Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice
Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice
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DOI：
10.1016/j.socscimed.2016.03.022
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发表时间：
2016-05-01
影响因子：
5.4
通讯作者：
Higginbottom, Gina
中科院分区：
文献类型：
--
作者：
Brummell, Stephen P.;Seymour, Jane;Higginbottom, Gina
尽管媒体的形象与之相反，急诊部门的心肺复苏往往是不成功的。这项人种学研究的目的是探讨在英国两个急诊科工作的卫生保健专业人员如何决定开始、继续或停止复苏。数据收集包括对复苏尝试的参与观察和对参与复苏尝试的护士、医务人员和辅助医务人员的深入访谈。构建了详细的案例进行对比分析。研究结果表明，急诊科工作人员利用经验和获得的隐性知识来构建心脏骤停类别的类型学，以帮助他们进行决策。分类是基于“少即是多”的启发式，它结合了显性和隐性知识，以促进快速决策。然后，工作人员作为一个团队工作，迅速吸收和解释从患者身体观察和技术生物医学监测数据中获得的信息。技术数据的含义是在员工互动过程中协商确定的。这一分析是由“身体”和“技术”轨迹对齐理论提供的，该理论最初是从死亡和重症监护病房死亡的民族志发展而来的。心脏骤停情况的分类和轨迹对齐是工作人员达成共识决定并确定应撤回尝试的点的手段。这使他们能够在极具挑战性的环境中构造一个可接受的死亡。(C) 2016 Elsevier Ltd.版权所有。
Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on 'less is more' heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient's body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances. (C) 2016 Elsevier Ltd. All rights reserved.