Hospital ward routine‐friend or foe?*

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Abstract
SUMMARY: The author examines the traditional model of nursing, which is dominated by hierarchy and routine, and concludes that it is an industrial rather than a professional model. It is a model which has developed to cope with the unique problems faced by nurses, but it appears to satisfy the needs of doctors rather than the individual needs of either patients or learners. Drawing on the results of a two‐stage research study of the ward learning environment conducted in wards of two general hospitals, the author suggests that the traditional model of nursing contributes to an automatic job performance and inhibits a spirit of enquiry, particularly during routine work. Changes to a professional model, which restore the patient to the centre of the nursing process, are advocated as a means of linking nursing theory with practice and detecting individual needs which fall outside the routine.In this paper selected findings from a two‐stage research study of the ward learning environment (Fretwell 1978) are discussed. Field work was carried out in two general hospitals and a unit in a third hospital, during 1975 and 1976. Methods and techniques were piloted with staff and learners in a large general hospital.The first stage was a ranking study in which 87 learners completed 327 rating questionnaires in respect of 14 training wards in which they had previously worked. In the second stage, observations were carried out in three pairs of high and low ranked wards from three specialities. Learners were interviewed about 571 observed activities in order to identify teaching and learning occurring under changing circumstances. By combining observations with interviews it was possible to identify covert as well as overt teaching and to ascertain how learners perceived a variety of ward activities.The findings can only be generalized to the wards that were studied but it may be that there is a ‘ring of truth’ in the descriptions that makes them recognizable in other places. Drawing on a search of the literature on nurse education, nursing over many decades, and on medical sociology, it is proposed to consider one or two themes in a wider context.

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