Power and conflict in intensive care clinical decision making

Coombs, Maureen

doi:10.1016/s0964-3397(03)00040-5

Cited by 92 publications

(91 citation statements)

References 20 publications

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“…The same researcher or team of researchers published several articles on the same study. [24][25][26][27][28][29][30][31][32][33][34] In 8 studies, the researchers collected data across several ICUs, but and covered interprofessional interactions (between 2 or more professional groups). One autoethnographic article 23 was excluded, for a final sample size of 23.…”

Section: Resultsmentioning

confidence: 99%

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Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Paradis¹,

Leslie²,

Puntillo³

et al. 2014

American Journal of Critical Care

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BackgroundThe sustained clinical and policy interest in the United States and worldwide in quality and safety activities initiated by the release of To Err Is Human has resulted in some high-profile successes and much disappointment. Despite the energy and good intentions poured into developing new protocols and redesigning technical systems, successes have been few and far between, leading some to argue that more attention should be given to the context of care. Objective To examine the insights provided by qualitative studies of interprofessional care delivery in intensive care. Methods A total of 532 article abstracts were reviewed. Of these, 24 met the inclusion criteria. Results Articles focused on the nurse-physician relationship, patient safety, patients' families and end-of-life care, and learning and cognition. The findings indicated the complexities and nuances of interprofessional life in intensive care and also that much needs to be learned about team processes. Conclusion The fundamental insight that interprofessional interactions in intensive care do not happen in a historical, social, and technological vacuum must be brought to bear on future research in intensive care if patient safety and quality of care are to be improved.

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Section: Resultsmentioning

confidence: 99%

“…Coombs 29 and Coombs and Ersser 30 found that medical dominance is a serious hindrance to teamwork in the ICU. Despite several examples of highly functioning interprofessional encounters, nurses' contributions were devalued during clinical decision making.…”

Section: The Nurse-physician Relationshipmentioning

confidence: 99%

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Paradis¹,

Leslie²,

Puntillo³

et al. 2014

American Journal of Critical Care

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“…In general, ICU nurses make 1 care decision every 30 seconds 12 and approximately 9 important patient-care decisions per hour, 13 suggesting that exercising judgment is a core nursing activity and influences the quality of care provided. Previous studies 11,[14][15][16] in European ICUs indicated that the levels of nurse autonomy differ between countries and that the decision-making capacity of these clinicians needs to be developed and strengthened. However, factors that may be associated with low autonomy among European ICU nurses have not been systematically studied.…”

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confidence: 99%

Professional Autonomy, Collaboration With Physicians, and Moral Distress Among European Intensive Care Nurses

Papathanassoglou

Karanikola

Kalafati

et al. 2012

American Journal of Critical Care

189

262

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Background Discretionary autonomy is a key factor in enhanced patient outcomes and nurses' work satisfaction. Among nurses, insufficient autonomy can result in moral distress. Objectives To explore levels of autonomy among European critical care nurses and potential associations of autonomy with nurse-physician collaboration, moral distress, and nurses' characteristics. Methods Descriptive correlational study of a convenience sample of 255 delegates attending a major European critical care conference in 2009. Respondents completed a selfadministered questionnaire with validated scales for nurses' autonomy, nurse-physician collaboration, and moral distress. Results The mean autonomy score (84.26; SD, 11.7; range, and the mean composite (frequency and intensity) moral distress score (73.67; SD, 39.19; range, were both moderate. The mean collaboration score was 47.85 (SD, 11.63; range,. Italian and Greek nurses reported significantly lower nurse-physician collaboration than did other nurses (P < .001). Greek and German nurses reported significantly higher moral distress (P < .001). Autonomy scores were associated with nurse-physician collaboration scores (P < .001) and with a higher frequency of moral distress (P = .04). Associations were noted between autonomy and work satisfaction (P = .001). Frequency of moral distress was associated inversely with collaboration (r = -0.339; P < .001) and autonomy (r = -0.210; P = .01) and positively with intention to quit (r = 0.257; P = .004). Autonomy is defined as the freedom to make decisions within the domain of an individual's profession and to act accordingly. 10,11 The ability to make discretionary and autonomous decisions based on comprehensive knowledge, clinical expertise, and evidence-based findings is a hallmark of professionalism. In general, ICU nurses make 1 care decision every 30 seconds 12 and approximately 9 important patient-care decisions per hour, 13 suggesting that exercising judgment is a core nursing activity and influences the quality of care provided. Previous studies 11,[14][15][16] in European ICUs indicated that the levels of nurse autonomy differ between countries and that the decision-making capacity of these clinicians needs to be developed and strengthened. However, factors that may be associated with low autonomy among European ICU nurses have not been systematically studied. Although, presumably, poor nursephysician collaboration may limit a nurse's ability to implement care-and unit-related decisions, associations between these 2 constructs have not been investigated. Evidence of the association between nurse-physician collaboration and ICU nurses' moral distress is likewise scant. Although the design of the study we report here was unsuitable for exploring either causative factors or antecedents of autonomy-and inferences may be limited by differences in responders' context of practice-we wished to address autonomy, nurse-physician collaboration, and moral distress simultaneously in a sample of European ICU nurses to gain preliminary insigh...

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“…3 The impact of conflict on patient safety and care are well documented. 4 In many ways, the need for education around conflict is a metaphor for the need for IPE. Successful strategies used to resolve conflict include direct communication, willingness to explore solutions, and demonstration of respect and humility.…”

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confidence: 99%

Interprofessional Health Sciences Education: It’s Time to Overcome Barriers and Excuses

Wilkes

Kennedy

2017

J GEN INTERN MED

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Physicians and medical educators have been slow to recognize the practice of medicine as a team sport. Over the past decade there have been dramatic changes in American hospitals, health care systems, and how health care is organized which have affected the way we deliver health care, the role of the health care professional, and the expectations of the patient. These changes have, in turn, impacted how the health care team functions and interacts. Interprofessional care has become the norm, with the physician being but one important player on the team. For too long the division between physicians and other health care providers has been hierarchical and rigid, with physicians feeling they were in charge and with other occupations seen as subordinate. We have done little to help our trainees understand the role and approaches to care offered by other team members, which includes social workers, psychologists, nurses, and physician assistants/ nurse practitioners, as well as complementary and alternative care providers including chiropractors, acupuncturists, and others whom our patients visit for care. When we attempt to teach Bsystems-based practice,^too often the model has been to teach our trainees leadership skills with the explicit and implicit assumptions that they will always be captains [of the ship] rather than just one important member of the crew.In this issue of JGIM, Alexandraki et al. detail the institutional and professional resistance to change within the culture of both medicine and academia.1 Despite the Liaison Committee on Medical Education (LCME) mandate to include interprofessional practice within professional health care training, most doctors, nurses, social workers, physical therapists, and others are still learning their trade in separate silos. In medicine, this is a result of our medical training systems having evolved from a Flexnerian academic mind-set rather than from a health care delivery mind-set. When we place trainees in academic hospitals, they are typically organized in silos and units, taught by one specialty at a time and focused on disease management rather than on broader issues of health. Medical education programs would never fail to teach our trainees cardiac auscultation, history taking, or anatomy, because these are considered by most in the profession as mission-critical. In stark contrast, the skills and attitudes involved in interprofessional education (IPE) are often considered fluff.While excuses for excluding interprofessional experiences from the curriculum have been heard for at least a decade, Alexandraki et al. have given us some indication that the attitudes of internal medicine (IM) clerkship directors are starting to change. Slowly, schools have taken small steps to incorporate IPE into the curriculum, although the additions often seem perfunctory. While 71% of respondents believed that IPE should be part of IM clerkships, in practice, respondents indicated that their programs often front-loaded their IPE experiences prior to their clerkship year, with ...

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Power and conflict in intensive care clinical decision making

Cited by 92 publications

References 20 publications

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Professional Autonomy, Collaboration With Physicians, and Moral Distress Among European Intensive Care Nurses

Interprofessional Health Sciences Education: It’s Time to Overcome Barriers and Excuses

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