[Limiting and facilitating factors of changes in the care of families of the critically ill patient].
BACKGROUND
Participatory action research (PAR) was conducted in an intensive care unit (UCI), with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit's background context limited or facilitated change. This paper presents findings based on this objective.


METHODS
Qualitative methodology.


METHODS
Participatory-action research (PAR). DATA GATHERING TECHNIQUES: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed.


RESULTS
Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses' lack of involvement in information flow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1) A sense of individual and shared commitment; 2) Leadership in day-to-day matters; 3) A process based on reflection.


CONCLUSIONS
A process of participatory action research can lead to change in clinical practice, although this is complex and requires substantial input in terms of personal energy. Contextual factors limiting this change are related to the actual structure of the unit, while factors facilitating it are circumstantial ones and are dependent upon individual people. In this sense, professionals working at the bedside are capable of introducing changes to the context in which they work.
Departament d'Infermeria i Fisioteràpia y Grupo de Investigación Crítica en Salud, Universitat de les Illes Balears, Palma de Mallorca, Islas Baleares, España.
C
C
Zaforteza Lallemand
A
A
García Mozo
S M
SM
Amorós Cerdá
E
E
Pérez Juan
M
M
Maqueda Palau
J
J
Delgado Mesquida
D003422:Critical Care; D016638:Critical Illness; D005190:Family; D006801:Humans