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Overcoming gendered and professional hierarchies in order to facilitate escalation of care in emergency situations: The role of standardised communication protocols

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  • Mackintosh, Nicola
  • Sandall, Jane

Abstract

It has been suggested that as many as 23,000 in-hospital cardiac arrests in the UK could be prevented with earlier detection and intervention (Hodgetts et al., 2002). Cases of 'failure to rescue' are often linked with difficulties relaying and interpreting information across occupational and professional boundaries. Standardised communication protocols have been recommended as a means of enabling the transmission of concise, salient information, licensing and empowering the individual to overcome established hierarchies in speaking out and asking for help. This paper critically examines the current discourse around such protocols. We find that there is a paucity of evidence regarding the complex relationship between social contexts, individual applications of these protocols and short- and long-term impact on safety and 'failure to rescue' rates. The paper highlights the complexities of the underlying power dynamics that are located within gendered and occupational hierarchies and explores the role of standardised communication protocols as a potential boundary object. The paper discusses the potential for these protocols to inter-relate and act as a mediating boundary object between nursing and medical staff, enabling understanding and sharing of cultural context.

Suggested Citation

  • Mackintosh, Nicola & Sandall, Jane, 2010. "Overcoming gendered and professional hierarchies in order to facilitate escalation of care in emergency situations: The role of standardised communication protocols," Social Science & Medicine, Elsevier, vol. 71(9), pages 1683-1686, November.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:9:p:1683-1686
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    References listed on IDEAS

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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. Standing, Holly & Patterson, Rebecca & Dalkin, Sonia & Exley, Catherine & Brittain, Katie, 2020. "A critical exploration of professional jurisdictions and role boundaries in inter-professional end-of-life care in the community," Social Science & Medicine, Elsevier, vol. 266(C).
    3. 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.
    4. Powell, Alison E. & Davies, Huw T.O., 2012. "The struggle to improve patient care in the face of professional boundaries," Social Science & Medicine, Elsevier, vol. 75(5), pages 807-814.
    5. Wiig, Siri & Robert, Glenn & Anderson, Janet E. & Pietikainen, Elina & Reiman, Teemu & Macchi, Luigi & Aase, Karina, 2014. "Applying different quality and safety models in healthcare improvement work: Boundary objects and system thinking," Reliability Engineering and System Safety, Elsevier, vol. 125(C), pages 134-144.
    6. Ozbilgin, Mustafa F. & Tsouroufli, Maria & Smith, Merryn, 2011. "Understanding the interplay of time, gender and professionalism in hospital medicine in the UK," Social Science & Medicine, Elsevier, vol. 72(10), pages 1588-1594, May.
    7. Liberati, Elisa Giulia & Gorli, Mara & Scaratti, Giuseppe, 2016. "Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care," Social Science & Medicine, Elsevier, vol. 150(C), pages 31-39.

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