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A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales. / Desiree J.R Tait

Swansea University Author: Desiree J.R Tait

Abstract

Aim: To interpret nurses' experiences of caring for patients with clinical deterioration and critical illness in a Welsh NHS Trust. Methodology: A Gadamerian hermeneutic study drawing on eight in-depth interviews using a purposive sampling technique of nurses who had experienced caring for pati...

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Published: 2008
Institution: Swansea University
Degree level: Doctoral
Degree name: D.N.Sc
URI: https://cronfa.swan.ac.uk/Record/cronfa42577
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spelling 2018-08-22T16:02:03.5510974 v2 42577 2018-08-02 A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales. f459228a80a5cf75268daa26ee27d4a4 NULL Desiree J.R Tait Desiree J.R Tait true true 2018-08-02 Aim: To interpret nurses' experiences of caring for patients with clinical deterioration and critical illness in a Welsh NHS Trust. Methodology: A Gadamerian hermeneutic study drawing on eight in-depth interviews using a purposive sampling technique of nurses who had experienced caring for patients with clinical deterioration. Data collection occurred during 2004. Other data sources included the historical context and the researcher's preunderstandings of the phenomena: clinical deterioration; suboptimal care and critical illness. Data were analysed using a dialogical approach and guided by conditions necessary for Gadamerian hermeneutic interpretation. Findings: The interpretation revealed that recognition of clinical deterioration included general and focused perception of triggers. These included; vigilance in the observation and scanning of patients; perception of clinical deterioration informed by historical and experiential awareness of triggers; and the use of selective combinations of historical, behavioural, interpersonal and physiological triggers. Response to clinical deterioration was influenced by the professional knowledge and confidence of the nurse, organisational culture, workload balance and skill mix. A model of professional gaze emerged that involved a circle of scanning, focused observation, waiting and balancing conditions for an effective response. Conclusions: What is known is that junior medical and nursing staff lack the knowledge, skills and support network required to recognise and respond effectively to patient clinical deterioration in acute hospital settings. The evidence base to support the clinical effectiveness of national guidelines, produced in 2007, for recognising and responding to physiological evidence of clinical deterioration was inconclusive at the time of this study. What this research adds is a model of professional gaze that highlights the complex and professional clinical decision making process involved in nurses' recognition and response to triggers in patient clinical deterioration. This process begins before physiological changes occur and the model provides a structure for recognising clinical concern that can be applied and tested in clinical settings. The model also highlights nurses' strategies for facilitating effective management of these patients. E-Thesis Nursing. 31 12 2008 2008-12-31 COLLEGE NANME Nursing COLLEGE CODE Swansea University Doctoral D.N.Sc 2018-08-22T16:02:03.5510974 2018-08-02T16:24:29.7278068 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Nursing Desiree J.R Tait NULL 1 0042577-02082018162505.pdf 10805326.pdf 2018-08-02T16:25:05.4370000 Output 8763329 application/pdf E-Thesis true 2018-08-02T16:25:05.4370000 false
title A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales.
spellingShingle A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales.
Desiree J.R Tait
title_short A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales.
title_full A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales.
title_fullStr A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales.
title_full_unstemmed A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales.
title_sort A Gadamerian hermeneutic study of nurses' experiences of recognising and managing patients with clinical deterioration and critical illness in a NHS trust in Wales.
author_id_str_mv f459228a80a5cf75268daa26ee27d4a4
author_id_fullname_str_mv f459228a80a5cf75268daa26ee27d4a4_***_Desiree J.R Tait
author Desiree J.R Tait
author2 Desiree J.R Tait
format E-Thesis
publishDate 2008
institution Swansea University
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Nursing{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Nursing
document_store_str 1
active_str 0
description Aim: To interpret nurses' experiences of caring for patients with clinical deterioration and critical illness in a Welsh NHS Trust. Methodology: A Gadamerian hermeneutic study drawing on eight in-depth interviews using a purposive sampling technique of nurses who had experienced caring for patients with clinical deterioration. Data collection occurred during 2004. Other data sources included the historical context and the researcher's preunderstandings of the phenomena: clinical deterioration; suboptimal care and critical illness. Data were analysed using a dialogical approach and guided by conditions necessary for Gadamerian hermeneutic interpretation. Findings: The interpretation revealed that recognition of clinical deterioration included general and focused perception of triggers. These included; vigilance in the observation and scanning of patients; perception of clinical deterioration informed by historical and experiential awareness of triggers; and the use of selective combinations of historical, behavioural, interpersonal and physiological triggers. Response to clinical deterioration was influenced by the professional knowledge and confidence of the nurse, organisational culture, workload balance and skill mix. A model of professional gaze emerged that involved a circle of scanning, focused observation, waiting and balancing conditions for an effective response. Conclusions: What is known is that junior medical and nursing staff lack the knowledge, skills and support network required to recognise and respond effectively to patient clinical deterioration in acute hospital settings. The evidence base to support the clinical effectiveness of national guidelines, produced in 2007, for recognising and responding to physiological evidence of clinical deterioration was inconclusive at the time of this study. What this research adds is a model of professional gaze that highlights the complex and professional clinical decision making process involved in nurses' recognition and response to triggers in patient clinical deterioration. This process begins before physiological changes occur and the model provides a structure for recognising clinical concern that can be applied and tested in clinical settings. The model also highlights nurses' strategies for facilitating effective management of these patients.
published_date 2008-12-31T03:53:14Z
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score 11.012924

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