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Negotiated Ventilation: Conceptualising Interprofessional Decision Work in Intensive Care-An Ethnographic Study
Andreas Küpper1,2, Marcel Schmucker1,2, Laura Hahn2
1Institute for Health Care and Nursing Sciences, Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen, Germany.
Aim:
To conceptualise how ventilation-related decisions are accomplished as interprofessional work in intensive care practice, moving beyond approaches that treat decision-making as discrete events.
Design:
Ethnography.
Methods:
Data were generated through 97 h of participant observation and 17 episodic interviews with nurses (n = 12) and physicians (n = 5) in two adult intensive care units of a German university hospital. Data collection and analysis proceeded iteratively between December 2023 and July 2025. Analysis was guided by the Qualitative Analysis Guide of Leuven.
Results/Findings:
Decision-making was found to be an ongoing, socially organised form of work unfolding across the patient's illness trajectory. The analysis differentiates between directional and adjustment decisions and identifies four interrelated domains of decision work: orienting, involving, negotiating and implementing. The findings highlight (1) the temporal and iterative organisation of decision work, (2) involving in organising participation and access to influence, (3) the significance of non-negotiation practices in stabilising decisions and (4) implementing as a constitutive and relational dimension through which decisions are enacted in practice.
Conclusions:
Viewing ventilation-related decision-making as interprofessional decision work shifts attention from discrete choices to the ongoing accomplishment of decisions in practice. This perspective makes visible how decision-making is shaped through distributed and practice-based contributions, with nurses playing a central role, particularly through implementing and adjustment work that remains underrepresented in cognitive models of decision-making.
Implications:
The conceptualisation of ventilation-related decision work supports more explicit recognition of nursing contributions in interprofessional collaboration, particularly in shaping decisions through adjustment and implementing practices and may inform approaches to organising decision-making in complex care settings.
Reporting Method:
This study was reported in accordance with the Standards for Reporting Qualitative Research (SRQR).
Patient Or Public Contribution:
This study did not include patient or public involvement in its design, conduct, or reporting.
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