Elsevier

Australian Critical Care

Volume 28, Issue 4, November 2015, Pages 235-237
Australian Critical Care

Article Critique
The concept of teamwork does not fully explain how interprofessional work occurs in intensive care

https://doi.org/10.1016/j.aucc.2015.07.002Get rights and content

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Research article for critique

Alexanian JA, Kitto S, Rak KJ, Reeves S. Beyond the team: understanding interprofessional work in two North American ICUs. Crit Care Med 2015. http://dx.doi.org/10.1097/CCM.0000000000001136.

Objective

The objective of this study was to examine how health professionals work together in intensive care units (ICUs) by considering the factors that impact on interprofessional collaboration.1

Design and setting

This study involved an ethnographic design of medical-surgical ICUs situated in two metropolitan teaching hospitals in Canada and the United States.

Research process

Medical anthropologists carried out observations with health professionals using a purposeful maximum variation sampling technique. Informal interviews were undertaken during observations in order to obtain additional clarification of what was observed. Semi-structured interviews were also conducted with health professionals. Researchers met weekly in analysing observational field notes and transcribed interviews. An analytic process of open coding was undertaken where categories were refined

Results

In total, 364 h of observation were obtained and 36 interviews were conducted. Participating discipline groups included intensivists, medical trainees, such as attendings and residents, nurses, and other health professionals, including respiratory therapists, physiotherapists, social workers, dietitians and pharmacists. Health professionals considered themselves as members of an ICU team who actively helped others and contributed beyond what was normally expected. The lead physician was

Conclusion

In the ICUs under investigation, interprofessional work did not function as a traditional form of teamwork. Instead, health professionals coordinated, which involved working in parallel on shared work; and they networked, which involved meeting virtually or in person on an ‘as needed’ basis. Collaboration, which involved active decision making about specific issues, tended to occur among medical staff only or with all health professionals during crisis situations. The dominance of the medical

Critique

Ineffective communication is inexorably linked to sentinel events, which are those events associated with considerable patient harm.2 In intensive care where patients require life-saving treatments and have a limited ability to be actively involved in decisions about their own care, effective interprofessional work between health professionals is expected. In Australia, hospitals and day procedure services are required to adhere to the National Safety and Quality Health Service (NSQHS)

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References (7)

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Cited by (7)

  • Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context

    2017, Australian Critical Care
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    This identified gap in education has been previously emphasised in other studies.17–20 Difficulties surrounding communication and decision making were highlighted as challenges when initiating and delivering EOL care,4,10,21 however there is currently limited guidance on how to manage communication at EOL amongst healthcare teams.11 A structured education program, individually tailored to nurses and physicians, should be developed to provide all clinicians who engage in EOL care discussions with appropriate knowledge and skills.

  • Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure

    2016, Social Science and Medicine
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    At a macro-level, culture (Hall, 2005) and discourse (Haddara and Lingard, 2013) have been shown to be in conflict with how IPC is understood and enacted through health policy, or where professional hierarchies and values find ways to subsist despite professional interaction (Paradis and Whitehead, 2015). At an organisational level, studies have illustrated the tensions inherent in interprofessional practice, such as when institutional rules conflict with public legislation (Lahey, 2012) or when scope of practice guidelines are unsuited for institutional systems (Khalili et al., 2014; Manias, 2015). At the individual level, studies have shown how role confusion in interprofessional collaboration leads to interpersonal and professional misunderstandings (Khalili et al., 2013; Rodriquez, 2015) and “incivilities” (Boateng and Adams, 2016).

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