Jodie Gary


What happens when critical care nurses find themselves in situations where patient care needs are not covered by practice guidelines or standard orders or when the needs conflict with those guidelines and orders? Sometimes usual practices such as call the supervisor, call the physician, or follow the protocol just do not meet the needs of the patient at the exact time and place. Experienced critical care nurses often discuss such situations in private; however, there is little information in the literature about the types of situations encountered and the decision- making processes used in these situations. Those discussions that were once shared only in private were shared anonymously using an online policy Delphi methodology to explore the care provided by experienced critical care nurses in situations where standard practice guidelines did not fit the needs of the specific care situation. Utilizing the descriptions gained from this research, patient-centered nursing care can be understood and can lead to further exploration of the outcomes of positively deviant nursing care. The long-term goal of this research was to bring to light the care provided by nurses in situations where practice guidelines were lacking and ultimately provide some answers and support for how nurses can provide care at the beside that is truly patient-centered. The results of this project are presented here in the form two manuscripts, a concept analysis of positive deviance in critical care nursing and a research study investigating the presence and nature of positive deviance in critical care nursing.

Date of publication

Spring 5-3-2012

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Nursing Commons