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Expert opinion supports the application of broad interdisciplinary team approaches to the care of the dying patient in the intensive care unit (ICU). Current literature contains many suggestions about how core team members-physicians, nurses, and patients/family members-could systematically enhance interdisciplinary collaboration in the care of the dying patient. In the few studies of ICU interdisciplinary collaborative care of the dying patient, investigator shave demonstrated improvement in care.

The purpose of this article is to propose that collaboration is a valuable way to address ethical issues associated with the treatment of elderly patients near the end of life in intensive care units (ICUs). Collaboration among health care providers and with patients and their families has been called “an ethical responsibility of the highest priority” (Levine, 1989, p. 5).

OBJECTIVE: To investigate the association of collaboration between intensive care unit (ICU) physicians and nurses and patient outcome.

DESIGN: Prospective, descriptive, correlational study using self-report instruments.

SETTINGS: A community teaching hospital medical ICU, a university teaching hospital surgical ICU, and a community non-teaching hospital mixed ICU, all in upstate New York.

SUBJECTS: Ninety-seven attending physicians, 63 resident physicians, and 162 staff nurses.

Ten intensive care unit nurses and 10 medical resident physicians were interviewed to compare their perceptions of the process of nurse-physician collaboration. The grounded theory method for concept development recommended by Strauss and Corbin (1990) was used. The core of the process of collaboration for both groups was working together.

OBJECTIVE: To assess and compare levels of nurse-physician collaboration and satisfaction with the decision-making process as reported by critical care nurses, resident physicians (residents), and attending physicians (attendings) in making decisions to transfer individual patients out of the critical care unit, and to assess if satisfaction predicts nurse retention.

DESIGN: Longitudinal descriptive correlational study using self-reporting instruments.

The psychometric assessment of a new instrument for measurement of the construct of nurse-physician collaboration in making specific patient care decisions. Collaboration and Satisfaction About Care Decisions (CSACD), is reported. Content validity for the tool was supported by literature review, nurse and physician experts, and potential subjects. In a pilot study 58 neonatal intensive care nurses' and resident physicians' responses showed variance; alpha reliability of the collaboration questions was 0.95.

OBJECTIVE: To develop and test two instruments measuring decision making about level of aggressiveness of intensive care unit (ICU) patient care. Decisions about Aggressiveness of Patient Care (DAC) measures care providers' general perceptions about decision making. Decisions about Aggressiveness of Patient Care for Specific Patients (DAC[SP]) measures perceptions in specific situations.

DESIGN: Two-phase psychometric instrument evaluation.

SETTING: Phase I, nationally mailed questionnaire. Phase II, northeastern medical center medical ICU.

We prospectively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit (MICU) using nurses' and residents' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care. Either readmission to the MICU or death was considered a negative patient outcome. Nurses' reports of collaboration were significantly (p = 0.02) and positively associated with patient outcome, controlling for severity of illness.

ICU nurses who are satisfied with their work are more likely to be retained, leading to institutional cost savings. In this study, higher levels of nurse-physician collaboration in making decisions about patient care were found to be very important to nurses' satisfaction.

There is increasing interest in the ability of health-care professionals to work together, and in understanding how such collaborative practice contributes to primary health care (PHC). Interprofessional education drives the need to identify and establish enabling mechanisms for collaborative practice in PHC. This study examines six PHC practice settings from both resource-constrained and resource-rich countries in order to identify not only the enabling mechanisms that facilitate collaborative practice to support PHC, but also barriers to such practice.