Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study.

OBJECTIVES

To develop a model to describe ICU interprofessional shared clinical decision making and the factors associated with its implementation.

DESIGN

Ethnographic (observations and interviews) and survey designs.

SETTING

Three ICUs (two in Israel and one in the United States).

SUBJECTS

A convenience sample of nurses and physicians.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Observations and interviews were analyzed using ethnographic and grounded theory methodologies. Questionnaires included a demographic information sheet and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. From observations and interviews, we developed a conceptual model of the process of shared clinical decision making that involves four stepped levels, proceeding from the lowest to the highest levels of collaboration: individual decision, information exchange, deliberation, and shared decision. This process is influenced by individual, dyadic, and system factors. Most decisions were made at the lower two levels. Levels of perceived collaboration were moderate with no statistically significant differences between physicians and nurses or between units.

CONCLUSIONS

Both qualitative and quantitative data corroborated that physicians and nurses from all units were similarly and moderately satisfied with their level of collaboration and shared decision making. However, most ICU clinical decision making continues to take place independently, where there is some sharing of information but rarely are decisions made collectively. System factors, such as interdisciplinary rounds and unit culture, seem to have a strong impact on this process. This study provides a model for further study and improvement of interprofessional shared decision making.