Interruptions to nurses’ work in dynamic healthcare settings
: part of a wider problem of competing demands

Student thesis: Doctoral ThesisDoctor of Philosophy


While much attention has been devoted to the topic of interruption over recent years, few studies have explored in detail the context of these events. The study aims to understand the nature of interruptions, and the role of clinical context in shaping nurses’ handling of these. 
The research was conducted in three purposively selected settings: an Accident and Emergency department, a surgical ward, and a chemotherapy centre, in one NHS trust. Phase One data collection involved, for each setting: 6 static observation sessions (lasting 48 hours in total), 8 nurse shadowing sessions (132 hours in total), and 4 semi-structured interviews. Phase Two data comprised, for each setting, structured observations of 8 nurses (60 hours in total), interviews with 4 nurses, and Hierarchical Task Analysis of two specific nursing tasks (surgical medication round and ambulance triage task). 
Phase One highlighted the complexity and dynamism of the clinical environment. Nurses intentionally interrupted tasks, in a strategic manner, to support the handling of competing demands. Interruptions allowed nurses to respond rapidly and flexibly to events, and to keep track of their workload. These findings challenge the ‘traditional account’ of interruptions, identified in the literature review, which implies that interruptions are externally imposed and undesirable events. A new conceptual framework was therefore developed, based on a further literature review, and this was used to guide Phase Two. 
Phase Two investigated nurses’ use of the healthcare system, and other strategic behaviours such as interruption, in handling competing demands during specific nursing tasks. Key aspects of the healthcare system that supported nurses’ task management included specific tools (e.g. drugs charts), technologies (e.g. A&E computer system), and teamworking, while adaptive strategies that proved useful included sensemaking and monitoring. 
In conclusion, the study reveals interruptions to be part of a wider problem of competing demands. It highlights the need for more contextualised research, which considers how interruptions, combined with other strategic behaviours, might support the management of healthcare complexity.
Date of Award1 Sept 2016
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJill Maben (Supervisor), Anne Marie Rafferty (Supervisor) & Janet Anderson (Supervisor)

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