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Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research
Author(s) -
Zaforteza Concha,
Gastaldo Denise,
Moreno Cristina,
Bover Andreu,
Miró Rosa,
Miró Margalida
Publication year - 2015
Publication title -
nursing inquiry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.66
H-Index - 49
eISSN - 1440-1800
pISSN - 1320-7881
DOI - 10.1111/nin.12112
Subject(s) - transformative learning , participatory action research , negotiation , citizen journalism , reflexivity , nursing , intensive care unit , power (physics) , psychology , collective action , action (physics) , unit (ring theory) , public relations , medicine , sociology , political science , developmental psychology , social science , physics , quantum mechanics , psychiatry , anthropology , law , mathematics education , politics
This study focuses on change strategies generated through a dialogical–reflexive–participatory process designed to improve the care of families of critically ill patients in an intensive care unit ( ICU ) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in‐depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional‐centered work to a more inclusive, patient‐centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained.