High technology medicine in practice : the organisation of work in intensive care

The thesis demonstrates the utility of 'craft' as a metaphor for understanding medical work in ICU and provides a critical empirical review and reformulation of nursing theory as it has been applied to ICU, and proposes a new conception of the relationship between medicine and nursing in the grounded situation of clinical work.

Abstract

The aim of this thesis is 
\nto 
\ndevelop 
\na grounded 
\nunderstanding of 
\nthe 
\npractice of 
\nhigh 
\ntechnology clinical work and 
\nhow it is 
\norganised. 
\nIt 
\ncombines systematic 
\nempirical 
\nanalysis of the clinical locale of 
\nintensive 
\ncare 
\nwith scholarly 
\nwork 
\nin 
\nmedical sociology 
\nand the related fields of 
\nhealth 
\nservices research, medicine, nursing 
\nand social studies 
\nof 
\nscience and technology. 
\nThe 
\nempirical 
\ndata 
\nwere obtained 
\nthrough fieldwork 
\non 
\nthree 
\nintensive care units (ICUs). The 
\nmethods comprised 
\nperiods of 
\ndetailed 
\nobservation, 
\ninformal conversational 
\ninterviews in the 
\nfield 
\nand 
\ntape-recorded 
\nsemi-structured 
\ninterviews. 
\nThe substantive contribution 
\nof the thesis is 
\nan 
\nanalysis of contemporary and traditional 
\nthemes in medical sociology: medical uncertainty; clinical 
\nknowledge in 
\npractice; 
\ninter- 
\noccupational relationships; 
\nthe 
\nmaterial and 
\nsocial 
\ncharacter of medical and nursing 
\nwork; and the organisational 
\n'reality' 
\nof one clinical 
\nsite within the 
\nmodem 
\nhospital. In 
\nparticular, the thesis demonstrates the 
\nutility of 
\n'craft' 
\nas a metaphor 
\nfor 
\nunderstanding 
\nmedical work in ICU; provides a critical empirical review and 
\nreformulation of nursing 
\ntheory as it has been applied to ICU; 
\nand proposes a 
\nnew 
\nconception of the 
\nrelationship 
\nbetween medicine and nursing in 
\nthe 
\ngrounded 
\nsituation of clinical work. 
\nTwo subsidiary contributions 
\nare 
\nalso 
\nmade: one 
\nmethodological 
\nand one theoretical. In 
\nterms of methodology, I provide 
\nconcrete 
\nexamples 
\nof 
\nhow 
\nethnographic 
\nanalysis 
\ncan 
\nexplain findings which have 
\nbeen derived from 
\nother 
\nhealth 
\nservices 
\nresearch 
\nmethods 
\nand thereby inform the future direction 
\nof such 
\nresearch. 
\nIn terms 
\nof 
\ntheory, I illuminate 
\ncurrent debates at the interface of 
\nmedical 
\nsociology 
\nand 
\nsocial 
\nstudies 
\nof 
\nscience 
\nand 
\ntechnology about the appropriateness 
\nof 
\na post-structural 
\nstyle 
\nof analysis. 
\nIn 
\nconclusion, I specify in what ways our understanding 
\nof 
\nhealth 
\ncare 
\nwork 
\nis 
\n- 
\nand is 
\nnot 
\n- enhanced by the adoption 
\nof 
\nActor-Network Theory.