what they encountered while interacting with others that did not share their care reality.

However, unlike the appraisal phase of coping theory, individuals within this research did not develop an assessment of the consequences of the introduction of the care reality during this phase. Rather, during this phase, the individuals realized that there were inconsistencies between his or her care reality and an alternative care reality being presented. Both care realities are explored and compared by the individual, and initial judgments based on the comparison are then made. Within this research on care realities, assessment does not occur until later in the process.

For example, Anya experienced the developing consciousness phase when her floor computerized the medication records. She said she was expected to switch from recording medication on the paper chart to recording it on either the COW2 or the

computer at the nurses’ station. This change was introduced by the hospital management as a better way to provide care because it reduced the risk of giving the wrong

medication, giving medication at the wrong time or giving too much medication. This was a different care reality than what had been originally introduced to Anya. It involved assigning more priority to informational care through the use of an IS than Anya’s care reality accepted. Anya demonstrated this when she stated:

“I don’t think that using the computer is giving care.” (Anya, interview 2)

In this phase, the individual becomes aware of his or her care reality; this does not often happen unless their care reality faces a challenge from an alternative source. For

example, when I interviewed Beth and asked her what she meant by “care,” she stated:

“I never thought about it before. It’s just, you know, what I do to take care of my patients.” (Beth, interview 2)

After an individual becomes aware of his or her care reality, the next step is to either accept or reject the alternative care reality introduced. Elizabeth, for example, rejected

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the definition of care included in an alternative care reality that rejected the use of

Information Systems. She spoke with frustration of some of the other nurses she worked with who did not want to use a new IS that would warn the nurse of possible drug

interactions:

“There are so many drugs out there now. . .and some of our patients are taking more than ten different drugs. There’s no way you can know all the possible reactions. The books are out of date before they’re published. The only way to make sure you’re providing care is to use this system.” (Elizabeth, interview 2)

Gail also rejected an alternative care reality when she was introduced to the care reality that involved using a laptop computer to document each home visit in Microsoft Word in her job as a district health nurse, and using an expert system to search for nursing

treatment suggestions. She rejected this definition of care:

“That’s not giving care. That’s just making sure I do things the way they want.” (Gail, interview 1)

In both of these examples, a nurse has compared his or her care reality to a new care reality and judged it as not defining care. (It is important to note that, if an individual rejects a care reality, he or she still has to continue through the process of sense-making and acclimatizing.)

By contrast, other nurses accept the existence a different care reality. This does not mean they take on the care reality; it means they accept that there is another possible way of providing care. Thus, instead of rejecting the definition of care given in an alternative care reality, the definition is accepted as a new possibility — the individual is open to a change. For example, Anya reflected this subcategory when she spoke of a colleague texting a patient to remind them to test their blood sugar:

“I don’t think I would do that but it’s a good way to try and get them to do it at the same time every day.” (Anya, interview 2)

The phase of developing consciousness conceptualizes the initial experiences and judgments made by the individual while responding to the introduction of different possible care realities. Individuals are exposed to a different care reality and judge if that care reality is valid. This is the starting point of negotiating care realities and it refers to an awareness of the discrepancies between the nurse’s care reality and the care reality being introduced. Once an individual has made an initial judgment of a care reality, he or she enters a phase of sense-making, in which the individual deals with the implications of the differences between care realities.