Nicola Mackintosh (PhD)
Supervisors: Jane Sandall & Charlotte Humphrey
Aims
This project will explore how the concept of clinical deterioration is negotiated and managed within medicine. This will be done by:
- Examining what forms of ‘encoded knowledge’ are perceived to signify clinical deterioration in a patient’s condition
- Exploring what written & unwritten rules, socio-cultural & political influencesgovern responses to calls for help
- Reviewing how medical response to clinical deterioration is perceived within the arena of accountability and culpability
Why is this important?
Effective management of the acutely unwell patient requires not only prompt recognition of warning signs, but interpretation and timely appropriate clinical management once deterioration is identified. We know that in emergency situations, junior medical staff can have difficulties securing appropriate help from senior staff and colleagues. Medical uncertainty can result in delays of provision of care and in some cases, patient harm. Recent contextual changes such as the European Working Time Directive, introduction of critical care outreach and increased numbers of critically ill on the wards may also have an impact on medical response behaviour. This project will generate new understanding about how deterioration is understood and managed within medical settings and the implications of this for future practice.
Participants
Ethnographic research is being carried out in two trusts (focusing on two acute medical wards). This will involve observing medical work on these wards, shadowing a range of medical staff during routine work and on calls, attending firm meetings and attending committee meetings over a period of 6 months. Juniors & senior medical staff, nurses and managers will also be interviewed.
Anticipated Outcomes
- Greater understanding of the complexity of meaning around defining deterioration and the way it is socially framed, negotiated and managed in medical care settings at both frontline and strategic level
- Production of academic papers and seminars to publicise learning
