Managing daily intensive care activities: An observational study concerning ad hoc decision making of charge nurses and intensivists

نویسندگان

  • Heljä Lundgrén-Laine
  • Elina Kontio
  • Juha Perttilä
  • Heikki Korvenranta
  • Jari Forsström
  • Sanna Salanterä
چکیده

INTRODUCTION Management of daily activities in ICUs is challenging. ICU shift leaders, charge nurses and intensivists have to make several immediate ad hoc decisions to enable the fluent flow of ICU activities. Even though the management of ICU activities is quite well delineated by international consensus guidelines, we know only a little about the content of the real clinical decision making of ICU shift leaders. METHODS We conducted an observational study with the think-aloud technique to describe the ad hoc decision making of ICU shift leaders. The study was performed in two university-affiliated hospital ICUs. Twelve charge nurses and eight intensivists were recruited. Observations were recorded and transcribed for qualitative content analysis using the protocol analysis method. The software program NVivo 7 was used to manage the data. The interrater agreement was assessed with percentages and by Cohen's κ. RESULTS We identified 463 ad hoc decisions made by the charge nurses and 444 made by the intensivists. During our data collection time, this breaks down to over 230 immediately made decisions per day (24 hours). We divided the ad hoc decision making of ICU shift leaders into two types: process-focused and situation-focused. Process-focused decision making included more permanent information, such as human resources, know-how and material resources, whereas situation-focused decision making included decisions about single events, such as patient admission. We named eight different categories for ICU ad hoc decision making: (1) adverse events, (2) diagnostics, (3) human resources and know-how, (4) material resources, (5) patient admission, (6) patient discharge, (7) patient information and vital signs and (8) special treatments. CONCLUSIONS ICU shift leaders make a great number of complex ad hoc decisions throughout the day. Often this decision making involves both intensivists and charge nurses. It forms a bundle that requires versatile, immediate information for a successful outcome. In the future, we need to investigate which information is crucial for ad hoc decision making. These challenges should also be emphasised when information technology programs for ICU care management are developed.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Immediate Decision-making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the decision making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decis...

متن کامل

National survey focusing on the crucial information needs of intensive care charge nurses and intensivists: same goal, different demands

BACKGROUND Although information technology adequately supports clinical care in many intensive care units (ICUs), it provides much poorer support for the managerial information needed to coordinate multi-professional care. To gain a general view of the most crucial multi-professional information needs of ICU shift leaders a national survey was conducted, focusing on the information needs of cha...

متن کامل

Evaluation of the effect of SBAR-based patient safety training program on nurses’ clinical decision-making in the intensive care unit

Background and Aim: ICU is one of the vital departments in the hospital to reduce mortality and morbidity. The department where nurses face complex situations that require decision-making skills. In fact, problem solving is an important and complex issue clinical practice, and decision-making is an important indicator. The purpose of the study was to investigate the effect of SBAR-based patient...

متن کامل

Guidelines for withholding and withdrawing therapy in the ICU: impact on decision-making process and interdisciplinary collaboration

INTRODUCTION Interdisciplinary collaboration in end-of-life decision-making is challenging. Guidelines developed within the interdisciplinary team may help to clarify, describe, and obtain consensus on standards for end-of-life decision-making and care. The aim of the study was to develop, implement, and evaluate guidelines for withholding and withdrawing therapy in the intensive care unit. M...

متن کامل

Measuring the Value of Remote Intensive Care Unit Monitoring

Patients in adult intensive care units (ICUs) require close monitoring, frequent invasive procedures, multiple medications, complicated decisionmaking processes, and multidisciplinary care. This complex care coupled with inadequate nurse-patient ratios, provider fatigue, on-the-job training, and poor communication can result in substantial morbidity, mortality, and costs. A powerful influence o...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:

دوره 15  شماره 

صفحات  -

تاریخ انتشار 2011