Perceptions of Inappropriate Care Prevalent Among ICU Staff

For ICU staff in Europe, Israel, perceptions independently linked to higher intent to leave job

TUESDAY, Dec. 27 (HealthDay News) -- Perceptions of inappropriate care are prevalent among intensive care unit (ICU) clinicians in Europe and Israel, according to a study published in the Dec. 28 issue of the Journal of the American Medical Association.

Ruth D. Piers, M.D., from Ghent University Hospital in Belgium, and colleagues investigated the prevalence of perceived inappropriateness of care among ICU clinicians (defined as specific patient-care situations in which the clinician acts in a manner contrary to his or her personal and professional beliefs) and identified its association with patient-related situations, personal characteristics, and work-related characteristics. A total of 1,651 ICU nurses and physicians, from 82 adult ICUs in nine European countries and Israel, were included, using a questionnaire designed for the study.

The investigators found that 439 clinicians (27 percent) reported perceived inappropriateness of care in at least one patient. Of these, 397 reported 445 situations which correlated with perceived inappropriateness of care; the most common report being perceived disproportionate care (65 percent of situations), which included "too much care" (89 percent) and "other patients would benefit more" (38 percent). Both doctors and nurses found that perceived inappropriateness of care was independently and significantly associated with symptom control decisions directed by physicians only (odds ratio [OR], 1.73), involvement of nurses in end-of-life decisions (OR, 0.76), good cooperation between nurses and physicians (OR, 0.72), and freedom to determine how to carry out work-related tasks (OR, 0.72). For nurses only, a high perceived workload significantly correlated with perceived inappropriateness of care (OR, 1.49). There was a significant and independent correlation between perceived inappropriateness of care and a higher intent to leave a job (OR, 1.65).

"Perceptions of inappropriate care were frequently reported and were inversely associated with factors indicating good teamwork," the authors write.

Several authors disclosed financial ties with the pharmaceutical industry.

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