Knowing in practice - a tool in the production of intensive care
The overall aim with the the present thesisi was to find out how intensive care is produced by focusing on the ICU staffs interaction with each other and the technological tools they use. Theoretical perspective draws on socio cultural theory and the concepts accounting practices, moralöity in discourse and workplace research. The method used is ethnography and the data has been collected through participant observations and interviews in an intensive care unit in Swedish health care. The result is presented through four papers. The first paper shows that intensive care to a great extent is produced through rutines. The division of labour is marked and taken for granted by the ICU staffs. Verbal reports, visual displays and activities make the information avaliable and shared understanding seems to make words redundant when the everyday practices are carried out. Further technology seems to be embedded in the caring for the patients. In the second paper the findings also show that technology intervenes in the division of labour and both challenges the ICU staffs' practical knowing and refurmulates practice. The awareness of routine problems is connected to the ability to "see" and to the ICU staffs cultural/contextual knowing. Knowing in practice transforms when new technology is introduced in the ICU. Problems are solved in concert often in a hierarchical way. The third paper in turn illuminates that the meaning of technology seems to be connected to the ICU staffs' accounting practices, i.e. their experiences of intensive care, thaier education, how long they have worked in the ICU and their positions in the network. Accounting practices is also socially shaped by the interaction among the ICU staff.It is the knowing that has been developed over time and it is the knowing that new ICU staff members have to learn to be competent actors in the ICU environment. Furthermore it is found in the fourth paper that moral values are negotiated in assessments of patients, medical decisions, other professionals (in)competence and othe institutions' activities. Thus it seems that moral values embedded and intertwined in the ICU staffs' everyday practices. It is concluded that the ICU staffs competence i.e. knowing in situated activities could be seen as a tool in the production of intensive care. And this knowing seems to be distributed between the humans and between humans and the technological tools to make everyday practices more flexible. The ICU staff does not solve problems solely through individual cognitive work rather staff members "borrow" knowing from each other and solve problems in concert. Intensive care is produced here and now at the same time as the past is present in the everyday pracitices. The meaning is shaped in context and moral values are embedded in the intensive care discourse. In this sense intensive care could be described as a technically, cognitively and morally intense environment.
Parts of work
I Wikström, A-C.,& Sätterlund Larsson, U. (2003). Patient on display- a study of everyday practice in intensive care. Journal of Advanced Nursing 43 (4), 376-383 ::PMID::12887356II Wikström, A-C., & Sätterlund Larsson, U. (2004). Technology an actor in the ICU: a study in workplace research tradition. Journal of Critical Nursing, 13, 555-561 ::PMID::15189408III Wikström, A-C., Cederborg, A-C., & Johanson, M. (2007). The meaning of technology of technology in an intensive care unit- an interview study. Intensive and Critical Care Nursing (in press).IV Wikström, A-C., Johanson, M., Plos, K., & Cederborg, A-C. Morality in discourse in an intensive care unit- a field study (submitted)
Doctor of Philosophy
Göteborg University. Sahlgrenska Academy
Inst of Health and Care Sciences