{'fraction_non_alphanumeric': 0.021208226221079693, 'fraction_numerical': 0.011889460154241645, 'mean_word_length': 5.2635814889336014, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The besieged ward manager: can we afford to continue to ignore the role?

Traditionally, intensive care environments can be viewed through a social interactionist lens as discrete ‘subcultural worlds’ (Fischer, 1995). Fischer (1995, p. 554) defines a subculture as, ‘.a set of people who share a defining trait, associate with one another, are members of institutions associated with their defining trait, adhere to a distinct set of values, share a set of cultural tools and take part in a common way of life’. Intensive care units can be viewed as isolated from the rest of the hospital, and practitioners who inhabit these environments adopt norms and values that are different to those adopted by those who inhabit and create the broader culture of an acute hospital. Therefore, on occasion we as critical care practitioners may be confounded by differences between the subcultural worlds of intensive care and acute wards, especially where we consider them strange or in contradiction to our own considerations and priorities. Such difference may seem exacerbated by limited contact with acute care colleagues when direct contact is only made when patients are either admitted or discharged from the unit or through outreach services. A number of recent policy initiatives have urged greater liaison and guidance to ensure more comprehensive communication of patient needs, particularly at the point of patient transfer [National Institute for Clinical Excellence (NICE), 2007, Clinical Guideline 50]. More recently, the NICE (2008) consultation document on intensive care rehabilitation raises the importance of providing specific physical and psychological support to facilitate patient recovery from an episode of critical illness. To fully understand how we might improve care for these patients, we need greater insight into the experiences of ward managers as it is they who are charged with the responsibility to transform practice and care delivery on the wards. McWhirter’s doctoral study into the contemporary role of the ward manager has illuminated some key challenges that face our colleagues. Using a grounded theory approach, she interviewed 9 ward managers (initially for 1–3 h and then with half an hour follow-up interviews on 12 occasions), 21 stakeholders (30 min to 1 h each interview) and undertook 35 h of participant observation on nine acute care wards. Data were analysed using dimensional analysis (Schatzman, 1991). Her findings concluded that without addressing the factors that impede the functioning of a ward manager to lead clinical change at ward level, the welcomed initiatives set out in the consultation document to improve patient’s rehabilitation or to improve the recognition of patient deterioration in an acute care setting, might flounder. Importantly, managers charged with the responsibility to implement any guideline need to take account of the circumstances in which ward managers’ work and their impoverished resilience to embrace yet more change. Without addressing these factors, we may not see the improvements in patient care that we all seek to achieve.