Flanagan's Critical Incident Technique Research Articles

Experienced critical incidents affecting lead-times in the stroke care chain for low-priority patients – A qualitative study with critical incident technique

BackgroundThe time elapsing from the alarm being raised to arrival at the stroke unit is crucial for patients suffering a conceivable stroke. More knowledge is needed about critical incidents—both favourable and unfavourable—affecting the lead time in the care chain. AimTo explore favourable and unfavourable critical incidents (CIs), affecting lead times in the care chain from the alerted ambulance to the stroke unit, as experienced by nurses, for low-priority patients suffering a conceivable acute stroke. MethodThe study had an explorative descriptive design using a qualitative approach of Flanagan's Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care chain at a hospital in western Sweden were interviewed about their experiences regarding CIs influencing the lead time for low-priority patients. ResultsThere were 363 CIs identified related to human interactions and organizational structures. The types of CIs varied depending on where in the care chain they were experienced. Both favourable and unfavourable factors had an impact on the length of the lead time from alerted ambulance to stroke unit for lowpriority patients. Furthermore, CIs occurring both early and later in the care chain affected the whole process. ConclusionsThere is a need for greater understanding within each interrelated department in the care chain about how CIs at one part of the care chain have an impact on another.

Theoretical Model for Accident Prevention Based on Root Cause Analysis With Graph Theory.

IntroductionDespite huge investments in new technology and transportation infrastructure, terrible accidents still remain a reality of traffic.MethodsSevere traffic accidents were analyzed from four prevailing modes of today's transportations: sea, air, railway, and road. Main root causes of all four accidents were defined with implementation of the approach, based on Flanagan's critical incident technique. In accordance with Molan's Availability Humanization model (AH model), possible preventive or humanization interventions were defined with the focus on technology, environment, organization, and human factors.ResultsAccording to our analyses, there are significant similarities between accidents. Root causes of accidents, human behavioral patterns, and possible humanization measures were presented with rooted graphs. It is possible to create a generalized model graph, which is similar to rooted graphs, for identification of possible humanization measures, intended to prevent similar accidents in the future. Majority of proposed humanization interventions are focused on organization. Organizational interventions are effective in assurance of adequate and safe behavior.ConclusionsFormalization of root cause analysis with rooted graphs in a model offers possibility for implementation of presented methods in analysis of particular events. Implementation of proposed humanization measures in a particular analyzed situation is the basis for creation of safety culture.

Canadian hospital nurses' roles in communication and decision-making about goals of care: An interpretive description of critical incidents

BackgroundNurses in acute medical units are uniquely positioned to support goals of care communication. Further understanding of nurse and physician perceptions about hospital nurses' actual and possible roles was required to improve goals of care communication. ObjectiveTo critically examine nurse and physician perceptions of the nurse's role in communication with seriously ill patients and their families. DesignWe focus on the qualitative component of a mixed method study. We employed an interpretive descriptive approach informed by Flanagan's critical incident technique. SettingsParticipants were recruited from the acute medical units at three tertiary care hospitals in three Canadian provinces. ParticipantsThirty participants provided interviews (10 from each site): 12 nurses, 9 staff physicians and 9 medical resident physicians. MethodsParticipants' described “critical incidents” they considered as “excellent” or “poor” or “usual” practice. Interviews, were audiotaped and transcribed. Team-based analysis used constant comparison and triangulation to identify healthcare team members' roles in goals of care communication. ResultsWe identified two major themes from 120 critical incidents: 1) the ambiguous nature of the nurse's role in formal, physician-led, decision-making communication, and 2) embedded in care serious illness communication. Physicians understood nurses' supportive role in relation to their own communication practices that culminated in decisions about care; nurses' reported their roles were determined by unit routines, physician practices and preferences, and their self-confidence in supporting decision-making. Nurses described their unique role in facilitating informal and spontaneous communication with patients and families that was critical background work to physician-led goals of care communication. ConclusionsNurses and physicians had different understandings, practices and beliefs about goals of care communication The value of nurses embedded in care work is key to supporting the interprofessional team's work during formal goals of care communication.

Critical incidents that help and hinder the development and maintenance of polyamorous relationships

ABSTRACTThis study explored the critical incidents that facilitated and hindered the development and maintenance of polyamorous relationships. The first author conducted semi-structured, open-ended interviews with eleven people who had been in a polyamorous relational dynamic for a minimum of one year in the two years prior. Participants were asked to report the critical incidents that helped or hindered their ability and/or desire to develop and/or maintain the relationship. Flanagan's (1954) Critical Incident Technique was the chosen method for gathering and analyzing the data. Of the 1398 incidents that were elicited, 832 were found to be helpful to participants’ ability or desire to develop and maintain polyamory, while 566 were found to be hindering of participants’ ability or desire to develop and maintain polyamory. The results indicate that polyamory can be facilitated by clear communication; having access to adequate support and resources; having beliefs and experiences that are beyond mainstream culture; embracing sexuality; finding the right people to be in relationship with; processing difficult emotions; having a desire for variety in relationships; addressing practical needs; having spiritual beliefs that align with polyamory; and experiencing fun and excitement through polyamory. Benefits and limitations of the study are discussed, as well as suggestions for future research.

“Estoy viejo” [I’m old]: Internalized Ageism as Self-Referential, Negative, Ageist Speech in the Republic of Panama

Ageism is a form of discrimination that anyone may experience at some point in life (Palmore 2004). Yet ageism is rarely the focus of behavioral research (Nelson 2005). Age can be understood as a social construct that reflects social norms (Lemus and Exposito 2005). Based on our review of the published literature, there were two studies on perceptions of aging among Latina/os in the United States (Beyene et al. 2002; Sarkisian et al. 2006). These studies investigated perceptions and expectations of aging among older Latina/o adults rather than direct experiences of ageism. It is important to note that Latina/os are not a homogenous group and that there are within-group differences. For this reason, this study explored internalized, negative ageism specifically in the Republic of Panama. Although Panama has unique characteristics, it also reflects Central American culture and therefore should provide initial insights regarding Central American self-referential, negative, ageist talk, which we labeled "Estoy viejo." Flanagan's Critical Incident Technique was used to access and understand participants' (ages 18-65) negative ageist talk (n=159). Participants who reported engaging in "Estoy viejo." (46.3% of those sampled) were significantly younger than participants who did not (p< .05). One potential explanation is that younger participants may have been more influenced by North American culture and its strongly negative ageist stereotypes than older participants, who may have identified primarily with Central American culture.

Behavioural indicators of perceived managerial and leadership effectiveness within Romanian and British public sector hospitals

PurposeThis paper aims to report the results of a replication study of perceived managerial and leadership effectiveness within a Romanian public sector hospital, and to discuss the extent to which they are similar to and different from findings from equivalent studies carried out in two British NHS Trust hospitals.Design/methodology/approachConcrete examples (critical incidents) of effective and ineffective managerial behaviour were collected using Flanagan's critical incident technique (CIT). The critical incidents were content analyzed to identify a smaller number of behavioural statements (BSs). These were then compared and contrasted against two British BS data sets using realist qualitative analytic methods, and deductively coded and sorted into extant behavioural categories.FindingsA total of 57 BSs were identified of which 30 were examples of effective and 27 of least effective/ineffective managerial behaviour. The multi‐case/cross‐nation comparative analysis revealed high degrees of commonality and relative generalization between the Romanian and British findings.Research limitations/implicationsData saturation may not have been achieved during the CIT collection phase of the study. The relevance and transferability of the findings to other public sector hospitals in Romania have yet to be demonstrated empirically. The results have potential as “best evidence” to inform and shape “evidence‐based HRD” initiatives designed to train and develop effective managers and leaders within the health services sector of Romania and the United Kingdom.Originality/valueThe study is a rare example of indigenous managerial behaviour research in a non‐Anglo country. The results lend strong empirical support for universalistic explanations of the nature of perceived managerial and leadership effectiveness.

Behavioural criteria of perceived mentoring effectiveness

PurposeMost past research on formal mentoring has investigated its antecedents, outcomes and benefits with little attention given to what goes on inside the dyadic relationship. The purpose of this paper is to explore the types of mentor and mentee behaviours that are perceived as critical factors contributing to either a positive or negative mentoring experience for the mentee and the mentor.Design/methodology/approachConcrete examples of “effective” and “ineffective” mentor and mentee behaviour were collected from the research participants using Flanagan's Critical Incident Technique (CIT). The obtained CIT data were analyzed using forms of open and axial coding. Variants of content analysis were then used for conducting a series of subsequent comparative analyses.FindingsFrom a total of 187 coded critical incidents the study identified 11 positive and four negative behavioural criteria of mentoring effectiveness as perceived from the mentee perspective, and nine positive and three negative behavioural criteria of mentoring effectiveness as perceived from the mentor perspective. Comparisons against “theoretical” and “best practice” models and taxonomies of positive and negative mentoring reveal varying degrees of overlap and commonality.Research limitations/implicationsThere are two main limitations. First, the number of research participants was at the bottom end of the typical sample range for qualitative research, which means the collection of critical incidents did not reach the point of data saturation. Second, the study explored the “start‐up” and “ongoing” phases of the mentoring lifecycle but not the “end” phase.Originality/valueThe findings provide new insights into mentor and mentee behavioural effectiveness within formal mentoring relationships, and thereby add to a sparse empirical knowledge base in this substantially neglected area of mentoring research. Also, they provide a foundation against which to compare and contrast future empirical research that may be conducted on perceived effective and ineffective mentor and mentee behaviours within formal mentoring relationships.

Awareness of Posttraumatic Stress Disorder in Veterans: A Female Spouse/Intimate Partner Perspective

The purpose of this qualitative study was to identify perspectives of female spouses/intimate partners regarding posttraumatic stress disorder (PTSD) in returning Iraq and Afghanistan combat Veterans. Through the use of a self-administered questionnaire based on Flanagan's critical incident technique, reports were obtained from a purposive sample of 34 spouses/intimate partners of Veterans recruited through a social group for military spouses and a university in southeastern North Carolina. Two-thirds of the participants reported not having received formal education about PTSD. The main perceived barriers to PTSD treatment seeking were denial of symptoms, fear, and stigma about disclosing PTSD symptoms. Spouses/intimate partners observed Veterans for changes in behavior and routines, disturbed sleep patterns, and nightmares. In the event of PTSD treatment resistance, spouses/intimate partners reported they would suggest the need for treatment, issue an ultimatum, take action, or offer patience and support without taking any action.

Värdighet som det visar sig för vårdare i en kirurgisk praxis

Background:When patients need emergency or planned care at a surgical ward, they expect to be treated with dignity. Studies show that there is unnecessary suffering in care. Aim: The aim was to describe how nurses experience preserved dignity versus violated dignity in surgical practice. Method: The study had a hermeneutic design where Flanagan's critical incident technique was used for data collection. Data included 49 written stories about preserved and humiliated dignity and was analyzed using hermeneutic text interpretation.Findings:Human dignity emerges when nurses listen to patients. On the other hand, human dignity is violated when nurses are forced to see what they do not want to see. These are two aspects of dignity, and prerequisites for human dignity to be preserved within care. When a nurse allows the patients to tell their stories, and when nurses want to come close to the patients and are willing to accept the patients' trust, dignity is preserved. When nurses are rude to patients and make t...

Using critical incident technique to inform aged and extended care nursing.

Flanagan's critical incident technique was used to explore the beliefs of a cross-section of careers (both nursing and others) and consumers about the value of nursing and the nature of nursing's contribution in aged and extended care. The exploratory study found that nurses' being there, with and for residents, their families, and other health professionals, was influenced by two major themes that emerged from the data: personal and structural considerations. In this article, the potential of critical incident technique as a research method in nursing and for generating information about critical aspects of nursing work in aged and extended care is demonstrated.

Developing Flanagan's critical incident technique to elicit indicators of high and low quality nursing care from patients and their nurses.

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.

Critical decision method for eliciting knowledge

A critical decision method is described for modeling tasks in naturalistic environments characterized by high time pressure, high information content, and changing conditions. The method is a variant of a J.C. Flanagan's (1954) critical incident technique extended to include probes that elicit aspects of expertise such as the basis for making perceptual discriminations, conceptual discriminations, typicality judgments, and critical cues. The method has been used to elicit domain knowledge from experienced personnel such as urban and wildland fireground commanders, tank platoon leaders, structural engineers, design engineers, paramedics, and computer programmers. A model of decision-making derived from these investigations is presented as the theoretical background to the methodology. Instruments and procedures for implementing the approach are described. Applications of the method include developing expert systems, evaluating expert systems' performance, identifying training requirements, and investigating basic decision research issues. >

Military heroism: an occupational definition.

While most of us recognize the concept of heroism, an operational definition has remained elusive. The body of published literature on heroism likewise does not focus on the personal attributes that predispose an individual to heroic acts. In this study, a body of work not previously analyzed-citations of Medal of Honor awardees-was used to develop and rank dimensions of military heroism, following Flanagan's critical incident technique. These dimensions then compared definitions of heroism across conflicts. Essentially, three dimensions were derived and served as a basis for examining military heroism. As an initial effort, this study directs our thoughts to an operational definition of military heroism.

The critical incident technique--a brief guide.

Flanagan's critical incident technique conceived in the dark days of World War II has stood the test of time. It has been successfully used by researchers as a means to identify those activities essential to good practice in a profession and as a tool to delineate the competencies needed by the members of the profession under study. Now, with problem-based learning being adopted as a principal curricular method in several new medical schools, e.g. at McMaster (Canada), Newcastle (Australia), Maastricht (Netherlands), interest in Flanagan's work has been revived–as a method for determining the curriculum.Flanagan's technique has been subject to modest criticism but it has secured extensive educational currency since it first appeared. Its purchasing power, after four decades of international exchange, has not weakened. Indeed, indications are that its stock is rising still and that educationists who have not already done so should invest in this part of the market.

Obtaining access to data sources: an exploration of method, problems and possible solutions.

A method, route and problems relating to the gaining of access to research data or respondents is discussed. In seeking permission to gather data from patients and staff in Scottish psychiatric hospitals, using Flanagan's Critical Incident Technique, a number of problems were encountered, viz. (i) the varying admnistrative levels to which the first formal request for entry had to be made; (ii) the varying routes which had to be followed in order to gain permission, and (iii) the time taken to obtain access to data sources. The problems, their possible consequences, and a number of long and short term recommendations are made. If implemented, these may go some way toward minimizing the difficulties associated with gaining access to data sources. The long term recommendations, including improved nurse representation on existing research and ethical committees, are directed to those who shape and influence policies relating to research practice generally. The short term recommendations are directed to the nurse researcher who is seeking access to field sites, with a view to minimizing problems relating to this aspect of planning and carrying out research activity.

A modified version of Flanagan critical incident technique applied to interaction of counterinsurgent forces with an indigenous population.

The interaction between indigenous populations and counterinsurgent forces from another country is a topic of both practical and theoretical importance. Although there is a considerable body of material published on such related activity as civic action, there are few empirical data. The Flanagan critical incidents technique was applied to an accidental sample of 25 special forces men, 15 enlisted men and 10 officers. The results were 83 positive and 47 negative incidents (130 incidents in all). The incidents revealed both clustering and diversity. Over half the incidents involved the giving of intelligence by the indigenous population. Commonly, the cause of a given action was unknown. An unexpected finding was the extent to which trades were worked out between the military and local populations. The technique as modified here would be useful in studying other forms of collective behavior.

The selection of psychiatric aides. I. Critical requirements of the job.

The present paper is the first in a series reporting on the development of a pre-employment selection program for psychiatric aides at the VA Hospital, Coatsville, Pennsylvania. 1. A survey of previous research in the area of aide selection suggests that equivocal, ambiguous, and only partly useful results have been obtained because of the lack of an adequate criterion of effectiveness of job performance. 2. Flanagan's Critical Incident Technique was used to develop a list of critical requirements for the job of psychiatric aide. Critical incidents were collected in prepared booklets from the professional staff of the hospital, supervisory and floor nurses, student nurses, and other personnel who routinely come into contact with aides in the course of their work. 3. An attempt to use booklets for the collection of critical incidents from aides was unsuccessful. Satisfactory response was obtained by interviewing the aides individually. 4. A total of 1,123 incidents was obtained from 325 respondents. These were sorted and categorized into 7 major areas and 22 subareas of job requirements. 5. Suggestions are made as to how these findings may be applied in other hospitals. Later papers will report on their specific application in this hospital.