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American Journal of Critical Care. 2007;16: 470-477
Copyright © 2007 by the American Association of Critical-Care Nurses.
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CE Article

Understanding Collaboration Between Nurses and Physicians as Knowledge at Work

By Jane Stein-Parbury, RN, PhD and Joan Liaschenko, RN, PhD. Jane Stein-Parbury is a professor in the Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, and the South Eastern Sydney Illawarra Area Mental Health Service, New South Wales, Australia. Joan Liaschenko is a professor in The Center for Bioethics and the School of Nursing, University of Minnesota, in Minneapolis.

Corresponding author: Professor Jane Stein-Parbury, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Kuring-gai Campus, PO Box 222, Lindfield, NSW Australia (email: jane.stein-parbury{at}uts.edu.au).

Background Collaboration between nurses and physicians is linked to positive outcomes for patients, especially in the intensive care unit. However, effective collaboration poses challenges because of traditional barriers such as sex and class differences, hierarchical organizational structures in health-care, and physicians’ belief that they are the final arbiter of clinical decisions.

Objective To further analyze the results of an investigation on how intensive care unit culture, expressed through everyday practices, affected the care of patients who became confused.

Methods A model of the types of knowledge (case, patient, and person) used in clinical work was used to analyze the breakdown in collaboration detected in the original study.

Results Breakdown of collaboration occurred because of the types of knowledge used by physicians and nurses. Certain types of knowledge were privileged even when not applicable to the clinical problem, whereas other types were dismissed even when applicable.

Conclusion Viewing collaboration through the conceptual lens of knowledge use reveals new insights. Collaboration broke down in the specific context of caring for patients with confusion because the use of case knowledge, rather than patient knowledge, was prominent in the intensive care unit culture.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the importance of collaboration in the context of caring for critically ill patients in the intensive care unit.
  2. Recognize the differences between case, patient, and personal knowledge.
  3. Understand differing perspectives and use of knowledge by both nurses and physicians.

To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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Am. J. Crit. Care., January 1, 2008; 17(1): 11 - 12.
[Full Text] [PDF]


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