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The habitus of ‘rescue’ and its significance for implementation of rapid response systems in acute health care

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  • Mackintosh, Nicola
  • Humphrey, Charlotte
  • Sandall, Jane

Abstract

The need to focus on patient safety and improve the quality and consistency of medical care in acute hospital settings has been highlighted in a number of UK and international reports. When patients on a hospital ward become acutely unwell there is often a window of opportunity for staff, patients and relatives to contribute to the ‘rescue’ process by intervening in the trajectory of clinical deterioration. This paper explores the social and institutional processes associated with the practice of rescue, and implications for the implementation and effectiveness of rapid response systems (RRSs) within acute health care. An ethnographic case study was conducted in 2009 in two UK hospitals (focussing on the medical directorates in each organisation). Data collection involved 180 h of observation, 35 staff interviews (doctors, nurses, health care assistants and managers) and documentary review. Analysis was informed by Bourdieu's logic of practice and his relational concept of the ‘field’ of the general medical ward. Three themes illustrated the nature of rescue work within the field and collective rules which guided associated occupational distinction practices: (1) the ‘dirty work’ of vital sign recording and its distinction from diagnostic (higher order) interpretive work; (2) the moral order of legitimacy claims for additional help; and (3) professional deference and the selective managerial control of rescue work. The discourse of rescue provided a means of exercising greater control over clinical uncertainty. The acquisition of ‘rescue capital’ enabled the social positioning of health care assistants, nurses and doctors, and shaped use of the RRS on the wards. Boundary work, professional legitimation and jurisdictional claims defined the social practice of rescue, as clinical staff had to balance safety, professional and organisational concerns within the field. This paper offers a nuanced understanding of patient safety on the front-line, challenging notions of the ‘quick fix’ safety solution.

Suggested Citation

  • Mackintosh, Nicola & Humphrey, Charlotte & Sandall, Jane, 2014. "The habitus of ‘rescue’ and its significance for implementation of rapid response systems in acute health care," Social Science & Medicine, Elsevier, vol. 120(C), pages 233-242.
  • Handle: RePEc:eee:socmed:v:120:y:2014:i:c:p:233-242
    DOI: 10.1016/j.socscimed.2014.09.033
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    References listed on IDEAS

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    1. Brown, Brian & Crawford, Paul & Nerlich, Brigitte & Koteyko, Nelya, 2008. "The habitus of hygiene: Discourses of cleanliness and infection control in nursing work," Social Science & Medicine, Elsevier, vol. 67(7), pages 1047-1055, October.
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    1. Duncan Smith & Mandeep Sekhon & Jill J. Francis & Leanne M. Aitken, 2019. "How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(21-22), pages 4139-4149, November.
    2. Doug Elliott & Emily Allen & Sharon McKinley & Lin Perry & Christine Duffield & Margaret Fry & Robyn Gallagher & Rick Iedema & Michael Roche, 2016. "User acceptance of observation and response charts with a track and trigger system: a multisite staff survey," Journal of Clinical Nursing, John Wiley & Sons, vol. 25(15-16), pages 2211-2222, August.
    3. Rachel M. Walker & Rhonda J. Boorman & Amanda Vaux & Marie Cooke & Leanne M. Aitken & Andrea P. Marshall, 2021. "Identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians using a behaviour change approach: A qualitative study," Journal of Clinical Nursing, John Wiley & Sons, vol. 30(5-6), pages 803-818, March.
    4. Emily Allen & Doug Elliott & Debra Jackson, 2017. "Recognising and responding to in‐hospital clinical deterioration: An integrative review of interprofessional practice issues," Journal of Clinical Nursing, John Wiley & Sons, vol. 26(23-24), pages 3990-4012, December.

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