The Domain of Nursing: Developing Practice Through Action Research in the Intensive Care Unit

In the intensive care unit (ICU) the bedside nurse is the person who carries out the fundamental care to sustain life and comfort for that patient and is the conduit between the patient, their family/whanau, the doctors and the multi disciplinary team. Nursing practice has an indelible impact on that patient's life and future and for their family. This thesis presents a project on the reconnaissance phase of a future critical action research project. The project involved ICU nurses collectively defining their practice within the context of ICU and identifying aspects which needed development and change. As this was the first time that the nurses had met to define and discuss their practice it was essential for them to take this time in order to focus on the reconnaissance phase as this will guide and inform all future action. The study is informed by Habermas' Theory of Communicative Action which has an emancipatory focus. The action research approach enabled the nurses to reach mutual understanding of their practice and reach consensus on areas of practice they wish to develop to enhance their care of the patient. Mutual understanding and consensus have been achieved using focus groups and interviews involving self reflection as well as collective reflection. The reconnaissance phase as described in this thesis involves the nurse participants collectively identifying their ideals of ICU nursing, then defining where they are unable to meet these ideals in the reality of every day practice. The themes emerging from the discussions are defined in terms of relationships; nurse to patient, nurse to family/whanau, nurse to doctor and nurse to nurse. These relationships are interconnected and all occur within the overarching theme of professional standards of care. Through the process of discussion and consensus the nurses identified nurse to nurse communication and support as the most important aspect of practice needing development. Reconnaissance in this research defines the beginning of the change process as the transformation begins with the creation of the communicative space enabling the nurses to connect and together to look ahead at what changes might now be possible.