Abstract:
Background: Collaboration between nurses and physicians is
linked to positive outcomes for patients, especially in the
intensive care unit. However, effective collaboration poses
challenges because of traditional barriers such as sex and class
differences, hierarchical organizational structures in healthcare,
and physicians’ belief that they are the final arbiter of
clinical decisions.
Objective: To further analyze the results of an investigation on
how intensive care unit culture, expressed through everyday
practices, affected the care of patients who became confused.
Methods: A model of the types of knowledge (case, patient,
and person) used in clinical work was used to analyze the
breakdown in collaboration detected in the original study.
Results: Breakdown of collaboration occurred because of the
types of knowledge used by physicians and nurses. Certain
types of knowledge were privileged even when not applicable
to the clinical problem, whereas other types were dismissed
even when applicable.
Conclusion: Viewing collaboration through the conceptual
lens of knowledge use reveals new insights. Collaboration
broke down in the specific context of caring for patients with
confusion because the use of case knowledge, rather than
patient knowledge, was prominent in the intensive care unit
culture. (American Journal of Critical Care. 2007;16:470-478)
