Prince of Songkla University, Songkhla, Thailand.
J Nepal Health Res Counc. 2022 Jun 2;20(1):180-185. doi: 10.33314/jnhrc.v20i01.4023.
Nursing today deals with organizational changes and reforms within the increased demands of care amid competing resources. In some developing countries, dealing with text documents is a challenge in hemodialysis service organizations. This study aimed to explicate the social organization of textual nursing practices in a hemodialysis unit of a public university hospital in Nepal.
This is a qualitative study that followed institutional ethnography design. Ten registered nurses who worked for at least six months in the hemodialysis unit were included for in-depth interviews. Data were also collected through 167 hours of observations, field notes, and two focus groups. Texts including policy, protocols, and record documents were incorporated in the analysis. Data analysis followed Smith's (1987) institutional ethnographic analysis.
Nepalese nursing work in a hemodialysis unit was mainly organized by the free hemodialysis policy of the government which was not available to the nurses at the hemodialysis unit, but it determined most of the nursing activities of patient care and documentation. Hemodialysis record form, hemodialysis schedule, and free hemodialysis claim form also had a great influence on nursing work. However, the nurses were not quite aware of how the textual documents determined their practices to meet the politico-economic interests of the hospital and government.
The hospital and Nepal's health ministry established the activities and recording requirements. Identification of texts and exploration of their influences on nurses' decisions, patient care, and documentation are essential to find the optimal solutions in daily care and determine the appropriate support for nurses in hemodialysis settings.
当今的护理工作涉及到组织变革和改革，以满足护理需求的增加，并应对竞争资源的挑战。在一些发展中国家，处理文本文件是血液透析服务机构面临的一个挑战。本研究旨在阐明尼泊尔一所公立大学附属医院血液透析病房中护理文本实践的社会组织。
这是一项定性研究，遵循机构民族志设计。我们纳入了 10 名在血液透析病房工作至少 6 个月的注册护士进行深入访谈。还通过 167 小时的观察、现场记录和两个焦点小组收集数据。包括政策、方案和记录文件在内的文本也纳入了分析。数据分析遵循了史密斯（1987）的机构民族志分析。
尼泊尔血液透析病房的护理工作主要由政府的免费血液透析政策组织，该政策在血液透析病房不可用，但它决定了大多数患者护理和文件记录的护理活动。血液透析记录表格、血液透析时间表和免费血液透析索赔表也对护理工作有很大影响。然而，护士们并不十分清楚文本文件如何决定他们的实践，以满足医院和政府的政治经济利益。
医院和尼泊尔卫生部制定了活动和记录要求。确定文本并探索其对护士决策、患者护理和文件记录的影响，对于在日常护理中找到最佳解决方案以及确定对血液透析环境中护士的适当支持至关重要。
