The dying patient in the ICU: role of the interdisciplinary team☆
Section snippets
Team
The term interdisciplinary team has various meanings in different settings. Schmitt et al [7] described the requirements for a collaborative interdisciplinary team as (a) members of multiple health disciplines, (b) with varied knowledge and skills, (c) who care for the same patients (d) using shared planning and goals, and who (e) systematically communicate to coordinate care. Schmitt [8] discussed various approaches to studying collaboration in teams. The most common paradigm for a team is a
Interdisciplinary collaboration
The key activity of teams is collaboration, which has been defined in the ICU context as “nurses and physicians cooperatively working together, sharing responsibility for solving problems, and making decisions to formulate and carry out plans for patient care” [10]. In a grounded theory study the process of collaboration between ICU nurses and resident physicians was found to entail “working together” as the core process, which incorporated a focus on the patient, recognition of the importance
Research on collaborative approaches to treatment and decision making for dying intensive care unit patients
There are a number of articles by physician authors that describe the process of care and limitation of treatment decision making for dying patients in the ICU focused on the work of the physician, patient, and family with no indication that the care team involves more than physicians. Some authors have given limited acknowledgment to the roles of ICU nurses and others as part of the team [25], [26], [27], [28].
Cassell et al [29] conducted ethnographic studies of three ICUs (two in the United
Bioethical decision making
Arguably most clinical decisions in ICUs have ethical overtones. For this review, we focused on bioethical decision making that was explicit in addressing ethical issues, most of which concerned questions regarding the use (or limitation) of life-sustaining treatment. In his ethnography of nurses in hospitals and the social organization of ethics, Beyond Caring, Chambliss [50] made a distinction between practical ethical problems and ethical dilemmas; the former, he claimed, are systematic, and
Research on nurses as members of the interdisciplinary team for dying intensive care unit patients
Puntillo described the critical care nurse as an integral member of the ICU team caring for the dying patient and noted, “critical care nurses play an essential role in the provision of the best possible care during their patients' end of life” [56]. She identified components of ICU nursing care for dying patients, one of which was identifying and recruiting all members of the health care team who can make a contribution to the end-of-life care of the patient. Kirchhoff and Beckstrand [57]
Research on the role of the interdisciplinary team in communicating with families of dying intensive care unit patients
A number of researchers have described use of team approaches in the ICU and a variety of improved outcomes for ICU patients associated with these approaches [42], [43], [44], [45], [46], [47], [48], [49], [63]). Although this research did not target dying patients and their families, the positive results suggest that interdisciplinary approaches may also improve the outcomes for dying ICU patients. Studying outcomes for families is also important in the ICU end-of-life context because few
Ethics consultation
ICU bioethical decision making in conjunction with an external clinical ethics consultation team also has been studied. Focusing on patients near the end of life, four studies were found in which the effects of an ethics consultation in the ICU were evaluated [74], [75], [76], [77]. Because the descriptions of the consultations were vague, it was not possible to tell whether they involved an interdisciplinary team or even a team. Similar in these studies was the use of a limited set of outcome
Summary
In conducting this review of the literature, we realized that both some researchers and we were missing potentially relevant studies. They were missed when researchers did not see the full relevance of their work to collaboration or to the interdisciplinary team, for example, when one discipline neglected to consider the involvement of the other or to consider the patient/family as part of the team. They were also missed when relevant key words for indexing (eg, team or collaboration) were not
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Funding in part by Grant No. R01 NR04940 from the National Institute of Nursing Research.