Table 1 Example of a mismatch situation: handling a complex procedure

In this case, a blood sample needs to be taken and a PVC is inserted. The patient says, “It’s difficult to puncture my blood vessels.” One nurse tries and fails, as does a second nurse. During the procedure much of what is happening is erroneous, resulting in stasis, and leading in turn to the patient’s hand bruising dark blue. The nurse taps quite hard on the patient’s hand although the patient says repeatedly, “That hurts!” The nurse, who is wearing gloves with cut fingers, does not disinfect the patient’s skin. The needle goes in and out of the plastic catheter. The patient repeatedly expresses discomfort. The observing student looks pensive. He glances towards the researcher in the room on several occasions (the latter has a nursing/teaching background). A more experienced nurse now enters the room and tries to insert the PVC. The same erroneous performance is repeated, except that this nurse does not have any gloves on. The experienced nurse looks towards the researcher and says, “It gets this way sometimes.” There is no discussion with the student afterwards about what she has seen and the student does not ask any questions either.