Intensive care unit cultures and end-of-life decision making

Judith Baggs, Sally A. Norton, Madeline H. Schmitt, Mary T. Dombeck, Craig R. Sellers, Jill R. Quinn

    Research output: Contribution to journalArticle

    51 Citations (Scopus)

    Abstract

    Purpose: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time and to evaluate similarities and differences in the cultural contexts of 4 ICUs and the relationship of those contexts to EOLDM. Materials and Methods: Ethnographic field work took place in 4 adult ICUs in a tertiary care hospital. Participants were health care providers (eg, physicians, nurses, and social workers), patients, and their family members. Participant observation and interviews took place 5 days a week for 7 months in each unit. Results: The ICUs were not monolithic. There were similarities, but important differences in EOLDM were identified in formal and informal rules, meaning and uses of technology, physician roles and relationships, processes such as unit rounds, and timing of initiation of EOLDM. Conclusions: As interventions to improve EOLDM are developed, it will be important to understand how they may interact with unit cultures. Attempting to develop one intervention to be used in all ICUs is unlikely to be successful.

    Original languageEnglish (US)
    Pages (from-to)159-168
    Number of pages10
    JournalJournal of Critical Care
    Volume22
    Issue number2
    DOIs
    StatePublished - Jun 2007

    Fingerprint

    Intensive Care Units
    Decision Making
    Physician's Role
    Tertiary Healthcare
    Research
    Tertiary Care Centers
    Workplace
    Health Personnel
    Nurses
    Research Personnel
    Observation
    Interviews
    Technology
    Physicians

    Keywords

    • Critical care
    • Critical illness
    • Decision-making
    • Ethnography
    • Intensive care (units)
    • Palliative care
    • Professional-family relations
    • Terminal care
    • Withholding treatment

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

    Cite this

    Baggs, J., Norton, S. A., Schmitt, M. H., Dombeck, M. T., Sellers, C. R., & Quinn, J. R. (2007). Intensive care unit cultures and end-of-life decision making. Journal of Critical Care, 22(2), 159-168. https://doi.org/10.1016/j.jcrc.2006.09.008

    Intensive care unit cultures and end-of-life decision making. / Baggs, Judith; Norton, Sally A.; Schmitt, Madeline H.; Dombeck, Mary T.; Sellers, Craig R.; Quinn, Jill R.

    In: Journal of Critical Care, Vol. 22, No. 2, 06.2007, p. 159-168.

    Research output: Contribution to journalArticle

    Baggs, J, Norton, SA, Schmitt, MH, Dombeck, MT, Sellers, CR & Quinn, JR 2007, 'Intensive care unit cultures and end-of-life decision making', Journal of Critical Care, vol. 22, no. 2, pp. 159-168. https://doi.org/10.1016/j.jcrc.2006.09.008
    Baggs, Judith ; Norton, Sally A. ; Schmitt, Madeline H. ; Dombeck, Mary T. ; Sellers, Craig R. ; Quinn, Jill R. / Intensive care unit cultures and end-of-life decision making. In: Journal of Critical Care. 2007 ; Vol. 22, No. 2. pp. 159-168.
    @article{cfef04d3223f47db8f2e189bf480faba,
    title = "Intensive care unit cultures and end-of-life decision making",
    abstract = "Purpose: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time and to evaluate similarities and differences in the cultural contexts of 4 ICUs and the relationship of those contexts to EOLDM. Materials and Methods: Ethnographic field work took place in 4 adult ICUs in a tertiary care hospital. Participants were health care providers (eg, physicians, nurses, and social workers), patients, and their family members. Participant observation and interviews took place 5 days a week for 7 months in each unit. Results: The ICUs were not monolithic. There were similarities, but important differences in EOLDM were identified in formal and informal rules, meaning and uses of technology, physician roles and relationships, processes such as unit rounds, and timing of initiation of EOLDM. Conclusions: As interventions to improve EOLDM are developed, it will be important to understand how they may interact with unit cultures. Attempting to develop one intervention to be used in all ICUs is unlikely to be successful.",
    keywords = "Critical care, Critical illness, Decision-making, Ethnography, Intensive care (units), Palliative care, Professional-family relations, Terminal care, Withholding treatment",
    author = "Judith Baggs and Norton, {Sally A.} and Schmitt, {Madeline H.} and Dombeck, {Mary T.} and Sellers, {Craig R.} and Quinn, {Jill R.}",
    year = "2007",
    month = "6",
    doi = "10.1016/j.jcrc.2006.09.008",
    language = "English (US)",
    volume = "22",
    pages = "159--168",
    journal = "Journal of Critical Care",
    issn = "0883-9441",
    publisher = "Elsevier BV",
    number = "2",

    }

    TY - JOUR

    T1 - Intensive care unit cultures and end-of-life decision making

    AU - Baggs, Judith

    AU - Norton, Sally A.

    AU - Schmitt, Madeline H.

    AU - Dombeck, Mary T.

    AU - Sellers, Craig R.

    AU - Quinn, Jill R.

    PY - 2007/6

    Y1 - 2007/6

    N2 - Purpose: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time and to evaluate similarities and differences in the cultural contexts of 4 ICUs and the relationship of those contexts to EOLDM. Materials and Methods: Ethnographic field work took place in 4 adult ICUs in a tertiary care hospital. Participants were health care providers (eg, physicians, nurses, and social workers), patients, and their family members. Participant observation and interviews took place 5 days a week for 7 months in each unit. Results: The ICUs were not monolithic. There were similarities, but important differences in EOLDM were identified in formal and informal rules, meaning and uses of technology, physician roles and relationships, processes such as unit rounds, and timing of initiation of EOLDM. Conclusions: As interventions to improve EOLDM are developed, it will be important to understand how they may interact with unit cultures. Attempting to develop one intervention to be used in all ICUs is unlikely to be successful.

    AB - Purpose: Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time and to evaluate similarities and differences in the cultural contexts of 4 ICUs and the relationship of those contexts to EOLDM. Materials and Methods: Ethnographic field work took place in 4 adult ICUs in a tertiary care hospital. Participants were health care providers (eg, physicians, nurses, and social workers), patients, and their family members. Participant observation and interviews took place 5 days a week for 7 months in each unit. Results: The ICUs were not monolithic. There were similarities, but important differences in EOLDM were identified in formal and informal rules, meaning and uses of technology, physician roles and relationships, processes such as unit rounds, and timing of initiation of EOLDM. Conclusions: As interventions to improve EOLDM are developed, it will be important to understand how they may interact with unit cultures. Attempting to develop one intervention to be used in all ICUs is unlikely to be successful.

    KW - Critical care

    KW - Critical illness

    KW - Decision-making

    KW - Ethnography

    KW - Intensive care (units)

    KW - Palliative care

    KW - Professional-family relations

    KW - Terminal care

    KW - Withholding treatment

    UR - http://www.scopus.com/inward/record.url?scp=34249683284&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=34249683284&partnerID=8YFLogxK

    U2 - 10.1016/j.jcrc.2006.09.008

    DO - 10.1016/j.jcrc.2006.09.008

    M3 - Article

    VL - 22

    SP - 159

    EP - 168

    JO - Journal of Critical Care

    JF - Journal of Critical Care

    SN - 0883-9441

    IS - 2

    ER -