Relationships, trust, decision-making and quality of care in a paediatric intensive care unit

To assess the care-giving practices of health-care practitioners in the paediatric intensive care unit (PICU) through their qualitative insights, reflections and experience in participatory action research.

Qualitative research in the form of 'participatory action research' was used to gather data from three sources within the unit: focus groups within disciplines, observations within the PICU, and semi-structured interviews. All staff members were active collaborators and equal stakeholders in the decision-making process, research and feedback.

The paediatric intensive care unit (PICU) of the Red Cross War Memorial Children's Hospital (RCWMCH).

All staff members from various disciplines working in the PICU.

Staff members described problems with respect to relationships, trust and decision-making within care-giving practices.

The study qualitatively describes how poor communication amongst staff members in respect of relationships and decision-making impacted on trust and how this tended to compromise care-giving practices in the PICU. The data suggested that this was more evident in informal rather than formal clinical decision-making procedures. The strength of the study was that the participatory action design in the research allowed staff members to address the very dynamics that they themselves cited as problematic.