Negotiated Ventilation: Conceptualising Interprofessional Decision Work in Intensive Care-An Ethnographic Study

Area of Science:

• Critical Care Medicine
• Healthcare Management
• Interprofessional Collaboration

Background:

• Decision-making in intensive care units (ICUs) is often viewed as discrete events.
• Understanding ventilation-related decisions as continuous interprofessional work is crucial for optimizing patient care.

Purpose of the Study:

• To conceptualize ventilation-related decision-making as an ongoing, interprofessional work process in intensive care.
• To move beyond traditional models that treat decision-making as isolated events.

Main Methods:

• Ethnographic study involving 97 hours of participant observation.
• 17 episodic interviews with nurses (n=12) and physicians (n=5) in two German university hospital ICUs.
• Iterative data collection and analysis (December 2023 - July 2025) using the Qualitative Analysis Guide of Leuven.

Main Results:

• Decision-making is an ongoing, socially organized process across the patient's illness trajectory.
• Four domains of decision work identified: orienting, involving, negotiating, and implementing.
• Key findings include the temporal organization of decision work, the role of involving in participation, the significance of non-negotiation, and implementing as a relational dimension.

Conclusions:

• Viewing ventilation decisions as interprofessional decision work highlights continuous accomplishment rather than discrete choices.
• This perspective reveals how distributed, practice-based contributions shape decisions, with nurses playing a central role in implementing and adjustment.
• The conceptualization supports recognizing nursing contributions in interprofessional collaboration and may inform organizing decision-making in complex care settings.