| Summary: | In the context of one Intensive Care Unit (ICU) and one High Dependency Unit (HDU), this thesis explores and analyses the nursing contribution to the development of critical care. This comprises over more than half a century, focussing on nurses' relationship with, and perceptions of one 'technology', weaning from mechanical ventilation, as part of everyday nursing practice in the new millennium. My findings suggest that nurses take a task-focussed approach to weaning, treating it as a `medical' technology transferred to them from doctors, rather than seeing its potential to become a ‘nursing technology' in which the nurse is enabled to transform weaning into a way of implementing care in order to improve patient outcomes. Analysis demonstrates when nurses work in this way weaning is delayed and as a result patients will be exposed to greater morbidity and mortality. Theoretically, my argument builds in particular on Sandelowski's (1996, 1997,1998,2000,2000a, 2000b) work on the nursing – technology relation in which she describes how technology has shaped nursing practice and was shaped by nursing practice. I build on Sandelowski's ideas to develop two concepts that are central to my argument: technology transferred and technology transformed. I have used an ethnographic approach to study nurses using technology in the work place. The empirical data were obtained through fieldwork on one critical care unit in a large teaching hospital in the Midlands over a six-month period. The methods include participant observation, interviews with twelve nurses and the collection of over two–hundred and fifty hours of field notes. My study of the nursing role in critical care contributes new knowledge to two fields: first, the history of intensive care as a specialism within the wider development of the National Health Service (NHS). My work adds to this literature by making visible the nursing contribution to that development and, in the process, raising a question about the extent to which previous histories may have been misleading: these (see for example Lassen 1953, Hamilton 1963, Ibsen 1966, Hilberman 1975, Pontoppidan, Wilson, Rie & Schneider 1977, Cule 1989, Crocket and Mercer 1995, Gilbertson 1995, Le Fanu 1999, Kesecioglu 2000) have tended to assume that its development was a result of new medical technology. Second, is the literature on 'technology' as it relates, to nursing. I believe that my definition of a 'nursing technology' makes it possible for the first time to put structures in place which will transform nurses' contribution to patient care, improving patient outcomes. I conclude that rather than extending and expanding their roles through the transfer of technology, nurses transform those technologies that preserve the nursing role and can contribute to positive outcomes for patients. Only in this way will the nursing contribution to the development of critical care be recognised and valued.
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