Journal Article

Prevalence and Factors of Intensive Care Unit Conflicts: The Conflicus Study

Sprung, Charles L, Valentin, Andreas, Kyprianou, Theodoros, Rusinova, Katerina, Svantesson, Mia, Cohen, Simon, Timsit, Jean-Francois, Abroug, Fekri, Benbenishty, Julie, Soares, Marcio, Lafabrie, Ariane, Abizanda, Ricardo, Benoit, Dominique, Gerlach, Herwig, Joynt, Gavin, Rubulotta, Francesca, Ksomos, Akos, de Vita, Michael, Ho, Kwok, Heyland, Daren, Chevret, Sylvie, Azeivedo-Maia, Paulo, Owczuk, Radoslaw, Kaarlola, Anne, Schlemmer, Benoit, Kompan, Lidija, Francais, Adrien, Conflicus Study Investigators and Ethics Section of European Society of Intensive Care Medicine, Michalsen, Andrej, Ricou, Bara, Azoulay, Elie

2009

Overview

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 pre- and 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: Am Thoracic Soc,Oxford University Press,American Thoracic Society
• Subject: Adult / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Attitude of Health Personnel / Biological and medical sciences / Burnout, Professional / Burnout, Professional - epidemiology / Burnout, Professional - psychology / Clinical death. Palliative care. Organ gift and preservation / Communication / Conflict (Psychology) / Cross-Sectional Studies / Decision making / Ethics / Europe / Europe - epidemiology / Female / Health Personnel / Health Personnel - psychology / Health Personnel - statistics & numerical data / Hospitals, Public / Hospitals, Public - statistics & numerical data / Hospitals, University / Hospitals, University - statistics & numerical data / Humans / Intensive care / Intensive care medicine / Intensive Care Units / Intensive Care Units - statistics & numerical data / Interpersonal Relations / Intervention / Life Sciences / Male / Medical sciences / Nurses / Occupational stress / Palliative care / Patients / Perception / Physicians / Prevalence / Questionnaires / Risk Factors / Santé publique et épidémiologie / Social Support / Stress, Psychological / Stress, Psychological - epidemiology / Stress, Psychological - psychology / Surveys and Questionnaires / Terminal Care / Terminal Care - psychology / Terminal Care - statistics & numerical data / Workload / Workload - psychology