Early Recognition of Patient Problems in Critical Care: An Interpretative Study

Abstract

Early recognition of patient problems is crucial in the critical care setting, however the process of early recognition remains elusive. The literature reflects growing consensus that expert clinicians routinely use “intuitive knowing” (embodied intelligence) in critical decision-making situations (Benner, 1984; Benner & Wrubel, 1989). The purpose of this study was to gain an understanding of the embedded knowledge used by critical care nurses in the early recognition of patient problems. Heideggerian hermeneutical analysis was chosen as the theoretical perspective and research method because of its usefulness in revealing contextual understanding of obscure constructs. A purposeful sampling technique was used to recruit the 30 critical care nurses as participants for this study from one of two hospitals in the North Georgia area. All 30 participants had a minimum of three years of experience in critical care nursing and were interviewed once. Eight of the participants were interviewed a second time; in addition, two key participants reviewed and confirmed the interpretation for a total of 40 interviews. Two patterns considered constitutive of the nurses’ Being were found implicitly and explicitly in every interview and were entitled: (a) the perception of early recognition: engendered through care and (b) practical knowing: embodied intelligence. Major themes that were identified were: (a) experience is requisite for early recognition, (b) communication between nurses and physicians, (c) technology: help or hindrance and (d) what sustains me in nursing. A meaningful understanding of process of early recognition of patient problems contributes to nursing science, nursing education and most importantly, to the improvement of patient care.