Using Activity Theory and Distributed Cognition to Understand the ICU Discharge Process
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Patient flow from ICU to the wards has been found to be problematic in many countries. It has been found that many discharges from ICU to ward were unsuccessful at the first attempt. Although after-hours ICU discharges have been found to be associated with increased mortality, after-hours discharges still take place in Australian ICUs. Refused and delayed ICU admissions have been associated with increased mortality, however statistics showed that there were still many patients unable to be admitted into ICUs in Australian hospitals. These findings indicate a resource constraint in Australian ICUs. Many researchers have implemented interventions to address these issues. The engagements of an ICU liaison nurse and an ICU outreach team to provide care to patients after ICU discharge were found to shorten ICU discharge delays and increase patient hospital survival. It is against this context this study was carried out. The aim of this study was to explore and describe the patient discharge process from ICU to the wards in a metropolitan hospital in Australia. Distributed cognition and activity theory were used as theoretical frameworks and cognitive ethnography was used as the research method. Ethnographic data collection techniques including informal interviews, direct observations, and collecting existing documents were used. A total of 56 one-on-one interviews were conducted with 46 participants; 28 discharges were observed; and numerous documents were collected during a three-month period. A triangulated technique was used in both data collection and data analysis to ensure the research rigour.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Item Access Status
Intensive care unit discharge