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Prevalence and factors of intensive care unit conflicts: The conflicus study

Azoulay, E and Timsit, JF and Sprung, CL and Soares, M and Rusinová, K and Lafabrie, A and Abizanda, R and Svantesson, M and Rubulotta, F and Ricou, B and Benoit, D and Heyland, D and Joynt, G and Francxais, A and Azeivedo-Maia, P and Owczuk, R and Benbenishty, J and De Vita, M and Valentin, A and Ksomos, A and Cohen, S and Kompan, L and Ho, K and Abroug, F and Kaarlola, A and Gerlach, H and Kyprianou, T and Michalsen, A and Chevret, S and Schlemmer, B (2009) Prevalence and factors of intensive care unit conflicts: The conflicus study. American Journal of Respiratory and Critical Care Medicine, 180 (9). 853 - 860. ISSN 1073-449X

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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 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 preand 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.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Azoulay, E
Timsit, JF
Sprung, CL
Soares, M
Rusinová, K
Lafabrie, A
Abizanda, R
Svantesson, M
Rubulotta, F
Ricou, B
Benoit, D
Heyland, D
Joynt, G
Francxais, A
Azeivedo-Maia, P
Owczuk, R
Benbenishty, J
De Vita, M
Valentin, A
Ksomos, A
Cohen, S
Kompan, L
Ho, K
Abroug, F
Kaarlola, A
Gerlach, H
Kyprianou, T
Michalsen, A
Chevret, S
Schlemmer, B
ContributionContributors NameEmailPitt UsernameORCID
CollaboratorPinsky, Michael Rpinsky@pitt.eduPINSKYUNSPECIFIED
Date: 1 November 2009
Date Type: Publication
Journal or Publication Title: American Journal of Respiratory and Critical Care Medicine
Volume: 180
Number: 9
Page Range: 853 - 860
DOI or Unique Handle: 10.1164/rccm.200810-1614oc
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1073-449X
PubMed ID: 19644049
Date Deposited: 27 Mar 2012 14:59
Last Modified: 04 Feb 2019 22:55


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