AutomedicationFrancoV1, Main, Exploration, bibRecord, 000217

Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.

Identifieur interne : 000217 ( Main/Exploration ); précédent : 000216; suivant : 000218

Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.

Auteurs : Bo Van Den Bulcke [Belgique] ; Victoria Metaxa [Royaume-Uni] ; Anna K. Reyners [Pays-Bas] ; Katerina Rusinova [République tchèque] ; Hanne I. Jensen [Danemark] ; J. Malmgren [Suède, Danemark] ; Michael Darmon [France] ; Daniel Talmor [États-Unis] ; Anne-Pascale Meert [Belgique] ; Laura Cancelliere [Italie] ; Lászl Zubek [Hongrie] ; Paulo Maia [Portugal] ; Andrej Michalsen [Allemagne] ; Erwin J O. Kompanje [Pays-Bas] ; Peter Vlerick [Belgique] ; Jolien Roels [Belgique] ; Stijn Vansteelandt [Belgique, Royaume-Uni] ; Johan Decruyenaere [Belgique] ; Elie Azoulay [France] ; Stijn Vanheule [Belgique] ; Ruth Piers [Belgique] ; Dominique Benoit [Belgique]

Source :

Intensive care medicine [ 1432-1238 ] ; 2020.

RBID : pubmed:31690968

Descripteurs français

KwdFr :
- Adulte (MeSH), Attitude du personnel soignant (MeSH), Culture organisationnelle (MeSH), Déontologie médicale (MeSH), Enquêtes et questionnaires (MeSH), Europe (MeSH), Femelle (MeSH), Humains (MeSH), Intention (MeSH), Mâle (MeSH), Personnel de santé (psychologie), Personnel de santé (statistiques et données numériques), Soins de réanimation (normes), Soins de réanimation (psychologie), Soins de réanimation (éthique), Unités de soins intensifs (organisation et administration), Unités de soins intensifs (statistiques et données numériques), Unités de soins intensifs (éthique), États-Unis (MeSH).
MESH :
- normes : Soins de réanimation.
- organisation et administration : Unités de soins intensifs.
- psychologie : Personnel de santé, Soins de réanimation.
- statistiques et données numériques : Personnel de santé, Unités de soins intensifs.
- éthique : Soins de réanimation, Unités de soins intensifs.
- Adulte, Attitude du personnel soignant, Culture organisationnelle, Déontologie médicale, Enquêtes et questionnaires, Europe, Femelle, Humains, Intention, Mâle, États-Unis.
Wicri :
- geographic : États-Unis.

English descriptors

KwdEn :
- Adult (MeSH), Attitude of Health Personnel (MeSH), Critical Care (ethics), Critical Care (psychology), Critical Care (standards), Ethics, Medical (MeSH), Europe (MeSH), Female (MeSH), Health Personnel (psychology), Health Personnel (statistics & numerical data), Humans (MeSH), Intensive Care Units (ethics), Intensive Care Units (organization & administration), Intensive Care Units (statistics & numerical data), Intention (MeSH), Male (MeSH), Organizational Culture (MeSH), Surveys and Questionnaires (MeSH), United States (MeSH).
MESH :
- geographic : Europe, United States.
- ethics : Critical Care, Intensive Care Units.
- organization & administration : Intensive Care Units.
- psychology : Critical Care, Health Personnel.
- standards : Critical Care.
- statistics & numerical data : Health Personnel, Intensive Care Units.
- Adult, Attitude of Health Personnel, Ethics, Medical, Female, Humans, Intention, Male, Organizational Culture, Surveys and Questionnaires.

Abstract

PURPOSE

Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.

METHODS

Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.

RESULTS

Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.

CONCLUSION

This is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.

DOI: 10.1007/s00134-019-05829-1
PubMed: 31690968
PubMed Central: PMC6954133

Affiliations:

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Le document en format XML

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<author><name sortKey="Maia, Paulo" sort="Maia, Paulo" uniqKey="Maia P" first="Paulo" last="Maia">Paulo Maia</name>
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<author><name sortKey="Michalsen, Andrej" sort="Michalsen, Andrej" uniqKey="Michalsen A" first="Andrej" last="Michalsen">Andrej Michalsen</name>
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<author><name sortKey="Kompanje, Erwin J O" sort="Kompanje, Erwin J O" uniqKey="Kompanje E" first="Erwin J O" last="Kompanje">Erwin J O. Kompanje</name>
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<author><name sortKey="Roels, Jolien" sort="Roels, Jolien" uniqKey="Roels J" first="Jolien" last="Roels">Jolien Roels</name>
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<author><name sortKey="Vansteelandt, Stijn" sort="Vansteelandt, Stijn" uniqKey="Vansteelandt S" first="Stijn" last="Vansteelandt">Stijn Vansteelandt</name>
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<affiliation wicri:level="3"><nlm:affiliation>London School of Hygiene and Tropical Medicine, London, UK.</nlm:affiliation>
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<author><name sortKey="Decruyenaere, Johan" sort="Decruyenaere, Johan" uniqKey="Decruyenaere J" first="Johan" last="Decruyenaere">Johan Decruyenaere</name>
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<wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent</wicri:regionArea>
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<author><name sortKey="Azoulay, Elie" sort="Azoulay, Elie" uniqKey="Azoulay E" first="Elie" last="Azoulay">Elie Azoulay</name>
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<author><name sortKey="Vanheule, Stijn" sort="Vanheule, Stijn" uniqKey="Vanheule S" first="Stijn" last="Vanheule">Stijn Vanheule</name>
<affiliation wicri:level="4"><nlm:affiliation>Department of Psycho-analysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Psycho-analysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent</wicri:regionArea>
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<author><name sortKey="Piers, Ruth" sort="Piers, Ruth" uniqKey="Piers R" first="Ruth" last="Piers">Ruth Piers</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Geriatric Medicine, Ghent University Hospital, Ghent</wicri:regionArea>
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<author><name sortKey="Benoit, Dominique" sort="Benoit, Dominique" uniqKey="Benoit D" first="Dominique" last="Benoit">Dominique Benoit</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent</wicri:regionArea>
<wicri:noRegion>Ghent</wicri:noRegion>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.</title>
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<author><name sortKey="Metaxa, Victoria" sort="Metaxa, Victoria" uniqKey="Metaxa V" first="Victoria" last="Metaxa">Victoria Metaxa</name>
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<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>King's College Hospital, London</wicri:regionArea>
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<author><name sortKey="Reyners, Anna K" sort="Reyners, Anna K" uniqKey="Reyners A" first="Anna K" last="Reyners">Anna K. Reyners</name>
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<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen</wicri:regionArea>
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<author><name sortKey="Rusinova, Katerina" sort="Rusinova, Katerina" uniqKey="Rusinova K" first="Katerina" last="Rusinova">Katerina Rusinova</name>
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<country xml:lang="fr">République tchèque</country>
<wicri:regionArea>Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague</wicri:regionArea>
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<author><name sortKey="Jensen, Hanne I" sort="Jensen, Hanne I" uniqKey="Jensen H" first="Hanne I" last="Jensen">Hanne I. Jensen</name>
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<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Department of Intensive Care Medicine, Institute of Regional Research, Vejle Hospital, Vejle</wicri:regionArea>
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<author><name sortKey="Malmgren, J" sort="Malmgren, J" uniqKey="Malmgren J" first="J" last="Malmgren">J. Malmgren</name>
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<country xml:lang="fr">Suède</country>
<wicri:regionArea>Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg</wicri:regionArea>
<wicri:noRegion>Gothenburg</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:affiliation>University of Southern Denmark, Odense, Denmark.</nlm:affiliation>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>University of Southern Denmark, Odense</wicri:regionArea>
<wicri:noRegion>Odense</wicri:noRegion>
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</author>
<author><name sortKey="Darmon, Michael" sort="Darmon, Michael" uniqKey="Darmon M" first="Michael" last="Darmon">Michael Darmon</name>
<affiliation wicri:level="3"><nlm:affiliation>Hôpital Saint-Louis and University Paris-7, Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Hôpital Saint-Louis and University Paris-7, Paris</wicri:regionArea>
<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="Talmor, Daniel" sort="Talmor, Daniel" uniqKey="Talmor D" first="Daniel" last="Talmor">Daniel Talmor</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA</wicri:regionArea>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Meert, Anne Pascale" sort="Meert, Anne Pascale" uniqKey="Meert A" first="Anne-Pascale" last="Meert">Anne-Pascale Meert</name>
<affiliation wicri:level="3"><nlm:affiliation>Service des Medicine Interne, Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Brussels, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Service des Medicine Interne, Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Brussels</wicri:regionArea>
<placeName><settlement type="city">Bruxelles</settlement>
<region nuts="2">Région de Bruxelles-Capitale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Cancelliere, Laura" sort="Cancelliere, Laura" uniqKey="Cancelliere L" first="Laura" last="Cancelliere">Laura Cancelliere</name>
<affiliation wicri:level="1"><nlm:affiliation>SCDU Anestesia e Rianimazione, Azienda and Ospedaliero Universitaria, Maggiore della Carità, Novara, Italy.</nlm:affiliation>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>SCDU Anestesia e Rianimazione, Azienda and Ospedaliero Universitaria, Maggiore della Carità, Novara</wicri:regionArea>
<wicri:noRegion>Novara</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Zubek, Laszl" sort="Zubek, Laszl" uniqKey="Zubek L" first="Lászl" last="Zubek">Lászl Zubek</name>
<affiliation wicri:level="3"><nlm:affiliation>Semmelweis University Budapest, Budapest, Hungary.</nlm:affiliation>
<country xml:lang="fr">Hongrie</country>
<wicri:regionArea>Semmelweis University Budapest, Budapest</wicri:regionArea>
<placeName><settlement type="city">Budapest</settlement>
<region nuts="2">Hongrie centrale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Maia, Paulo" sort="Maia, Paulo" uniqKey="Maia P" first="Paulo" last="Maia">Paulo Maia</name>
<affiliation wicri:level="1"><nlm:affiliation>Intensive Care Department, Hospital S.António, Porto, Portugal.</nlm:affiliation>
<country xml:lang="fr">Portugal</country>
<wicri:regionArea>Intensive Care Department, Hospital S.António, Porto</wicri:regionArea>
<wicri:noRegion>Porto</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"><nlm:affiliation>Tettnang Hospital, Tettnang, Germany.</nlm:affiliation>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Tettnang Hospital, Tettnang</wicri:regionArea>
<wicri:noRegion>Tettnang</wicri:noRegion>
<wicri:noRegion>Tettnang</wicri:noRegion>
<wicri:noRegion>Tettnang</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Kompanje, Erwin J O" sort="Kompanje, Erwin J O" uniqKey="Kompanje E" first="Erwin J O" last="Kompanje">Erwin J O. Kompanje</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Intensive Care Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Intensive Care Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam</wicri:regionArea>
<placeName><settlement type="city">Rotterdam</settlement>
<region nuts="2" type="province">Hollande-Méridionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Vlerick, Peter" sort="Vlerick, Peter" uniqKey="Vlerick P" first="Peter" last="Vlerick">Peter Vlerick</name>
<affiliation wicri:level="4"><nlm:affiliation>Faculty of Psychology and Educational Sciences, Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Faculty of Psychology and Educational Sciences, Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent</wicri:regionArea>
<orgName type="university">Université de Gand</orgName>
<placeName><settlement type="city">Gand</settlement>
<region>Région flamande</region>
<region type="district" nuts="2">Province de Flandre-Orientale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Roels, Jolien" sort="Roels, Jolien" uniqKey="Roels J" first="Jolien" last="Roels">Jolien Roels</name>
<affiliation wicri:level="4"><nlm:affiliation>Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent</wicri:regionArea>
<orgName type="university">Université de Gand</orgName>
<placeName><settlement type="city">Gand</settlement>
<region>Région flamande</region>
<region type="district" nuts="2">Province de Flandre-Orientale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Vansteelandt, Stijn" sort="Vansteelandt, Stijn" uniqKey="Vansteelandt S" first="Stijn" last="Vansteelandt">Stijn Vansteelandt</name>
<affiliation wicri:level="4"><nlm:affiliation>Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent</wicri:regionArea>
<orgName type="university">Université de Gand</orgName>
<placeName><settlement type="city">Gand</settlement>
<region>Région flamande</region>
<region type="district" nuts="2">Province de Flandre-Orientale</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:affiliation>London School of Hygiene and Tropical Medicine, London, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>London School of Hygiene and Tropical Medicine, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Decruyenaere, Johan" sort="Decruyenaere, Johan" uniqKey="Decruyenaere J" first="Johan" last="Decruyenaere">Johan Decruyenaere</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent</wicri:regionArea>
<wicri:noRegion>Ghent</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Azoulay, Elie" sort="Azoulay, Elie" uniqKey="Azoulay E" first="Elie" last="Azoulay">Elie Azoulay</name>
<affiliation wicri:level="3"><nlm:affiliation>Hôpital Saint-Louis and University Paris-7, Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Hôpital Saint-Louis and University Paris-7, Paris</wicri:regionArea>
<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="Vanheule, Stijn" sort="Vanheule, Stijn" uniqKey="Vanheule S" first="Stijn" last="Vanheule">Stijn Vanheule</name>
<affiliation wicri:level="4"><nlm:affiliation>Department of Psycho-analysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Psycho-analysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent</wicri:regionArea>
<orgName type="university">Université de Gand</orgName>
<placeName><settlement type="city">Gand</settlement>
<region>Région flamande</region>
<region type="district" nuts="2">Province de Flandre-Orientale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Piers, Ruth" sort="Piers, Ruth" uniqKey="Piers R" first="Ruth" last="Piers">Ruth Piers</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Geriatric Medicine, Ghent University Hospital, Ghent</wicri:regionArea>
<wicri:noRegion>Ghent</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"><nlm:affiliation>Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.</nlm:affiliation>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent</wicri:regionArea>
<wicri:noRegion>Ghent</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">Intensive care medicine</title>
<idno type="eISSN">1432-1238</idno>
<imprint><date when="2020" type="published">2020</date>
</imprint>
</series>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term>
<term>Attitude of Health Personnel (MeSH)</term>
<term>Critical Care (ethics)</term>
<term>Critical Care (psychology)</term>
<term>Critical Care (standards)</term>
<term>Ethics, Medical (MeSH)</term>
<term>Europe (MeSH)</term>
<term>Female (MeSH)</term>
<term>Health Personnel (psychology)</term>
<term>Health Personnel (statistics & numerical data)</term>
<term>Humans (MeSH)</term>
<term>Intensive Care Units (ethics)</term>
<term>Intensive Care Units (organization & administration)</term>
<term>Intensive Care Units (statistics & numerical data)</term>
<term>Intention (MeSH)</term>
<term>Male (MeSH)</term>
<term>Organizational Culture (MeSH)</term>
<term>Surveys and Questionnaires (MeSH)</term>
<term>United States (MeSH)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term>
<term>Attitude du personnel soignant (MeSH)</term>
<term>Culture organisationnelle (MeSH)</term>
<term>Déontologie médicale (MeSH)</term>
<term>Enquêtes et questionnaires (MeSH)</term>
<term>Europe (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Intention (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Personnel de santé (psychologie)</term>
<term>Personnel de santé (statistiques et données numériques)</term>
<term>Soins de réanimation (normes)</term>
<term>Soins de réanimation (psychologie)</term>
<term>Soins de réanimation (éthique)</term>
<term>Unités de soins intensifs (organisation et administration)</term>
<term>Unités de soins intensifs (statistiques et données numériques)</term>
<term>Unités de soins intensifs (éthique)</term>
<term>États-Unis (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="geographic" xml:lang="en"><term>Europe</term>
<term>United States</term>
</keywords>
<keywords scheme="MESH" qualifier="ethics" xml:lang="en"><term>Critical Care</term>
<term>Intensive Care Units</term>
</keywords>
<keywords scheme="MESH" qualifier="normes" xml:lang="fr"><term>Soins de réanimation</term>
</keywords>
<keywords scheme="MESH" qualifier="organisation et administration" xml:lang="fr"><term>Unités de soins intensifs</term>
</keywords>
<keywords scheme="MESH" qualifier="organization & administration" xml:lang="en"><term>Intensive Care Units</term>
</keywords>
<keywords scheme="MESH" qualifier="psychologie" xml:lang="fr"><term>Personnel de santé</term>
<term>Soins de réanimation</term>
</keywords>
<keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Critical Care</term>
<term>Health Personnel</term>
</keywords>
<keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Critical Care</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Health Personnel</term>
<term>Intensive Care Units</term>
</keywords>
<keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Personnel de santé</term>
<term>Unités de soins intensifs</term>
</keywords>
<keywords scheme="MESH" qualifier="éthique" xml:lang="fr"><term>Soins de réanimation</term>
<term>Unités de soins intensifs</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Attitude of Health Personnel</term>
<term>Ethics, Medical</term>
<term>Female</term>
<term>Humans</term>
<term>Intention</term>
<term>Male</term>
<term>Organizational Culture</term>
<term>Surveys and Questionnaires</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte</term>
<term>Attitude du personnel soignant</term>
<term>Culture organisationnelle</term>
<term>Déontologie médicale</term>
<term>Enquêtes et questionnaires</term>
<term>Europe</term>
<term>Femelle</term>
<term>Humains</term>
<term>Intention</term>
<term>Mâle</term>
<term>États-Unis</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>États-Unis</term>
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<front><div type="abstract" xml:lang="en"><p><b>PURPOSE</b>
</p>
<p>Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>This is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">31690968</PMID>
<DateCompleted><Year>2020</Year>
<Month>09</Month>
<Day>14</Day>
</DateCompleted>
<DateRevised><Year>2021</Year>
<Month>01</Month>
<Day>10</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1432-1238</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>46</Volume>
<Issue>1</Issue>
<PubDate><Year>2020</Year>
<Month>01</Month>
</PubDate>
</JournalIssue>
<Title>Intensive care medicine</Title>
<ISOAbbreviation>Intensive Care Med</ISOAbbreviation>
</Journal>
<ArticleTitle>Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.</ArticleTitle>
<Pagination><MedlinePgn>46-56</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1007/s00134-019-05829-1</ELocationID>
<Abstract><AbstractText Label="PURPOSE">Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.</AbstractText>
<AbstractText Label="METHODS">Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.</AbstractText>
<AbstractText Label="RESULTS">Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.</AbstractText>
<AbstractText Label="CONCLUSION">This is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Van den Bulcke</LastName>
<ForeName>Bo</ForeName>
<Initials>B</Initials>
<Identifier Source="ORCID">http://orcid.org/0000-0001-5379-8886</Identifier>
<AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. bo.vandenbulcke@uzgent.be.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Metaxa</LastName>
<ForeName>Victoria</ForeName>
<Initials>V</Initials>
<AffiliationInfo><Affiliation>King's College Hospital, London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Reyners</LastName>
<ForeName>Anna K</ForeName>
<Initials>AK</Initials>
<AffiliationInfo><Affiliation>Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Rusinova</LastName>
<ForeName>Katerina</ForeName>
<Initials>K</Initials>
<AffiliationInfo><Affiliation>Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Jensen</LastName>
<ForeName>Hanne I</ForeName>
<Initials>HI</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Institute of Regional Research, Vejle Hospital, Vejle, Denmark.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Malmgren</LastName>
<ForeName>J</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>University of Southern Denmark, Odense, Denmark.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Darmon</LastName>
<ForeName>Michael</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Hôpital Saint-Louis and University Paris-7, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Talmor</LastName>
<ForeName>Daniel</ForeName>
<Initials>D</Initials>
<AffiliationInfo><Affiliation>Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Meert</LastName>
<ForeName>Anne-Pascale</ForeName>
<Initials>AP</Initials>
<AffiliationInfo><Affiliation>Service des Medicine Interne, Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Brussels, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Cancelliere</LastName>
<ForeName>Laura</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>SCDU Anestesia e Rianimazione, Azienda and Ospedaliero Universitaria, Maggiore della Carità, Novara, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zubek</LastName>
<ForeName>László</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Semmelweis University Budapest, Budapest, Hungary.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Maia</LastName>
<ForeName>Paulo</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Intensive Care Department, Hospital S.António, Porto, Portugal.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Michalsen</LastName>
<ForeName>Andrej</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Tettnang Hospital, Tettnang, Germany.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kompanje</LastName>
<ForeName>Erwin J O</ForeName>
<Initials>EJO</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Vlerick</LastName>
<ForeName>Peter</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Faculty of Psychology and Educational Sciences, Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Roels</LastName>
<ForeName>Jolien</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Vansteelandt</LastName>
<ForeName>Stijn</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>London School of Hygiene and Tropical Medicine, London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Decruyenaere</LastName>
<ForeName>Johan</ForeName>
<Initials>J</Initials>
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Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.

Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.

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