Norman I J, Redfern S J, Tomalin D A, Oliver S
Department of Nursing Studies, King's College London, England.
J Adv Nurs. 1992 May;17(5):590-600. doi: 10.1111/j.1365-2648.1992.tb02837.x.
This paper discusses a development of Flanagan's critical incident technique (CIT) to elicit indicators of high and low quality nursing from patients and their nurses on medical, surgical and elderly care wards. Stages in undertaking the CIT are identified and presuppositions held by most researchers about the nature of the technique are identified. The paper describes how the authors moved to a different set of presuppositions during the course of the study. Preliminary analysis of interview transcripts revealed that critical incidents need not always be demarcated scenes with a clear beginning and end, but may arise from respondents summarizing their overall experience within their description of one incident. Characteristically respondents were unable to give a detailed account of such incidents but validity may be established by the fact that respondents appear to recount what actually happened as they saw it, and what they said was clearly important to them. The researchers found that the most appropriate basic unit of analysis was not the incident itself but 'happenings' revealed by incidents that are 'critical' by virtue of being important to respondents with respect to the quality of nursing care. The importance of CIT researchers achieving an understanding of the 'meaning' of critical happenings to respondents is emphasized. Analysis of the interview transcripts is facilitated by the use of INGRES, a relational database computer program which should enable a 'personal theory' of quality nursing for each respondent, both patients and nurses, to be described. The study suggests that the CIT is a flexible technique which may be adapted to meet the demands of nursing research. If carefully applied, the CIT seems capable of capitalizing on respondents' own stories and avoids the loss of information which occurs when complex narratives are reduced to simple descriptive categories. Patients and nurses have unique perspectives on nursing and their views are of primary importance in understanding what quality means with respect to the interpersonal processes that are integral to nursing care. This paper discusses the identification of indicators of quality nursing from interviews with patients and nurses using the authors' development of Flanagan's critical incident technique.
本文探讨了弗拉纳根关键事件技术（CIT）的一种发展形式，旨在从医疗、外科和老年护理病房的患者及其护士那里获取高质量和低质量护理的指标。确定了开展关键事件技术的各个阶段，并明确了大多数研究人员对该技术性质的预设。本文描述了作者在研究过程中是如何转向另一组预设的。对访谈记录的初步分析表明，关键事件不一定总是有清晰开头和结尾的划定场景，而是可能源于受访者在描述一个事件时对其总体经历的总结。典型的情况是，受访者无法详细描述此类事件，但有效性可以通过以下事实来确立：受访者似乎在讲述他们所看到的实际发生的事情，而且他们所说的对他们显然很重要。研究人员发现，最合适的基本分析单位不是事件本身，而是事件所揭示的“事件”，这些事件因其对受访者在护理质量方面很重要而具有“关键性”。强调了关键事件技术研究人员理解关键事件对受访者的“意义”的重要性。使用INGRES（一种关系数据库计算机程序）有助于对访谈记录进行分析，该程序应能描述每个受访者（包括患者和护士）关于优质护理的“个人理论”。该研究表明，关键事件技术是一种灵活的技术，可以进行调整以满足护理研究的需求。如果谨慎应用，关键事件技术似乎能够利用受访者自己的故事，避免在将复杂叙述简化为简单描述类别时出现的信息丢失。患者和护士对护理有独特的视角，他们的观点对于理解护理质量在护理人际过程中的含义至关重要。本文讨论了通过使用作者对弗拉纳根关键事件技术的改进，从对患者和护士的访谈中识别优质护理指标的问题。
