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Medical hegemony in decision-making: a barrier to interdisciplinary working in intensive care?

Medical hegemony in decision-making: a barrier to interdisciplinary working in intensive care?
Medical hegemony in decision-making: a barrier to interdisciplinary working in intensive care?
Background: Health care policy in the United Kingdom identifies the need for health professsionals to find new ways of working to deliver patient-focussed and economic care. Much debate has followed on the nature of working relationships within the health care team.
Aim: This paper reports on an ethnographic study that examined the nursing role in clinical decision-making in intensive care units. This was chosen as a case for analysis due to the close doctor-nurse relationships that are essential in this acute and complex care setting.
Methods: Data were collected during two-stages of fieldwork using participant observation, in-depth ethnographic interviews and documentation across three clinical sites.
Findings: The findings revealed the different types of knowledge used for, divergence of roles involved in and degree of authority in clinical decision-making. Furthermore, conflict arose between doctors and nurses due to these differences and in particular because medicine dominated the decision-making process.
Conclusions: The nursing role, whilst pivotal to implementing clinical decisions, remained unacknowledged and devalued. Medical hegemony continues to render nurses unable to influence substantially the decision-making process. This has fundamental ramifications for the quality of team decision-making and the effectiveness of new ways of inter-professional working in intensive care.
medical hegemony, clinical decision-making, nursing role, ethnography, intensive care
0309-2402
245-252
Coombs, Maureen
e7424ed2-6beb-481d-8489-83f3595fd04c
Ersser, Steven J.
e04fca2d-1d1b-41df-93f0-510b0e656c96
Coombs, Maureen
e7424ed2-6beb-481d-8489-83f3595fd04c
Ersser, Steven J.
e04fca2d-1d1b-41df-93f0-510b0e656c96

Coombs, Maureen and Ersser, Steven J. (2004) Medical hegemony in decision-making: a barrier to interdisciplinary working in intensive care? Journal of Advanced Nursing, 46 (3), 245-252. (doi:10.1111/j.1365-2648.2004.02984.x).

Record type: Article

Abstract

Background: Health care policy in the United Kingdom identifies the need for health professsionals to find new ways of working to deliver patient-focussed and economic care. Much debate has followed on the nature of working relationships within the health care team.
Aim: This paper reports on an ethnographic study that examined the nursing role in clinical decision-making in intensive care units. This was chosen as a case for analysis due to the close doctor-nurse relationships that are essential in this acute and complex care setting.
Methods: Data were collected during two-stages of fieldwork using participant observation, in-depth ethnographic interviews and documentation across three clinical sites.
Findings: The findings revealed the different types of knowledge used for, divergence of roles involved in and degree of authority in clinical decision-making. Furthermore, conflict arose between doctors and nurses due to these differences and in particular because medicine dominated the decision-making process.
Conclusions: The nursing role, whilst pivotal to implementing clinical decisions, remained unacknowledged and devalued. Medical hegemony continues to render nurses unable to influence substantially the decision-making process. This has fundamental ramifications for the quality of team decision-making and the effectiveness of new ways of inter-professional working in intensive care.

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More information

Published date: 2004
Keywords: medical hegemony, clinical decision-making, nursing role, ethnography, intensive care

Identifiers

Local EPrints ID: 9209
URI: https://eprints.soton.ac.uk/id/eprint/9209
ISSN: 0309-2402
PURE UUID: 0ab5a2cb-478c-429d-ae30-3553d7f6ec51

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Date deposited: 19 May 2006
Last modified: 17 Jul 2017 17:11

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Contributors

Author: Maureen Coombs
Author: Steven J. Ersser

University divisions

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