Patient involvement in micro-decisions in intensive care

Area of Science:

• Critical Care Medicine
• Patient-Provider Communication
• Decision-Making Processes

Background:

• Intensive care settings involve complex communication dynamics.
• Mechanically ventilated patients often face challenges in expressing preferences.
• Bedside micro-decisions significantly impact patient care and experience.

Purpose of the Study:

• To explore the nature of micro-decisions made at the bedside between conscious, mechanically ventilated patients and healthcare providers.
• To identify types of micro-decisions and analyze the underlying decision-making processes.

Main Methods:

• Video recordings of bedside interactions were used for data collection.
• 10 mechanically ventilated patients and 60 healthcare providers participated.
• An interpretative approach was employed to analyze decision-making themes.

Main Results:

• Six types of micro-decisions were identified: non-invited, substituted, guided, invited, shared, and self-determined.
• Key themes included observer vs. participant roles, negotiating individualized care, and balancing empowerment with energy restoration.
• Decision-making processes showed high variability.

Conclusions:

• Bedside decision-making in intensive care is highly variable.
• Communication barriers impede patients' ability to express preferences.
• Further understanding of micro-decisions with non-vocal patients is needed to improve patient participation.