Canadian hospital nurses' roles in communication and decision-making about goals of care: An interpretive description of critical incidents.
Appl Nurs Res
; 40: 26-33, 2018 04.
Article
in En
| MEDLINE
| ID: mdl-29579495
ABSTRACT
BACKGROUND:
Nurses in acute medical units are uniquely positioned to support goals of care communication. Further understanding of nurse and physician perceptions about hospital nurses' actual and possible roles was required to improve goals of care communication.OBJECTIVE:
To critically examine nurse and physician perceptions of the nurse's role in communication with seriously ill patients and their families.DESIGN:
We focus on the qualitative component of a mixed method study. We employed an interpretive descriptive approach informed by Flanagan's critical incident technique. SETTINGS Participants were recruited from the acute medical units at three tertiary care hospitals in three Canadian provinces.PARTICIPANTS:
Thirty participants provided interviews (10 from each site) 12 nurses, 9 staff physicians and 9 medical resident physicians.METHODS:
Participants' described "critical incidents" they considered as "excellent" or "poor" or "usual" practice. Interviews, were audiotaped and transcribed. Team-based analysis used constant comparison and triangulation to identify healthcare team members' roles in goals of care communication.RESULTS:
We identified two major themes from 120 critical incidents 1) the ambiguous nature of the nurse's role in formal, physician-led, decision-making communication, and 2) embedded in care serious illness communication. Physicians understood nurses' supportive role in relation to their own communication practices that culminated in decisions about care; nurses' reported their roles were determined by unit routines, physician practices and preferences, and their self-confidence in supporting decision-making. Nurses described their unique role in facilitating informal and spontaneous communication with patients and families that was critical background work to physician-led goals of care communication.CONCLUSIONS:
Nurses and physicians had different understandings, practices and beliefs about goals of care communication The value of nurses embedded in care work is key to supporting the interprofessional team's work during formal goals of care communication.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Patient Care Planning
/
Physicians
/
Communication
/
Medical Errors
/
Nurse's Role
/
Decision Making
/
Nursing Staff, Hospital
Type of study:
Qualitative_research
Limits:
Adult
/
Female
/
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
Appl Nurs Res
Journal subject:
ENFERMAGEM
Year:
2018
Document type:
Article