Interprofessional collaboration and family member involvement in intensive care units: emerging themes from a multi-sited ethnography

Abstract

This article presents emerging findings from the first year of a two-year study, which employed ethnographic methods to explore the culture of interprofessional collaboration (IPC) and family member involvement in eight North American intensive care units (ICUs). The study utilized a comparative ethnographic approach - gathering observation, interview and documentary data relating to the behaviors and attitudes of healthcare providers and family members across several sites. In total, 504 hours of ICU-based observational data were gathered over a 12-month period in four ICUs based in two US cities. In addition, 56 semi-structured interviews were undertaken with a range of ICU staff (e.g. nurses, doctors and pharmacists) and family members. Documentary data (e.g. clinical guidelines and unit policies) were also collected to help develop an insight into how the different sites engaged organizationally with IPC and family member involvement. Directed content analysis enabled the identification and categorization of major themes within the data. An interprofessional conceptual framework was utilized to help frame the coding for the analysis. The preliminary findings presented in this paper illuminate a number of issues related to the nature of IPC and family member involvement within an ICU context. These findings are discussed in relation to the wider interprofessional and health services literature.

A nursing perspective of interprofessional work in critical care: Findings from a secondary analysis

“…Collaborative interprofessional interactions, a key factor in critical care team (CCT) performance, influence patient outcomes [1][2][3][4][5]. Critically ill patients are vulnerable both clinically, where small errors in care can produce significant morbidity and mortality [3,4], as well as psychologically, where patients may experience "voicelessness" due to their lifethreatening conditions and power imbalance between the patient and provider relationship [ 6,7].…”

“…Reeves and colleagues' [11]conceptual model for understanding interprofessional teamwork [ Figure 1] captures the interrelationships between the multitude of team, organizational, and managerial factors that can impact patient outcomes; the factors are organized into four interrelated domains, relational, processual, organizational, and contextual. Evidentiary support for the model is growing [1,2,5].…”

Intensidad de colaboración interprofesional entre enfermeras de cuidados intensivos de un hospital de tercer nivel

“…Respecto a la preocupación por la integración de actividades colaborativas en el trabajo diario, nuestros resultados coinciden con estudios anteriores que informan cómo a pesar de realizarse reuniones profesionales, estas reuniones no suelen contar con el total de las profesiones que conformaban los equipos de trabajo 24 , sino 11 que suelen ser reuniones uni-profesionales, segmentadas por tipos de profesión 25 , lo que dificulta las interacciones colaborativas positivas entre los miembros del equipo 24 .…”

“…De resultados similares informan Reeves et al 25 , con médicos y enfermeras (de UCI), que trabajaban de forma separada y sólo interactúan entre sí con interacciones cortas y fortuitas, para resolver alguna consulta clínica. En este mismo estudio, Reeves et al 25 también destacan el segundo de los grandes temas de preocupación encontrados en el nuestro: las relaciones jerarquizadas.…”

“…En este mismo estudio, Reeves et al 25 también destacan el segundo de los grandes temas de preocupación encontrados en el nuestro: las relaciones jerarquizadas. Según estos autores, no solo las interacciones son pocas sino que, además, las discusiones interprofesionales están marcadas por la tradicional jerarquía médica sobre el resto de las profesiones sanitarias 25 .…”