The nursing profession consists of never-ending diagnostic work: A nurse treats directly perceivable smells, visual cues and noises from people and machines as being potentially relevant next attention and action spaces. A nurse also is acutely aware of other action spaces and is reachable by non-present others through mobile technologies such as pagers and phones. The present article shows how exactly this essential ability for hospital nurses is accomplished: How do nurses constantly monitor direct or indirect sensual cues for various needs and demands for action in their immediate or more distant working environment? Mondada (2008) regards all kinds of parallel activities as multi-activity. However, we make a distinction between how the nurses’ heightened awareness sometimes results in multitasking (i.e. attending simultaneously to several tasks and sometimes changing action trajectory to the benefit of another task) or multi-activity (i.e. accomplishing the task at hand with the help of various communicative resources, such as talk and written documents).
In the professional literature, nursing is often defined as a symbiosis of communication, ethics for the patient and technical skills. We aim at showing in this article – through a close multimodal data analysis – how exactly these competences are interwoven and to what extent they demand skilful attending not just to the task at hand but to possible other, co-present or more distant, calls for assistance. The claims made in the present article are based on 21 hours of videoed data from a hospital ward in Denmark in which the everyday working practices (dealing with patients, participating in meetings, etc.) of nurses were followed. The nurses in focus were also in charge of nursing students in the ward – a task that added to the complexity of their working activities.
We are able to show that the heightened awareness necessary for nursing often concerns totally different and equally important tasks (i.e. multitasking) and frequently results in the other action (space) taking abruptly over. However, the skill lies in not letting the task-at-hand being disturbed by the waiting other(s). For instance, a patient treated should feel they are in total focus. We show how nurses accomplish different tasks (interacting with colleagues and students in corridors and other spaces, focusing on a patient with nursing students, etc.) through visible body torques (Schegloff 1998) and through keeping under control possible visible orientations (also body torques) to the other action space when at a patient. This in contrast to nursing students’ showing surprise (also through body torque) when the nurse’s action trajectory suddenly changes. The data also illustrates that nurses sometimes have to move between spaces (in and out of corridors, patient, storage, meeting, lunch and other rooms) which adds to the chances of different action trajectories becoming relevant to follow. In other words, multitasking at a hospital ward can be an occasioned phenomenon.
One important aspect of clinical nurses’ multitasking skills in taking care of not just patients but also nursing students at the patients is how they ‘hide’ the advice giving part of multitasking (i.e. taking care of the patient and instructing the student) in an activity that on the surface looks like a common endeavor. The evidence for the difference can be seen in the preceding activity in the corridor where the nurse and the student are in a typical teacher-pupil framework in which the student rehearses the ensuing activity and in which the teacher does reminding, asks questions, etc. It is clear that accomplishing the action as a conjoint one is possible due to the material-discursive affordances of the situation: The patient has to be handled or talked to/with, and in doing this, various material resources (written documents, pagers, etc.) are utilized. This joint multi-activity gives room for the nurse to turn multitasking (instructing, caring) to multi-activity (caring together, with the help of the different resources), which demands only one identity category (nurse) for accomplishing the task.
In conversation analytic and ethnomethodological studies of healthcare interactions, the focus has shifted increasingly to recognising patients as bodily beings and to diagnostic work as a whole as an embodied undertaking. Our results in the present paper point to the same direction: It seems that a much better understanding of the bodily practices is required to understand nursing as an occupation in which multitasking and multi-activity are central, not least for patient satisfaction – and safety.
Literature:
Mondada, L. (2008) Using video for a sequential and multimodal analysis of social interaction: Videotaping institutional telephone calls. Forum: Qualitative Social Research 9(3).
Schegloff, E. (1998) Body torque. Social Research 65(3): 535-596.