Relationships, trust, decision-making and quality of care in a paediatric intensive care unit

Abstract

Objective: To assess the care-giving practices of health-care practitioners in the paediatric intensive care unit (PICU) through their qualitative insights, reflections and experience in participatory action research.

Design and methods: Qualitative research in the form of 'participatory action research' was used to gather data from three sources within the unit: focus groups within disciplines, observations within the PICU, and semi-structured interviews. All staff members were active collaborators and equal stakeholders in the decision-making process, research and feedback.

Setting: The paediatric intensive care unit (PICU) of the Red Cross War Memorial Children's Hospital (RCWMCH).

Participants: All staff members from various disciplines working in the PICU.

Results: Staff members described problems with respect to relationships, trust and decision-making within care-giving practices.

Conclusion: The study qualitatively describes how poor communication amongst staff members in respect of relationships and decision-making impacted on trust and how this tended to compromise care-giving practices in the PICU. The data suggested that this was more evident in informal rather than formal clinical decision-making procedures. The strength of the study was that the participatory action design in the research allowed staff members to address the very dynamics that they themselves cited as problematic.