Abstract:

The objectives:
The paper describes the process by which the results of an empirical research have been used to design a training experience tailored to Intensive Care Units (ICUs) physicians. The project starts from a problem highlighted by the Italian Group for the Evaluation of Interventions in Intensive Care Units (GiViTI). On the base of a ten years longitudinal research, GiViTI assumed that, to better understand what elements influence the quality of health care practices, it is necessary to go beyond the purely medical aspects, focusing on communicative patterns, leadership styles and relational dynamics (Nattino, Finazzi e Bertolini, 2014; Bertolini, 2014). Moreover, GiViTI realized that the influence of such elements is stronger in decision-making (DM) processes: therefore, it decided to foster a qualitative research aimed to investigate this aspect in ICU contexts. The qualitative researchers involved in the research realize that the results of this research can be used to draw a training program that makes ICU physicians aware of what influence their DM processes, improving the quality of care they offer and making this research relevant and transformative.

Methodology:
This research rests on the epistemological principle according to which to understand experience, you must take the world as an object of meaning. Next to the world of things – the visible world – there is the invisible world, a world made out of thoughts, affections, desires, expectations, fears, beliefs and especially ideas that can be revealed better by an approach that is faithful to the phenomena (Mortari 2013; Mortari 2014). According to this, the research is based on a phenomenological approach and the “wooden horse”, chosen to investigate the research object is embodied by the discursive practices because a discursive practice is a speech act that contains bodily patterns and mental activities that might ‘embrace the different forms in which the world is meaningfully constructed’ (Reckwitz, 2002, pp. 254-255).

Conclusions:
The findings of the research leads to (a) discover what communicative practices draw the deliberative profiles of each ICU involved in the research project (b) develop a method to understand how different discursive acts influence DM processes. This allows to design two types of training experiences: one specifically tailored on the ICUs involved in the research project and another more generally addressed to physician working in ICU contexts. The first training experience show to physicians who actively participated to the research not only what kind of discursive practices emerge when they need to make a decision, but also how they concretely act, making them clear the discrepancy between what they think they do and that they “really” do. Moreover, this experience has had a direct feedback because it has allowed the involved physicians to see their real actions from a different perspective, making them more aware of how the organizational, communicative and relational elements affect their reaching a clinical decision. The second training experience has the aim to make the physician able to use the qualitative tool developed in order to analyze their own conversational exchanges. This means to make them aware of the role that various acts discursive play in DM processes and able to handle the communicative, relational and organisational aspects that affect this pivotal aspect of their professional practice.

Keywords:

Education & Training for Health Professionals, Intensive Care Units, Qualitative Research, Decision-making.