title: Intensive care unit cultures and end-of-life decision making.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: School of Nursing, Oregon Health and Science University, Portland, OR 97239-2941, USA. baggsj@ohsu.edu
authors.forename: Judith Gedney
authors.initials: JG
authors.lastname: Baggs
authors.forename: Sally A
authors.initials: SA
authors.lastname: Norton
authors.forename: Madeline H
authors.initials: MH
authors.lastname: Schmitt
authors.forename: Mary T
authors.initials: MT
authors.lastname: Dombeck
authors.forename: Craig R
authors.initials: CR
authors.lastname: Sellers
authors.forename: Jill R
authors.initials: JR
authors.lastname: Quinn
mesh_terms: D000328:Adult; D000884:Anthropology, Cultural; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008020:Life Support Care; D008873:Mid-Atlantic Region; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D010819:Physician's Role; D011368:Professional-Family Relations; D011446:Prospective Studies; D016414:Resuscitation Orders; D013727:Terminal Care / Q000458:organization & administration; D013997:Time Factors; D028761:Withholding Treatment