Elsevier

Critical Care Clinics

Volume 20, Issue 3, July 2004, Pages 525-540
Critical Care Clinics

The dying patient in the ICU: role of the interdisciplinary team

https://doi.org/10.1016/j.ccc.2004.03.008Get rights and content

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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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References (82)

  • K.M Melia

    Ethical issues and the importance of consensus for the intensive care team

    Soc Sci Med

    (2001)
  • J Currey et al.

    Hemodynamic team decision making in the cardiac surgical intensive care context

    Heart Lung

    (2003)
  • T.G Buchman et al.

    Families' perceptions of surgical intensive care

    J Am Coll Surg

    (2003)
  • J.R Curtis et al.

    Studying communication about end-of-life care during the ICU family conference: development of a framework

    J Crit Care

    (2002)
  • V Swigart et al.

    Letting go: family willingness to forgo life support

    Heart Lung

    (1996)
  • M.L Campbell et al.

    Impact of a proactive approach to improve end-of-life care in a medical ICU

    Chest

    (2003)
  • D Field et al.

    Extending specialist palliative care to all?

    Soc Sci Med

    (1999)
  • T.J Prendergast et al.

    A national survey of end-of-life care for critically ill patients

    Am J Respir Crit Care Med

    (1998)
  • L Esserman et al.

    Potentially ineffective care: a new outcome to assess the limits of critical care

    JAMA

    (1995)
  • Crossing the quality chasm: a new health system for the 21st century

    (2001)
  • M.H Schmitt et al.

    Conceptual and methodological problems in studying the effects of interdisciplinary geriatric teams

    Gerontologist

    (1988)
  • M.H Schmitt

    Collaboration improves the quality of care: methodological challenges and evidence from US health care research

    J Interprof Care

    (2001)
  • L.A Hawryluck et al.

    Pulling together and pushing apart: tides of tension in the ICU team

    Acad Med

    (2002)
  • J.G Baggs et al.

    Collaboration between nurses and physicians

    Image J Nurs Sch

    (1988)
  • J.G Baggs et al.

    Nurses' and resident physicians' perceptions of the process of collaboration in an MICU

    Res Nurs Health

    (1997)
  • E.J Thomas et al.

    Discrepant attitudes about teamwork among critical care nurses and physicians

    Crit Care Med

    (2003)
  • J.G Baggs et al.

    Collaboration: a tool addressing ethical issues for elderly patients near the end of life in intensive care units

    J Gerontol Nurs

    (2000)
  • J.G Baggs

    End-of-life care for older adults in ICUs

    Annu Rev Nurs Res

    (2002)
  • R Stroud

    The withdrawal of life support in adult intensive care: an evaluative review of the literature

    Nurs Crit Care

    (2002)
  • S.D Surgenor et al.

    Teamwork and collaboration in critical care: lessons from the cockpit

    Crit Care Med

    (2003)
  • T.J Prendergast et al.

    Withdrawal of life support: intensive caring at the end of life

    JAMA

    (2002)
  • J.G Baggs et al.

    Nurse–physician collaboration and satisfaction with the decision-making process in three critical care units

    Am J Crit Care

    (1997)
  • M.Z Solomon et al.

    Decisions near the end of life: professional views on life-sustaining treatments

    Am J Public Health

    (1993)
  • D Cook et al.

    Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit

    N Engl J Med

    (2003)
  • D.K Heyland et al.

    End-of-life decision making in the seriously ill hospitalized patient: an organizing framework and results of a preliminary study

    J Palliat Care

    (2000)
  • K Faber-Langendoen et al.

    Process of forgoing life-sustaining treatment in a university hospital: an empirical study

    Crit Care Med

    (1992)
  • D.K.P Lee et al.

    Withdrawing care: experience in a medical intensive care unit

    JAMA

    (1994)
  • J Cassell et al.

    Surgeons, intensivists, and the covenant of care: administrative models and values affecting care at the end of life—updated

    Crit Care Med

    (2003)
  • J.E Heffner et al.

    Procedure-specific do-not-resuscitate orders: effect on communication of treatment limitations

    Arch Intern Med

    (1996)
  • P Noah et al.

    Organ/tissue donation request: a multidisciplinary approach

    Crit Care Nurs Q

    (1999)
  • Cited by (0)

    Funding in part by Grant No. R01 NR04940 from the National Institute of Nursing Research.

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