Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.
Decision-making
Ethical climate
Intent to leave
Interdisciplinary reflection
Respect
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
28
06
2019
accepted:
10
10
2019
pubmed:
7
11
2019
medline:
15
9
2020
entrez:
7
11
2019
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 31690968
doi: 10.1007/s00134-019-05829-1
pii: 10.1007/s00134-019-05829-1
pmc: PMC6954133
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
46-56Subventions
Organisme : FWO senior clinical investigators grant
ID : 1800513N
Pays : International
Références
Van der Heijden BIJM, Kummerling A, van Dam K, van der Schoot E, Estryn-Behar M, Hasselhorn HM (2010) The impact of social support upon intention to leave among female nurses in Europe: secondary analysis of data from the NEXT survey. Int J Nurs Stud 47(4):434–445
doi: 10.1016/j.ijnurstu.2009.10.004
Hasselhorn HM, Tackenberg P, Muller BH (eds) (2003) Working conditions and intent to leave the profession among nursing staff in Europe. National Institute for Working Life, Stockholm
Coomber B, Barriball KL (2007) Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of job-related and non-related factors. Int J Nurs Stud 44:297–314
doi: 10.1016/j.ijnurstu.2006.02.004
Poncet MC, Toullic P, Papazian L et al (2007) Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 175(7):698–704
doi: 10.1164/rccm.200606-806OC
Merlani P, Verdon M, Businger A et al (2011) Burnout in ICU caregivers: a multicenter study of factors associated to centers. Am J Respir Crit Care Med 184(10):1140–1146
doi: 10.1164/rccm.201101-0068OC
Ackerman AD (1993) Retention of critical care staff. Crit Care Med 21(9):S394–S395
doi: 10.1097/00003246-199309001-00063
Piers RD, Azoulay E, Ricou B et al (2011) Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. J Am Med Assoc 306(24):2694–2703
doi: 10.1001/jama.2011.1888
Piers RD, Azoulay E, Ricou B, Dekeyser GF, Max A, Michalsen A et al (2014) Inappropriate care in European ICUs: confronting views from nurses and junior and senior physicians. Chest 146(2):267–275
doi: 10.1378/chest.14-0256
Galletta M, Portoghese I, Carta MG, D’Aloja E, Campagna M (2016) The effect of nurse-physician collaboration on job satisfaction, team commitment, and turnover intention in nurses. Res Nurs Health 39(5):375–385
doi: 10.1002/nur.21733
Azoulay É, Timsit J-F, Sprung CL et al (2009) Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med 180(9):853–860
doi: 10.1164/rccm.200810-1614OC
Schwarzkopf D, Ruddel H, Thomas-Ruddel DO, Felfe J, Poidinger B, Matthaus-Kramer CT et al (2017) Perceived nonbeneficial treatment of patients, burnout, and intention to leave the job among ICU nurses and junior and senior physicians. Crit Care Med 45(3):e265–e273
doi: 10.1097/CCM.0000000000002081
Jensen HI, Hebsgaard S, Hansens TCB, et al (2019) Perceptions of ethical decision-making climate among clinicians working in European and US ICUs: differences between nurses and physicians in submission. Crit Care Med. https://doi.org/10.1097/CCM0000000000004017
doi: 10.1097/CCM0000000000004017
pubmed: 31625980
Azoulay E, Metnitz B, Sprung CL, Timsit JF, Lemaire F, Bauer P et al (2009) End-of-life practices in 282 intensive care units: data from the SAPS 3 database. Intensive Care Med 35(4):623–630
doi: 10.1007/s00134-008-1310-6
Benoit DD, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M et al (2018) Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA. Intensive Care Med 44:1039–1049
doi: 10.1007/s00134-018-5231-8
Michalsen A et al (2019) Interprofessional shared decision-making in the ICU: a systematic review and recommendations from an expert panel. Crit Care Med 47(9):1258–1266. https://doi.org/10.1097/CCM.0000000000003870
doi: 10.1097/CCM.0000000000003870
pubmed: 31169620
Guarino CM, Santibañez L, Daley GA (2006) Teacher recruitment and retention: a review of the recent empirical literature. Rev Educ Res 76:173–208
doi: 10.3102/00346543076002173
Flannery L, Ramjan LM, Peters K (2016) End-of-life decisions in the intensive care unit (ICU)-exploring the experiences of ICU nurses and doctors: a critical literature review. Aust Crit Care 29(2):97–103
doi: 10.1016/j.aucc.2015.07.004
Hämmig O (2018) Explaining burnout and the intention to leave the profession among health professionals: a cross-sectional study in a hospital setting in Switzerland. BMC Health Serv Res 18(1):785
doi: 10.1186/s12913-018-3556-1
Austin CL, Saylor R, Finley PJ (2017) Moral distress in physicians and nurses: impact on professional quality of life and turnover. Psychol Trauma Theory Res Pract Policy 9(4):399–406
doi: 10.1037/tra0000201
Van den Bulcke B, Piers R, Jensen HI, Malmgren J, Metaxa V, Reyners AK et al (2018) Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool. BMJ Qual Saf 27:781–789
doi: 10.1136/bmjqs-2017-007390
Liljegren M, Ekberg K (2009) Job mobility as predictor to health and burnout. J Occup Organ Psychol 82:317–329
doi: 10.1348/096317908X332919
Vyt A (2016) Interprofessional education and collaborative practice in health and social care: the need for transdisciplinary mindsets, instruments and mechanisms. In: Gibbs P (ed) Transdisciplinary professional learning and practice. Springer Publishers, Berlin, pp 69–88
Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J et al (2006) The safety attitudes questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 3(6):44
doi: 10.1186/1472-6963-6-44
Stogdill RM, Coons AE (1957) Leadership behavior description questionnaire (LGDQ). Oxford : Ohio State University, p 957
Agresti A (2013) Categorical data analysis, 3rd edn. John Wiley & Sons, Hoboken
Vandenberg RJ, Nelson JB (1999) Disaggregating the motives underlying turnover intentions: when do intentions predict turnover behaviour? Hum Relat 52:1313–1336
Vansteelandt S, Bekaert M, Claeskens G (2012) On model selection and model misspecification in causal inference. Stat Methods Med Res 21(1):7–30. https://doi.org/10.1177/0962280210387717
doi: 10.1177/0962280210387717
pubmed: 21075803
Simon M, Muller BH, Hasselhorn HM (2010) Leaving the organization or the profession: a multilevel analysis of nurses’ intentions. J Adv Nurs 66(3):616–626
doi: 10.1111/j.1365-2648.2009.05204.x
Camerino D, Conway PM, Van der Heijden BIJM, Estryn-Behar M, Consonni D, Gould D, Hasselhorn HM (2006) Low-perceived work ability, ageing and intention to leave nursing: a comparison among 10 European countries. J Adv Nurs 56(5):542–552
doi: 10.1111/j.1365-2648.2006.04046.x
Hamric AB, Blackhall LJ (2007) Nurse-physician perspective on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med 35(2):422–429
doi: 10.1097/01.CCM.0000254722.50608.2D
Jensen HI, Ammentorp J, Ording H (2011) Withholding or withdrawing therapy in Danish regional ICUs: frequency, patient characteristics and decision process. Acta Anaesthesiol Scand 55(3):344–351
doi: 10.1111/j.1399-6576.2010.02375.x
Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR (2015) Estimating the effect of palliative care interventions and advance care planning on the ICU utilization: a systematic review. Crit Care Med 43:1102–1111
doi: 10.1097/CCM.0000000000000852
Donovan AL, Aldrich JM, Gross AK, Barchas DM, Thornton KC, Schell-Chaple HM et al (2018) Interprofessional care and teamwork in the ICU. Crit Care Med 46(6):980–990
doi: 10.1097/CCM.0000000000003067
Mealer M (2016) Burnout syndrome in the intensive care unit future directions for research. Ann Am Thorac Soc 13:997–998
doi: 10.1513/AnnalsATS.201604-280ED
van Dam K, Meeuwis M, van der Heijden BI (2013) Securing intensive care: towards a better understanding of intensive care nurses’ perceived work pressure and turnover intention. J Adv Nurs 69(1):31–40
doi: 10.1111/j.1365-2648.2012.05981.x
Van den Bulcke B, Vyt A, Vanheule S, Hoste E, Decruyenaere J, Benoit D (2016) The perceived quality of interprofessional teamwork in an intensive care unit: a single centre intervention study. J Interprof Care 30(3):301–308
doi: 10.3109/13561820.2016.1146876
Maslach C, Schaufeli WB, Leiter MP (2001) Job burnout. Annu Rev Psychol 52:397–422
doi: 10.1146/annurev.psych.52.1.397
Sokol-Hessner L, Folcarelli PH, Annas CL, Brown SM, Fernandez L, Roche SD et al (2018) A road map for advancing the practice of respect in health care: the results of an interdisciplinary modified Delphi consensus study. Jt Comm Jt Qual Patient Saf 44(8):463–476
Dekeyser GF, Engelberg R, Torres N, Curtis JR (2016) Development of a model of Interprofessional shared clinical decision making in the ICU: a mixed-methods study. Crit Care Med 44(4):680–689
doi: 10.1097/CCM.0000000000001467
Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP (2003) Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol 88(5):879–903
doi: 10.1037/0021-9010.88.5.879