Table 4.

Theme III: categories pertaining to the role of ICU nurses

Categories	Codes	Quotes
Liaison and translator between physician, and patient and family	Nurse is eyes and ears of the physician; nurse translates medical world for patient; nurse makes sure information is clear after a family conference; sharing vulnerabilities can improve communication between clinicians	ICU Nurse (N): Then after the family conference, you let it sink in, and you start repeating it and repeating it. And you try to use the same words as the physician—because I’ve noticed families say: I think it’s so difficult, one says this and the others says this – but that’s because [families] don’t understand. P: What kind of support we need, how the family is doing, how the patient is doing, sleeping, pain—there are a lot of things they have a lot of insight about, yes. P: Where I see the nurse is(…)as a translator of what the patient was like at home, who are they, what type of person were they, what is their social safety net like(…). That information is very valuable(…). So I think that their added value is in the clarification of the social context. N: That is kind of the role we take on: [translating the family’s wishes for the physicians.
Incorporating non-medical information in ICU decision-making	Nurse provides social and empathetic point of view; ICU nurse is at bedside for 24 hours a day; talking about it when something doesn’t feel right; nurse participation in conversation depends on how assertive they are	N: Yes—[nurses] think it’s important to be of value in decision moments. Continuing or not, you know. Of course you need to do so based on medical information, but also based on the holistic view, and I think we should play a larger part in that, because we also know the family really well. N: I think generally it is a very medically-focused decision-making process in which the nurse is heard and listened to(…)but I don’t think we have that big of a share in the eventual decision.
Difficulties in communication between physicians and nurses	Cooperation with nurses; discrepancy of opinion between ICU physicians and nurses regarding end-of-life care for complicated cases; nurse doesn’t feel welcome in multidisciplinary meeting; ICU nurse feels like they are not being taken seriously	P: There are nurses that are well spoken and they’ll tell you their stuff. They are there, but they are a minority. Plus, they won’t always say it to everyone, because they know some [physicians] won’t listen. N: Then the next day there was a new [intensivist] that didn’t know the patient, but I had been at the bedside the entire day, so I told them [what the previous intensivist and I had decided).(Then they said:)‘Well, that wasn’t communicated with me, I don’t agree with you, we won’t do it’. So then you’re not heard.
Questioning physician’s decision to continue treatment	Conflict arises around complex patients who are at the ICU for a long time; medical point-of-view takes precedence; whether nurse’s point-of-view is heard depends on which physician is on shift	N: We often feel that when the patient is there for a very long time, and we see them deteriorating—the physicians often think: we can try this and we should approach them, maybe they know something—and then we think: should we do all of this? N: I think: there are limits. Sometimes it’s enough. If you’ve done everything—you shouldn’t stop based on emotions(…)but other times I think: [recovery)’s just not going to happen.

ICU, intensive care unit; N, ICU nurse; P, ICU physician.