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The division of labour in day-to-day practice : An ethnographic study of health professional work in intensive care

Student thesis: Doctoral ThesisDoctor of Philosophy

This study examines health professional work in intensive care units (ICUs) aiming to draw out the associated interplay of context-specific factors and social processes through which clinicians accomplish their day-to-day practice. The study was conducted against a backdrop of political and public pressure for safe, quality and efficient healthcare, in which inter-professional work was argued as key to containing these challenges. The study has been theoretically informed by an interactionist perspective to the division of labour and has followed an ethnographic approach. Data have been collected through fieldwork in three London ICUs employing observation of actual and in situ practice complemented by interviews with health professionals.
Findings indicated that in response to the critical and fluctuating nature of patients’ conditions in ICUs, day-to-day health professional work was organised in dynamic terms, in which professional jurisdictions were shared and disputed, influenced by professional care priorities, staff seniority and work urgency. Differing professional priorities regarding patient care posed a challenge to conventional professional boundaries, giving rise to inter-professional disputes. These were managed through interaction as they arose in day-to-day practice. Senior staff made confident claims over aspects of work and utilised direct communication approaches while junior staff evaded overt confrontation. Under conditions of intense urgent work, where patient deterioration was rapid and the potential for death was high, jurisdiction concerns appeared suspended as professionals coordinated their work through non-verbal and highly attuned interaction.
Considered together, these findings indicate that health professional work in ICU
operates within an intricate system of professions which is influenced by wider health policies and context-specific clinical exigencies, is prone to disputes over jurisdictions, and is accomplished through day-to-day discursive and tacit interaction. Through this study a deeper insight into health professional work in ICU is gained that can inform the development of more refined and resilient health policies. Understanding the ways in which health professional work is organised and delivered in ICU will help to equip clinicians with the insight required to shape the future of this service towards the provision of safe and high-quality healthcare.
Original languageEnglish
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Award date2014

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