Fernanda RE Gimenes1*, PhD, RN, Patricia B Marck2, PhD, RN, Elisabeth Atila3, RN,
Mayara Carvalho Godinho Rigobello1, Ms, RN, Ana Paula Gobbo Motta1, Ms Student, RN,
Emanuel Nunes4, RN, Rosana Aparecida Pereira5, Ms student, RN
Objectives: To gain a comprehensive understanding of medication safety and potential improvements in a
Brazilian intensive care unit (ICU), we included an exploration of related workarounds.
Methods: We adapted participatory photographic research methods from the field of ecological restoration
to study a Brazilian ICU. Using focus groups, nurse-led photo-narrated walkabouts, and photo elicitation in
iterative phases of data collection and analysis, we identified a theme of ‘living with workarounds on a day-to
day basis’.
Results: Participants recognized barriers within their work environment that might contribute to perpetuating
medication workarounds, and the visual methods enabled them identify ideas to minimize workarounds related
to these processes of care.
Conclusions: The participatory photo methods helped participants and researchers to develop in depth
discussions to understand how nurses work around systemic vulnerabilities to optimize the delivery of patient
care. The methods also increased participants’ awareness of such behaviors and provided opportunities to
identify ideas to reduce risk. We expect that similar methods could be successfully used in the future in a variety
of practice settings to improve medication processes and other patient safety issues.
