Ethnography of the critical care nursing administered in ICUs

目的：运用民族志方法，研究危重症护理实践中不能单独用专业解释的特殊现象。方法：对两所综合医院ICU的文化进行参与式观察，并对包括护士在内的ICU团队进行半结构化访谈。结果：通过160天的实地调查和61个故事，发现护士在复杂的日常工作中为追求卓越而挣扎，护士与医生之间价值观差异所带来的道德困境，以及接受继续教育和留住护士的困难。讨论：本研究结果提示，护理人员无法将护理实践达到满意程度的感觉可能是由于对安全的严格要求，他们所期望的护理水平与现实存在差距。

Purpose: Using ethnography, studied the phenomena of nursing practice peculiar to critical care that cannot be explained by specialty alone. Method: Participatory observation of the culture of two general hospital ICU's and a semi-structured interviews of ICU teams including nurses. Results: Based on 160 days of fieldwork and 61 stories,finding included, the struggles of nurses to practice for excellence in spite of complex daily duties, ethical dilemmas experienced due to gaps of values between nurses and those of physicians, and difficulty with receiving continuing education and with retention of nurses. Discussions: The finding of this study suggests that the nursing's feeling of not being able to practice nursing to their satisfaction was probably because of the gaps between the level of care they desire and the reality due to strict demand for safety.