Nursing Care Practices and Workplace Relations in a Thai Surgical Ward: An Exploration of Clinical Decision-Making

Abstract

This thesis offers a study of how a local ward culture underpins nursing actions of Thai surgical nurses in order to account for issues such as lack of sustainability, and failure to use research, including evidence-based nursing practice and the new multimodal model of care which has been officially adopted in the Thai hospital context. The study was conducted at a Thai surgical ward to illuminate and describe the culture of the Thai surgical nurse, including the ways in which the organizational culture influences or guides their thinking, decision-making, and actions in a patterned way. The knowledge about how the Thai surgical nurses allocate care, and make clinical decisions in the surgical ward in the context of social relations and staff culture is constructed through an ethnographic approach based on fieldwork at the non-private general surgical wards of one university hospital in Southern Thailand. A better understanding of the diversity of Thai surgical nursing practice is then enacted from a typical day in the life of the Thai surgical nurses, which consists of the realities, ritualised practices, relations, and integration both with within their group and with others.

The study results represent the way that nursing organizational culture informs the practices, decision-making, and the predictions of the nurses’ possible response to change. The pre- and post-operative cares allocated by the nurses of the TSW are routinised, almost ritualised, and reflect fixed assumptions about the way cares ought to be delivered, including those reflecting the lack of commitment to implementing new multimodal models of care as well as research utilization and evidence-based practice. The study raises significant concerns about the status of professional nursing in Thailand in terms of professional autonomy and the status of the nurses within the Thai hospital context. Empowering professional nursing is therefore recommended as a first priority to change Thai nursing culture. The ritualised practices, task-oriented working system, and the dominance of the medical model in the Thai nursing culture further reflect the need to establish an evidence-based nursing culture to create professional identity and improve the quality of care.