Learning in Critical Care: A Focused Ethnography of Interprofessional Learning Culture

Adult critical care is complex; therefore, the workforce develops specialist knowledge. Whilst interprofessional collaboration is concomitant with critical care, the ways different professions learn together are indistinct. This thesis explores the factors influencing interprofessional learning (IPL) culture in adult critical care, providing rich insight into staff perceptions and experiences of IPL, and investigates factors that promote or inhibit IPL in this acute care environment.

IPL culture was explored using focused ethnography, adopting an interpretive
epistemological position, with an ontological stance of social constructionism. Data collected over 12 months, in three adult critical care units in North East England, used partial participant observation and semi-structured interviews with critical care professions. Rich ethnographic data was thematically analysed.

Findings showed that IPL occurred in all environments studied, but engagement with IPL differed across professions and potential IPL opportunities were missed. IPL culture was shaped by individuals, teams and organisations, and a changeable IPL climate existed which was affected by holistic influential factors. The environment was key to embedding IPL; in a space the visibility of professions promoted IPL more than their proximity, and each critical care department adapted spaces for IPL to occur. The IPL environment guide developed from the research findings indicates ways to enhance IPL. Whilst formal IPL opportunities were limited, professions perceived safe holistic patient centred care as a shared motivation to learn from others. Professions shared knowledge based upon their assumptions of peers’ expertise, and IPL was
enhanced when rationales underpinned instructions and when decision-making was interprofessional; the CAUSE decision-making model is a framework developed that incorporates rationales to promote IPL. Four stages of IPL were observed: preparing, enquiring, acting, and sharing, and IPL was enhanced when staff effectively collaborated, felt safe to ask questions, and when they humanised their professional role through humour and emotions as members of the community of critical care practice.

With rich insight into the complexities of IPL in adult critical care, further work is
needed to explore potential IPL improvements based upon the ethnographic findings in this thesis.