Critical care outreach 2: uncovering the underpinning philosophy and knowledge through collaborative reflection

Critical care outreach (Outreach) was introduced as part of a government strategy to address increasing demands on limited intensive care (level 3) and high-dependency (level 2) resources. The discipline of Outreach developed rapidly and, as a result, the fundamental philosophical theories and sources of knowledge that underpin its practice remain, at least to some extent, unexplored, and their contribution to practice overlooked. It is important that we understand these philosophical theories and sources of knowledge so that we are able to provide sound rationale and guidance for practice and address the increasing pressure to demonstrate effectiveness. The authors argue that the complex situations encountered and managed by Outreach are not entirely amenable to traditional forms of measurement, and that its impact on patient care is, therefore, not readily acknowledged. In applying a model of collaborative reflection, this study analyses the management of a clinical case by a nurse consultant in Outreach. In doing so, it explores the realities of practice by deconstructing the complexity of a particular situation and highlights the variety of knowledge that contributes to effective Outreach practice.