Sign reading: making sense of what is going on in the ward ANN WAKEFIELD MSc, PhD, RGN, RMN, RCNT, RNT, Cert Ed Lecturer in Nursing, The University of Manchester, Coupland III, Manchester M13 9PL, UK Accepted for publication 26 September 1997 Summary · When entering a ward the environment observed can be perceived in one of two ways: either from the perspective of `background', this being the backdrop against which events take place, or as the main focus of attention, thereby alerting the observer to what is going on in the setting. · Whilst undertaking their work nurses emit signs which patients, relatives and other staff interpret and through which they gain an understanding of the type of work about to be undertaken at the clinical interface. · The themes of private work, showdown work and tragic plight work, which were generated from an observational study in a surgical ward, are discussed in this article. · Findings show that, despite nurses attempts to hide the gravity of a message from patients, they in fact give more away than they hide. Keywords: screening practices, sign reading, types of nursing work, understand- ing nursing work. Introduction There are times during the working day in a ward when the `visibility' of nursing work is more apparent to the on- looker than at others. For example, when curtains are drawn around a patient's bed they can form the backdrop against which work takes place. Alternatively, their presence can make the area stand out from the rest of its surroundings, becoming the focus of attention for all those present in the locality (Wake®eld, 1996). This paper, derived from a doctoral study examining the organization of surgical nursing work, explores this element of nursing practice, namely `screening' proce- dures. The process of `screening' a patient's bed area can be seen in terms of `®gure' and `ground' concepts ± namely that on some occasions scenes observable within the ward are made to stand out from their surroundings (®gure) whilst on others events are observed on a `taken for granted' basis (ground). When patients, relatives and staff encounter a ward for the ®rst time they attempt to make sense of a series of `signs' observable in the environment which act as clues helping the observer to make sense of what is happening. The presence or not of curtains around a patient makes events `visible' and `accountable' (Gar®nkel & Sacks, 1986) by providing the observer with an account of the event taking place. Figure and ground concepts can be perceived as reversible occurrences, as there are occasions when events are made to stand out from their surroundings, focusing the observer's attention towards a speci®c aspect of the ward, while on other occasions events or scenes within the ward can be likened to a landscape, a concept representing the background against which nursing work takes place, giving the work context and meaning. For example when persons are situated inside a curtained-off bed area the screen forms the backdrop to the interaction. On the other Journal of Clinical Nursing 1998; 7: 499±504 Ó 1998 Blackwell Science Ltd 499