Interventions to Improve Surrogate Decision Making in ICUs
Interventions to Improve Surrogate Decision Making in ICUs
Many aspects of care for critically ill patients that were once managed exclusively by physicians are now collaboratively managed by clinicians from several disciplines. However, most of the responsibility remains with physicians to help surrogate decision makers deliberate about goals of care for patients with advanced critical illness. This is rational if decision making is conceptualized as a purely cognitive process requiring only physicians' technical biomedical knowledge. However, this narrow conceptualization is at odds with the reality that surrogate decision making is also an emotional and moral endeavor.
Moreover, the simple goal of ensuring timely, consistent communication in intensive care units (ICUs) is an organizational challenge. When conceptualized in this way, the importance of multidisciplinary collaboration is clear—no single individual has sufficient skills and time to attend to the diverse challenges that surrogates face in ICUs. In this article, I present a multidimensional framework of the barriers to high quality surrogate decision making in ICUs and present 5 ways that clinical nurses could be more explicitly incorporated into interventions to improve surrogate decision making in ICUs.
Abstract and Introduction
Introduction
Many aspects of care for critically ill patients that were once managed exclusively by physicians are now collaboratively managed by clinicians from several disciplines. However, most of the responsibility remains with physicians to help surrogate decision makers deliberate about goals of care for patients with advanced critical illness. This is rational if decision making is conceptualized as a purely cognitive process requiring only physicians' technical biomedical knowledge. However, this narrow conceptualization is at odds with the reality that surrogate decision making is also an emotional and moral endeavor.
Moreover, the simple goal of ensuring timely, consistent communication in intensive care units (ICUs) is an organizational challenge. When conceptualized in this way, the importance of multidisciplinary collaboration is clear—no single individual has sufficient skills and time to attend to the diverse challenges that surrogates face in ICUs. In this article, I present a multidimensional framework of the barriers to high quality surrogate decision making in ICUs and present 5 ways that clinical nurses could be more explicitly incorporated into interventions to improve surrogate decision making in ICUs.
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