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Table 1 Sensemaking Properties: Differences Between Nursing Home RNs and LPNs

From: A qualitative study describing nursing home nurses sensemaking to detect medication order discrepancies

Sensemaking Properties Explanation Differences between Nursing Home RN and LPN Sensemaking
Identity construction Members of organizations come to know themselves through interactions with others in the organization RNs and LPNs perceive themselves as equal in skills and abilities despite differences in their education and licensure. This perceived equivalence poses a risk that collaboration between the roles may not routinely occur when performing medication reconciliation. LPNs also perceive themselves superior to RNs because RNs ask questions. The perception that asking questions is a sign of incompetence suggests that LPNs are less likely to ask questions when clinically necessary.
Retrospective Individuals make sense of events after they occur RNs past experience with identifying discrepancies provides opportunities to learn from these experiences, thus influencing the detection of future discrepancies. In contrast, because LPNs are not recognizing discrepancies, they have limited opportunity to learn from past experiences, therefore future discrepancies may go undetected and unresolved.
Enactment Individuals in part create the environments they encounter; they mentally create what they expect to find RNs anticipation that medication order changes will occur leads them to clarify intentional changes versus errors. LPNs on the other hand anticipation that orders are written as intended leads them to make assumptions about any changes including unintentional changes that may have occurred, thus potentially harmful errors can go undetected and unresolved.
Social Individuals are influenced by relationships and interactions with others Either RN or LPN likelihood of detecting discrepancies may be expanded or limited based on their interaction with either valued or adversarial colleagues.
Ongoing An event’s history and context influence ongoing understanding of future events RNs consider medication reconciliation within the context of resident safety and medication appropriateness, therefore placing an emphasis on medications type and the resident’s clinical history, as well as any recent events (i.e., hospitalization). LPNs on the other hand consider medication reconciliation within the context of the transfer routine and what they anticipate to occur.
Extracted cues Individuals will extract cues out of familiar structures or known points of reference within their environment RNs have a richer mental model than LPNs because of their expanded education; therefore RNs recognize cues differently than LPNs. Also, when nurses’ (either RN or LPN) have an overreliance on organizational cues (i.e., rules/regulations/policies) this may limit their ability to think beyond defined cues and not notice other sources of error.
Plausibility rather than accuracy Individuals seek to behave in a reasonable fashion within the context of the unexpected event so they can move quickly past it. Both RNs and LPNs likelihood of detecting discrepancies may be influenced by time constraints or shift pressures that cause them to overlook subtle cues or signs. However, RNs recognize the risk to safety, therefore focus more on the cognitive nature of the process in spite of time constraints.