Versatility and flexibility: attributes of the Critical Incident Technique in nursing research

Nurses' Perceptions of Telephone Triage in Child and Adolescent Psychiatric Services - An Enhanced Critical Incident Technique Study

In Sweden, units managed by nurses specialised in counselling and telephone triage, have been developed within the Child and Adolescent Mental Health services (CAMHS). This study has a qualitative design and illuminates the nurses' perceptions of what helps or hinders their assessments and telephone triage. The Enhanced Critical Incident Technique was utilised, eight nurses were interviewed in depth, to identify factors influencing triage. The study is the first to provide a comprehensive description of helpful and hindering factors while performing telephone triage. It illuminates telephone triage in Swedish CAMHS settings and provides insights how to enhance and implement this practice.

Piloting an Interprofessional Narrative-Based Interactive Workshop for End-of-Life Conversations: Implications for Learning and Practice

BACKGROUND

Based on the principles of Narrative Medicine, this study explored a narrative-based workshop for multi-level interdisciplinary clinicians who have EOL conversations.

METHODS

Fifty-two clinicians participated in narrative-based interactive workshops. Participants engaged narrative in three forms: viewing narratives, writing/sharing narratives, and co-constructing narratives. Post workshop interviews were conducted and thematically analyzed.

RESULTS

Five themes characterized how the workshop shaped learning and subsequent care experiences: (1) learning to enter/respond to the patient stories, (2) communicating across professions and disciplines, (3) practicing self-care. Additional themes emphasized (4) barriers to narrative learning and (5) obstacles to applying narrative to practice.

DISCUSSION

Results highlight the function/utility of narrative forms such as the value of processing emotions via reflective writing, feeling vulnerable while sharing narratives, and appreciating colleagues' obstacles while observing patient-clinician simulations. Challenges associated with narrative such as writing anxiety and barriers to implementation such as time constraints are detailed to inform future initiatives.

Healthcare professionals' perceptions of interprofessional teamwork in the emergency department: a critical incident study

BACKGROUND

Interprofessional teams contribute to patient safety during clinical care. However, little is known about how interprofessional teams manage and cope with critical incidents in the emergency department (ED). Therefore, the study aimed to describe healthcare professionals (HCPs) perceptions of critical incidents linked to the enablers of and barriers to interprofessional teamwork in a high-risk setting, the ED.

METHODS

Individual interviews with HCPs regarding events at the ED were held during the period of May 2019-January 2020. The Critical Incident Technique approach was used to guide the interviews and the qualitative analysis. Data were analyzed inductively using qualitative content analysis.

RESULTS

Interview participants (n = 28) included 7 physicians (25%), 12 registered nurses (43%), 7 nurse assistants (25%) and 2 administrators (7%). Overall, 108 critical incidents were described. Eight categories that described functional and dysfunctional experiences within interprofessional teamwork were identified: salience of reflection; professional experience makes a difference; demanding physical and psychosocial work environment; balancing communication demands; lacking management support, structure, and planning; tensions between professional role and responsibility; different views on interprofessional teamwork; and confidence in interprofessional team members.

CONCLUSION

Findings of this study indicate that poor ED-specific communication and limited professional experience are essential factors in handling critical incidents related to interprofessional teamwork. An important aspect of critical incident management is the ergonomics of the physical work environment and how it enables interprofessional teamwork. This study emphasizes the factors enabling interprofessional teamwork to manage critical incidents in the complex working environment of the ED.

Informed consent prior to nursing care: Nurses' use of information

BACKGROUND

Informed consent prior to nursing care procedures is an established principle which acknowledges the right of the patient to authorise what is done to him or her; consent prior to nursing care should not be assumed. Nursing care procedures have the potential to be unwanted by the patient and hence require an appropriate form of authorisation that takes into consideration the relationship between the nurse and patient and the ongoing nature of care delivery.

RESEARCH QUESTION

How do nurses obtain consent from patients prior to nursing care?.

DESIGN

Critical incident technique and the collection of critical happenings.

PARTICIPANTS

17 participants who were all qualified nurses took part in in-depth interviews.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the university ethics committee.

FINDINGS

Information giving is a key component prior to nursing care procedures. Nurses provide information to patients as a routine aspect of care delivery, and do so even when the patient is unable to communicate themselves. Whilst some participants described how information giving might be rushed or overlooked at times, it is clearly an established part of nursing care and is provided to ensure the patient knows what to expect when care is delivered. What is less clear is the extent to which information is given in order to seek the consent - rather than merely inform the patient - about nursing care.

CONCLUSION

Implied consent is often an appropriate way in which consent is obtained prior to nursing care procedures. It takes into account the ongoing care provision and the relationship that exists between the nurse and patient. However implied consent should not be assumed. Nurses need to ensure that information is given not only to inform the patient about a procedure but to enable the patient to give his or her consent and to find an alternative way forward if the patient withholds their consent.

'People with intellectual disabilities living in the communities is bad enough let alone…having sex': Exploring societal influence on social care workers' attitudes, beliefs and behaviours towards support for personal and sexual relationship needs

BACKGROUND

Services have a duty to uphold the personal and sexual relationship (P&SR) rights of adults with intellectual disability. However, little is known about how social care workers' (SCWs) perceptions of public views of intellectual disability and sexuality might affect their attitudes, believes and behaviours towards supporting P&SR needs. This exploratory study addresses this gap in knowledge.

MATERIALS AND METHODS

Qualitative interviews using critical incident technique were conducted with 18 SCWs. Data were transcribed and thematically analysed.

RESULTS

Four dominant themes were identified; socio-cultural, practice-policy gaps, fear and safety needs. These highlights how perceptions of public attitudes impact on SCWs' attitudes towards supporting development of P&SR both directly and through perceptions of organisational policies. This leads to prioritisation of safety needs over support for P&SR.

CONCLUSIONS

Public expectations strongly influenced SCWs' interpretation of organisational policy, emphasising a need for practice-based support to manage public expectations and reduce fear.

What do positive and negative experiences of patients, relatives, general practitioners, medical assistants, and nurses tell us about barriers and supporting factors in outpatient palliative care? A critical incident interview study

Background: The strengthening of the general practitioners’ (GPs’) role in palliative care (PC) has been identified as a top priority in order to improve PC in Germany. This study aims at exploring positive and negative experiences in PC in Germany from the perspectives of patients, relatives, and health care professionals in a primary care setting.

Methods: Between March 2017 and August 2017, a total of 16 interviews with patients, relatives, GPs, medical assistants, and nurses were conducted. The Critical Incident Technique (CIT) was used to explore factors that influence excellent versus undesirable events in PC provision. Two researchers independently defined and counted critical incidents (CIs) from interview transcripts, performed a thematic analysis, and clustered the CIs into dimensions.

Results: In summary, 16 interviews contained 280 CIs, divided into 130 positive and 150 negative CIs. The thematic analysis resulted in seven content domains, with each including positive and negative CIs, respectively: 1) way of care provision, 2) availability of care providers, structures, medication, and aids, 3) general formal conditions of care provision, 4) bureaucracy, 5) working practices in health care teams, 6) quality and outcome of care provision, and 7) communication.

Conclusions: The results raise awareness for the aspects that lead to successful or undesirable PC experiences, observed from different perspectives. They open up the potential for primary PC improvement. Future research will facilitate development and implementation of more tailored interventions in order to improve generalists’ PC.

Qualitative factors shaping MS patients' experiences of infusible disease-modifying drugs: a critical incident technique analysis

OBJECTIVE

To explore factors shaping the experiences of patients with relapsing-remitting multiple sclerosis with infusible disease-modifying drugs in a hospital setting.

DESIGN AND SETTINGS

The critical incident technique served as a framework for collecting and analysing patients' qualitative account practices involving infusible disease-modifying drugs. Data were collected through semistructured interviews and one single-case study. Participants were recruited from all five regions in Denmark. Inductive thematic analysis was used to identify and interpret factors shaping patients' infusion journey over time.

PARTICIPANTS

Twenty-two patients with relapsing-remitting multiple sclerosis receiving infusion with disease-modifying drugs (natalizumab, alemtuzumab and ocrelizumab).

RESULTS

Four time scenarios-preinfusion, day of infusion, long-term infusion and switch of infusion-associated with the infusion of disease-modifying drugs were analysed to reveal how different factors could both positively and negatively affect patient experience. Time taken to make the treatment decision was affected by participants' subjective perceptions of their disease activity; this may have set off a treatment dilemma in the event of a pressing need for treatment. Planning and routine made infusion practices manageable, but external and internal surroundings, including infusion room ambience and the quality of relationships with healthcare professionals and fellow patients, affected patients' cognitive state and well-being irrespective of the infusion regimen. Switching the infusion regimen can reactivate worries akin to the preinfusion scenario.

CONCLUSION

This study provides novel insight into the positive and negative factors that shape patients' experience of infusion care practices. From a patient's perspective, an infusion practice is not a solitary event in time but includes planning and routine which become an integral part of their multiple sclerosis management. The quality of space and the ambience of the infusion room, combined with the relationship with healthcare professionals and fellow patients, can be a significant source of knowledge and support people with relapsing-remitting multiple sclerosis in their experience of agency in life.

Following-up midwives after adverse incidents: How front-line management practices help second victims

OBJECTIVE

To describe how front-line managers of maternity wards provide support to midwives as second victims in the aftermath of an adverse incident.

DESIGN

A qualitative study using critical incident technique and a content analytic approach of semi-structured in-depth interviews.

SETTING

Maternity wards in 10 Norwegian hospitals with more than 200 registered births annually were included in the study.

PARTICIPANTS

A purposeful sample of 33 midwives with more than two years' working experience described 57 adverse incidents.

FINDINGS

Maternity ward managers utilised four types of practices to support midwives after critical incidents: management, transformational leadership, distributed leadership and laissez-faire leadership.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The study shows that proactive managers who planned for how to handle critical incidents provided midwives with needed individual support and learning. Proactive transformational leadership and delegating roles for individual support should be promoted when assisting second victims after critical incidents. Managers can limit the potential harm to second victims by preparing for the eventuality of a crisis and institute follow-up practices.

Towards an organisational theory of hubris: Symptoms, behaviours and social fields within finance and banking

Hubris has become a popular explanation for all kinds of business failure. It is often reduced to the one-dimensional notion of ‘over-confidence’, particularly on the part of CEOs. There is a need to clarify the extent to which other attitudes and behaviours constitute hubris, and how they are affected by such organisational dynamics as the struggle for power, status and material rewards between actors. This article explores these issues within the finance and banking sectors. It uses the Critical Incident Technique to identify behaviours associated with hubris and probes the interaction between them and the organisational contexts in which they occur. Five categories of behaviour based on an analysis of 101 incidents are described, as are a series of ‘inflection dynamics’ that reinforce the behaviours in question and constitute a social field conducive to hubris. I challenge the reductionist views that hubris is primarily a psychological state consisting mainly of ‘over-confidence’. This article seeks to complexify the term hubris and to develop an organisational rather than purely psychology theory of its emergence and institutionalisation within finance and banking.

Actions helping expressed or anticipated needs: Patients with advanced cancer and their family caregivers' experiences of specialist palliative home care teams

Patients with advanced cancer and family caregivers in palliative care face physical, psychological, social and existential challenges, much of the time home alone. Specialist palliative home care team services can be instrumental for sense of security in an uncertain situation. The aim of this study was to describe patients' and family caregivers' experiences of specialist palliative home care team actions that are identified by the participants as helping or hindering interventions. Six patients and seven family caregivers were interviewed using the enhanced critical incident technique. Ninety-five critical incidents and wish list items were identified. Providing adequate resources, keeping promises and being reliable, and creating partnerships are actions by specialist palliative care teams that patients and family caregivers experienced as helping in meeting expressed or anticipated needs in patients and family caregivers. Being reliable and including patients and family caregivers in partnerships help to continue with daily life, even though death may be close. Unmet needs resulted in experiences of disrespect or violation of personal space/integrity.

The critical incident technique reappraised

Purpose

The purpose of this paper is to offer a reconceptualization of the critical incident technique (CIT) and affirm its utility in management and organization studies.

Design/methodology/approach

Utilizing a case study from a leadership context, the paper applies the CIT to explore various leadership behaviours in the context of nonprofit boards in Canada. Semi-structured critical incident interviews were used to collect behavioural data from 53 participants – board chairs, board directors, and executive directors – from 18 diverse nonprofit organizations in Alberta, Canada.

Findings

While exploiting the benefits of a typicality of events, in some instances the authors were able to validate aspects of transformational leadership theory, in other instances the authors found that theory falls short in explaining the relationships between organizational actors. The authors argue that the CIT potentially offers the kind of “thick description” that is particularly useful in theory building in the field.

Research limitations/implications

Drawing on interview material, the authors suggest that incidents can be classified based on frequency of occurrence and their salience to organizational actors, and explore the utility of this distinction for broader theory building purposes.

Practical implications

Principally, the paper proposes that this method of investigation is under-utilized by organization and management researchers. Given the need for thick description in the field, the authors suggest that the approach outlined generates exceptionally rich data that can illuminate multiple organizational phenomena.

Social implications

The role of nonprofit boards is of major importance for those organizations and the clients that they serve. This paper shed new light on the leadership dynamics at the top of these organizations and therefore can help to guide improved practice by those in board and senior management positions.

Originality/value

The CIT is a well-established technique. However, it is timely to revisit it as a core technique in qualitative research and promote its greater use by researchers. In addition, the authors offer a novel view of incidents as typical, atypical, prototypical or archetypal of organizational phenomena that extends the analytical value of the approach in new directions.

Managing stress in prehospital care: Strategies used by ambulance nurses

BACKGROUND

Ambulance nurses display stress symptoms, resulting from their work with patients in an emergency service. Certain individuals seem, however, to handle longstanding stress better than others and remain in exposed occupations such as ambulance services for many years. This paper examines stress inducing and stress defusing factors among ambulance nurses.

METHODS

A qualitative descriptive design using critical incident technique was used. A total of 123 critical incidents were identified, and a total of 61 strategies dealing with stress were confirmed. In all, 13 sub-categories (seven stress factors and five stress reducing factors) were merged into four categories (two stress categories and two stress reducing categories).

RESULTS AND CONCLUSION

The study shows that ambulance nurses in general experience emergency calls as being stressful. Unclear circumstances increase the stress level, with cases involving children and childbirth being especially stressful. Accurate information and assistance from the dispatch centre reduced the stress. Having discussions with colleagues directly after the assignment were particularly stress reducing. Advanced team collaboration with teammates was viewed as effective means to decrease stress, in addition to simple rituals to defuse stress such as taking short breaks during the workday. The study confirmed earlier studies that suggest the benefits of defusing immediately after stress reactions.

To pass or to fail? Understanding the factors considered by faculty in the clinical evaluation of nursing students

Making the decision to pass or to fail a nursing student is difficult for nurse educators, yet one that all educators face at some point in time. To make this decision, nurse educators draw from their past experiences and personal reflections on the situation. Using the qualitative method of critical incident technique, the authors asked educators to describe a time when they had to make a decision about whether to pass or fail a student in the clinical setting. The findings describe student and faculty factors important in clinical evaluation decisions, demonstrate the benefits of reflective practice to nurse educators, and support the utility of critical incident technique not only as research methodology, but also as a technique for reflective practice.

Effective Classroom Teaching Methods: A Critical Incident Technique from Millennial Nursing Students’ Perspective

Engaging nursing students in the classroom environment positively influences their ability to learn and apply course content to clinical practice. Students are motivated to engage in learning if their learning preferences are being met. The methods nurse educators have used with previous students in the classroom may not address the educational needs of Millennials. This manuscript presents the findings of a pilot study that used the Critical Incident Technique. The purpose of this study was to gain insight into the teaching methods that help the Millennial generation of nursing students feel engaged in the learning process. Students’ perceptions of effective instructional approaches are presented in three themes. Implications for nurse educators are discussed.

Creative power of metaphorical expression

Gathering metaphors of holistic nurses provides for an exploration of how that metaphor is captured in real-life experiences. Metaphors are a way of describing an experience or a perceived notion as a personal expression of thought. The metaphoric understanding of what practicing as a holistic nurse means is discussed with reference to the personal, emotional, and spiritual component of being a holistic nurse. Capturing the superfluity and vividness of these beautiful expressions embedded in participants' metaphors produced insight and a deeper apprehension of the connectedness in nursing. This study used a qualitative exploratory approach to collect data from 75 holistic nurses. Data were collected using participants' own expression of the metaphor of holistic nursing and correlating critical incident reports of how that metaphor was expressed in practice. Metaphors were not analyzed but correlated by themes. The critical incident reports were analyzed to uncover and isolate key aspects of commonalities. The results capture the abundance and diversity of metaphorical expressions embedded in participants' metaphors produced insight and a deeper appreciation of the connectedness in nursing.

Effectiveness of past and current critical incident analysis on reflective learning and practice change

OBJECTIVES

Critical incident analysis (CIA) is one of the strategies frequently used to facilitate reflective learning. It involves the thorough description and analysis of an authentic and experienced event within its specific context. However, CIA has also been described as having the potential to expose vulnerabilities, threaten learners' coping mechanisms and increase rather than reduce their anxiety levels. The aim of this study was to compare the analysis of current critical incidents with that of past critical incidents, and to further explore why and how the former is more conducive to reflective learning and practice change than the latter.

METHODS

A collaborative research study was conducted. Eight occupational therapists were recruited to participate in a reflective learning group that convened for 12 meetings held over a 15-month period. The group facilitator planned and adapted the learning strategies to be used to promote reflective learning and guided the group process. Critical incident analysis represented the main activity carried out in the group discussions. The data collected were analysed using the grounded theory method.

RESULTS

Three phenomena were found to differentiate between the learning contexts created by the analysis of, respectively, past and current critical incidents: attitudinal disposition; legitimacy of purpose, and the availability of opportunities for experimentation. Analysis of current clinical events was found to improve participants' motivation to self-evaluate, to increase their self-efficacy, and to help them transfer learning into action and to progressively self-regulate.

CONCLUSIONS

The results of this collaborative research study suggest that the analysis of current clinical events in order to promote reflection offers a safer and more constructive learning environment than does the analysis of incidents that have occurred in the past. This learning strategy is directly grounded in health professional practice. The remaining challenge for continuing education providers is that of creating conditions conducive to its use.

Worries and concerns experienced by nurse specialists during inter-hospital transports of critically ill patients: a critical incident study

OBJECTIVES

Inter-hospital patient transports are required around the clock. During these transports it is the responsibility of the accompanying nurse specialists to ensure their patient's safety, while at the same time providing optimal nursing care in an unusual and often stressful situation. The aim of this study was to explore and describe the nurse specialists' cause of worries and concerns (WaC) and how they manage these.

DESIGN

An explorative and qualitative design based on the critical incident technique was used.

DATA COLLECTION

Interviews were conducted with 30 nurse specialists within the fields of anaesthetic, intensive and pre-hospital care in the south of Sweden.

RESULTS

WaC felt by the nurse specialists were based on being unable to influence their work situation, or carry out their tasks as expected. Their responses to these unusual situations were resolved by using internal (acquired knowledge and experience) and external resources (consulting colleagues having different competences).

CONCLUSION

A safe working environment improves the possibility to deliver a satisfactory work performance. Shared experiences and communication between colleagues should be encouraged; teamwork should be enhanced by the implementation of local and national training courses, and unambiguous work guidelines should be given.

Critical incidents as a technique for teaching professionalism

BACKGROUND

The issue of professional behavior in medicine has been extensively discussed in the medical literature and clarity regarding what constitutes professional behavior, and strategies for assessing professionalism have begun to emerge.

AIM

To address the information gap on effective strategies for teaching professionalism.

METHODS

The critical incident technique (CIT) established by Flanagan has proven to be a useful way to structure teaching and/or evaluation of professionalism.

RESULTS

By analyzing 'real-life' occurrences of unprofessional behavior with learners, the CIT yields common terminology and definitions of professionalism that can be explored within a structured framework for discussion.

CONCLUSIONS

CIT is a versatile strategy as it can be utilized with varied audiences (e.g., students, faculty), in a wide array of settings (e.g., workshops, grand rounds). Examples of CIT use associated with teaching professionalism are reviewed and key features associated with its success are identified.

Ethical dilemmas: the experiences of israeli nurses

In this study I explored ethical dilemmas in nursing to gain a better understanding of nurses' work and their professional status. Qualitative data on ethical dilemmas were collected by interviewing 52 nurses in 18 hospitals and health maintenance organizations. The transcribed interviews were analyzed using a stepwise method. Results indicate a large number of dilemmas that can be divided into five main categories: caring vs. following formal codes; fair process vs. fair outcome; organizational standards vs. family agenda; autonomy vs. deference to higher authority, and guarding secrecy vs. duty to report. The study findings might enhance nurses' ability to cope with ethical dilemmas and bring about change in their professional status. In addition, the results might guide nurses and their supervisors toward developing practitioner programs for nurses that deal with ethical aspects. All these might reduce the expected shortage of nurses and improve the ability of the system to provide quality health care.

Radiographers' areas of professional competence related to good nursing care

BACKGROUND

Radiographers' ability and competence is a matter of vital importance for patients. Nursing care is an integral part of the radiographer's work. The demand for high competence in clinical activities has increased in diagnostic radiology and has had an impact on the development of the profession.

AIM

The aim was to describe the radiographer's areas of professional competence in relation to good nursing care based on critical incidents that occur in the course of radiological examinations and interventions.

METHOD

A descriptive design with a qualitative approach, using the Critical Incident Technique was employed. Interviews were conducted with a strategic sample of registered radiographers (n = 14), based at different hospitals in Sweden.

ETHICAL ISSUES

The appropriate ethical principles were followed. All the participants provided informed consent, and formal approval for conducting the research was obtained according to national and local directives.

RESULTS

The data analysis resulted in two main areas; direct and indirect patient-related areas of competence, which describe the radiographers' skills that either facilitate or hinder good nursing care. In the direct patient-related area of competence, four categories emerged, which illustrate good nursing care in the patient's immediate surroundings. In the indirect patient-related area of competence, four categories illuminated good nursing care that is provided without direct contact with the patient.

CONCLUSIONS

The study highlights the different areas of the radiographer's unique professional competence. The findings provide insight into the radiographer's profession, on one hand as a carer and on the other as a medical technologist as well as highlighting the importance of each role. The radiographer's work encompasses a variety of components--from caring for the patient to handling and checking the technical equipment.

Nurses' experience in clinical encounters with children experiencing abuse and their parents

AIM AND OBJECTIVES

The aim of this study was to identify nurse's experiences in the clinical care of children experiencing abuse. The objective was to assess how nurses remain professional especially when the suspected perpetrator is a parent.

BACKGROUND

The diagnosis of child abuse is a difficult one, yet essential because of the high morbidity and significant mortality rates. Young children may be unable to give a clear history; parents may be unwilling to be truthful, and the signs and symptoms of abuse are often not conclusive. A contributing factor to the challenges of providing nursing care to children in a context of abuse is the lack of education in this field. Nurses working in the care of paediatric patients may not be familiar with situations in which they cannot rely on histories provided by parents.

DESIGN

A qualitative study.

METHODS

Investigators used a qualitative design with a critical incident technique. Eleven nurses who cared for abused children and their parents at a tertiary care children's hospital were interviewed.

RESULTS

We highlighted three areas in the analysis of the interviews: Feelings of ambivalence, nurses' professionalism and the nurses' care strategies. Participants expressed difficulties in maintaining a professional role in clinical encounters with the parents. The nurses were unhappy in their conflicting roles of both policing (a judging function) and nursing (a caring function).

CONCLUSIONS

The nurses expressed that they had devised strategies to remain professional in the clinical encounter with abused children and their parents. To remain professional, education, counselling and experience was essential.

RELEVANCE TO CLINICAL PRACTICE

By identifying nurses' experiences in clinical encounters with children experiencing abuse and their parents, nurses can assess what kind of specific interventions should be used to improve the caring situation.

Inconsistent use of the critical incident technique in nursing research

AIM

This paper is a critique of the use of critical incident technique in nursing and a demonstration of how its development has resulted in inconsistency and confusion.

BACKGROUND

Critical incident technique is used globally by nurse researchers to explore a plethora of nursing issues. Its main strengths are flexibility and adaptability, but its popularity has resulted in ambiguity and confusion.

DATA SOURCES

A search of the CINAHL database for the period 1956-2007 was performed using the search terms critical incident technique and nursing. Together with hand searching, this produced a total of 59 papers. The papers were analysed according to country of origin, research topic, sample size, data collection method, inclusion/exclusion criteria, data analysis and terminology. We then categorized the results of this analysis depending on similarities and differences in the papers.

DISCUSSION

We focus on two areas: methodology and terminology. From a methodological perspective critical incident technique has become inconsistent and in relation to terminology, the diverse language associated with the technique has created confusion. Moreover, issues of rigour may be compromised as a result of this inconsistency. A great deal of inconsistency has been created by nurse researchers' attempts to advance critical incident technique. This has led to confusion, which is not helpful for advancing nursing knowledge.

CONCLUSION

While embracing the continued development of critical incident technique, we advocate a standardized approach to its use. Unless nurse researchers are alert to the methodological and terminological inconsistencies in use of the critical incident technique, it risks becoming an interminable quagmire through which navigation will be impossible.

Critique of the critical incident technique

The CIT is a practical and efficient methodology that encourages participants to tell their story; with happenings that are memorable events in participants' lives. It is a form of story-telling, as participants share their singular experience as a story to the researcher. It is a qualitative, systematic, open-ended technique for educing descriptive data from participants as well as being an effective naturalistic tool for focusing participants' on a specific event. The CIT is a user-friendly instrument that can foster reflection and promote personal expression. The development of the CIT to generate indicators of specific happenings relative to research questions demonstrates the technique's suppleness and emphasises the capability of this methodology in nursing research. As nurses learn more about this methodology and its application to the study of nurses and nursing care, they will begin to comprehend how simple and effortless this technique is to use. The CIT can be developed to conform to any area of nursing and provide a more comprehensive awareness of what nurses do and the needs of our clients.

Patient's self-determination in intensive care-from an action- and confirmation theoretical perspective. The intensive care nurse view

When becoming an intensive care patient life changes dramatically. In order to save life, different actions are performed by the caregivers and the patient's ability to exercise self-determination is non-existent. After the acute phase the patient is more awake and the possibilities for self-determination change. The purpose of this study was to describe intensive care nurses' (ICNs) views of patient's self-determination in an intensive care unit and to systematize ICNs' nursing actions for supporting patient's self-determination from an action- and confirmation-theoretic perspective. In order to answer these questions, 17 interviews with ICNs were conducted by the use of the Critical Incident Technique (CIT). The transcripts were then analysed using a hermeneutic analysis method and structured by the SAUC model for confirming nursing. The main findings were that the ICN thought that the ICU patient's self-determination was low and restricted. It was more common that the ICN acted to strengthen the patient's self-determination in nursing care, but there were no specific nursing goals for patient's self-determination. The most common actions for supporting self-determination were supplying the patient with information and engaging the patient in making a day plan. The nursing implications are that the ICN's view of human being as an acting subject is important for the ICN's awareness to recognise the patient's own personal resources to handle the critically ill situation and that the ICN's competence to manifest qualified nursing is necessary for strengthening patient's self-determination.

Using the critical incident technique to explore student nurses' perceptions of language awareness

Current evidence demonstrates that language awareness in nursing contributes to high quality patient care. Although language awareness amongst qualified nurses has been considered, there is a dearth of literature that examines how student nurses respond to language sensitivity in the healthcare setting. The critical incident technique was used to elicit the perceptions of student nurses regarding language awareness. Twenty students produced written descriptions of incidents that they had encountered during clinical practice and they subsequently reflected on these incidents. Data were analysed using framework analysis whereby meaning units were organised into themes and categories. Four distinct themes emerged from the analysis; namely, facilitating language choice, vulnerable groups, quality of care and student learning. Each theme was characterised by a number of subcategories. Student nurses identified positive and negative instances of language matters in health care that are driven by personal and organisational strategies and impact on patient care and student learning. Student nurses were conscious of the influence of language awareness on patient care and noted that structural and process elements relating to language awareness were in play in the healthcare setting. Moreover, they indicated that the consequent outcomes of these elements influenced the quality of care and student learning.

Critical incident technique utilization in research on holistic nurses

This article describes the critical incident technique (CIT) as it informs holistic nursing. The CIT is a qualitative, systematic, open-ended technique for educing descriptive data from participants. It is an effective naturalistic tool for focusing participants on a specific event. The CIT is a user-friendly instrument that can foster reflection and promote personal expression. Holistic nursing is a personal and professional commitment to the healing process of self and others. The competency of holistic nurses revolves around their ability to incorporate the concepts and standards of the philosophy of holistic nursing into their life and practice. This article explores the use of the CIT in 2 separate studies on holistic nurses. Both studies utilized the CIT as a secondary source of data collection. All participants in both studies were members of the American Holistic Nurses Association. One study explored how experienced certified holistic nurses learned to become competent practitioners, while the other study focused on holistic nurses' experience with modalities, the perceived benefits to self and client.

"Never again" stories of nurses: dilemmas in nursing practice

The authors describe significant turning points immanent in "never again" stories that practicing nurses, having participated in previously, vowed not to allow to recur during future, similar situations. Nurses submitted written accounts of critical, "never again" situations. The authors used critical incident technique and employed Colaizzi's approach to reveal the essential structure. Patient outcomes were fatal, close calls, dehumanizing, or isolating. Never again stories incorporated ethical dilemmas, deficits in nurses' knowledge, lack of confidence in clinical abilities, and failure to act correctly. Patients' welfare was the center of accounts. Circumstances threatened patients' and family members' trust in nurses and other providers. Patients' wishes were denied because of haste, providers' arrogance, or providers' desire not to be inconvenienced. Nurses' emotions mirrored a sense of failed responsibility for patients. Regret was tempered by nurses' pledges. Critical incidents revealed dilemmas in which nurses' autonomous clinical practice was constrained by feelings of powerlessness.

Nursing ethics in practice: issues for perioperative nursing

Consent is a concept inherent in any nurse-patient relationship and provides nursing with both theoretical and practical challenges. Within the perioperative area written informed consent is obtained for surgical and anaesthetic interventions. Consent is not formally negotiated for the multitude of interventions undertaken to facilitate the most straightforward of surgical procedures. An explorative, qualitative research project was undertaken to explore the processes used by perioperative nurses for negotiating such consent. Data was collected from perioperative nurses working in an acute teaching hospital using ‘consent episodes’ as units of data focusing on daily tasks of perioperative patient care. Findings indicate there is a dominant discourse of implied consent in which perioperative nursing practice is located.

Use of critical incident reports in medical education. A perspective

Critical incident reports are now being widely used in medical education. They are short narrative accounts focusing on the most important professional experiences of medical students, residents, and other learners. As such, critical incident reports are ideally suited for addressing values and attitudes, and teaching professional development. This manuscript describes critical incident reports and gives examples of their use, provides a theoretical underpinning that explains their effectiveness, and describes the educational impacts of critical incident reports and similar methods that use reflective learning. The author recommends critical incident reports as an especially effective means to address learners' most deeply held values and attitudes in the context of their professional experiences.

Strategies for Developing Competency Models

There is an emerging trend within healthcare to introduce competency-based approaches in the training, assessment, and development of the workforce. The trend is evident in various disciplines and specialty areas within the field of behavioral health. This article is designed to inform those efforts by presenting a step-by-step process for developing a competency model. An introductory overview of competencies, competency models, and the legal implications of competency development is followed by a description of the seven steps involved in creating a competency model for a specific function, role, or position. This modeling process is drawn from advanced work on competencies in business and industry.