Collaboration between nurses and doctors in the decision-making process when considering ending the life-prolonging treatment of intensive care patients

AIMS

The aim of the study was to explore intensive care nurses' collaboration with doctors' when considering ending the life-prolonging treatment of patients in the intensive care unit.

DESIGN

A qualitative method with an explorative descriptive design was employed.

METHODS

Data were collected through semi-structured interviews with four intensive care nurses and four doctors working in three intensive care units at two university hospitals and one local hospital. The data were analysed using systematic text condensation. This study was reported according to the consolidated criteria for reporting qualitative research checklist.

RESULTS

Two categories were identified in the data analysis: listening to each other during the decision-making process and continuity and having time to facilitate regular discussions of prognosis and treatment plans.

How do nurses and physicians assess inter-professional collaboration in long-term care homes? A survey study

Aims

To assess inter‐professional collaboration between nurses and physicians in long‐term care facilities and to determine if there are differences between subgroups of nurses.

Design

A cross‐sectional questionnaire survey was carried out between January 2018 and January 2020.

Methods

408 health professionals (345 nurses, 63 physicians) from 37 nursing homes in Baden‐Wuerttemberg (Germany) participated in the survey. For data collection, the “Team‐Scale” and “Work Situation Questionnaire for nurses/physicians” instruments were used. Furthermore, five self‐generated items were employed assessing how ward rounds and documentation are implemented. For the evaluation, descriptive analyses, one‐way variance analyses (ANOVAs) and a multilevel analysis were performed.

Results

Inter‐professional teamwork was rated positively overall. However, the nursing staff usually gave more critical assessments than the physicians (for example, regarding mutual appreciation). Critical assessments could be used to initiate constructive change processes.

Nurses' integrity and coping strategies: An integrative review

INTRODUCTION

Integrity is one of the core values in nursing that needs to be maintained by nurses in practice. However, the complexity in the nursing milieu can pose threats to integrity. An understanding of the common threats and coping strategies might assist nurses in preserving integrity in everyday practice.

AIMS AND OBJECTIVES

To review and synthesis the concept of integrity in nursing and identify common threats and coping strategies.

METHODS

Whittemore and Knafl's integrative review method was implemented. A search was performed in Scopus, Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Proquest Health and Medical electronic databases published in English between 2000-2017. Two reviewers independently assessed eligibility for inclusion. Methodological appropriateness for the included studies was assessed using the critical appraisal skills programme. The constant comparative method of grounded theory was used to analyse and synthesise data from seven peer-reviewed articles.

RESULTS

Two major conceptions of integrity were identified. These included the sense of wholeness with regard to personal-professional concerns and ethical-moral conducts. Five entities, self, patients, teamwork and work culture, the nature of work, and organisation, were identified as interweaving elements that may induce threats to integrity. When integrity is threatened, nurses use two key strategies to survive: adjusting and compensating. An emergent framework to facilitate understanding of nurses' threats to integrity is discussed.

CONCLUSIONS

A threat to nurses' integrity takes form when there is an unmitigated gap between a nurse's expectation and reality. While the expectation comes from within the nurse, the reality materialises out of the complex interplays that occur in the healthcare workforce. Maintaining integrity demands a continual strive to balance personal expectations, professional concerns and nursing realities.

Professional responsibility and decision-making in the context of a disease-focused model of nursing care: The difficulties experienced by Spanish nurses

When, in 1977, nurse education in Spain was transferred to universities a more patient-centred, the Anglo-American philosophy of care was introduced into a context in which nurses had traditionally prioritised their technical skills. This paper examines the characteristics of the nurse's professional role in Spain, where the model of nursing practice has historically placed them in a position akin to that of physician assistants. The study design was qualitative and used the method of analytic induction. Participants were selected by means of theoretical sampling and then underwent in-depth interviews. The resulting material was analysed using an approach based on the principles of grounded theory. Strategies were applied to ensure the credibility, transferability, dependability and confirmability of the findings. The main conclusion is that nurses in Spain continue to work within a disease-focused model of care, making it difficult for them to take responsibility for decision-making.