title: Conflict in the intensive care unit: Nursing advocacy and surgical agency.
abstract: BACKGROUND
  Nurses and surgeons may experience intra-team conflict during decision making about the use of postoperative life-sustaining treatment in the intensive care unit due to their perceptions of professional roles and responsibilities. Nurses have a sense of advocacy-a responsibility to support the patient's best interest; surgeons have a sense of agency-a responsibility to keep the patient alive.
  
  
  OBJECTIVE
  The objectives were to (1) describe the discourse surrounding the responsibilities of nurses and surgeons, as "advocates" and "agents," and (2) apply these findings to determine how differences in role responsibilities could foster conflict during decision making about postoperative life-sustaining treatment in the intensive care unit.
  
  
  METHODS
  Articles, books, and professional documents were explored to obtain descriptions of nurses' and surgeons' responsibilities to their patients. Using discourse analysis, responsibilities were grouped into themes and then compared for potential for conflict. Ethical considerations: No data were collected from human participants and ethical review was not required. The texts were analyzed by a surgeon and a nurse to minimize profession-centric biases.
  
  
  RESULTS
  Four themes in nursing discourse were identified: responsibility to support patient autonomy regarding treatment decisions, responsibility to protect the patient from the physician, responsibility to act as an intermediary between the physician and the patient, and the responsibility to support the well-being of the patient. Three themes in surgery discourse were identified personal responsibility for the patient's outcome, commitment to patient survival, and the responsibility to prevent harm to the patient from surgery.
  
  
  CONCLUSIONS
  These responsibilities may contribute to conflict because each profession is working toward different goals and each believes they know what is best for the patient. It is not clear from the existing literature that either profession understands each other's responsibilities.
  
  
  CONCLUSIONS
  Interventions that improve understanding of each profession's responsibilities may be helpful to reduce intra-team conflict in the intensive care unit.
authors.affiliation: University of Wisconsin-Madison, USA.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Pecanac
authors.affiliation: University of Wisconsin-Madison, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Schwarze
mesh_terms: D003220:Conflict, Psychological; D006801:Humans; D007362:Intensive Care Units; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D010344:Patient Advocacy; D010348:Patient Care Team / Q000458:organization & administration; D010819:Physician's Role; D019555:Physician-Nurse Relations; D066231:Surgeons / Q000523:psychology*
keywords: Advocacy; agency; areas of practice; conflict; decision making; end-of-life issues; intensive care; interdisciplinary communication; surgery; topic areas