title: Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study.
abstract: OBJECTIVE
  To develop a model to describe ICU interprofessional shared clinical decision making and the factors associated with its implementation.
  
  
  METHODS
  Ethnographic (observations and interviews) and survey designs.
  
  
  METHODS
  Three ICUs (two in Israel and one in the United States).
  
  
  METHODS
  A convenience sample of nurses and physicians.
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: 1Faculty of Medicine, Hadassah Hebrew University School of Nursing, Jerusalem, Israel. 2Division of Pulmonary and Critical Care Medicine, Cambia Palliative Care Center of Excellence, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA. 3Department of Psychiatry and Behavioral Sciences, Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations and Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Freda
authors.initials: F
authors.lastname: DeKeyser Ganz
authors.forename: Ruth
authors.initials: R
authors.lastname: Engelberg
authors.forename: Nicole
authors.initials: N
authors.lastname: Torres
authors.forename: Jared Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D003299:Cooperative Behavior; D005260:Female; D066296:Grounded Theory; D006801:Humans; D033181:Information Dissemination; D007362:Intensive Care Units / Q000458:organization & administration*; D007407:Interviews as Topic; D007557:Israel; D008297:Male; D017146:Models, Organizational; D019555:Physician-Nurse Relations; D014481:United States