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Intensive care unit patients in the post-anesthetic recovery room : a case study exploring how registered nurses manage change

University of British Columbia

Health care in the acute setting is in a constant state of change with evolving technology, higher acuity, and changing patient care models. In the midsize hospital in this study there was a practice change which involved the Recovery Room nurses caring for Intensive Care Unit (ICU) overflow patients. The purpose of this research was to explore the experiences of the Recovery Room nurses during this practice change. Six Recovery Room nurses from this midsized hospital participated in this study. Participants were interviewed using a semi-structured format with open-ended questions to guide the conversation. Interviews lasted 25 to 35 minutes, were digitally recorded, transcribed verbatim by a transcriptionist, and then checked for accuracy. Interpretive Description was used to guide the data analysis. The first three transcripts were read independently by co-investigators who then met to construct an initial coding framework. This framework was used to code the remaining interviews with constant comparative analysis to ensure accuracy and integrity of the codes. The coding framework was then reviewed by the remaining committee members to further enhance coding integrity. The coding framework was continually refined throughout the study to strive for accuracy. Three main themes were constructed from the data: the Expert Mind-set, Specialty Practice and Unit Culture. Expert mind-set was further broken down into sub-themes, Knowing but not Doing and Dual Focus/Dual Duty. Specialty Practice was broken down into sub-themes Doing but not Knowing and Contextual Supports. Finally, Unit Culture was broken down into Identity and Relationships. These findings lead to a more in-depth discussion of the dilemma of not being able to deliver a standard of care, i.e. the concept of knowing but not doing, and the dilemma of generalist versus specialist approach to critical care, i.e. the concept of doing but not knowing. The results of this study have multifaceted implications which include the use of a change model when implementing practice change; developing relationships to support practice change; valuing a self-directed learning culture; and the importance of having practice standards and resources available to support practice change.

Text

2012-04-11

Attribution-NonCommercial-ShareAlike 3.0 Unported

http://hdl.handle.net/2429/41947

Nursing

University of British Columbia

UBCO

http://creativecommons.org/licenses/by-nc-sa/3.0/