title: Obstacles to Shared Expectations in a Burn Intensive Care Unit.
abstract: Critical care patients are dependent on the health care team and their family members to effect care goals that are consistent with their core values and wishes. This study aimed to identify and understand how obstacles to communication affect these two disparate groups. Ten burn intensive care unit (BICU) care team and 20 family members participated in in-depth semistructured interviews. A two-cycle coding, inductive analytical approach was used to derive three obstacle metathemes: family engagement, information exchange, and process transparency and standardization. However, care team and family members' themes within each metatheme were different. Although the thematic structure was derived inductively, our findings in retrospect appeared to be consistent with Law's four resistances associated with actor-networks. From this perspective, actor-network theory provides a plausible explanation for perceived obstacles and may, in the future, guide the development of interventions to improve shared agency across networks.
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Fanning
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Farkas
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Paula M
authors.initials: PM
authors.lastname: DeWitt
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Tinsley H G
authors.initials: THG
authors.lastname: Webster
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: John
authors.initials: J
authors.lastname: Burnam
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Piras
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schenck
authors.affiliation: 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Miller
mesh_terms: D001291:Attitude of Health Personnel; D002056:Burns / Q000628:therapy*; D003142:Communication; D003422:Critical Care / Q000458:organization & administration; D003657:Decision Making; D005190:Family / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007407:Interviews as Topic; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D010348:Patient Care Team / Q000458:organization & administration*; D011368:Professional-Family Relations; D013727:Terminal Care / Q000458:organization & administration
keywords: bereavement / grief; communication; decision making; end of life issues; exploratory methods; qualitative; southern United States