Vesin, Aurélien, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal Paris, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-Centre Hospitalier Universitaire CHU Grenoble (CHUGA)-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center Jerusalem, Intensive Care Unit, Instituto Nacional de Câncer, Prague University Hospital, Servei de Medicina Intensiva, Hospital Universitario Asociado General de Castellón, Centre for Health Care Sciences, Örebro University Hospital Örebro, Sweden, Policlinico University Hospital Catania, Department of Intensive Care, Geneva University Hospitals and University of Geneva, Department of Intensive Care Medicine, Ghent University Hospital, Department of Medicine, Queen's University Kingston, Canada, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong Hong Kong (CUHK)-Prince of Wales Hospital, Department of Anesthesia and Intensive Care, Hospital de S. João, Department of Anaesthesiology and Intensive Therapy, Medical University of Gdańsk, University of Pittsburgh Medical Center Pittsburgh, PA, États-Unis (UPMC), General and Medical Intensive Care Unit, II, Medical Department, Surgical Intensive Care Unit, Semmelweis University Budapest, University College of London London (UCL), Clinical Centre Ljubljana, University of Ljubljana, Royal Perth Hospital, CHU Fattouma Bourguiba Monastir (HFB), Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital Finland (HUS), Department of Anesthesiology, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukoelln, Computer Science Department Cyprus, University of Cyprus Nicosia (UCY), HELIOS Spital, Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Zdroj:
American Journal of Respiratory and Critical Care Medicine, Vol. 180, No 9 (2009) pp. 853-860
Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs.To record the prevalence, characteristics, and risk factors for conflicts in ICUs.One-day cross-sectional survey of ICU clinicians. Data on perceived conflicts in the week before the survey day were obtained from 7,498 ICU staff members (323 ICUs in 24 countries).Conflicts were perceived by 5,268 (71.6%) respondents. Nurse-physician conflicts were the most common (32.6%), followed by conflicts among nurses (27.3%) and staff-relative conflicts (26.6%). The most common conflict-causing behaviors were personal animosity, mistrust, and communication gaps. During end-of-life care, the main sources of perceived conflict were lack of psychological support, absence of staff meetings, and problems with the decision-making process. Conflicts perceived as severe were reported by 3,974 (53%) respondents. Job strain was significantly associated with perceiving conflicts and with greater severity of perceived conflicts. Multivariate analysis identified 15 factors associated with perceived conflicts, of which 6 were potential targets for future intervention: staff working more than 40 h/wk, more than 15 ICU beds, caring for dying patients or providing pre- and postmortem care within the last week, symptom control not ensured jointly by physicians and nurses, and no routine unit-level meetings.Over 70% of ICU workers reported perceived conflicts, which were often considered severe and were significantly associated with job strain. Workload, inadequate communication, and end-of-life care emerged as important potential targets for improvement.
Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs.To record the prevalence, characteristics, and risk factors for conflicts in ICUs.One-day cross-sectional survey of ICU clinicians. Data on perceived conflicts in the week before the survey day were obtained from 7,498 ICU staff members (323 ICUs in 24 countries).Conflicts were perceived by 5,268 (71.6%) respondents. Nurse-physician conflicts were the most common (32.6%), followed by conflicts among nurses (27.3%) and staff-relative conflicts (26.6%). The most common conflict-causing behaviors were personal animosity, mistrust, and communication gaps. During end-of-life care, the main sources of perceived conflict were lack of psychological support, absence of staff meetings, and problems with the decision-making process. Conflicts perceived as severe were reported by 3,974 (53%) respondents. Job strain was significantly associated with perceiving conflicts and with greater severity of perceived conflicts. Multivariate analysis identified 15 factors associated with perceived conflicts, of which 6 were potential targets for future intervention: staff working more than 40 h/wk, more than 15 ICU beds, caring for dying patients or providing pre- and postmortem care within the last week, symptom control not ensured jointly by physicians and nurses, and no routine unit-level meetings.Over 70% of ICU workers reported perceived conflicts, which were often considered severe and were significantly associated with job strain. Workload, inadequate communication, and end-of-life care emerged as important potential targets for improvement.
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