Intensive care unit cultures and end-of-life decision making.
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.
Baggs
Judith Gedney
JG
School of Nursing, Oregon Health and Science University, Portland, OR 97239-2941, USA. baggsj@ohsu.edu
Norton
Sally A
SA
Schmitt
Madeline H
MH
Dombeck
Mary T
MT
Sellers
Craig R
CR
Quinn
Jill R
JR
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