Prevalence and Factors of Intensive Care Unit Conflicts The Conflicus Study
Identifieur interne : 008150 ( Main/Exploration ); précédent : 008149; suivant : 008151Prevalence and Factors of Intensive Care Unit Conflicts The Conflicus Study
Auteurs : Elie Azoulay [France] ; Jean-François Timsit [France] ; Charles L. Sprung [Israël] ; Marcio Soares [Brésil] ; Kate Ina Rusinova [République tchèque] ; Ariane Lafabrie [France] ; Ricardo Abizanda [Espagne] ; Mia Svantesson [Suède] ; Francesca Rubulotta [Italie] ; Bara Ricou [Suisse] ; Dominique Benoit [Belgique] ; Daren Heyland [Canada] ; Gavin Joynt [Hong Kong] ; Adrien Francais [France] ; Paulo Azeivedo-Maia [Portugal] ; Radoslaw Owczuk [Pologne] ; Julie Benbenishty [Israël] ; Michael De Vita [États-Unis] ; Andreas Valentin [Autriche] ; Akos Ksomos [Hongrie] ; Simon Cohen [Royaume-Uni] ; Lidija Kompan [Slovénie] ; Kwok Ho [Australie] ; Fekri Abroug [Tunisie] ; Anne Kaarlola [Finlande] ; Herwig Gerlach [Allemagne] ; Theodoros Kyprianou [Chypre (pays)] ; Andrej Michalsen [Allemagne] ; Sylvie Chevret ; Benoit Schlemmer [France]Source :
- American journal of respiratory and critical care medicine [ 1073-449X ] ; 2009.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
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 5 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.
Affiliations:
- Allemagne, Australie, Autriche, Belgique, Brésil, Canada, Chypre (pays), Espagne, Finlande, France, Hong Kong, Hongrie, Israël, Italie, Pologne, Portugal, Royaume-Uni, République tchèque, Slovénie, Suisse, Suède, Tunisie, États-Unis
- Angleterre, Auvergne-Rhône-Alpes, Berlin, Bohême centrale, Grand Londres, Hongrie centrale, Pennsylvanie, Rhône-Alpes, Vienne (Autriche), État de Rio de Janeiro, Île-de-France
- Berlin, Budapest, Grenoble, Londres, Paris, Prague, Rio de Janeiro, Sha Tin, Vienne (Autriche)
- University College de Londres, Université chinoise de Hong Kong
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Catania</s1><s3>ITA</s3><sZ>9 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Policlinico University Hospital Catania</wicri:noRegion></affiliation></author><author><name sortKey="Ricou, Bara" sort="Ricou, Bara" uniqKey="Ricou B" first="Bara" last="Ricou">Bara Ricou</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Department of Intensive Care, Geneva University Hospitals and University of Geneva</s1><s2>Geneva</s2><s3>CHE</s3><sZ>10 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Benoit, Dominique" sort="Benoit, Dominique" uniqKey="Benoit D" first="Dominique" last="Benoit">Dominique Benoit</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Department of Intensive Care Medicine, Ghent University Hospital</s1><s2>De Pintelaan Ghent</s2><s3>BEL</s3><sZ>11 aut.</sZ></inist:fA14><country>Belgique</country><wicri:noRegion>De Pintelaan Ghent</wicri:noRegion></affiliation></author><author><name sortKey="Heyland, Daren" sort="Heyland, Daren" uniqKey="Heyland D" first="Daren" last="Heyland">Daren Heyland</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Department of Medicine, Queen's University</s1><s2>Kingston, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Kingston, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Joynt, Gavin" sort="Joynt, Gavin" uniqKey="Joynt G" first="Gavin" last="Joynt">Gavin Joynt</name><affiliation wicri:level="4"><inist:fA14 i1="12"><s1>Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital</s1><s2>Shatin</s2><s3>HKG</s3><sZ>13 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Shatin</wicri:noRegion><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Francais, Adrien" sort="Francais, Adrien" uniqKey="Francais A" first="Adrien" last="Francais">Adrien Francais</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>INSERM U823, Hopital Michallon, CHU de Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Azeivedo Maia, Paulo" sort="Azeivedo Maia, Paulo" uniqKey="Azeivedo Maia P" first="Paulo" last="Azeivedo-Maia">Paulo Azeivedo-Maia</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Department of Anesthesia and Intensive Care, Hospital de S. João</s1><s2>Porto</s2><s3>PRT</s3><sZ>15 aut.</sZ></inist:fA14><country>Portugal</country><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Owczuk, Radoslaw" sort="Owczuk, Radoslaw" uniqKey="Owczuk R" first="Radoslaw" last="Owczuk">Radoslaw Owczuk</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk</s1><s2>Gdansk</s2><s3>POL</s3><sZ>16 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Gdansk</wicri:noRegion></affiliation></author><author><name sortKey="Benbenishty, Julie" sort="Benbenishty, Julie" uniqKey="Benbenishty J" first="Julie" last="Benbenishty">Julie Benbenishty</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center</s1><s2>Jerusalem</s2><s3>ISR</s3><sZ>3 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Israël</country><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author><author><name sortKey="De Vita, Michael" sort="De Vita, Michael" uniqKey="De Vita M" first="Michael" last="De Vita">Michael De Vita</name><affiliation wicri:level="2"><inist:fA14 i1="15"><s1>University of Pittsburgh Medical Center</s1><s2>Pittsburgh, Pennsylvania</s2><s3>USA</s3><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Valentin, Andreas" sort="Valentin, Andreas" uniqKey="Valentin A" first="Andreas" last="Valentin">Andreas Valentin</name><affiliation wicri:level="3"><inist:fA14 i1="16"><s1>General and Medical Intensive Care Unit, II, Medical Department, KA Rudolfsftiftung, Juchgasse</s1><s2>Vienna</s2><s3>AUT</s3><sZ>19 aut.</sZ></inist:fA14><country>Autriche</country><placeName><settlement type="city">Vienne (Autriche)</settlement><region nuts="2" type="province">Vienne (Autriche)</region></placeName></affiliation></author><author><name sortKey="Ksomos, Akos" sort="Ksomos, Akos" uniqKey="Ksomos A" first="Akos" last="Ksomos">Akos Ksomos</name><affiliation wicri:level="3"><inist:fA14 i1="17"><s1>Semmelweis University, Surgical Intensive Care Unit</s1><s2>Budapest</s2><s3>HUN</s3><sZ>20 aut.</sZ></inist:fA14><country>Hongrie</country><placeName><settlement type="city">Budapest</settlement><region nuts="2">Hongrie centrale</region></placeName></affiliation></author><author><name sortKey="Cohen, Simon" sort="Cohen, Simon" uniqKey="Cohen S" first="Simon" last="Cohen">Simon Cohen</name><affiliation wicri:level="4"><inist:fA14 i1="18"><s1>Department of Medicine, University College London</s1><s2>London</s2><s3>GBR</s3><sZ>21 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Kompan, Lidija" sort="Kompan, Lidija" uniqKey="Kompan L" first="Lidija" last="Kompan">Lidija Kompan</name><affiliation wicri:level="1"><inist:fA14 i1="19"><s1>Clinical Centre Ljubljana, University of Ljubljana</s1><s2>Ljubljana</s2><s3>SVN</s3><sZ>22 aut.</sZ></inist:fA14><country>Slovénie</country><wicri:noRegion>Ljubljana</wicri:noRegion></affiliation></author><author><name sortKey="Ho, Kwok" sort="Ho, Kwok" uniqKey="Ho K" first="Kwok" last="Ho">Kwok Ho</name><affiliation wicri:level="1"><inist:fA14 i1="20"><s1>Intensive Care Unit, Royal Perth Hospital</s1><s2>Perth</s2><s3>AUS</s3><sZ>23 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Perth</wicri:noRegion></affiliation></author><author><name sortKey="Abroug, Fekri" sort="Abroug, Fekri" uniqKey="Abroug F" first="Fekri" last="Abroug">Fekri Abroug</name><affiliation wicri:level="1"><inist:fA14 i1="21"><s1>Intensive Care Unit, CHU Fatouma Bourguiba</s1><s2>Monastir</s2><s3>TUN</s3><sZ>24 aut.</sZ></inist:fA14><country>Tunisie</country><wicri:noRegion>Monastir</wicri:noRegion></affiliation></author><author><name sortKey="Kaarlola, Anne" sort="Kaarlola, Anne" uniqKey="Kaarlola A" first="Anne" last="Kaarlola">Anne Kaarlola</name><affiliation wicri:level="1"><inist:fA14 i1="22"><s1>Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital</s1><s2>Helsinki</s2><s3>FIN</s3><sZ>25 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Helsinki</wicri:noRegion></affiliation></author><author><name sortKey="Gerlach, Herwig" sort="Gerlach, Herwig" uniqKey="Gerlach H" first="Herwig" last="Gerlach">Herwig Gerlach</name><affiliation wicri:level="3"><inist:fA14 i1="23"><s1>Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes Klinikum Neukölln</s1><s2>Berlin</s2><s3>DEU</s3><sZ>26 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Kyprianou, Theodoros" sort="Kyprianou, Theodoros" uniqKey="Kyprianou T" first="Theodoros" last="Kyprianou">Theodoros Kyprianou</name><affiliation wicri:level="1"><inist:fA14 i1="24"><s1>Department of Computer Science, University of Cyprus</s1><s2>Nicosia</s2><s3>CYP</s3><sZ>27 aut.</sZ></inist:fA14><country>Chypre (pays)</country><wicri:noRegion>Nicosia</wicri:noRegion></affiliation></author><author><name sortKey="Michalsen, Andrej" sort="Michalsen, Andrej" uniqKey="Michalsen A" first="Andrej" last="Michalsen">Andrej Michalsen</name><affiliation wicri:level="1"><inist:fA14 i1="25"><s1>Department of Anesthesiology and Critical Care Medicine, HELIOS Spital</s1><s2>Überlingen/See</s2><s3>DEU</s3><sZ>28 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Überlingen/See</wicri:noRegion><wicri:noRegion>HELIOS Spital</wicri:noRegion><wicri:noRegion>Überlingen/See</wicri:noRegion></affiliation></author><author><name sortKey="Chevret, Sylvie" sort="Chevret, Sylvie" uniqKey="Chevret S" first="Sylvie" last="Chevret">Sylvie Chevret</name></author><author><name sortKey="Schlemmer, Benoit" sort="Schlemmer, Benoit" uniqKey="Schlemmer B" first="Benoit" last="Schlemmer">Benoit Schlemmer</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>30 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">09-0455348</idno><date when="2009">2009</date><idno type="stanalyst">PASCAL 09-0455348 INIST</idno><idno type="RBID">Pascal:09-0455348</idno><idno type="wicri:Area/PascalFrancis/Corpus">002A84</idno><idno type="wicri:Area/PascalFrancis/Curation">003540</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">002918</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">002918</idno><idno type="wicri:doubleKey">1073-449X:2009:Azoulay E:prevalence:and:factors</idno><idno type="wicri:Area/Main/Merge">008887</idno><idno type="wicri:Area/Main/Curation">008150</idno><idno type="wicri:Area/Main/Exploration">008150</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Prevalence and Factors of Intensive Care Unit Conflicts The Conflicus Study</title><author><name sortKey="Azoulay, Elie" sort="Azoulay, Elie" uniqKey="Azoulay E" first="Elie" last="Azoulay">Elie Azoulay</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>30 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Timsit, Jean Francois" sort="Timsit, Jean Francois" uniqKey="Timsit J" first="Jean-François" last="Timsit">Jean-François Timsit</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>INSERM U823, Hopital Michallon, CHU de Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Sprung, Charles L" sort="Sprung, Charles L" uniqKey="Sprung C" first="Charles L." last="Sprung">Charles L. Sprung</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center</s1><s2>Jerusalem</s2><s3>ISR</s3><sZ>3 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Israël</country><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author><author><name sortKey="Soares, Marcio" sort="Soares, Marcio" uniqKey="Soares M" first="Marcio" last="Soares">Marcio Soares</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Intensive Care Unit, Instituto Nacional de Câncer</s1><s2>Rio de Janeiro</s2><s3>BRA</s3><sZ>4 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">Rio de Janeiro</settlement><region type="state">État de Rio de Janeiro</region></placeName></affiliation></author><author><name sortKey="Rusinova, Kate Ina" sort="Rusinova, Kate Ina" uniqKey="Rusinova K" first="Kate Ina" last="Rusinova">Kate Ina Rusinova</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Anesthesiology and Critical Care Medicine, Medical ICU, Prague University Hospital</s1><s2>Prague</s2><s3>CZE</s3><sZ>5 aut.</sZ></inist:fA14><country>République tchèque</country><placeName><settlement type="city">Prague</settlement><region type="région" nuts="2">Bohême centrale</region></placeName></affiliation></author><author><name sortKey="Lafabrie, Ariane" sort="Lafabrie, Ariane" uniqKey="Lafabrie A" first="Ariane" last="Lafabrie">Ariane Lafabrie</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>30 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Abizanda, Ricardo" sort="Abizanda, Ricardo" uniqKey="Abizanda R" first="Ricardo" last="Abizanda">Ricardo Abizanda</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Servei de Medicina Intensiva, Hospital Universitario Asociado General de Castellón</s1><s2>Castellón</s2><s3>ESP</s3><sZ>7 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Castellón</wicri:noRegion></affiliation></author><author><name sortKey="Svantesson, Mia" sort="Svantesson, Mia" uniqKey="Svantesson M" first="Mia" last="Svantesson">Mia Svantesson</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Centre for Health Care Sciences, Orebro University Hospital</s1><s2>Orebro</s2><s3>SWE</s3><sZ>8 aut.</sZ></inist:fA14><country>Suède</country><wicri:noRegion>Orebro</wicri:noRegion></affiliation></author><author><name sortKey="Rubulotta, Francesca" sort="Rubulotta, Francesca" uniqKey="Rubulotta F" first="Francesca" last="Rubulotta">Francesca Rubulotta</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Policlinico University Hospital Catania</s1><s3>ITA</s3><sZ>9 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Policlinico University Hospital Catania</wicri:noRegion></affiliation></author><author><name sortKey="Ricou, Bara" sort="Ricou, Bara" uniqKey="Ricou B" first="Bara" last="Ricou">Bara Ricou</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Department of Intensive Care, Geneva University Hospitals and University of Geneva</s1><s2>Geneva</s2><s3>CHE</s3><sZ>10 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Benoit, Dominique" sort="Benoit, Dominique" uniqKey="Benoit D" first="Dominique" last="Benoit">Dominique Benoit</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Department of Intensive Care Medicine, Ghent University Hospital</s1><s2>De Pintelaan Ghent</s2><s3>BEL</s3><sZ>11 aut.</sZ></inist:fA14><country>Belgique</country><wicri:noRegion>De Pintelaan Ghent</wicri:noRegion></affiliation></author><author><name sortKey="Heyland, Daren" sort="Heyland, Daren" uniqKey="Heyland D" first="Daren" last="Heyland">Daren Heyland</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Department of Medicine, Queen's University</s1><s2>Kingston, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Kingston, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Joynt, Gavin" sort="Joynt, Gavin" uniqKey="Joynt G" first="Gavin" last="Joynt">Gavin Joynt</name><affiliation wicri:level="4"><inist:fA14 i1="12"><s1>Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital</s1><s2>Shatin</s2><s3>HKG</s3><sZ>13 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Shatin</wicri:noRegion><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Francais, Adrien" sort="Francais, Adrien" uniqKey="Francais A" first="Adrien" last="Francais">Adrien Francais</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>INSERM U823, Hopital Michallon, CHU de Grenoble</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Azeivedo Maia, Paulo" sort="Azeivedo Maia, Paulo" uniqKey="Azeivedo Maia P" first="Paulo" last="Azeivedo-Maia">Paulo Azeivedo-Maia</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Department of Anesthesia and Intensive Care, Hospital de S. João</s1><s2>Porto</s2><s3>PRT</s3><sZ>15 aut.</sZ></inist:fA14><country>Portugal</country><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Owczuk, Radoslaw" sort="Owczuk, Radoslaw" uniqKey="Owczuk R" first="Radoslaw" last="Owczuk">Radoslaw Owczuk</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk</s1><s2>Gdansk</s2><s3>POL</s3><sZ>16 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Gdansk</wicri:noRegion></affiliation></author><author><name sortKey="Benbenishty, Julie" sort="Benbenishty, Julie" uniqKey="Benbenishty J" first="Julie" last="Benbenishty">Julie Benbenishty</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center</s1><s2>Jerusalem</s2><s3>ISR</s3><sZ>3 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Israël</country><wicri:noRegion>Jerusalem</wicri:noRegion></affiliation></author><author><name sortKey="De Vita, Michael" sort="De Vita, Michael" uniqKey="De Vita M" first="Michael" last="De Vita">Michael De Vita</name><affiliation wicri:level="2"><inist:fA14 i1="15"><s1>University of Pittsburgh Medical Center</s1><s2>Pittsburgh, Pennsylvania</s2><s3>USA</s3><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Valentin, Andreas" sort="Valentin, Andreas" uniqKey="Valentin A" first="Andreas" last="Valentin">Andreas Valentin</name><affiliation wicri:level="3"><inist:fA14 i1="16"><s1>General and Medical Intensive Care Unit, II, Medical Department, KA Rudolfsftiftung, Juchgasse</s1><s2>Vienna</s2><s3>AUT</s3><sZ>19 aut.</sZ></inist:fA14><country>Autriche</country><placeName><settlement type="city">Vienne (Autriche)</settlement><region nuts="2" type="province">Vienne (Autriche)</region></placeName></affiliation></author><author><name sortKey="Ksomos, Akos" sort="Ksomos, Akos" uniqKey="Ksomos A" first="Akos" last="Ksomos">Akos Ksomos</name><affiliation wicri:level="3"><inist:fA14 i1="17"><s1>Semmelweis University, Surgical Intensive Care Unit</s1><s2>Budapest</s2><s3>HUN</s3><sZ>20 aut.</sZ></inist:fA14><country>Hongrie</country><placeName><settlement type="city">Budapest</settlement><region nuts="2">Hongrie centrale</region></placeName></affiliation></author><author><name sortKey="Cohen, Simon" sort="Cohen, Simon" uniqKey="Cohen S" first="Simon" last="Cohen">Simon Cohen</name><affiliation wicri:level="4"><inist:fA14 i1="18"><s1>Department of Medicine, University College London</s1><s2>London</s2><s3>GBR</s3><sZ>21 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Kompan, Lidija" sort="Kompan, Lidija" uniqKey="Kompan L" first="Lidija" last="Kompan">Lidija Kompan</name><affiliation wicri:level="1"><inist:fA14 i1="19"><s1>Clinical Centre Ljubljana, University of Ljubljana</s1><s2>Ljubljana</s2><s3>SVN</s3><sZ>22 aut.</sZ></inist:fA14><country>Slovénie</country><wicri:noRegion>Ljubljana</wicri:noRegion></affiliation></author><author><name sortKey="Ho, Kwok" sort="Ho, Kwok" uniqKey="Ho K" first="Kwok" last="Ho">Kwok Ho</name><affiliation wicri:level="1"><inist:fA14 i1="20"><s1>Intensive Care Unit, Royal Perth Hospital</s1><s2>Perth</s2><s3>AUS</s3><sZ>23 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Perth</wicri:noRegion></affiliation></author><author><name sortKey="Abroug, Fekri" sort="Abroug, Fekri" uniqKey="Abroug F" first="Fekri" last="Abroug">Fekri Abroug</name><affiliation wicri:level="1"><inist:fA14 i1="21"><s1>Intensive Care Unit, CHU Fatouma Bourguiba</s1><s2>Monastir</s2><s3>TUN</s3><sZ>24 aut.</sZ></inist:fA14><country>Tunisie</country><wicri:noRegion>Monastir</wicri:noRegion></affiliation></author><author><name sortKey="Kaarlola, Anne" sort="Kaarlola, Anne" uniqKey="Kaarlola A" first="Anne" last="Kaarlola">Anne Kaarlola</name><affiliation wicri:level="1"><inist:fA14 i1="22"><s1>Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital</s1><s2>Helsinki</s2><s3>FIN</s3><sZ>25 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Helsinki</wicri:noRegion></affiliation></author><author><name sortKey="Gerlach, Herwig" sort="Gerlach, Herwig" uniqKey="Gerlach H" first="Herwig" last="Gerlach">Herwig Gerlach</name><affiliation wicri:level="3"><inist:fA14 i1="23"><s1>Department of Anesthesia, Intensive Care Medicine, and Pain Management, Vivantes Klinikum Neukölln</s1><s2>Berlin</s2><s3>DEU</s3><sZ>26 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Kyprianou, Theodoros" sort="Kyprianou, Theodoros" uniqKey="Kyprianou T" first="Theodoros" last="Kyprianou">Theodoros Kyprianou</name><affiliation wicri:level="1"><inist:fA14 i1="24"><s1>Department of Computer Science, University of Cyprus</s1><s2>Nicosia</s2><s3>CYP</s3><sZ>27 aut.</sZ></inist:fA14><country>Chypre (pays)</country><wicri:noRegion>Nicosia</wicri:noRegion></affiliation></author><author><name sortKey="Michalsen, Andrej" sort="Michalsen, Andrej" uniqKey="Michalsen A" first="Andrej" last="Michalsen">Andrej Michalsen</name><affiliation wicri:level="1"><inist:fA14 i1="25"><s1>Department of Anesthesiology and Critical Care Medicine, HELIOS Spital</s1><s2>Überlingen/See</s2><s3>DEU</s3><sZ>28 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Überlingen/See</wicri:noRegion><wicri:noRegion>HELIOS Spital</wicri:noRegion><wicri:noRegion>Überlingen/See</wicri:noRegion></affiliation></author><author><name sortKey="Chevret, Sylvie" sort="Chevret, Sylvie" uniqKey="Chevret S" first="Sylvie" last="Chevret">Sylvie Chevret</name></author><author><name sortKey="Schlemmer, Benoit" sort="Schlemmer, Benoit" uniqKey="Schlemmer B" first="Benoit" last="Schlemmer">Benoit Schlemmer</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>30 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">American journal of respiratory and critical care medicine</title><title level="j" type="abbreviated">Am. j. respir. crit. care med.</title><idno type="ISSN">1073-449X</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">American journal of respiratory and critical care medicine</title><title level="j" type="abbreviated">Am. j. respir. crit. care med.</title><idno type="ISSN">1073-449X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Caregiver</term><term>Intensive care</term><term>Intensive care unit</term><term>Nurse</term><term>Occupational burnout</term><term>Prevalence</term><term>Resuscitation</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Prévalence</term><term>Unité soin intensif</term><term>Aidant</term><term>Infirmier</term><term>Epuisement professionnel</term><term>Réanimation</term><term>Soin intensif</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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 5 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.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Autriche</li><li>Belgique</li><li>Brésil</li><li>Canada</li><li>Chypre (pays)</li><li>Espagne</li><li>Finlande</li><li>France</li><li>Hong Kong</li><li>Hongrie</li><li>Israël</li><li>Italie</li><li>Pologne</li><li>Portugal</li><li>Royaume-Uni</li><li>République tchèque</li><li>Slovénie</li><li>Suisse</li><li>Suède</li><li>Tunisie</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Auvergne-Rhône-Alpes</li><li>Berlin</li><li>Bohême centrale</li><li>Grand Londres</li><li>Hongrie centrale</li><li>Pennsylvanie</li><li>Rhône-Alpes</li><li>Vienne (Autriche)</li><li>État de Rio de Janeiro</li><li>Île-de-France</li></region><settlement><li>Berlin</li><li>Budapest</li><li>Grenoble</li><li>Londres</li><li>Paris</li><li>Prague</li><li>Rio de Janeiro</li><li>Sha Tin</li><li>Vienne (Autriche)</li></settlement><orgName><li>University College de Londres</li><li>Université chinoise de Hong Kong</li></orgName></list><tree><noCountry><name sortKey="Chevret, Sylvie" sort="Chevret, Sylvie" uniqKey="Chevret S" first="Sylvie" last="Chevret">Sylvie Chevret</name></noCountry><country name="France"><region name="Île-de-France"><name sortKey="Azoulay, Elie" sort="Azoulay, Elie" uniqKey="Azoulay E" first="Elie" last="Azoulay">Elie Azoulay</name></region><name sortKey="Francais, Adrien" sort="Francais, Adrien" uniqKey="Francais A" first="Adrien" last="Francais">Adrien Francais</name><name sortKey="Lafabrie, Ariane" sort="Lafabrie, Ariane" uniqKey="Lafabrie A" first="Ariane" last="Lafabrie">Ariane Lafabrie</name><name sortKey="Schlemmer, Benoit" sort="Schlemmer, Benoit" uniqKey="Schlemmer B" first="Benoit" last="Schlemmer">Benoit Schlemmer</name><name sortKey="Timsit, Jean Francois" sort="Timsit, Jean Francois" uniqKey="Timsit J" first="Jean-François" last="Timsit">Jean-François Timsit</name></country><country name="Israël"><noRegion><name sortKey="Sprung, Charles L" sort="Sprung, Charles L" uniqKey="Sprung C" first="Charles L." last="Sprung">Charles L. Sprung</name></noRegion><name sortKey="Benbenishty, Julie" sort="Benbenishty, Julie" uniqKey="Benbenishty J" first="Julie" last="Benbenishty">Julie Benbenishty</name></country><country name="Brésil"><region name="État de Rio de Janeiro"><name sortKey="Soares, Marcio" sort="Soares, Marcio" uniqKey="Soares M" first="Marcio" last="Soares">Marcio Soares</name></region></country><country name="République tchèque"><region name="Bohême centrale"><name sortKey="Rusinova, Kate Ina" sort="Rusinova, Kate Ina" uniqKey="Rusinova K" first="Kate Ina" last="Rusinova">Kate Ina Rusinova</name></region></country><country name="Espagne"><noRegion><name sortKey="Abizanda, Ricardo" sort="Abizanda, Ricardo" uniqKey="Abizanda R" first="Ricardo" last="Abizanda">Ricardo Abizanda</name></noRegion></country><country name="Suède"><noRegion><name sortKey="Svantesson, Mia" sort="Svantesson, Mia" uniqKey="Svantesson M" first="Mia" last="Svantesson">Mia Svantesson</name></noRegion></country><country name="Italie"><noRegion><name sortKey="Rubulotta, Francesca" sort="Rubulotta, Francesca" uniqKey="Rubulotta F" first="Francesca" last="Rubulotta">Francesca Rubulotta</name></noRegion></country><country name="Suisse"><noRegion><name sortKey="Ricou, Bara" sort="Ricou, Bara" uniqKey="Ricou B" first="Bara" last="Ricou">Bara Ricou</name></noRegion></country><country name="Belgique"><noRegion><name sortKey="Benoit, Dominique" sort="Benoit, Dominique" uniqKey="Benoit D" first="Dominique" last="Benoit">Dominique Benoit</name></noRegion></country><country name="Canada"><noRegion><name sortKey="Heyland, Daren" sort="Heyland, Daren" uniqKey="Heyland D" first="Daren" last="Heyland">Daren Heyland</name></noRegion></country><country name="Hong Kong"><noRegion><name sortKey="Joynt, Gavin" sort="Joynt, Gavin" uniqKey="Joynt G" first="Gavin" last="Joynt">Gavin Joynt</name></noRegion></country><country name="Portugal"><noRegion><name sortKey="Azeivedo Maia, Paulo" sort="Azeivedo Maia, Paulo" uniqKey="Azeivedo Maia P" first="Paulo" last="Azeivedo-Maia">Paulo Azeivedo-Maia</name></noRegion></country><country name="Pologne"><noRegion><name sortKey="Owczuk, Radoslaw" sort="Owczuk, Radoslaw" uniqKey="Owczuk R" first="Radoslaw" last="Owczuk">Radoslaw Owczuk</name></noRegion></country><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="De Vita, Michael" sort="De Vita, Michael" uniqKey="De Vita M" first="Michael" last="De Vita">Michael De Vita</name></region></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Valentin, Andreas" sort="Valentin, Andreas" uniqKey="Valentin A" first="Andreas" last="Valentin">Andreas Valentin</name></region></country><country name="Hongrie"><region name="Hongrie centrale"><name sortKey="Ksomos, Akos" sort="Ksomos, Akos" uniqKey="Ksomos A" first="Akos" last="Ksomos">Akos Ksomos</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Cohen, Simon" sort="Cohen, Simon" uniqKey="Cohen S" first="Simon" last="Cohen">Simon Cohen</name></region></country><country name="Slovénie"><noRegion><name sortKey="Kompan, Lidija" sort="Kompan, Lidija" uniqKey="Kompan L" first="Lidija" last="Kompan">Lidija Kompan</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Ho, Kwok" sort="Ho, Kwok" uniqKey="Ho K" first="Kwok" last="Ho">Kwok Ho</name></noRegion></country><country name="Tunisie"><noRegion><name sortKey="Abroug, Fekri" sort="Abroug, Fekri" uniqKey="Abroug F" first="Fekri" last="Abroug">Fekri Abroug</name></noRegion></country><country name="Finlande"><noRegion><name sortKey="Kaarlola, Anne" sort="Kaarlola, Anne" uniqKey="Kaarlola A" first="Anne" last="Kaarlola">Anne Kaarlola</name></noRegion></country><country name="Allemagne"><region name="Berlin"><name sortKey="Gerlach, Herwig" sort="Gerlach, Herwig" uniqKey="Gerlach H" first="Herwig" last="Gerlach">Herwig Gerlach</name></region><name sortKey="Michalsen, Andrej" sort="Michalsen, Andrej" uniqKey="Michalsen A" first="Andrej" last="Michalsen">Andrej Michalsen</name></country><country name="Chypre (pays)"><noRegion><name sortKey="Kyprianou, Theodoros" sort="Kyprianou, Theodoros" uniqKey="Kyprianou T" first="Theodoros" last="Kyprianou">Theodoros Kyprianou</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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