Power and conflict in intensive care clinical decision making.

Full Abstract

It is clear that current government policy places increasing emphasis on the need for flexible team working. This requires a shared understanding of roles and working practices. However, review of the current literature reveals that such a collaborative working environment has not as yet, been fully achieved. Role definitions and power bases based on traditional and historical boundaries continue to exist. This ethnographic study explores decision making between doctors and nurses in the intensive care environment in order to examine contemporary clinical roles in this clinical specialty. Three intensive care units were selected as field sites and data was collected through participant observation, ethnographic interviews and documentation. A key issue arising in this study is that whilst the nursing role in intensive care has changed, this has had little impact on how clinical decisions are made. Both medical and nursing staff identify conflict during patient management discussions. However, it is predominantly nurses who seek to redress this conflict area through developing specific behaviours for this clinical forum. Using this approach to resolve such team issues has grave implications if the government vision of interdisciplinary team working is to be realised.

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Author information

Author/s: Coombs, Maureen (M);

Affiliation: Southampton University Hospitals Trust, School of Nursing and Midwifery, and Intensive Care Unit, Southampton General Hospital, University of Southmpton, UK. maureen.combs(-atsign-)suht.swest.nhs.uk

Journal and publication information

Publication Type: Journal Article

Journal: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (Intensive Crit Care Nurs), published in Scotland. (Language: eng)

Reference: 2003-Jun; vol 19 (issue 3) : pp 125-35

Dates: Created 2003/05/26; Completed 2003/08/27; Revised 2004/11/17;

PMID: 12765632, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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