Navigation Links
Perception of inappropriate care frequent among ICU workers
Date:12/27/2011

CHICAGO A survey of nurses and physicians in intensive care units (ICUs) in Europe and Israel indicated that the perception of inappropriate care, such as excess intensity of care for a patient, was common, and that these perceptions were associated with inadequate decision sharing, communication and job autonomy, according to a study in the December 28 issue of JAMA.

"Clinicians perceive the care they provide as inappropriate when they feel that it clashes with their personal beliefs and/or professional knowledge. Intensive care unit workers who provide care perceived as inappropriate experience acute moral distress and are at risk for burnout. This situation may jeopardize the quality of care and increase staff turnover," according to background information in the article. The extent of perceived inappropriateness of care in the ICU is unknown.

Ruth D. Piers, M.D., of Ghent University Hospital, Gent, Belgium, and colleagues conducted a study to determine the prevalence and characteristics of perceived inappropriateness of care among clinicians in ICUs. The study consisted of an evaluation on May 11, 2010, of 82 adult ICUs in 9 European countries and Israel. The participants were 1,953 ICU nurses and physicians providing bedside care, who were surveyed regarding perceived inappropriateness of care, defined as a specific patient-care situation in which the clinician acts in a manner contrary to his or her personal and professional beliefs.

Of the 1,651 clinicians who provided responses, 439 (27 percent) reported perceived inappropriateness of care in at least 1 patient. Of the 1,218 nurses who completed the perceived inappropriateness of care questionnaire, 300 (25 percent) reported perceived inappropriateness of care. Of the 407 ICU physicians who provided care, 132 (32 percent) reported perceived inappropriateness of care in at least 1 of their patients.

In all, 397 clinicians completed 445 perceived inappropriateness of care questionnaires. Perceived disproportionate care was the most common reported reason (65 percent) for perceived inappropriateness of care; in 89 percent of these cases, the amount of care was perceived as excessive and in 11 percent as insufficient. Feeling that other patients would benefit more from ICU care than the present patient was the second most common reason (38 percent) for perceived inappropriateness of care. This feeling of distributive injustice was significantly more common among physicians than among nurses, the authors write.

Analysis indicated that several factors were independently associated with lower perceived inappropriateness of care rates: decisions about symptom control shared by nurses and physicians as opposed to being made by the physicians only; involvement of nurses in end-of-life decisions; good collaboration between nurses and physicians; work autonomy (freedom to decide how to perform work-related tasks); and perceived lower workload (only among nurses).

"In conclusion, perceived inappropriateness of care is common among nurses and physicians in ICUs and is significantly associated with an intent to leave the current clinical position, suggesting a major impact on clinician well-being. The main reported reason for perceived inappropriateness of care is a mismatch between the level of care and the expected patient outcome, usually in the direction of perceived excess intensity of care," the researchers write.

The authors add that the challenge for ICU managers is "to create ICUs in which self-reflection, mutual trust, open communication, and shared decision making are encouraged in order to improve the well-being of the individual clinicians and, thereby, the quality of patient care."

(JAMA. 2011;306[24]:2694-2703. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Perceived Inappropriateness of Care in the ICU

In an accompanying editorial, Scott D. Halpern, M.D., Ph.D., of the University of Pennsylvania, Philadelphia, writes that "although the report by Piers et al provides a hazy lens through which to view appropriateness of care, it yields more clarity than prior studies."

"Thus, the greatest contribution of [this study] may be to provide the clarion call needed to spur more rigorous study of what happens to clinicians and the care they provide when requests for care do not resonate with clinicians' conceptions of appropriateness. Such clinician-centered outcomes research, in other words, may usefully supplement the patient's perspective in gauging the quality of health care delivery."

(JAMA. 2011;306[24]:2725-2726. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

To contact Ruth D. Piers, M.D., email ruth.piers@ugent.be. To contact editorial author Scott D. Halpern, M.D., Ph.D., call Jessica Mikulski at 215-349-8369 or email jessica.mikulski@uphs.upenn.edu.


'/>"/>

Contact: Ruth D. Piers, M.D.
ruth.piers@ugent.be
JAMA and Archives Journals
Source:Eurekalert

Related medicine news :

1. Perception of poor sleep may predict postpartum mood disturbances in healthy new mothers
2. Perception: Skinny people arent lazy but overweight people are
3. Sleep colors your view of the world: Study suggests sleep may restore color perception
4. California Family Raising Confident, Blind Child Sharing Successes to Change Perceptions of Blindness
5. Male breast cancer in family leads to high perception of risk, low likelihood of genetic counseling
6. The impact of chronic diseases on patients also depends on their perception of the disease
7. Team colors on cans change perceptions of alcohol risks, MU study finds
8. Acupuncture changes brains perception and processing of pain
9. Widening our perceptions of reading and writing difficulties
10. Sense of Touch May Influence Gender Perception
11. How does anesthesia disturb self-perception?
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/28/2016)... ... May 28, 2016 , ... May 26, 2016- In search of the K. ... theme event of “K Warriors” on June 4, 2016 at Ashbury Hotel and Suites ... is sponsored and hosted by Shaolin Institute and sanctioned by KSF (Kungfu Sanda Federation), ...
(Date:5/27/2016)... Columbia, SC (PRWEB) , ... May 27, 2016 , ... ... launched a line of classic American timber frame barn kits, which can be found ... are inspired by historic American barn plans, and they highlight the craftsmanship of ...
(Date:5/27/2016)... ... 2016 , ... With over 60 percent of acute stroke survivors being left ... to aid in the rehabilitation process has steadily increased. Ekso Bionics had been working ... due to stroke. , Ekso Bionics has now received clearance from the U.S. Food ...
(Date:5/27/2016)... Texas (PRWEB) , ... May 27, 2016 , ... ... satisfying Army body fat composition regulations. This is the first time that Coolsculpting ... normally screened at least every six months to ensure they meet the prescribed body-fat ...
(Date:5/27/2016)... ... May 27, 2016 , ... With a team ... and food industries. Aside from its GMP accreditation, Validation Center is also a ... certified products, services and staff. , Validation Center is ISO17025 accredited and only ...
Breaking Medicine News(10 mins):
(Date:5/25/2016)... NORTH CHESTERFIELD, Va. , May 25, 2016 ... commercially-available next-generation sequencing test for wounds and infections. ... fungi, ALL parasites, and select viruses. The test ... infected area. David G. ... advanced molecular testing to facilitate wound healing: "We ...
(Date:5/25/2016)... PUNE, India , May 25, 2016 /PRNewswire/ ... Pipeline Review, H1 2016"market research report that provides ... complete with comparative analysis at various stages, therapeutics ... route of administration (RoA) and molecule type, along ... releases. It also reviews key players involved in ...
(Date:5/24/2016)...   , Study met ... bowel cleansing and superiority in , ... of the ascending colon   ... Norgine B.V. today announced new positive data from the phase ... preparation) versus standard 2 litre PEG with ascorbate. The study met ...
Breaking Medicine Technology: