Pediatric Intensive Care Unit nurses’ lived experience of environmental and quality improvement changes in the context of a major hospital transformation
Bibliographic record
Abstract
Background: An important growth in healthcare construction is currently witnessed across many countries and the organisations that renew their infrastructure often use this opportunity to optimize their clinical and administrative practices. The changes that result from these projects are complex and transformational. Research into these major hospital transformations, mega-projects that involve construction as well as quality improvement initiatives, is relatively new and the nursing perspective has yet to be studied. Nurses’ perspective is essential because they are key to successful healthcare change and they represent the largest professional workforce. Moreover, changes can have a high impact on nurses’ health and professional practice. Objective: Within this major transformational context, the objective of this study was to explore pediatric intensive care unit nurses’ lived experience of environmental and quality improvement changes.Methodology: This study used a hermeneutic-phenomenological design, inspired by the works of philosopher Heidegger, and nursing researcher Benner. The study site is a 32 single-patient bed pediatric intensive care unit in a large Canadian pediatric hospital located in an urban setting. The study participants were 15 pediatric intensive care unit nurses who experienced both the old and the new infrastructure of the unit. Data was collected over a six-month period (September 2018 – March 2019) by the candidate, under the supervision of senior qualitative researchers. Data collection methods consisted in semi-structured audio-recorded individual interviews (n=15; 58 minutes/interview), follow-up interviews (n=9; 15 minutes/interview), photographs taken by the participants (28 photographs), participant observation (91.5 hours of 24/7 observation, and 46 informal interviews in the field), and document review (142 documents and 47 files). The hermeneutic analysis method described by Benner was used, supported by the NVivo 12 Pro software. Narrative syntheses were completed from each data collection episode. In constructing these syntheses, the candidate moved in and out of the detail of the data in an iterative manner, asking repeatedly: How is the phenomena being revealed/veiled in this encounter? What is the meaning for the interviewee of this element in relation to the studied phenomena, and why? In this back and forth movement from part to whole (hermeneutic circle), preunderstandings are repeatedly questioned until a bridge of understanding is created between the researcher’s and the participant’s horizons of significance. This hermeneutic circle allowed common and divergent meanings to be extracted from the data.Results: The study illuminated pediatric intensive care unit nurses’ lived experience of environmental and quality improvement changes in the context of a major hospital transformation through the heuristics of negotiation of spaces with families and erosion of their critical care identity. Nurses in this study negotiated physical and practice spaces with families by interpreting that nurses do not belong in the home-like patient room, and exhibiting gatekeeping comportments. Furthermore, the interplay between numerous changes brought about by the hospital transformation, and the unit context eroded nurses’ critical care identity.Conclusion: Major hospital transformations can have profound impacts on nurses – transforming core nursing activities and identity. Nursing managers need to support nurses through transitions to favour staff well-being, as well as the successful implementation of envisioned change. The potential richness or downfall of hospital transformations comes from intersections of changes in the physical and clinical environments, as well as the context in which these changes are situated – highlighting the importance of planning changes together, and further investigating the challenges presented by the collision of multiple change initiatives
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.006 | 0.007 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.006 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".