Staff stress on the intensive care unit: a comparison of doctors and nurses

Single-Bed or Multibed Room Designs Influence ICU Staff Stress and Family Satisfaction, But Do Not Influence ICU Staff Burnout

OBJECTIVE

To compare the impact of single-bed versus multibed room intensive care units (ICU) architectural designs on the stress and burnout of ICU staff and on the stress and satisfaction of family visitors.

BACKGROUND

There are countless architectural variations among ICUs, but all involve single-bed or multibed rooms. Although it is well known that ICU design affects important patient outcomes, the effect of ICU design on family and staff has been insufficiently studied.

METHODS

Among ICU staff and family visitors, stress was evaluated with Lipp's Inventory of Stress Symptoms. ICU staff burnout was evaluated with the Maslach Burnout Inventory. Family visitor satisfaction was evaluated with Molter's Critical Care Family Needs Inventory.

RESULTS

Among 156 ICU professionals who were interviewed, similar burnout rates were observed between ICU staff who worked single-bed versus multibed rooms. However, stress reported by ICU staff within the previous 24 hr was higher among the ICU staff who worked in single-bed rooms (14.3% vs. 4.7%, p = .04). Among 176 family visitors who were interviewed, a similar level of stress was reported by family members who visited patients in single-bed or multibed rooms. However, the satisfaction of family members visiting patients in single-bed rooms was higher (96.0% vs. 84.6%, p = .02).

CONCLUSIONS

Single-bed ICU design was associated with greater satisfaction of family visitors yet with higher levels of stress for ICU staff. Meanwhile, similar burnout levels were observed for ICU staff who worked in single-bed or multibed rooms.

Assessing stress associated with temporomandibular joint disorder through Fonseca's anamnestic index among the Saudi physicians

The study aims to investigate signs and symptoms of temporomandibular disorders (TMD) among physicians in a tertiary health-care center. It has estimated the level of symptomatology, determined the association with demographic data, and identified the related occupational risk factors. A cross-sectional survey was used, and physicians of genders, all age groups, and nationalities from King Abdulaziz Medical City in Riyadh, Saudi Arabia, were recruited. Subjects who had rheumatic arthritis, osteoarthritis, trigeminal neuralgia, or temporomandibular joint (TMJ) trauma were excluded. The data were collected through a self-administered questionnaire that measured TMD severity and oral parafunctional behaviors. Fonseca's anamnestic index (FAI) and an oral validated behavior checklist were used to assess the signs and symptoms of TMD. A total of 282 physicians participated in the study, and the prevalence of TMD signs among physicians was 37% (106); among them, 88 (83%) were within the light dysfunction category. Female physicians reported significantly higher FAI than males for side-to-side mandibular movement (12% vs. 5%, P = 0.04), reporting ear pain (18% vs. 10%, P = 0.04), and noticing clicking when chewing or opening the mouth (35% vs. 20%, P = 0.006). Younger practitioners (28-31 years old) who reported clicking while chewing or opening the mouth tended to have reported higher TMD dysfunction (35%) than those aged 40 and above (13%; P = 0.007). Self-reported signs of TMD were 37% among our population. Information collected from FAI is useful in early diagnosis and prevention of TMD.

Nature Contacts

Objective:

This study was designed to ascertain the amount of outdoor, indoor, and indirect nature contact exposures hospital employees have in a workweek.

Background:

Hospital employees have been found particularly vulnerable to work-related stress. Increasing the nature contact exposure for hospital employees can reduce perceived stress; stress-related health behaviors; and stress-related health outcomes from outdoor, indoor, and indirect exposures to nature.

Methods:

Staff on the fourth floor postsurgical unit of a large hospital ( N = 42) were ask to participate in an employee questionnaire “nature contact questionnaire”. This 16-item nature environment questionnaire measures the amount and types of nature contact exposures employees have during a workweek.

Results:

Majority of employees reported few, if any, nature contact exposures, specifically in the area of outdoor nature contacts with limited indoor and indirect contacts. These results indicated that employees on the fourth floor postsurgical floor have limited ability to reduce stress through nature contact exposures which could impact their perceived levels of work stress and stress-related behaviors and health outcomes.

Conclusions:

Nature contact exposures are both a relatively easy and an inexpensive way to improve employee stress. These findings indicate limitations to employees’ exposure to nature contacts. Healthcare environments would benefit from a concerted effort to provide increased outdoor, indoor, and indirect nature contact exposures for employees.

Stress levels of critical care doctors in India: A national survey

Background:

Doctors working in critical care units are prone to higher stress due to various factors such as higher mortality and morbidity, demanding service conditions and need for higher knowledge and technical skill.

Aim:

The aim was to evaluate the stress level and the causative stressors in doctors working in critical care units in India.

Materials and Methods:

A two modality questionnaire-based cross-sectional survey was conducted. In manual mode, randomly selected delegates attending the annual congress of Indian Society of Critical Care Medicine filled the questionnaire. In the electronic mode, the questionnaires were E-mailed to critical care doctors. These questionnaires were based on General Health Questionnaire-12 (GHQ-12). Completely filled 242 responses were utilized for comparative and correlation analysis.

Results:

Prevalence of moderate to severe stress level was 40% with a mean score of 2 on GHQ-12 scale. Too much responsibility at times and managing VIP patients ranked as the top two stressors studied, while the difficult relationship with colleagues and sexual harassment were the least. Intensivists were spending longest hours in the Intensive Care Unit (ICU) followed by pulmonologists and anesthetists. The mean number of ICU bed critical care doctors entrusted with was 13.2 ± 6.3. Substance abuse to relieve stress was reported as alcohol (21%), anxiolytic or antidepressants (18%) and smoking (14%).

Conclusion:

Despite the higher workload, stress levels measured in our survey in Indian critical care doctors were lower compared to International data. Substantiation of this data through a wider study and broad-based measures to improve the quality of critical care units and quality of the lives of these doctors is the need of the hour.

Increasing the Retirement Age in Intensive Care Medicine: Perception of the Effect on Patient Safety and Personal Health

The government has recently increased the retirement age and as a result doctors are going to have to work longer. Intensive care medicine is a demanding specialty with significant on-call commitment, and this paper looks at the potential ramifications of this policy change on patient safety and personal health of intensivists. All consultants working in Wales with sessions in intensive care medicine were asked to complete a survey to ascertain their opinion on whether increasing age would affect patient safety or their personal health. If asked to work beyond the age of 60, 80% of respondents thought that patient safety would be jeopardised and 67% of respondents felt their personal health would be affected. Twenty-seven respondents (43%) have had or currently have health problems linked with work, and this correlates with the intensity of the on-call (p<0.004). Intensivists have substantial concern about whether increasing the retirement age is a realistic proposition in this specialty. If a consultant feels that he or she is not providing safe care it is important that the problem can be raised and addressed with the full support of the employers and the profession, and without penalty.

Perceived occupational stress in nurses working in Ireland

BACKGROUND

Stress has been seen as a routine and accepted part of the health care worker's role. There is a lack of research on stress in nurses in Ireland.

AIMS

To examine the levels of stress experienced by nurses working in an Irish teaching hospital and investigate differences in perceived stress levels by ward area and associations with work characteristics.

METHODS

A cross-sectional study design was employed, with a two-stage cluster sampling process. Data collection was by means of a self-administered questionnaire, and nurses were investigated across 10 different wards using the Nursing Stress Scale and the Demand Control Support Scales.

RESULTS

The response rate was 62%. Using outpatients as a reference ward, perceived stress levels were found to be significantly higher in the medical ward, accident and emergency, intensive care unit and paediatric wards (P < 0.05). There was no significant difference between the wards with regard to job strain; however, differences did occur with levels of support, the day unit and paediatric ward reporting the lowest level of supervisor support (P < 0.01). A significant association was seen between the wards and perceived stress even after adjustment (P < 0.05).

CONCLUSIONS

The findings suggest that perceived stress does vary within different work areas in the same hospital. Work factors, such as demand and support, are important with regard to perceived stress. Job control was not found to play an important role.

[The characteristics of nurses' and caregivers' behaviour in different clinical settings with special attention to burnout syndrome]

The author draws attention to the up-to-datedness of the selected topic and its personal and institutional effects. Stress in work (workplace stress) has a significant role in the pathomechanism of burnout. Nurses are exposed to excessive stress burden in work so expected incidence of burnout is relatively high among them. Goal of this study is to draw a picture about the situation, condition of mental health, degree and rate of burnout in nurses in given health care situations.

METHODS

Self-completed, anonymous questionnaire questioning the surveyed socio-demographic data while using three standardized questionnaires with the measurement of the degree of burnout, physical and mental exhaustion and fatigue as well as dysfunctional attitudes.

RESULTS

The study surveyed 805 individuals analyzing the specific characteristics of supporting relationship and joining points between degree of burnout and (hospital) department care form. Among 374 nurses working in the intensive care unit 9.4% suffer from burnout, while among 155 nurses working in active care unit this rate is 0.6%. According to the findings of the study there are also other influential elements, namely the facts that nurses have part-time jobs (second jobs) besides their full-time jobs and the lack of moral and financial respect or recognition. Among the surveyed population 273 individuals--33.9%--are at risk regarding burnout, 44 individuals--5.5%--show signs of burnout and 7 individuals--0.9%--are in a condition where treatment is needed. The study supposed the influential role of certain personality factors (dysfunctional attitudes) in the development of burnout. Comparison showed that burnout phenomenon and dysfunctional attitudes are correlated.

CONCLUSION

The survey results confirmed that socio-demographic factors had no effect on burnout development. The severity of patients' condition and the degree of permanent stressful situation in intensive care units are among determinant workplace factors.

Job Satisfaction, Stress and Burnout in Anaesthetic Technicians in New Zealand

Anaesthetic technicians play a key role in the operating room, yet little is known about their levels of job satisfaction or workplace stress. A blinded, confidential single mail-out survey was posted to anaesthetic technicians in New Zealand. The survey consisted of demographic information, a job satisfaction survey, the Maslach Burnout Inventory and the Short Form 12. At total of 154 forms were returned (51% response rate). Respondents worked predominantly in public hospitals and many had duties outside the operating room. Job satisfaction was related to teamwork, practical nature of work and patient contact, while dissatisfaction was related to lack of respect from nurses and limited career pathway. High to moderate levels of emotional exhaustion (48%), depersonalisation (39%) and low levels of personal accomplishment (58%) were indicators of burnout. The Short Form 12 revealed high levels of physical impairment in 24% and emotional impairment in 35% of respondents. These data suggest that work is needed to evaluate anaesthetic assistants’ job structure and actively manage their important physical and emotional sequelae.

Matching nurse skill with patient acuity in the intensive care units: a risk management mandate

AIM

This paper aims to highlight the need for the traditional concept of nursing skill mix to be reconfigured within a new concept of skill matching.

BACKGROUND

Substantive literature describes staff deployment and patient-dependency models. However, limited information exists as to what informs decision making regarding nurse skill assessment and subsequent patient allocation in intensive care units.

KEY ISSUES

In intensive care units, nurse numbers, available nursing skills and patient allocation decisions, impact directly on care provision and outcomes. This paper argues that staffing decisions that are based on insufficient knowledge which lack consideration of all pertinent factors result in poor 'skill matching', potential adverse events and poor outcomes. A critical inextricable link exists between staffing decisions, patient safety and risk in the intensive care unit. Use of a multifactorial skill-matching approach within a dedicated staffing decision-support system is recommended.

CONCLUSION

This commentary paper adds a new perspective to nurse-staffing decision practices and their relationship to risk management in the intensive care unit and offers a new research direction.

Factors That Enable or Complicate End-of-Life Transitions in Critical Care

• Background Nurses in medical intensive care units are routinely involved in negotiations to maintain or withdraw life support. How nurses move from aggressively attempting to extend life to letting life end is not well understood.

• Objective To explore nurses’ experiences of moving from cure- to comfort-oriented care and to describe factors that inhibit or facilitate such transitions.

• Method A descriptive qualitative research design with brief observation of participants and focus group interviews was used. Participants were 19 female and 5 male nurses in an 18-bed medical intensive care unit in a 719-bed acute care hospital in the northeastern United States.

• Results The transition point between cure- and comfort-oriented care was unclear. Nurses reported that the patient’s age, misunderstanding of the illness by the patient’s family, family discord, and shifting medical care decisions made end-of-life transitions difficult. Conversely, developing a consensus among patients, patients’ families, and staff about the direction of medical therapy; exhausting treatment options; and patients’ lack of response to aggressive medical interventions helped nurses move toward comfort care.

• Conclusions The most distressing situations for staff were dealing with younger patients with an acute life-threatening illness and performing futile care on elderly patients. End-of-life transitions were difficult when patients’ families had conflicts or were indecisive about terminating treatment and when physicians kept offering options that were unlikely to change patients’ prognosis. The most important factor enabling nurses to move from cure- to comfort-oriented care was developing a consensus about the treatment.

Speaking about dying in the intensive care unit, and its implications for multidisciplinary end-of-life care

This article addresses how professionals working in an intensive care unit in Australia speak about dying, with particular reference to the contradictions and complexities that characterize their work in this setting. The article reflects on the incommensurabilities in these clinicians' talk, and the consequences of this for how different professionals work together and care for extremely ill patients. Examples are drawn from talk recorded during ward rounds and focus groups. The article argues that intensive care units are settings where being reflexive about one's work and assumptions is especially difficult because it involves negotiating decisions and taking moral responsibility for decisions affecting very sick patients. These decisions and responsibilities put into sharp relief the 'wicked problems and tragic choices' of end-of-life existence and of intensive care in specific. This article shows some of the complex ways in which specific clinicians' discourse absorbs and manifests these tensions and responsibilities. The article concludes that these kinds of complexities are unlikely to be resolved with reference to formal knowledge or in-principle conviction, and that a new interactive basis needs to be found where clinicians can rehearse alternative ways of speaking with which to approach each other, the dying, and their families.

Stress in UK intensive care unit doctors

BACKGROUND

Doctors have long been considered at risk of occupational stress.

METHODS

A postal survey of all members of the Intensive Care Society using validated instruments.

RESULTS

Eight-five per cent of members returned questionnaires and 70% were eligible for the study. Twenty-nine per cent were suffering General Health Questionnaire-12 (GHQ-12) identified distress and 12% Symptom Checklist-Depression (SCL-D) defined depression. There were no significant age or sex differences between staff suffering distress or depression and those who did not. Dissatisfaction with career correlated highly with both distress and depression (P<0.01). Twenty doctors (3%) were bothered by suicidal thoughts. The most stressful aspects of work were bed allocation, being over-stretched, effect of hours of work and stress on personal/family life, and compromising standards when resources are short. Logistic regression revealed mental health problems were predicted by five stressors: 'lack of recognition of one's own contribution by others'; 'too much responsibility at times'; 'effect of stress on personal/family life'; 'keeping up to date with knowledge'; and 'making the right decision alone'.

CONCLUSIONS

Nearly one in three ICU doctors appeared distressed (GHQ), and one in 10 depressed (SCL-D); this is no greater than that reported in other specialities. Perceived stressors reveal some key areas of concern for the employer and the specialty.

Balancing values and imperatives: a study of nursing service in an ICU

There has been significant attention from the managers and purchasers of health services regarding the economic advantages that result from changes to the patterns of health care delivery in the acute hospital setting. The impact of these changes, whilst often rendering advantage at the economic management level of health care, can have different consequences for the people who deliver and the people who receive health service. This paper reports on a study that was conducted with a group of nurses to investigate the practice milieu of a critical care unit in the context of changes to health service management. Interpretive methods were used to capture the perspective of the nurses and the way they interpret the multiple factors that influence their practice and their practice environment. The findings indicate that the nurses in the study setting interpret these factors according to the influences they have on the structure, the geography and the value of their work. Explication of these findings provides a research base to inform recommendations relating to improving the practice milieu of the critical care environment.

Well-being of intensive care nurses (WEBIC): a job analytic approach

AIMS OF THE STUDY

This paper presents the results of a validation study of the so-called well-being of intensive care nurses (WEBIC)-questionnaire that is designed to perform a detailed job analysis of intensive care unit (ICU) nurses' jobs.

BACKGROUND

The WEBIC-questionnaire is based on modern sociotechnical systems theory, and distinguishes four integrated task categories: (1) operational, (2) organizing, (3) preparatory, and (4) supportive tasks. For each task, the WEBIC assesses (1) how demanding this task is, and (2) how satisfying the performance of this task is. Using the WEBIC, information is gathered about ICU nurses' qualitative workload, and typical job-related risks for ICU nurses' well-being at work can be mapped.

METHODS

A cross-sectional survey on work and well-being of almost 2000 ICU-nurses in 13 different European areas was conducted. Exploratory factor analyses were performed to study the validity of the factorial structure of the WEBIC-questionnaire. The construct validity of the WEBIC-questionnaire was studied by performing hierarchical multiple regression analyses of the WEBIC-factors on two types of job-related well-being, i.e. burnout and general job satisfaction.

RESULTS

Results of the exploratory factor analyses showed that the hypothesized four-factor structure of the WEBIC is confirmed by our data. Internal consistencies of the different factors varied from 0.77 to 0.91. Intensive care unit nurses' most central (operational) tasks turned out to pose the greatest demands, but also seemed to drive their satisfaction. With respect to the relationships between the four WEBIC-factors, and burnout and general job satisfaction, it was found that, especially for the satisfying tasks, significant relationships with these outcomes were found.

CONCLUSION

The reliability and construct validity of the WEBIC-questionnaire can be considered satisfactory. Furthermore, the questionnaire provides a systematical and detailed coverage of ICU nurses' tasks. In relation to this, the questionnaire is not only useful for scientific purposes but also for practical use.

A consensus driven method to measure the required number of intensive care nurses in Australia

This paper describes a methodology for determining the number of nurses required to staff Australia's intensive care unit (ICU) beds. The evidence used is level IV, that is the use of expert panel opinion, and it is the strongest and most accurate attempt yet to describe how Australia's ICU beds should be staffed with nurses. The researchers provide ratios of staffing applicable to a variety of situations that should be of use to ICU managers and hospital administrators. Equally, the broader calculations explaining the national supply and demand needs provide an easy to use approach and explanation suitable to health professionals, health administrators, policy advisors, governments, politicians and the broader community. Limitations of the approach and further recommendations are made to encourage future work in this area. Finally, a strong correlation between the number of available 'open' ICU beds in Australia and the number of nurses actually working in ICU at any given time is well demonstrated using the methodology outlined in this paper. Clarification of scope and terminology: This paper focuses on the nursing requirements of ICUs only; occasionally we use the word critical care nurse--this generally refers to those nurses who have completed a generic critical care nursing course but who, for the purposes of our study, are working in ICUs. Critical care units encompass ICUs but may also encompass recovery room, cardiothoracic units, coronary care, emergency departments and many other environments where critically ill patients are cared for and treated. This paper does not cover the broader scope of critical care units, only ICUs.