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Knowing in practice: a tool in the production of intensive care
University West, Department of Nursing, Health and Culture, Division of Advanced Nursing. University West, Department of Health Sciences, Section for nursing - graduate level.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim with the the present thesisi was to find out how intensive care is produced by focusing on the ICU staffs interaction with each other and the technological tools they use. Theoretical perspective draws on socio cultural theory and the concepts accounting practices, moralöity in discourse and workplace research. The method used is ethnography and the data has been collected through participant observations and interviews in an intensive care unit in Swedish health care. The result... mer

is presented through four papers. The first paper shows that intensive care to a great extent is produced through rutines. The division of labour is marked and taken for granted by the ICU staffs. Verbal reports, visual displays and activities make the information avaliable and shared understanding seems to make words redundant when the everyday practices are carried out. Further technology seems to be embedded in the caring for the patients. In the second paper the findings also show that technology intervenes in the division of labour and both challenges the ICU staffs' practical knowing and refurmulates practice. The awareness of routine problems is connected to the ability to "see" and to the ICU staffs cultural/contextual knowing. Knowing in practice transforms when new technology is introduced in the ICU. Problems are solved in concert often in a hierarchical way. The third paper in turn illuminates that the meaning of technology seems to be connected to the ICU staffs' accounting practices, i.e. their experiences of intensive care, thaier education, how long they have worked in the ICU and their positions in the network. Accounting practices is also socially shaped by the interaction among the ICU staff.It is the knowing that has been developed over time and it is the knowing that new ICU staff members have to learn to be competent actors in the ICU environment. Furthermore it is found in the fourth paper that moral values are negotiated in assessments of patients, medical decisions, other professionals (in)competence and othe institutions' activities. Thus it seems that moral values embedded and intertwined in the ICU staffs' everyday practices. It is concluded that the ICU staffs competence i.e. knowing in situated activities could be seen as a tool in the production of intensive care. And this knowing seems to be distributed between the humans and between humans and the technological tools to make everyday practices more flexible. The ICU staff does not solve problems solely through individual cognitive work rather staff members "borrow" knowing from each other and solve problems in concert. Intensive care is produced here and now at the same time as the past is present in the everyday pracitices. The meaning is shaped in context and moral values are embedded in the intensive care discourse. In this sense intensive care could be described as a technically, cognitively and morally intense environment.

Place, publisher, year, edition, pages
Göteborg: Göteborg University. Sahlgrenska Academy , 2007. , 52 p.
Keyword [en]
accounting practices, competence, ethnography, human-human-machine, interaction, intensive care, meaning, morality, technology
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-2629OAI: oai:DiVA.org:hv-2629DiVA: diva2:344751
Available from: 2010-08-20 Created: 2010-08-20 Last updated: 2016-11-29Bibliographically approved
List of papers
1. Patient on display: a study of everyday practice in intensive care
Open this publication in new window or tab >>Patient on display: a study of everyday practice in intensive care
2003 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 43, no 4, 376-83 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This study investigates the situated organization in a workplace producing intensive care, that is an intensive care unit (ICU). The workplace research tradition concerns work and interaction/communication in technology-intensive environments. Communication is seen as social action and cannot be separated from production or from the context in which the activities are situated. AIM: The aim of the present study was to explore how intensive care is produced by analysing a recurrent situated activity in the ICU, namely the delivery and reception of a patient coming from the operation unit. METHOD: In the fieldwork, participant observations was used to study everyday practice in an ICU, combined with written field notes. FINDINGS AND DISCUSSION: Intensive care is to a great extent produced through routine practices. The division of labour is marked and is taken for granted: everyone knows what to do. The actors' physical location in the room is connected to their functions and work with supportive tools. Verbal reports, visual displays and activities make the information transmission available to everyone in the patient room. Shared understanding of the situation seems to make words redundant when the activities of competent actors are co-ordinated. There is also coordination between the actors in the ICU and the technological equipment, which constantly produces new information that must be interpreted. Enrolled Nurses are physically closest to the patients, the physician is the one most physically distant from patients and Registered Nurses bridge the gap between them. These actors produce and re-produce intensive care through constant sense-making in the here and now at the same time as the past is present in their activities.

Keyword
human technology, communication, routine practice, intensive care, participant observation, nursing
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-1762 (URN)10.1046/j.1365-2648.2003.02726.x (DOI)12887356 (PubMedID)
Available from: 2009-10-06 Created: 2009-10-02 Last updated: 2016-11-29Bibliographically approved
2. Technology -an actor in the ICU: a study in workplace research tradition.
Open this publication in new window or tab >>Technology -an actor in the ICU: a study in workplace research tradition.
2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 5, 555-61 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The present study focuses on human-machine interaction in an intensive care unit in the West of Sweden. AIMS: The aim of the present study was to explore how technology intervenes and challenges the ICU staff's knowing in practice. THEORETICAL PERSPECTIVE: The study's theoretical starting point draws on workplace research tradition. Workplace studies encompass the interaction between the actors' situated activities and the technological tools that make their activities possible. METHOD: Fieldwork or in situ studies of everyday practice in an intensive care unit documented in written field notes constituted the data. RESULTS: The findings show first how technology intervenes in the division of labour when the taken-for-granted "old" everyday practice is disrupted when a new machine intervenes in the morning's work; secondly, it reveal how technology challenges practical knowing and thirdly, it shows how technology reformulates practice. Staff members' awareness of routine problems is often connected to the ability to see, which is always related to cultural/contextual competence. CONCLUSION: It is concluded that it is not talk alone that helps the caregivers to "(dis)solve" the problems. The ability to see the problems, the work environment and to find the relevant supporting tools for "(dis)solving" the routine problems is also crucial. But it is not possible to say that it is the skillful work of humans that solve problems, nor do we claim it is the tools that do so. Humans and tools are interwoven in the problem-solving process. Relevance to clinical practice. Routine problems in the intensive care unit are not "(dis)solved" through the cognitive work of individual staff members alone. Problems are also "(dis)solved" jointly with other staff members. Staff members "borrow" the knowing from each other and problems are re-represented through communication. The knowing has to be distributed among the intensive care unit staff to make the everyday work flexible.

National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-1755 (URN)10.1111/j.1365-2702.2004.00899.x (DOI)15189408 (PubMedID)
Available from: 2009-10-06 Created: 2009-10-02 Last updated: 2016-11-29Bibliographically approved
3. The meaning of technology in an intensive care unit-an interview study
Open this publication in new window or tab >>The meaning of technology in an intensive care unit-an interview study
2007 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 23, no 4, 187-195 p.Article in journal (Refereed) Published
Keyword
Accounting practices, intensive care, meaning making, technology
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-103 (URN)10.1016/j.iccn.2007.03.003 (DOI)
Available from: 2009-04-02 Created: 2009-04-02 Last updated: 2016-11-29Bibliographically approved
4. Morality in discourse in a intensive care unit: a field studt
Open this publication in new window or tab >>Morality in discourse in a intensive care unit: a field studt
(English)Article in journal (Refereed) Submitted
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-2627 (URN)
Available from: 2010-08-20 Created: 2010-08-20 Last updated: 2016-11-29Bibliographically approved

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