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

Mackintosh, Nicola; Sandall, Jane

doi:10.1111/1467-9566.12339

Cited by 13 publications

(17 citation statements)

References 58 publications

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“…A variety of different studies have highlighted the key part that nurses play in patient safety by effecting rescues or intervening directly to prevent errors or omissions that cause or contribute to events that harm patients 51‐53 . Ward‐based and specialist nurses have been reported to act in different ways to effect patient safety rescues in clinical practice 51‐54 …”

Section: Discussionmentioning

confidence: 99%

‘Nurses whisper.’ Identities in nurses’ patient safety narratives of nurse‐trainee doctors’ interactions

et al. 2021

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Context Nurses are integral to patient safety, but little is known about their narrative constructions of identity in relation to their dyadic interactions with trainee doctors about patient safety and competence during the trajectory of a medical career. Aim We sought to examine how identities are constructed by experienced nurses in their narratives of patient safety encounters with trainee doctors. Methods Our qualitative study gathered narrative data through semi‐structured interviews with nurses of different professional standing (n = 20). Purposive sampling was used to recruit the first eight participants, with the remainder recruited through theoretical sampling. Audio recordings were transcribed verbatim and analysed inductively through a social constructionist framework and deductively using a competence framework. Results We classified seven identities that participants constructed in their narratives of dyadic interactions with trainee doctors in relation to patient safety: nurses as teacher, guardian of patient wellbeing, provider of emotional support, provider of general support, expert advisor, navigator and team player. These identities related to the two key roles of nurses as educators and as practitioners. As they narrated these dyadic interactions, participants constructed identities that positioned trainee doctors in character tropes, suggesting gaps in professional competence: nurses as provider of general support was commonly narrated in the context of perceived deficits of personal or functional capabilities and nurses as team player was mainly associated with concerns (or reassurances) around ethical capabilities. Discussion and Conclusion Our findings are consistent with, and extend the wider literature on the development of professional competence, interprofessional collaboration in health care, and the nature and organisation of nursing work. Nurses' work in ensuring patient safety and support trainee doctors’ professional development merits greater formal recognition and legitimation.

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Section: Discussionmentioning

confidence: 99%

‘Nurses whisper.’ Identities in nurses’ patient safety narratives of nurse‐trainee doctors’ interactions

et al. 2021

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“…Furthermore, multiple logics typically exist in the workplace and these must be reconciled (Dodier, 1998). In our case, for example, the logic of deterioration that governs rescue activity may be in tension with the dominant logic of a particular setting, such as the logic of recovery, typical in maternity (Mackintosh and Sandall, 2016) and post-anaesthetic care contexts, with important implications for implementation.…”

Section: Tmtmentioning

confidence: 97%

Analysing healthcare coordination using translational mobilization

Allen

2018

JHOM

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PurposeThe purpose of this paper is to introduce translational mobilization theory (TMT) and explore its application for healthcare quality improvement purposes.Design/methodology/approachTMT is a generic sociological theory that explains how projects of collective action are progressed in complex organizational contexts. This paper introduces TMT, outlines its ontological assumptions and core components, and explores its potential value for quality improvement using rescue trajectories as an illustrative case.FindingsTMT has value for understanding coordination and collaboration in healthcare. Inviting a radical reconceptualization of healthcare organization, its potential applications include: mapping healthcare processes, understanding the role of artifacts in healthcare work, analyzing the relationship between content, context and implementation, program theory development and providing a comparative framework for supporting cross-sector learning.Originality/valuePoor coordination and collaboration are well-recognized weaknesses in modern healthcare systems and represent important risks to quality and safety. While the organization and delivery of healthcare has been widely studied, and there is an extensive literature on team and inter-professional working, we lack readily accessible theoretical frameworks for analyzing collaborative work practices. TMT addresses this gap in understanding.

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“…Tools and measures embody logics and sets of ethical dispositions and work as ethical actors (Armstrong et al . 2018, Gardner and Cribb 2016, Mackintosh and Sandall 2015). We now turn to our last analytical theme which highlights how the papers in this collection illustrate the ways in which uncertainty is intertwined with and shaped by the socio‐political context of contemporary health care.…”

Section: Managing Uncertainty: Work To Structure and Tamementioning

confidence: 99%

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

Mackintosh

Armstrong

2020

Sociology Health & Illness

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In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts ‐ Alzheimer’s disease, neonatal surgery, cardiovascular disease prevention, cancer, addiction (use of alcohol and other drugs during pregnancy), mental health/disorders and medical education – and many tackle issues of contemporary relevance, such as an ageing population, and novel medical interventions and their sequelae. These empirical papers are complemented by a further theoretical contribution, which considers the role of ‘implicit normativity’ in masking and containing potential ethical uncertainty. By mapping themes across the collection, in this introduction we present a number of core analytical strands: (1) conceptualising uncertainty; (2) intersections of uncertainty with aspects of care; (3) managing uncertainty; and (4) structural constraints, economic austerity and uncertainty work. We reflect on the methodological and theoretical stances used to think sociologically about uncertainty in health care, and the strengths, silences and gaps we observe in the collection. We conclude by considering the implications of the insights gained for ‘synthesising certainty’ in practice and for future research in this area.

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

Cited by 13 publications

References 58 publications

‘Nurses whisper.’ Identities in nurses’ patient safety narratives of nurse‐trainee doctors’ interactions

‘Nurses whisper.’ Identities in nurses’ patient safety narratives of nurse‐trainee doctors’ interactions

Analysing healthcare coordination using translational mobilization

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

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