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AACN Excellence in Research
Judith Gedney Baggs, PhD, RN, FAAN
Oregon Health and Science University School of Nursing, Portland, OR
As an ICU staff nurse, I have observed that decisions and their interactions are better when nurses and physicians work together. As a beginning researcher, I studied collaboration between MICU nurses and physicians in making decisions to transfer patients from the ICU, remembering that Kathy Dracup had said physicians should make ICU admission decisions, nurses should decide about transfers out. The more collaboration nurses reported, the less likely patients were to die or be readmitted to the ICU, and both nurses and residents were more satisfied with their work. Satisfaction influenced nurse retention.
With AACN funding, I studied nurse-physician collaboration in making decisions about the level of aggressiveness of care for MICU patients. Although both believed patients should be involved in decision making, they also believed that patients often were not involved.
I studied the transfer decision in three ICUs (MICU, SICU, combined medical-surgical ICU). Nurses’ reports of collaboration predicted better patient outcomes in the MICU, where the patients were more complex and sicker. Units’ rank on structures supporting collaboration corresponded to their rank in better outcomes.
I combined an interest in end-of-life decision making (EOLDM) with my focus on collaboration, expanding collaboration to include patients and families. I conducted a four-year study of culture related to EOLDM in four adult ICUs. Each unit was distinctive in aspects such as timing of involvement of families in EOLDM during a patient’s illness, use of technology and roles and relationships of healthcare providers.
In the current healthcare climate, where care is integrated, improving implementation of collaborative care is crucial. Collaboration improves quality of care for the most complex critically ill. Preventing readmissions can save costs related to premature transfers. Findings from the ethnographic study will identify barriers and facilitators for good EOLDM and encourage intervention researchers to individualize interventions for each unit.
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