'Scraps': hidden nursing information and its influence on the delivery of care

What nurses commonly describe as 'scraps' are defined as the personalized r ecordings of information that is routinely made on any available piece of p aper (hence scraps) or in small notebooks. The use of scraps is common in p ractice and has been noted in research from across the globe. Drawing on an empirical study it is argued that scraps are a unique combination of perso nal and professional knowledge that informs the delivery of care. The overa ll aim of the study was to discover how nurses define and communicate infor mation about patients and the delivery of care to each other on an elderly care unit. The processes by which information was constructed and the organ izational structure and interactions that influenced this were also identif ied. The research design was an ethnographic one that involved: observation s of formal nursing end of shift reports (23 handovers) and informal intera ctions between nurses (146 hours); interviews (n + 34) with registered nurs es, student nurses and nursing auxiliaries; and analysis of written records . Data were collected from five acute elderly care wards at a district gene ral hospital in the south of England. A grounded theory analysis was undert aken which revealed that scraps may have a significant role in the communic ation of information and the delivery of care. Therefore a categorization o f scraps within three main themes was undertaken. First, the analysis revea led the processes involved in the construction of scraps. Second, the conte nt and role of scraps in influencing the delivery of care was exposed. Fina lly, the potentially confidential nature of scraps and consequent problems of storage and disposal was recognized. The findings are discussed in relat ion to a suggested model of the interrelationship between paperwork, scraps , handovers and the delivery of nursing care. It is concluded that scraps a re significant in facilitating nursing care and that this should be recogni zed in research, education and practice.