Children in intensive care : nurses perceptions of need.
This study investigates the manner in which intensive care nurses perceive, and take
action to meet, the needs of the critically ill child, with the aim of answering three
research questions: 1. What care is provided for the critically ill child in the intensive care
unit? 2. How do nurses identify and act on the needs of the critically ill child? 3. What
dimensionso f knowing underpint he way in which nursesp erceivea nd act on the needs
of the critically ill child?
A modified Delphi technique was used to provide an expert opinion on the needs of the
critically ill child. A case study approach, informed by ethnographic principles, was used
to structure observationsa nd interviewsi n one paediatrici ntensivec are unit (ICU) and
two general ICUs. Carper's (1978) four dimensions of knowing (aesthetic, ethical,
empiricala nd personakl nowing) underpinnedc ases tudy data collectiona nd analysis.
The study findings expanded Carper's original work by identifying an additional
dimension of knowing, referred to as contextual knowing, which nurses used to relate
empirical and aesthetic knowledge to the individual child. This influenced their
perception of whether a changed situation constituted a need. The five dimensions of
knowing were used in an inter-related way by the nurses; no hierarchy was evident as
priority was given to the dimension most relevant in a given situation. The findings
highlight the key role of the nurse at the bedside (the allocated nurse) in identifying,
legitimising and acting on the needs of the child. The importance of experience and
confidence in enabling the nurses to undertake activities such as gate-keeping andprioritising in order to meett he needso f the child was also emphasisedT. he shift leader
supported the nurses and co-ordinated the overall activity on the Unit. There was no
overall difference in the role adopted by families in the General and Paediatric ICUs.
Nursing records were an historical record of care, rather than a plan of care, and did not
detail decision-making and prioritising activity frequently observed in the intensive care
Recommendations are made for strategies to retain experienced nursing staff at the
bedside, the active promotion of learning through experience, incorporating prioritising
of care in records and a more inclusive framework for measuring and costing nursing
workload in ICU