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Qual Health Res. 2017 Feb;27(3):351-362. doi: 10.1177/1049732315616619. Epub 2016 Jul 10.

Obstacles to Shared Expectations in a Burn Intensive Care Unit.

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1 Vanderbilt University Medical Center, Nashville, Tennessee, USA.


Critical care patients are dependent on the health care team and their family members to effect care goals that are consistent with their core values and wishes. This study aimed to identify and understand how obstacles to communication affect these two disparate groups. Ten burn intensive care unit (BICU) care team and 20 family members participated in in-depth semistructured interviews. A two-cycle coding, inductive analytical approach was used to derive three obstacle metathemes: family engagement, information exchange, and process transparency and standardization. However, care team and family members' themes within each metatheme were different. Although the thematic structure was derived inductively, our findings in retrospect appeared to be consistent with Law's four resistances associated with actor-networks. From this perspective, actor-network theory provides a plausible explanation for perceived obstacles and may, in the future, guide the development of interventions to improve shared agency across networks.


bereavement / grief; communication; decision making; end of life issues; exploratory methods; qualitative; southern United States

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