How do intensive care unit (ICU) nurses interact with physicians to facilitate discussion of patients' preferences about resuscitation

The contextual essay explores two of the predominate concerns relating to nurses' roles in hospitals in the United States during the twentieth century. The first: are nurses merely intelligent machines gathering data about patients or are they capable of critical thought and independent action? The second: how do nurses and physicians communicate about patient concerns especially in crisis situations? These recurring, unresolved issues often resulted in either nurse-physician conflict or interdisciplinary collaboration.; The research study explores one source of nurse-physician conflict during the past thirty years, the use of cardiopulmonary resuscitation (CPR) at the end of life. This study is a grounded theory exploration of the process that Intensive Care Unit (ICU) nurses utilize to learn patient preferences about CPR, facilitate discussion of these preferences with physicians and family, and decide about appropriate end-of-life care. Fifteen experienced ICU nurses were interviewed; the interviews were tape recorded and later analyzed.; Grounded theory, as described by Glaser, a method of continuous comparison was used to guide data analysis. Analysis revealed a core variable, developing awareness that the patient is a person who may be dying, and a three stage process describing how nurses facilitate the discussion of patients' preferences about resuscitation. The stages in the process were: seeing the patient as a person, developing a consensus that the person is probably dying, and reaching a decision about end of life care.; The ICU nurses in this study served as patient advocates, attempting to avoid conflict and striving to work collaboratively to assure that their patients' wishes about end-of-life care were respected. They did far more than merely report the data they had collected to the physicians. They critically analyzed patient situations, facilitated discussion with physicians of their patients' concerns about resuscitation, and communicated, often in crisis situations, with other decision makers to determine and deliver appropriate end-of-life care to their patients.