What is appropriate care? A qualitative study into the perceptions of healthcare professionals in Flemish university hospital intensive care units

This study examines when healthcare professionals consider intensive care as appropriate care. Despite attempts to conceptualize appropriate care in prior research, there is a lack of insight into its meaning and implementation in practice. This is an important issue because healthcare professionals as well as patients and relatives report inappropriate care in the intensive care unit (ICU) on a regular basis. A qualitative study was designed, based on principles of grounded theory. Seventeen semi-structured interviews were conducted with nurses, doctors and doctors in training from three Flemish university hospitals. Analyses followed the Quagol method; insights were gained by means of the constant comparative method. Healthcare professionals described appropriate care as socially sustainable care, high-quality care, patient-oriented care, dignified care and meaningful care. They considered it important that care is not only proportional to the expected survival and quality of life of the patient and in line with the patient's or relatives’ wishes, but also that the pursuit of the care goals is proportional to the patient's suffering. Although healthcare professionals indicated the same elements of appropriate care, they were defined and interpreted in individual and therefore different ways. This diversity lies at the basis of fields of tension and frustrations among healthcare professionals. Appropriate care is defined and interpreted in individual and therefore different ways. In order to decide which type of care is appropriate for a specific patient, a process of open and constructive communication in a team is recommended. •Equal distribution of care and sustainability of the healthcare system are crucial.•The intensity of care must be proportional to an individual's estimated prognosis.•The pursuit of future prospects is proportional to the patient's suffering.•Integrating the perspectives of doctors and nurses can reduce uncertainty.•A framework could facilitate reflecting on appropriate care in an ICU team.