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

By Maureen A. Coombs | Go to book overview

Chapter 6

Clinical decision making and the hierarchies of knowledge

In this chapter I explore the main areas of knowledge that were used in decision making in intensive care. From the outset of the fieldwork, it was clear that doctors and nurses used some shared and some distinct types of knowledge to inform patient and service management decisions. To illustrate the results presented, data excerpts are used. Field data appears in quotation marks or in displayed text. Any particular emphasis made by the participants is demonstrated through italic text. Clarification of any abbreviations or terms used by participants is in brackets [ ] in the field data. This format is similarly used through the remaining chapters in this book.

Knowledge used by all clinicians in intensive care was primarily related to the treatment and support of the critically ill patient. This required knowledge of the patient's underlying disease process; an understanding of the potential clinical sequelae; and the specific monitoring and interventions required. There were key areas of knowledge that were familiar to, and used by both doctors and nurses as they worked to support critically ill patients. There were other discrete areas of knowledge that lay principally within, and were used by one discipline.

In the area of clinical service management, the pattern was similar in that both shared and discrete sources of knowledge were revealed. To facilitate effective management of the clinical service, distinct knowledge was used to understand the organisational needs of intensive care; the resources required to provide and sustain the service; and how to work within the systems required to support service delivery. There were well defined areas that were monitored and reported on in order to maintain the health of the service. These were key areas of knowledge that were recognised and used by the clinical management team (doctors, nurses and managers) as they worked to manage the units. Some knowledge was shared and used by doctors, nurses and managers but there were other discrete areas of knowledge that were only held and used by one discipline. In this way, the clinical and service management fields demonstrated two very different, and yet parallel worlds.

This chapter will explore the shared and the distinct areas of knowledge used in clinical and service management decisions. The importance of the objective,

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

Table of contents

  • Title Page iii
  • Contents v
  • Illustrations vii
  • Acknowledgements ix
  • Abbreviations and Glossary xi
  • Introduction xv
  • Chapter 1 - Nursing Role Developments 1
  • Chapter 2 - Collaboration 11
  • Chapter 3 - Clinical Management Teams 25
  • Chapter 4 - The Study 37
  • Chapter 5 - Understanding the Context 52
  • Chapter 6 - Clinical Decision Making and the Hierarchies of Knowledge 63
  • Chapter 7 - Roles in Clinical Decision Making 84
  • Chapter 8 - Power and Conflict on the Clinical Decision-Making Stage 97
  • Chapter 9 - Breaking Through the Inner Circle 118
  • References 127
  • Index 144
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