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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
Author: Tait, Desiree J. R.
Awarding Body: Swansea University
Current Institution: Swansea University
Date of Award: 2008
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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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.N.Sc.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available