3 ABSTRACTPurpose: This paper presents a secondary analysis of nurse interviews from a two-year comparative ethnographic study exploring cultures of collaboration across intensive care units (ICU). Critically ill patients rely on their interprofessional healthcare team to communicate and problem-solve quickly to give patients the best outcome available. Critical care nurses function at the hub of patient care giving them a distinct perspective of how interprofessional interactions impact collaborative practice. Materials and Methods: Secondary analysis of a subset of primary qualitative data is appropriate when analysis extends rather than exceeds the primary study aim. Primary ethnographic data included 178 semi-structured interviews of ICU professionals from eight medical-surgical ICUs in North America; purposeful maximum variation sampling was used to accurately represent each profession. Fifteen anonymized ICU nurse interview transcripts were coded iteratively to identify emerging themes impacting interprofessional collaborative practice. Results: Findings suggest quality of interprofessional collaboration is a product of a multitude of factors occurring at multiple levels within the organization. Managerial and organizational factors related to ICU nurse training and staffing may impede development of nurses' interprofessional skills. Conclusion: Deliberative development of ICU nurses' interprofessional skills is essential if nursing to move from primary coordinator to active collaborator in patient management.

Main results: While the concept of teamwork is often central to interventions to improve patient safety in the ICU, our observations suggest that this concept does not fully describe how interprofessional work actually occurs in this setting. With the exception of crisis situations, most interprofessional interactions in the two ICUs we studied could be better described as forms of interprofessional work other than teamwork, that include collaboration, coordination, and networking.Conclusions: A singular notion of team is too reductive to account for the ways in which work happens in the ICU, and therefore cannot be taken for granted in quality improvement initiatives or amongst health care professionals in this setting. Adapting interventions to the complex nature of interprofessional work and each ICUs unique local 1

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Research on best practices for family member involvement has shown that such involvement improves care quality in critical care settings and helps to reduce medical errors leading to adverse events. Although many critical care units promote the principle of “patient-centered care” and family member involvement, there can be a significant gap between knowledge about these processes and their translation into practice. This article is based on an implementation trial of a patient and family involvement knowledge-based tool that involves an educational component for frontline health care workers. By combining ethnographic observation, semistructured interviews, focus groups, and document analysis, we were able to not only examine health care provider views on family involvement but also explore the areas of tension that arose in practice because the introduction of the family involvement tool exposed local factors that shaped the conditions of possibility of family involvement. In particular, unspoken preferences, assumptions, and concerns about family involvement were brought to the fore because this intervention disrupted well-entrenched power dynamics related to family involvement and professional boundaries. Through this ethnographic research, we found that the concept of patient-centered care is not uncontroversial among health care providers and that the form of its practice was largely up for individual interpretation. Interventions and policies that aim to promote patient-centered and family-centered care would benefit from addressing the ways in which these ideas affect the work of different health care professionals and incorporating nursing concerns around family involvement.