Perceptions of risk and safety in the ICU: a qualitative study of cognitive processes relating to staffing
File(s)
Published version
Author(s)
D'Lima, DM
Murray, EJ
Brett, SJ
Type
Journal Article
Abstract
Objectives: The aims of this study were to 1) examine individual professionals’ perceptions of staffing risks and safe staffing in intensive care and 2) identify and examine the cognitive processes that underlie these perceptions.
Design: Qualitative case study methodology with nurses, doctors, and physiotherapists.
Setting: Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group.
Subjects: Forty-four ICU team members of diverse professional backgrounds and seniority.
Interventions: None.
Main Results: Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an “A” team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a “dynamic balance” influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals’ risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit.
Conclusions: This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals’ cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals’ perfectionist or pragmatic approach. Perfectionists’ team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived “A” team but diminished by interdisciplinary tensions. Third, counter intuitively, higher “situational” awareness for some individuals increased their stress and anxiety. Finally, our results suggest that professionals have varying concepts of where their personal responsibility to minimize risk begins and ends, which we have termed “risk horizons” and that these horizons may affect their behavior both within and beyond the unit.
Design: Qualitative case study methodology with nurses, doctors, and physiotherapists.
Setting: Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group.
Subjects: Forty-four ICU team members of diverse professional backgrounds and seniority.
Interventions: None.
Main Results: Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an “A” team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a “dynamic balance” influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals’ risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit.
Conclusions: This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals’ cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals’ perfectionist or pragmatic approach. Perfectionists’ team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived “A” team but diminished by interdisciplinary tensions. Third, counter intuitively, higher “situational” awareness for some individuals increased their stress and anxiety. Finally, our results suggest that professionals have varying concepts of where their personal responsibility to minimize risk begins and ends, which we have termed “risk horizons” and that these horizons may affect their behavior both within and beyond the unit.
Date Issued
2018-01-01
Date Acceptance
2017-09-04
Citation
Critical Care Medicine, 2018, 46 (1), pp.60-70
ISSN
0090-3493
Publisher
Wolters Kluwer Health
Start Page
60
End Page
70
Journal / Book Title
Critical Care Medicine
Volume
46
Issue
1
Copyright Statement
Copyright © 2017 The Author(s). Published by Wolters Kluwer Health,
Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer
Health, Inc. This is an open-access article distributed under the terms
of the Creative Commons Attribution-Non Commercial-No Derivatives
License 4.0 (CCBY-NC-ND), where it is permissible to download and
share the work provided it is properly cited. The work cannot be changed
in any way or used commercially without permission from the journal.
Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer
Health, Inc. This is an open-access article distributed under the terms
of the Creative Commons Attribution-Non Commercial-No Derivatives
License 4.0 (CCBY-NC-ND), where it is permissible to download and
share the work provided it is properly cited. The work cannot be changed
in any way or used commercially without permission from the journal.
Subjects
Attitude of Health Personnel
Cognitive Dissonance
Culture
Hospitals, University
Humans
Intensive Care Units
Interdisciplinary Communication
Intersectoral Collaboration
London
Patient Care Team
Patient Safety
Psychological Theory
Qualitative Research
Retrospective Studies
Risk
Risk Management
1103 Clinical Sciences
1110 Nursing
1117 Public Health And Health Services
Emergency & Critical Care Medicine
Publication Status
Published