Interprofessional ward rounds in an adult intensive care unit: an appreciative inquiry into the central collaboration between the consultant and the bedside nurse

ABSTRACT

Done well, ward rounds (WRs) promote effective, safe care and collaboration; but WR quality varies. An improvement-focused appreciative inquiry (AI) into a large intensive care unit’s WR practices identified a pivotal axis of collaboration between the most senior medical role (the consultant) and the bedside nurse (BSN). This paper examines that axis of interprofessional collaboration (IPC) to deepen understanding of its implications. Data included ethnographic observations, interviews, and co-constructed AI with groups of staff. Four key concepts emerged from cyclical interpretive analysis: “need,” “presence,” “ability” and “willingness.” BSNs and consultants needed the interprofessional WR to enable their work; WR effectiveness was affected by whether they were both present, then able and willing to participate in IPC. BSN presence was necessary for effective and efficient IPC between these key roles. Indirect contributions, based on prior exchanges with colleagues or through written notes, reduced the joint problem-solving through discussion and negotiation that characterizes IPC to less efficient asynchronous interprofessional coordination. Factors affecting “presence,” “ability” and “willingness” are discussed alongside potential mitigations and acknowledgment of asymmetric power. Appreciative examination of interprofessional WRs identified mechanisms supporting and undermining effective WR IPC and the centrality of consultants’ and BSNs’ collaboration.

KEYWORDS:

• Nurse-doctor interaction
• interprofessional collaboration
• critical care
• appreciative inquiry
• ward round

Declarations

This study was not supported by grant funding. The authors have not benefited financially from this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Level 3 patients require advanced respiratory support alone or monitoring and support for two or more organ systems. Level 2 patients require detailed observation or intervention, including support for a single failing organ system or post-operative care, and include those “stepping down” from higher levels of care. (Faculty of Intensive Care Medicine, The and Intensive Care Society, 2015).

2. ACCU “trainees” are qualified doctors, participating in Internal Medicine Training Specialty Training before becoming eligible to apply for consultant posts.

3. Apart from very minor editing for clarity or readability, participants words are reproduced in quotations in preference to “tidying up” spoken language so that it resembles written language.

4. Colloquial: If something can go wrong it will.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Clair Merriman

Dr Clair Merriman is a Principal Lecturer at Oxford Brookes University and Post Doctoral Nursing Researcher at Oxford University Hospital NHS Foundation Trust.  Her interests include critical care, workforce development , interprofessional collaboration, workplace learning and learning through simulated professional practice, all of which support patient safety and the quality of working lives.

Della Freeth

Professor Della Freeth is Executive Director of Education at the Royal College of Physicians and honorary Professor of Professional Education in the School of Medicine & Dentistry at Queen Mary University of London.  Her academic and development interests centre on workforce development needs, credentialling, interprofessional collaboration, workplace learning and learning through simulated professional practice, all of which support patient safety and the quality of working lives.