The intensive care unit (ICU) is one of the most challenging and complex locations in a hospital environment. Patients admitted to the ICU are in critical condition, exhibiting a wide range of illnesses and traumas. Managing care in an ICU ward requires continuous coordinated and multidisciplinary care. There are multiple interprofessional collaborations and teams ongoing which include critical care nurses, advanced practice providers, physicians of various types, respiratory care, rehabilitation specialists, pharmacists, social workers, case managers, dietitians, and spiritual care providers, among other potential professionals that may be included on a case-by-case basis (Donovan et al., 2018). Each specialist in the context of interprofessional care provides unique expertise and perspective to the treatment, playing a key role in addressing the diverse needs of patients and their families. One aspect, that needs improvement among these interdisciplinary teams is professional communication, as many specialists do a competent job in their respective evaluations and treatment, but do not communicate thoroughly with the teams, relying on the nurses to maintain the chain of information. This paper will explore how the iCARE concept could improve interprofessional care in the ICU, particularly in the context of enhancing communication.
A nurse can incorporate compassion by promoting compassionate collaborative care (CCC) framework and emphasizing the values of compassion in interdisciplinary communication. CCC is a patient and family-centered approach to care that focuses on the values of empathy, sharing, and respect. However, in order to achieve these outcomes, it is necessary to practice closer communication and shared decision-making (Pfaff & Markaki, 2017). Nurses can implement the model by demonstrating a more compassionate and empathetic approach in the process of interdisciplinary treatment and collaboration, attempting to foster collective empathy and closeness in the attempt to provide the best patient-centered care. Through an emphasis on compassion for patients and families, practitioners can understand their needs better, and therefore form more effective collaborative treatments or support. By shifting towards CCC, the culture within an interdisciplinary team would become more personable and ‘warm’ as individuals are more likely to demonstrate openness and compassion with each other as well. ICARE in the ICU Relations
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Nurses have a unique perspective and responsibility to the patient, which may differ and conflict at times with physicians, surgeons, and other members of the interdisciplinary team who have slightly differing perspectives. For nurses, the key thematic responsibilities are supporting patient autonomy, protecting the patient (including from other practitioners), serving as the intermediary between the patient/family and the physician, and supporting the well-being of the patient. Meanwhile, physicians may have more direct objectives and responsibilities such as commitment to the survival of the patient and bearing personal responsibility for the outcome (Pecanac & Schwarze, 2016). This may undoubtedly create conflict in both approaches to treatment in the interprofessional collaboration and the communication of what may be best for the patient. It is the role of the nurse to advocate on behalf of the patient and their family on the best course of action, even if it goes against the perceptions of a physician. Other members of the interdisciplinary team may be less willing to consider elements of patient autonomy and desires, but a nurse is responsible for starting the dialogue on behalf of the patient, which is likely in heavy condition while in the ICU.
While early literature presented resilience as avoiding burnout, modern research demonstrates that resilience stems from the ability to adapt to professional roles and challenges, and actually thriving in such an environment. Some of the key characteristics of resilience are optimism, flexibility, tolerance, organizational skills, teamwork, upholding professional boundaries, and a strong sense of self-worth (Matheson et al., 2016). A nurse can enhance resilience in an interprofessional team by maintaining excellent communication, both informational in order for team members to remain prepared as well as emotional, ensuring that team members feel included and valued. Tight collaboration in a high-stress environment can strengthen resilience, as the culture of the multidisciplinary team will be more unified and responsive to change.
While collaborative care is vital in the ICU to ensure better outcomes, the environment is often complex, dynamic, and rapidly moving which decreases communication. However, findings in studies have determined that evidence-based practice is best implemented when there is cohesive and comprehensive coordination and communication among multidisciplinary teams. Nurses can contribute to this in two ways, by enhancing evidence-based practice communication by keeping track of all the interventions by different specialists and by communicating changes among team members, as well as by fostering a culture in the ICU teams with a shared mental approach. The key component of effective teamwork is having all the specialists on the same page and having a strong awareness regarding their own abilities and treatments as well as those of their team members (Costa et al., 2017).
ICU interprofessional teams collaborate in a complex and high-stress environment often fighting to preserve the lives of patients. iCARE components discussed in this paper are aimed at providing nursing action that can enhance and improve elements of interprofessional collaboration. The majority of aspects discussed focus on the importance of communication, and how it in various ways contributes to the effectiveness of the team in achieving the best outcomes, contributing to the well-being of the patient, or working more efficiently and evidence-based as a team. Employing the iCARE principles and interventions discussed in an ICU setting can beneficially impact the team collaboration and general environment towards a more positive, resilient, and communication-focused unit.
Costa, D., Iwashyna, T., Manojlovich, M., & Valley, T. (2017). All together now: Interprofessionally diverse ICU team participation facilitates effective complex care delivery, study shows. Web.
Donovan, A. L., Aldrich, J. M., Gross, A. K., Barchas, D. M., Thornton, K. C., Schell-Chaple, H. M., Gropper, M. A., & Lipshutz, A. K. M. (2018). Interprofessional care and teamwork in the ICU. Critical Care Medicine, 46(6), 980–990. Web.
Pecanac, K. E., & Schwarze, M. L. (2016). Conflict in the intensive care unit: Nursing advocacy and surgical agency. Nursing Ethics, 25(1), 69–79. Web.
Pfaff, K., & Markaki, A. (2017). Compassionate collaborative care: An integrative review of quality indicators in end-of-life care. BMC Palliative Care, 16(1). Web. ICARE in the ICU Relations