Patient involvement in micro-decisions in intensive care
Marte Marie Wallander Karlsen, Mary Beth Happ, Arnstein Finset, Kristin Heggdal, Lena Günterberg Heyn
Abstract
OBJECTIVE: The objective of this study was to explore how bedside micro-decisions were made between conscious patients on mechanical ventilation in intensive care and their healthcare providers. METHODS: Using video recordings to collect data, we explored micro-decisions between 10 mechanically ventilated patients and 60 providers in interactions at the bedside. We first identified the types of micro-decisions before using an interpretative approach to analyze the decision-making processes and create prominent themes. RESULTS: We identified six types of bedside micro-decisions; non-invited, substituted, guided, invited, shared and self-determined decisions. Three themes were identified in the decision-making processes: 1) being an observer versus a participant in treatment and care, 2) negotiating decisions about individualized care (such as tracheal suctioning or medication),and 3) balancing empowering activities with the need for energy restoration. CONCLUSION: This study revealed that bedside decision-making processes in intensive care were characterized by a high degree of variability between and within patients. Communication barriers influenced patients' ability to express their preferences. An increased understanding of how micro-decisions occur with non-vocal patients is needed to strengthen patient participation. PRACTICE IMPLICATIONS: We advise providers to make an effort to solicit patients' preferences when caring for critically ill patients.