• Patricia H Strachan, Jennifer Kryworuchko, Elysée Nouvet, James Downar, and John J You.
• McMaster University, School of Nursing, HSC 3N28H, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada. Electronic address: strachan@mcmaster.ca.
• Appl Nurs Res. 2018 Apr 1; 40: 26-33.

BackgroundNurses in acute medical units are uniquely positioned to support goals of care communication. Further understanding of nurse and physician perceptions about hospital nurses' actual and possible roles was required to improve goals of care communication.ObjectiveTo critically examine nurse and physician perceptions of the nurse's role in communication with seriously ill patients and their families.DesignWe focus on the qualitative component of a mixed method study. We employed an interpretive descriptive approach informed by Flanagan's critical incident technique.SettingsParticipants were recruited from the acute medical units at three tertiary care hospitals in three Canadian provinces.ParticipantsThirty participants provided interviews (10 from each site): 12 nurses, 9 staff physicians and 9 medical resident physicians.MethodsParticipants' described "critical incidents" they considered as "excellent" or "poor" or "usual" practice. Interviews, were audiotaped and transcribed. Team-based analysis used constant comparison and triangulation to identify healthcare team members' roles in goals of care communication.ResultsWe identified two major themes from 120 critical incidents: 1) the ambiguous nature of the nurse's role in formal, physician-led, decision-making communication, and 2) embedded in care serious illness communication. Physicians understood nurses' supportive role in relation to their own communication practices that culminated in decisions about care; nurses' reported their roles were determined by unit routines, physician practices and preferences, and their self-confidence in supporting decision-making. Nurses described their unique role in facilitating informal and spontaneous communication with patients and families that was critical background work to physician-led goals of care communication.ConclusionsNurses and physicians had different understandings, practices and beliefs about goals of care communication The value of nurses embedded in care work is key to supporting the interprofessional team's work during formal goals of care communication.Copyright © 2017 Elsevier Inc. All rights reserved.

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