Article CritiqueThe concept of teamwork does not fully explain how interprofessional work occurs in intensive care
Section snippets
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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