The habitus of ‘rescue’ and its significance for implementation of rapid response systems in acute health care

Mackintosh, Nicola; Humphrey, Christopher; Sandall, Jane

doi:10.1016/j.socscimed.2014.09.033

Cited by 37 publications

(83 citation statements)

References 40 publications

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“…Case studies and ethnographic methods, including rapid assessments and mini-ethnographies, frequently occur together in health research when the goal is to understand outcomes, processes, or behaviors in context (Storesund & McMurray, 2009). This combination approach has often been applied in hospitals and other clinical settings to inform HIV care, nursing practice, and other health services (Mackintosh, Humphrey, & Sandall, 2014). …”

Section: Methodsmentioning

confidence: 99%

Displacement and HIV: Factors Influencing Antiretroviral Therapy Use by Ethnic Shan Migrants in Northern Thailand

DiStefano

Yang

et al. 2016

Journal of the Association of Nurses in AIDS Care

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Migrant populations face increased HIV vulnerabilities, including limited access to antiretroviral therapy (ART). Civil conflict in Myanmar has displaced thousands of people from the minority Shan ethnic group into northern Thailand, where they bear a disproportionate HIV burden. To identify barriers and facilitators of ART use in this population, we conducted a rapid ethnographic assessment and case study with a clinical sample of Shan migrants receiving treatment for HIV in a district hospital in Chiang Mai, Thailand, Thai nurses providing their care, and health care administrators (n = 23). Barriers included fears of arrest and deportation, communication difficulties, perceived social marginalization, limited HIV knowledge, and lack of finances. Facilitating factors included hospital-based migrant registration services and community outreach efforts involving support group mobilization, referral practices, and radio broadcasts. These findings provided a contextualized account to inform policies, community interventions, and nursing practice to increase treatment access for minority migrant groups.

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Section: Methodsmentioning

confidence: 99%

Displacement and HIV: Factors Influencing Antiretroviral Therapy Use by Ethnic Shan Migrants in Northern Thailand

DiStefano

Yang

et al. 2016

Journal of the Association of Nurses in AIDS Care

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“…Evaluating users' views for new charts in practice is important for the developing knowledge base on elements of the afferent limb of a RRS. While objective data are necessary to develop effective evidence-based observation charts (Preece et al 2012a, Christofidis et al 2015, understanding and preferences of clinical staff (Preece et al 2013) and work culture (Williams et al 2011, Shearer et al 2012, Mackintosh et al 2014, Brier et al 2015, Douglas et al 2016 are also likely to influence successful adoption in practice (Hills 2011, Douglas et al 2016, as reflected in our findings.…”

Section: Discussionmentioning

confidence: 67%

“…), a highly charged professional space particularly within the context of a deteriorating patient (Mackintosh et al . ). Importantly, traditional, ritualistic vital signs monitoring practices (Osborne et al .…”

Section: Discussionmentioning

confidence: 97%

User acceptance of observation and response charts with a track and trigger system: a multisite staff survey

Elliott

Allen

McKinley

et al. 2016

Journal of Clinical Nursing

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Aims and objectives. To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical-surgical patients. Background. Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Five chart templates were developed in Australia, combining human factors design principles with a track and trigger system for escalation of care. Two chart templates were previously tested in simulations, but none had been evaluated in clinical practice. Design. Prospective multisite survey of user acceptance of the charts in practice. Methods. New observation and response charts were trialled in parallel with existing charts for 24 hours across 36 adult acute medical-surgical wards, covering 108 shifts, in five Australian states. Surveys were completed by 477 staff respondents, with open-ended comments and narrative from short informal feedback groups providing elaboration and context of user experiences. Results. Respondents were broadly supportive of the chart format and content for monitoring patients, and as a prompt for escalating care. Some concerns were noted for chart size and style, use of ranges to graph vital signs and with specific human factors design features. Information and training issues were identified to improve usability and adherence to chart guidelines and to support improved detection and response for patients with clinical deterioration.Conclusions. This initial evaluation demonstrated that the charts were perceived as appropriate for documenting observations and as a prompt to detect clinical deterioration. Further evaluation after some minor modifications to the chart is recommended.What does this paper contribute to the wider global clinical community?• Implementing practice initiatives to improve recognition and response to clinical deterioration (the afferent limb of the rapid response system) remains a global healthcare challenge This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Relevance to clinical practice. Explicit training on the principles and rationale of human factors chart design, use of embedded change management strategies and addressing practical issues will improve authentic engagement, staff acceptance and adoption by all clinical users when implementing a similar observation and response chart into practice.

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“…These systems help shape constructs of deterioration and the point of intervention, and provide legitimacy for calling for help (Mackintosh and Sandall , Mackintosh et al . ). Escalation pathways had been put in place to ensure that acutely ill patients had access to appropriate critical care services.…”

Section: Resultsmentioning

confidence: 97%

The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings

Mackintosh

Sandall

2015

Sociology Health & Illness

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The normative position in acute hospital care when a patient is seriously ill is to resuscitate and rescue. However, a number of UK and international reports have highlighted problems with the lack of timely recognition, treatment and referral of patients whose condition is deteriorating while being cared for on hospital wards. This article explores the social practice of rescue, and the structural and cultural influences that guide the categorisation and ordering of acutely ill patients in different hospital settings. We draw on Strauss et al.'s notion of the patient trajectory and link this with the impact of categorisation practices, thus extending insights beyond those gained from emergency department triage to care management processes further downstream on the hospital ward. Using ethnographic data collected from medical wards and maternity care settings in two UK inner city hospitals, we explore how differences in population, cultural norms, categorisation work and trajectories of clinical deterioration interlink and influence patient safety. An analysis of the variation in findings between care settings and patient groups enables us to consider socio‐political influences and the specifics of how staff manage trade‐offs linked to the enactment of core values such as safety and equity in practice.

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The habitus of ‘rescue’ and its significance for implementation of rapid response systems in acute health care

Cited by 37 publications

References 40 publications

Displacement and HIV: Factors Influencing Antiretroviral Therapy Use by Ethnic Shan Migrants in Northern Thailand

Displacement and HIV: Factors Influencing Antiretroviral Therapy Use by Ethnic Shan Migrants in Northern Thailand

User acceptance of observation and response charts with a track and trigger system: a multisite staff survey

The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings

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