Balancing intertwined responsibilities: A grounded theory study of teamwork in everyday intensive care unit practice

Abstract

This study aimed to describe and explain teamwork and factors that influence team processes in everyday practice in an intensive care unit (ICU) from a staff perspective. The setting was a Swedish ICU. Data were collected from 38 ICU staff in focus groups with registered nurses, assistant nurses, and anaesthetists, and in one individual interview with a physiotherapist. Constant comparative analysis according to grounded theory was conducted, and to identify the relations between the emerged categories, the paradigm model was applied. The core category to emerge from the data was "balancing intertwined responsibilities." In addition, eleven categories that related to the core category emerged. These categories described and explained the phenomenon's contextual conditions, causal conditions, and intervening conditions, as well as the staff actions/interactions and the consequences that arose. The findings indicated that the type of teamwork fluctuated due to circumstantial factors. Based on the findings and on current literature, strategies that can optimise interprofessional teamwork are presented. The analysis generated a conceptual model, which aims to contribute to existing frameworks by adding new dimensions about perceptions of team processes within an ICU related to staff actions/interactions. This model may be utilised to enhance the understanding of existing contexts and processes when designing and implementing interventions to facilitate teamwork in the pursuit of improving healthcare quality and patient safety.

A case study of a collaborative allied health and nursing crisis response

“…Prior studies have noted the strength of interprofessional collaboration in the critical care setting, identifying the benefits for improved patient outcomes (Bjurling-Sjöberg et al, 2017;Rose, 2011). The focus of these studies however tends to reside in team working based on independent disciplines working parallel to one another and maintaining their role boundaries.…”

Communication about patients during ward rounds and verbal handovers: A gender perspective

“…The nursing discourse, of which the interprofessional teams that carried out the verbal handovers are a part, provides wider-and more 'open contextual' understandings of the patient when compared to the 'medical discourse', which provides narrower and more 'contextually demarcated' understandings of the patient (Kitson, Marshall, Bassett, & Zeitz, 2012). Even though the medical discourse was challenged by the nurse discourse (upheld by the participating nurses) during the ward rounds, the medical discourse tended to prevail due to the higher value credited to the physicians' competency domain (Suter et al, 2009) based on the traditional hierarchical order within healthcare (Bjurling-Sjöberg et al, 2017). As a consequence, the focus in the communication ended up primarily around the medical situation of the patient, which may explain the fewer statements about social-, cultural-, and environmental aspects and thereby also less utterances of informal, judgmental and arbitrary nature.…”

“…In the light of this research, efforts have been made to avoid substandard communication, in order to improve cooperation and ultimately the individual experience of care. Earlier research shows that general cooperation difficulties within interprofessional teams may occur due to insufficient communication skills (van Dijk-de Vries, van Dongen, & van Bokhoven, 2017) and role understanding (Suter et al, 2009) as well as due to a lack of appreciation for other professions' work (Bjurling-Sjöberg, Wadensten, Pöder, Jansson, & Nordgren, 2017;Dow et al, 2017;Ryland, Akers, Gowland, & Malik, 2017). Therefore, in a variety of regulatory and policy documents (Diskrimineringsombudsmannen, 2012;Socialstyrelsen, 2006;Svensk författningssamling, 1982;1998), and in specific concepts that are used in healthcare such as 'holistic care' (Andreasson & Winge, 2010;World Health Organization, 1994) and 'patientcentred care' (Sidani, 2008;Wasson, Godfrey, Nelson, Johnson, & Batalden, 2007), several ideas and suggestions on how to improve communication have been presented.…”

Information concerning ICU patients’ families in the handover—The clinicians’ «game of whispers»: A qualitative study

“…The ICU team consists first and foremost of nurses and physicians from the ICU, but the extended team includes health professionals from different disciplines such as physicians from other specialties, physiotherapists, social workers and chaplains (Bjurling-Sjöberg, Wadensten, Pöder, Jansson, & Nordgren, 2017;Donovan et al, 2018).…”

“…Further, the ICU team is seldom constant. Due to shift work, in-service training and dynamic changes in patient needs, team members may change from day to day (Bjurling-Sjöberg et al, 2017;Ervin et al, 2018;Hoskote et al, 2017). This instability results in challenging handovers and disruptions in continuity of care for patients and their families.…”