Resource Center

Background: To support the process of effective family decision-making, it is important to recognize and understand informal roles various family members may play in the end-of-life decision-making process.

Objective: The purpose of this study was to describe some informal roles consistently enacted by family members involved in the process of end-of-life decision-making in intensive care units (ICUs).

Purpose: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time, to evaluate similarities and differences in the cultural contexts of four ICUs and the relationship of those contexts to EOLDM.

In this editorial, the author describes and evaluates an intervention study by Drs. Hamric and Blackhall.  Particularly significant is the determination of positive relationships between collaboration and a) satisfaction with quality of care and b) ethical climate for two groups of nurses and the single group of physicians studied. Collaboration also was related inversely to moral distress.

The author gives an overview of a special issue of The Online Journal of Issues in Nursing, highlighting several themes: At the beginning is interdisciplinary education, with nascent providers of various professions learning together both about substance and about the perspectives of each other’s professions. In the process of professional work, there is the need to consider multiple perspectives and to communicate thoughtfully, not only in traditional teams, during interdisciplinary rounds, and in telephone communications but using new forms of technology.

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.