Narratives, memorable cases and metaphors of night nursing: findings from an interpretative phenomenological study

Abstract

The aim of the study was to explore the experiences of night nurses. An interpretative phenomenological study was undertaken, and 35 nurses working in Italian medical, surgical and intensive care units were purposely recruited. Data were gathered in 2010 by semi-structured interviews, collecting nurses' narratives, memorable cases and metaphors, aimed at summarising the essence of work as a nurse during the night. The experience of night nursing is based on four interconnected themes: (i) working in a state of alert, (ii) growing by expanding autonomy and responsibility, (iii) assuring sensitive surveillance and (iv) experiencing deep intimacy. Memorable episodes were polarised along (i) expected/unexpected events; (ii) positive/negative epilogues; and (iii) life/death issues. Many of the emergent metaphors described working during the night as being in the middle of a space where an apparent calm scene takes place, but unpredictable factors may suddenly change the order of events and the outcomes, creating chaos. Working during the night alerts nurses, who increase autonomy, expanding their role and assuming more responsibility with respect to that assumed during daily shifts. The nurses' clinical reasoning is based on data they carefully listen to, and on the meaning that nurses give time by time to different noises and silence. While in the past a sense of companionships was reported, a loneliness or a 'neutral' experience concerning the relationships with colleagues seems to prevail during night nursing. Working night shifts is a complex task, and specific training must be assured to students/novices.

Conceptualizing nurses' night work: an inductive content analysis

“…Patients’ need for sleep at night is not just a ‘period of quiet inactivity’ for nurses (Zannini et al . ) or indeed a mere reflection of their work during the day. The work nurses undertake at night and the demanding organizational and clinical environments where they do this are uniquely related to the time of day.…”

“…Historically, nursing at night has been seen as a specific skill that required adaptation of the approaches to care nursing used during the day. The primary intent of the night nurse was understood as ensuring sleep and enabling the essential process of care to take place in minimally lit clinical environments where light was seen as a disturbance and a disruption to the restorative sleep of other patients (Zannini et al 2015). While this view of nurses' night work has changed and there is less appreciation of the time-ofday determined differences in nurses' night work, the quieter, less hectic clinical environment is appreciated by many and seen as a definite advantage for night work (Table 4).…”

Is it possible to feel at home in a patient room in an intensive care unit? Reflections on environmental aspects in technology‐dense environments

“…Personal expression is related to the creation of territories within these physical structures, while the mental condition is concerned with control and safety, and the sense of “being at home”. Zannini, Ghitti, Martin, Palese, and Saiani, () have phenomenologically described nursing at night in an ICU as being in the middle of a calm and intimate space that can suddenly erupt into chaos.…”

Rituals, ghosts and glorified babysitters: A narrative analysis of stories nurses shared about working the night shift

“…Murray, Schmidt, and Goodyear (2018) and Tahghighi, Rees, Brown, Breen, and Hegney (2017) found that night nurses thought they were poorly regarded and supported. Zannini, Ghitti, Martin, Palese, and Saiani (2015) further explained the unique context of night work by suggesting that night work involved qualitatively different professional and personal patterns from those of day shifts. They commented on the peculiar aspects of needing to be vigilant and alert at night, even though there may be long stretches of inactivity.…”