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2021-01-07
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- INI - Artigos de Periódicos [3654]
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PREVALENCE AND FACTORS OF INTENSIVE CARE UNIT CONFLICTS: THE CONFLICUS STUDY
1 AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, Paris, France; 2 INSERM U823, Hopital Michallon, CHU de Grenoble, Grenoble, France; 3 Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel; 4 Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; 5 Department of Anesthesiology and Critical Care Medicine, Medical ICU, Prague University Hospital, Prague, Czech Republic; 6 Servei de Medicina Intensiva, Hospital Universitario Asociado General de Castellón, Castellón, Spain; 7 Centre for Health Care Sciences, Orebro University Hospital, Orebro, Sweden; 8 Policlinico University Hospital Catania, Italy; 9 Department of Intensive Care, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; 10Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan Ghent, Belgium; 11Department of Medicine, Queen’s University, Kingston, Ontario, Canada; 12Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; 13Department of Anesthesia and Intensive Care, Hospital de S. João, Porto, Portugal; 14Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland; 15University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; 16General and Medical Intensive Care Unit, II, Medical Department, KA Rudolfsftiftung, Juchgasse, Vienna, Austria; 17Semmelweis University, Surgical Intensive Care Unit, Budapest, Hungary; 18Department of Medicine, University College London, London, United Kingdom; 19Clinical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia; 20Intensive Care Unit, Royal Perth Hospital, Perth, Australia; 21Intensive Care Unit, CHU Fatouma Bourguiba, Monastir, Tunisia; 22Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland; 23Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes Klinikum Neukölln, Berlin, Germany; 24Department of Computer Science, University of Cyprus, Nicosia, Cyprus; 25Department of Anesthesiology and Critical Care Medicine, HELIOS Spital, Überlingen/See, Germany; 26Biostatistical Department, U717 INSERM, AP-HP, Paris 7 University, Saint-Louis Hospital, Paris, France.
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Abstract
Rationale: Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs. Objectives: To record the prevalence, characteristics, and risk factors for conflicts in ICUs. Methods: 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). Measurements and Main Results: 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 preand postmortem care within the last week, symptom control not ensured jointly by physicians and nurses, and no routine unit-level meetings. Conclusions: 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.
Publisher
American Thoracic Society
Citation
AZOULAY, Élie et al. Prevalence and factors of intensive care unit conflicts: the conflicus study. American Journal of Respiratory and Critical Care Medicine, v. 180, n. 9, p. 853-860, 2009.DOI
10.1164/rccm.200810-1614OCISSN
1073-449XNotes
Fernando Augusto Bozza. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. A informação consta no suplemento da publicação.1 AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, Paris, France; 2 INSERM U823, Hopital Michallon, CHU de Grenoble, Grenoble, France; 3 Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel; 4 Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; 5 Department of Anesthesiology and Critical Care Medicine, Medical ICU, Prague University Hospital, Prague, Czech Republic; 6 Servei de Medicina Intensiva, Hospital Universitario Asociado General de Castellón, Castellón, Spain; 7 Centre for Health Care Sciences, Orebro University Hospital, Orebro, Sweden; 8 Policlinico University Hospital Catania, Italy; 9 Department of Intensive Care, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; 10Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan Ghent, Belgium; 11Department of Medicine, Queen’s University, Kingston, Ontario, Canada; 12Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; 13Department of Anesthesia and Intensive Care, Hospital de S. João, Porto, Portugal; 14Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland; 15University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; 16General and Medical Intensive Care Unit, II, Medical Department, KA Rudolfsftiftung, Juchgasse, Vienna, Austria; 17Semmelweis University, Surgical Intensive Care Unit, Budapest, Hungary; 18Department of Medicine, University College London, London, United Kingdom; 19Clinical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia; 20Intensive Care Unit, Royal Perth Hospital, Perth, Australia; 21Intensive Care Unit, CHU Fatouma Bourguiba, Monastir, Tunisia; 22Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland; 23Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes Klinikum Neukölln, Berlin, Germany; 24Department of Computer Science, University of Cyprus, Nicosia, Cyprus; 25Department of Anesthesiology and Critical Care Medicine, HELIOS Spital, Überlingen/See, Germany; 26Biostatistical Department, U717 INSERM, AP-HP, Paris 7 University, Saint-Louis Hospital, Paris, France.
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