Focused ethnography of nurses' interactions and behaviours in the therapeutic positioning of patients with traumatic brain injury in Pakistan: study protocol.

Abstract

Proper positioning in trauma care is essential to prevent associated complications by stabilising haemodynamics, preserving the spine, securing the airway and protecting skin integrity. Motor vehicle crashes are the leading cause of traumatic brain injury (TBI) in Pakistan, necessitating rigorous safety measures and high-quality care due to their severe impact and high mortality rates. Resource-limited settings face significant challenges in providing adequate neurosurgical services. Moreover, there is a notable gap in the existing literature regarding effective care of patients with TBI. This study aims to address a gap in neurosurgical nursing research by exploring how nurses' interactions and behaviors during positioning interventions contribute to the cultural understanding of nursing care strategies and how the specific cultural context of the neurosurgical ward shapes and informs these interactions. The current study will use a focused ethnography design. Patients with TBI, along with nurses and doctors, will be purposively selected from the neurosurgical wards of two tertiary care hospitals in Islamabad, Pakistan, based on set eligibility criteria. Data will be collected through participant observation, semistructured interviews and analysis of documents and artefacts to ensure diversity and trustworthiness. Braun and Clarke's Reflexive Thematic Analysis approach will be used for data analysis. This study has been approved by the institutional review boards (IRBs) of Shifa Tameer-e-Millat University (IRB# 125-24) and the Pakistan Institute of Medical Sciences (No. f.1.1/215/ERB/SZABMU/1298). Potential ethical concerns will be addressed by protecting the rights of participants including avoiding harm, ensuring privacy and confidentiality and obtaining informed consent. In line with ethnography guidelines, this study adopted the process-informed consent to ensure informed and autonomous involvement. The study results will be shared with key stakeholders and published in scientific journals and presented at conferences.