Factors Nurses in the Intensive Care Unit Consider When Making Decisions About Patient Mobility

2019 ◽  
Vol 28 (4) ◽  
pp. 281-289 ◽  
Author(s):  
Anna E. Krupp ◽  
William J. Ehlenbach ◽  
Barbara King
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Content Analysis ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Program Implementation ◽  
Structured Interviews ◽  
Patient Mobility ◽  
Related Factors ◽  
Directed Content Analysis

Background Early mobility interventions in the intensive care unit can improve patients’ outcomes, yet they are not routinely implemented in many intensive care units. In an effort to identify opportunities to implement and sustain evidence-based practice, prior work has demonstrated that understanding the decision-making process of health professionals is critical for identifying opportunities to improve program implementation. Nurses are often responsible for mobilizing patients, but how they overcome barriers and make decisions to mobilize patients in the intensive care unit is not understood. Objective To describe processes that nurses in intensive care units use to make decisions and barriers that influence their decision-making about patient mobility. Methods An exploratory descriptive approach using semi-structured interviews of a purposive sample of registered nurses in 2 intensive care units at 2 hospitals was used. Interviews were transcribed and analyzed by using directed content analysis to identify categories that describe nurses’ decision-making about patient mobility. Results Semistructured interviews were conducted with 20 nurses in a 1-on-1 setting. Four main categories that influenced nurses’ decision-making about mobility were identified in the directed content analysis: purpose of mobility, gathering information, establishing and activating the plan, and barriers to progressing the plan. Conclusions Deciding to mobilize patients in the intensive care unit is a multifaceted, individualized decision made by nurses, and numerous patient-, nurse-, and unit-related factors influence that decision. Future studies that target unit culture and interprofessional perspectives are needed.

scholarly journals Time-limited trials: A qualitative study exploring the role of time in decision-making on the Intensive Care Unit

2019 ◽  
Vol 15 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Bradley Lonergan ◽  
Alexandra Wright ◽  
Rachel Markham ◽  
Laura Machin
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Units ◽  
Treatment Withdrawal ◽  
Structured Interviews ◽  
Open Communication ◽  
North West

Background Withholding and withdrawing treatment are deemed ethically equivalent by most Bioethicists, but intensivists often find withdrawing more difficult in practice. This can lead to futile treatment being prolonged. Time-limited trials have been proposed as a way of promoting timely treatment withdrawal whilst giving the patient the greatest chance of recovery. Despite being in UK guidelines, time-limited trials have been infrequently implemented on Intensive Care Units. We will explore the role of time in Intensive Care Unit decision-making and provide a UK perspective on debates surrounding time-limited trials. Methods This qualitative study recruited 18 participants (nine doctors, nine nurses) from two Intensive Care Units in North West England for in-depth, one-to-one semi-structured interviews. A thematic analysis was performed of the data. Results Our findings show time is utilised by Intensive Care Unit staff in a variety of ways including managing uncertainty when making decisions about a patient’s prognosis or the reversibility of a disease, constructing relationships with patients’ relatives, communicating difficult messages to patients’ relatives, justifying resource allocation decisions to colleagues, and demonstrating compassion towards patients and their families. Conclusions Time shifts the balance towards greater certainty in Intensive Care Unit decision-making, by demonstrating futility, and can ease the difficult transition for staff and families from active treatment to palliation. However, this requires clear and open communication, both within the Intensive Care Unit team and with the family, being prioritised when time is used in decision-making.

scholarly journals Nurses' work in intensive care units: feelings of suffering

2009 ◽  
Vol 17 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Júlia Trevisan Martins ◽  
Maria Lúcia do Carmo Cruz Robazzi
Keyword(s):  
Physical Activity ◽  
Intensive Care Unit ◽  
Content Analysis ◽  
Intensive Care ◽  
Data Collection ◽  
Descriptive Study ◽  
Qualitative Approach ◽  
Structured Interviews ◽  
Team Members ◽  
Defense Strategies

The purpose of this study was to investigate the feelings of suffering that Intensive Care Unit (ICU) nurses experience, and the strategies they use to face these feelings. It is a descriptive study using a qualitative approach and based on content analysis. The study used previous studies on Work Psychodynamics as complementary groundwork. Data collection occurred by means of semi-structured interviews, which were transcribed, categorized, and subcategorized. Results showed that suffering is related to: taking care of a young patient in critical condition, taking problems home, the patient's family, the team's work, and technology at work. As for the defense strategies used, emphasis is given to the search for strength in religion, promoting inter-relationships among team members, engaging in physical activity, and withdrawing from the patient.

Half the family members of intensive care unit patients do not want to share in the decision-making process: A study in 78 French intensive care units*

2004 ◽  
Vol 32 (9) ◽  
pp. 1832-1838 ◽  
Author(s):  
Élie Azoulay ◽  
Frédéric Pochard ◽  
Sylvie Chevret ◽  
Christophe Adrie ◽  
Djilali Annane ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Family Members ◽  
Decision Making Process ◽  
The Family

scholarly journals Relief and care in the shade: A concept extracted from practices of neonatal nurses during pain management

2020 ◽  
Author(s):  
Zahra Hadian Shirazi ◽  
Mitra Soltanian ◽  
Raheleh Sabet Sarvestani
Keyword(s):  
Content Analysis ◽  
Intensive Care ◽  
Pain Management ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Family Care ◽  
Neonatal Intensive Care Units ◽  
Structured Interviews ◽  
Knowledge And Attitude ◽  
The Impact

Background & Aim: Nowadays, despite the improvements in the knowledge and attitude of healthcare professionals, there are still obstacles against pain management in neonatal intensive care units. Hence, it is necessary to know about the problems of pain management in neonatal intensive care units. This research aimed to explore the pain management experiences of neonatal intensive care unit nurses and neonatologists. Methods & Materials: This content analysis study was conducted on six experienced neonatal intensive care units nurses and two neonatologists in one hospital affiliated to Shiraz University of Medical Sciences who were selected through purposive sampling which continued until saturation. The data were collected through semi-structured interviews and field notes. The data were simultaneously analyzed using inductive content analysis. Results: Analysis of the data generated one theme and three categories and seven subcategories. The theme was “pain relief in the shade”. The categories were “responsibility versus ignorance”, “family caregiver as a barrier or facilitator”, and “newborn, sacrificed due to imbalanced context”. This study showed that professional caregivers managed pain on the margin of other cares. The effects of family care were identified as paradox, helping, or disturbing. The participants also emphasized the impact of environmental disruptions on pain management. Conclusion: The experiences of pain management in neonatal intensive care units were identified at three levels of professional caregivers, family caregivers, and organizational atmosphere. Exploring this experience could help improve pain management and reduce its side effects in susceptible neonates. Hence, healthcare workers are recommended to ensure effective pain management in neonatal intensive care units by ongoing monitoring and audit.

scholarly journals THE APPLICATION OF CLINICAL JUDGMENT AND DECISION MAKING OF CRITICAL CARE NURSES IN INTENSIVE CARE UNITS (ICUs)

2019 ◽  
Vol 2 (1) ◽  
pp. 1-14
Author(s):  
Indah Mei Rahajeng ◽  
Faridatul Muslimah
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Critical Care Nurses ◽  
Short Period

Background Intensive Care Unit (ICU) is the hospital setting in which applied specific application of clinical decision making and judgement. The critical patient conditions in ICU may drive nurses to make decision and clinical judgement in short period of time. The approach of clinical decision making which appropriate to be applied in the critical circumstances is important to be identified, thus it could become a guidance for novice and expert critical nurses. Aim The aim of this study was to explain how clinical decision making is applied in Intensive Care Unit (ICU)  Method A systematic review of 22 articles was carried out, articles were retrieved from CINAHL, MEDLINE, PUBMED and DISCOVERED databases. The articles were critically reviewed and analized to answer this study’s aim. Result The critically review of the articles were categorized in themes: 1) application of Tanner’s clinical judgment model  in ICU, 2) Types of decisions in ICU, 3) Theoretical approach: implementation of decision-making in ICU, 4) Case illustration of decision-making scheme in ICU, 5) Influencing factors of decision-making in ICU, 6) Supporting tools for clinical decision-making in ICU, 7) Understanding of attributes and concepts may enhance the quality of the clinical decision-making process in ICU, 8) Implications for nursing education and practice of understanding clinical decision making in ICU. Conclusions Critical care nurses usually combine different techniques in making decisions; analytical methods including the hypothetic-deductive method, pattern recognition, intuition, narrative thinking, and decision analysis theory are potentially applied. Clinical decision activities in ICU appear in many clinical situations, such as intervention decisions, communication decisions, and evaluation decisions. There are several factors influencing clinical decision-making in intensive care units, including nurses’ experience, the patient’s situation, the layout of the ICU, shift work, inter-professional collaboration practice, physical and personnel resources. The application of clinical decision making could be supported by systematic tools, and the nurses’ knowledge about the concepts and attributes used in ICUs affect their clinical decision-making abilities.     Keywords: clicinal decision making, critical care nurse, ICU

scholarly journals Decision-making in intensive care medicine – A review

2017 ◽  
Vol 19 (3) ◽  
pp. 247-258 ◽  
Author(s):  
Fiona R James ◽  
Nicola Power ◽  
Shondipon Laha
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Intensive Care Units ◽  
Severity Of Illness ◽  
Patient Choice ◽  
Decision Making Process ◽  
Do Not Resuscitate ◽  
Admission Decisions

Decision-making by intensivists around accepting patients to intensive care units is a complex area, with often high-stakes, difficult, emotive decisions being made with limited patient information, high uncertainty about outcomes and extreme pressure to make these decisions quickly. This is exacerbated by a lack of clear guidelines to help guide this difficult decision-making process, with the onus largely relying on clinical experience and judgement. In addition to uncertainty compounding decision-making at the individual clinical level, it is further complicated at the multi-speciality level for the senior doctors and surgeons referring to intensive care units. This is a systematic review of the existing literature about this decision-making process and the factors that help guide these decisions on both sides of the intensive care unit admission dilemma. We found many studies exist assessing the patient factors correlated with intensive care unit admission decisions. Analysing these together suggests that factors consistently found to be correlated with a decision to admit or refuse a patient from intensive care unit are bed availability, severity of illness, initial ward or team referred from, patient choice, do not resuscitate status, age and functional baseline. Less research has been done on the decision-making process itself and the factors that are important to the accepting intensivists; however, similar themes are seen. Even less research exists on referral decision and demonstrates that in addition to the factors correlated with intensive care unit admission decisions, other wider variables are considered by the referring non-intensivists. No studies are available that investigate the decision-making process in referring non-intensivists or the mismatch of processes and pressure between the two sides of the intensive care unit referral dilemma.

scholarly journals Factors influencing Intensive Care Units nurses in end-of-life decisions

2015 ◽  
Vol 49 (4) ◽  
pp. 0572-0579 ◽  
Author(s):  
Michelle Freire Baliza ◽  
Regina Szylit Bousso ◽  
Kátia Poles ◽  
Maiara Rodrigues dos Santos ◽  
Lucía Silva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Cultural Context ◽  
Decision Making Process ◽  
Structured Interviews ◽  
End Of Life Decisions ◽  
Family Centered

OBJECTIVETo identify the factors that influence the Intensive Care Unit nurse in the decision-making process in end-of-life situations.METHODEthnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-structured interviews with 10 nurses.RESULTSThe inductive thematic analysis enabled us to identify four themes:The cultural context of the Intensive Care Unit: decision-making in situations of end-of-life; Beliefs and subjectivity of care in end-of-life situations; Professional experience and context characteristics of end-of-life care situations; and Humanization practices in end-of-life situations: the patient and family centered care.CONCLUSIONProfessional maturity, the ability to transmit information and the ability to negotiate are directly related to the inclusion of nurses in the decision-making process.

Nurses’ autonomy in end-of-life situations in intensive care units

2014 ◽  
Vol 22 (7) ◽  
pp. 803-814 ◽  
Author(s):  
Maria Cristina Paganini ◽  
Regina Szylit Bousso
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Intensive Care Units ◽  
Life Support ◽  
Qualitative Interviews ◽  
Daily Basis ◽  
Medical Council ◽  
Institutional Ethics

Background: The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses’ involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. Objective: To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Research design: Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Participants and research context: Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse’s experience in exercising autonomy relating to end-of-life decision-making. Ethical considerations: Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. Findings: The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Conclusion: Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process.

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