Power & Conflict between Doctors and Nurses: Breaking through the Inner Circle in Clinical Care

By Maureen A. Coombs | Go to book overview
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Chapter 5

Understanding the context

This chapter sits between presentation of the study and the main chapters that explore key issues relating to clinical decision making in intensive care. In this chapter I set the scene so that the reader can understand the context within which decision making occurred. There are two elements to this. The first is to have a familiarity with the settings within which this work was undertaken. To this end, in the first half of the chapter I describe the specific clinical units. In this, I will describe the units with details about their size, clinical services offered together with any general observations made while I was undertaking fieldwork. Any specific projects or developments that occurred on the unit during the study and that I used to explore interdisciplinary working are also made explicit.

In the second half of this chapter I explore the clinical and service management forums within which decisions were made. The types of forums, and their structure and membership are reviewed. I hope that in taking some time to explore such essential background detail, the stage will be set to address the key matters arising from this work.


The clinical sites

As outlined in the previous chapter, all three of the clinical units used in this study were classified as general intensive care units. One site was a large university teaching hospital unit with complex service configurations and regional services and one was a district general hospital site. This mix, despite offering broadly similar clinical services, demonstrated variation in terms of the size of the unit and clinical speciality services offered. The third site was chosen as it was an established nursing development unit (NDU). These clinical units, with a nursing centred philosophy, have a strong focus on clinical nursing, education, and research developments within a facilitative, non-hierarchical structure (Manley 1990; Mills 1997). The inclusion of an intensive care nursing development unit, therefore, gave opportunities to explore whether developing a prominent nursing culture altered in any way the dynamics of how doctors and nurses work to make decisions. This site acted as a case for analysis, demonstrating variance from the other two. Each of these sites is now described in some depth.

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