AbstractThe National Health Service (NHS) in England is facing resource management challenges. There are NHS initiatives promoting sustainability of resources, although minimal research exists about frontline practitioners’ understanding of and concerns about sustainability issues. This research focused on critical care because it uses a large amount of NHS resources by serving patients with complex health needs and life-threatening illness. There is limited research-based literature about sustainability in critical care practice. This study, therefore, aimed to address the gap by generating a substantive theory from asking: 1) How is sustainability constructed by practitioners working in critical care? and 2) What are the social processes involved in making sustainability a component of critical care practice?
The constructivist grounded theory study collected qualitative data through in-depth, semi-structured interviews in an online session or telephone call. There were eleven participants (nurses, physiotherapists and a technician) who worked in NHS critical care units in the South of England. Sampling began as purposive and progressed to theoretical. Other fundamental grounded theory methods included memoing and concurrent data generation and analysis. Constant comparison analysis was facilitated by dimensional analysis, and constructivist grounded theory coding procedures were used for conceptualising, abstracting and theorising. Data analysis continued until theoretical sufficiency had been reached.
Sustainability was defined by participants as a way of sustaining resources for critical care practice into the future. Those resources had financial, environmental and social properties along with broader contextual and conditional influences impacting upon critical care practice and the NHS. Sustainability existed on a continuum with normative, responsible, sustainable and flourishing stages. Full sustainability occurred when all four of these stages were achieved. Satisficing (satisfy + suffice) emerged as the central social process which significantly strengthened the level of sustainability. Satisficing referred to decision-making in practice when someone was satisfied quality critical care had been given within the limits of available resources. Bounded rationality represented the cognitive and environmental factors influencing decision-making and showed ‘how’ satisficing happened. Stewarding was found among participants to be an ethic to use resources responsibly and explained ‘why’ satisficing occurred. The substantive theory, based upon satisficing, bounded rationality and stewarding, is the first theoretical framework for sustainability in critical care practice. This theory offers new insight into how practitioners realise sustainability within their working lives and frames the way sustainable critical care practice can be fostered, taught, and managed.
|Date of Award||Mar 2019|
|Supervisor||Julie Scholes (Supervisor), Janet Richardson (Supervisor) & Clair Hebron (Supervisor)|
- Critical care
- Intensive care
- Bounded rationality
- Constructivist grounded theory