title: Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research.
abstract: This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained.
authors.affiliation: University of Balearic Islands, Balearic Islands, Spain.
authors.forename: Concha
authors.initials: C
authors.lastname: Zaforteza
authors.affiliation: University of Toronto, Toronto, ON, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Gastaldo
authors.affiliation: University of Balearic Islands, Balearic Islands, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Moreno
authors.affiliation: University of Balearic Islands, Balearic Islands, Spain.
authors.forename: Andreu
authors.initials: A
authors.lastname: Bover
authors.affiliation: University of Balearic Islands, Balearic Islands, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Miró
authors.affiliation: University of Balearic Islands, Balearic Islands, Spain.
authors.forename: Margalida
authors.initials: M
authors.lastname: Miró
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D064648:Critical Care Nursing; D005260:Female; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D011209:Power, Psychological; D011368:Professional-Family Relations; D058996:Quality Improvement; D012944:Social Support
keywords: action research; critical care; family; intensive care units; power; quality improvement; relatives; social change