Christiane S Hartog1,2, F Hoffmann3, A Mikolajetz3, S Schröder4, A Michalsen5, K Dey6, R Riessen7, U Jaschinski8, M Weiss9, M Ragaller10, S Bercker11, J Briegel12, C Spies13, D Schwarzkopf3. 1. Klinik für Anästhesie m.S. operative Intensivmedizin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. Christiane.hartog@mailbox.org. 2. Klinik Bavaria Kreischa, Kreischa, Deutschland. Christiane.hartog@mailbox.org. 3. Klinik für Anästhesie und Intensivmedizin, Universitätsklinik Jena, Jena, Deutschland. 4. Klinik für Anästhesiologie, operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Krankenhaus Düren, Düren, Deutschland. 5. Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Medizin Campus Bodensee - Klinik Tettnang, Tettnang, Deutschland. 6. Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland. 7. Medizinische Klinik, Universitätsklinikum Tübingen, Tübingen, Deutschland. 8. Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Augsburg, Deutschland. 9. Klinik für Anästhesiologie, Universitätsklinikum Ulm, Ulm, Deutschland. 10. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland. 11. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland. 12. Klinik für Anästhesiologie, Klinikum der Universität, LMU München, München, Deutschland. 13. Klinik für Anästhesie m.S. operative Intensivmedizin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Abstract
BACKGROUND: End-of-life care (EOLC) in the intensive care unit (ICU) is becoming increasingly more common but ethical standards are compromised by growing economic pressure. It was previously found that perception of non-beneficial treatment (NBT) was independently associated with the core burnout dimension of emotional exhaustion. It is unknown whether factors of the work environment also play a role in the context of EOLC. OBJECTIVE: Is the working environment associated with perception of NBT or clinician burnout? MATERIAL AND METHODS: Physicians and nursing personnel from 11 German ICUs who took part in an international, longitudinal prospective observational study on EOLC in 2015-2016 were surveyed using validated instruments. Risk factors were obtained by multivariate multilevel analysis. RESULTS: The participation rate was 49.8% of personnel working in the ICU at the time of the survey. Overall, 325 nursing personnel, 91 residents and 26 consulting physicians participated. Nurses perceived NBT more frequently than physicians. Predictors for the perception of NBT were profession, collaboration in the EOLC context, excessively high workload (each p ≤ 0.001) and the numbers of weekend working days per month (p = 0.012). Protective factors against burnout included intensive care specialization (p = 0.001) and emotional support within the team (p ≤ 0.001), while emotional exhaustion through contact with relatives at the end of life and a high workload were both increased (each p ≤ 0.001). DISCUSSION: Using the example of EOLC, deficits in the work environment and stress factors were uncovered. Factors of the work environment are associated with perceived NBT. To reduce NBT and burnout, the quality of the work environment should be improved and intensive care specialization and emotional support within the team enhanced. Interprofessional decision-making among the ICU team and interprofessional collaboration should be improved by regular joint rounds and interprofessional case discussions. Mitigating stressful factors such as communication with relatives and high workload require allocation of respective resources.
BACKGROUND: End-of-life care (EOLC) in the intensive care unit (ICU) is becoming increasingly more common but ethical standards are compromised by growing economic pressure. It was previously found that perception of non-beneficial treatment (NBT) was independently associated with the core burnout dimension of emotional exhaustion. It is unknown whether factors of the work environment also play a role in the context of EOLC. OBJECTIVE: Is the working environment associated with perception of NBT or clinician burnout? MATERIAL AND METHODS: Physicians and nursing personnel from 11 German ICUs who took part in an international, longitudinal prospective observational study on EOLC in 2015-2016 were surveyed using validated instruments. Risk factors were obtained by multivariate multilevel analysis. RESULTS: The participation rate was 49.8% of personnel working in the ICU at the time of the survey. Overall, 325 nursing personnel, 91 residents and 26 consulting physicians participated. Nurses perceived NBT more frequently than physicians. Predictors for the perception of NBT were profession, collaboration in the EOLC context, excessively high workload (each p ≤ 0.001) and the numbers of weekend working days per month (p = 0.012). Protective factors against burnout included intensive care specialization (p = 0.001) and emotional support within the team (p ≤ 0.001), while emotional exhaustion through contact with relatives at the end of life and a high workload were both increased (each p ≤ 0.001). DISCUSSION: Using the example of EOLC, deficits in the work environment and stress factors were uncovered. Factors of the work environment are associated with perceived NBT. To reduce NBT and burnout, the quality of the work environment should be improved and intensive care specialization and emotional support within the team enhanced. Interprofessional decision-making among the ICU team and interprofessional collaboration should be improved by regular joint rounds and interprofessional case discussions. Mitigating stressful factors such as communication with relatives and high workload require allocation of respective resources.
Entities:
Keywords:
Critical care; End-of-life care; Occupational stress; Quality of health care; Terminal care
Authors: Ruth D Piers; Elie Azoulay; Bara Ricou; Freda Dekeyser Ganz; Johan Decruyenaere; Adeline Max; Andrej Michalsen; Paulo Azevedo Maia; Radoslaw Owczuk; Francesca Rubulotta; Pieter Depuydt; Anne-Pascale Meert; Anna K Reyners; Andrew Aquilina; Maarten Bekaert; Nele J Van den Noortgate; Wim J Schrauwen; Dominique D Benoit Journal: JAMA Date: 2011-12-28 Impact factor: 56.272
Authors: Bo Van den Bulcke; Ruth Piers; Hanne Irene Jensen; Johan Malmgren; Victoria Metaxa; Anna K Reyners; Michael Darmon; Katerina Rusinova; Daniel Talmor; Anne-Pascale Meert; Laura Cancelliere; Làszló Zubek; Paolo Maia; Andrej Michalsen; Johan Decruyenaere; Erwin J O Kompanje; Elie Azoulay; Reitske Meganck; Ariëlla Van de Sompel; Stijn Vansteelandt; Peter Vlerick; Stijn Vanheule; Dominique D Benoit Journal: BMJ Qual Saf Date: 2018-02-23 Impact factor: 7.035
Authors: U Janssens; H Burchardi; G Duttge; R Erchinger; P Gretenkort; M Mohr; F Nauck; S Rothärmel; F Salomon; P Schmucker; A Simon; H Stopfkuchen; A Valentin; N Weiler; G Neitzke Journal: Anaesthesist Date: 2013-01 Impact factor: 1.041
Authors: Marc Moss; Vicki S Good; David Gozal; Ruth Kleinpell; Curtis N Sessler Journal: Am J Respir Crit Care Med Date: 2016-07-01 Impact factor: 21.405
Authors: Ruth D Piers; Elie Azoulay; Bara Ricou; Freda DeKeyser Ganz; Adeline Max; Andrej Michalsen; Paulo Azevedo Maia; Radoslaw Owczuk; Francesca Rubulotta; Anne-Pascale Meert; Anna K Reyners; Johan Decruyenaere; Dominique D Benoit Journal: Chest Date: 2014-08 Impact factor: 9.410
Authors: Manfred Weiss; Andrej Michalsen; Anke Toenjes; Franz Porzsolt; Thomas Bein; Marc Theisen; Alexander Brinkmann; Heinrich Groesdonk; Christian Putensen; Friedhelm Bach; Dietrich Henzler Journal: BMC Anesthesiol Date: 2017-07-11 Impact factor: 2.217
Authors: Nicola Magnavita; Paolo Maurizio Soave; Walter Ricciardi; Massimo Antonelli Journal: Int J Environ Res Public Health Date: 2020-11-08 Impact factor: 3.390