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dc.contributor.authorPiers, Ruth D.-
dc.contributor.authorAzoulay, Elie-
dc.contributor.authorRicou, Bara-
dc.contributor.authorDeKeyser Ganz, Freda-
dc.contributor.authorDecruyenaere, Johan-
dc.contributor.authorMax, Adeline-
dc.contributor.authorMichalsen, Andrej-
dc.contributor.authorAzevedo Maia, Paulo-
dc.contributor.authorOwczuk, Radoslaw-
dc.contributor.authorRubulotta, Francesca-
dc.contributor.authorDepuydt, Pieter-
dc.contributor.authorMeert, Anne-Pascale-
dc.contributor.authorReyners, Anna K.-
dc.contributor.authorAquilina, Andrew-
dc.contributor.authorBekaert, Maarten-
dc.contributor.authorNoortgate, Nele J. Van Den-
dc.contributor.authorSchrauwen, Wim J.-
dc.contributor.authorBenoit, Dominique D.-
dc.date.accessioned2019-08-14T09:32:38Z-
dc.date.available2019-08-14T09:32:38Z-
dc.date.issued2011-
dc.identifier.citationPiers, R. D., Azoulay, E., Ricou, B., DeKeyser Ganz, F. D., Decruyenaere, J., Max, A.,...Benoit,D. D. (2011). Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. Jama, 306(24), 2694-2703.en_GB
dc.identifier.urihttps://www.um.edu.mt/library/oar/handle/123456789/45555-
dc.description.abstractContext: Clinicians in intensive care units (ICUs) who perceive the care they provide as inappropriate experience moral distress and are at risk for burnout. This situation may jeopardize patient quality of care and increase staff turnover. Objective: To determine the prevalence of perceived inappropriateness of care among ICU clinicians and to identify patient-related situations, personal characteristics, and work-related characteristics associated with perceived inappropriateness of care. Design, Setting, and Participants: Cross-sectional evaluation on May 11, 2010, of 82 adult ICUs in 9 European countries and Israel. Participants were 1953 ICU nurses and physicians providing bedside care. Main Outcome Measure: 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, as assessed using a questionnaire designed for the study. Results: Of 1651 respondents (median response rate,93%overall; interquartile range, 82%-100% [medians 93% among nurses and 100% among physicians]), perceived inappropriateness of care in at least 1 patient was reported by 439 clinicians overall (27%; 95%CI,24%-29%),300 of 1218 were nurses (25%), 132 of 407 were physicians (32%), and 26 had missing answers describing job title. Of these 439 individuals, 397 reported 445 situations associated with perceived inappropriateness of care. The most common reports were perceived disproportionate care (290 situations [65%;95%CI,58%-73%], of which "too much care" was reported in 89% of situations, followed by "other patients would benefit more" (168 situations [38%;95%CI, 32%-43%]). Independently associated with perceived inappropriateness of care rates both among nurses and physicians were symptom control decisions directed by physicians only (odds ratio [OR], 1.73; 95% CI, 1.17-2.56; P=.006); involvement of nurses in end-of-life decision making (OR, 0.76;95%CI, 0.60-0.96; P=.02); good collaboration between nurses and physicians (OR, 0.72;95%CI, 0.56-0.92; P=.009); and freedom to decide how to perform work-related tasks (OR, 0.72;95%CI, 0.59-0.89; P=.002); while a high perceived workload was significantly associated among nurses only(OR,1.49;95%CI, 1.07-2.06;P=.02). Perceived inappropriateness of care was independently associated with higher intent to leave a job (OR, 1.65;95%CI, 1.04-2.63; P=.03). In the subset of 69 ICUs for which patient data could be linked, clinicians reported received inappropriateness of care in 207 patients, representing 23% (95% CI, 20%-27%) of 883 ICU beds. Conclusion: Among a group of European and Israeli ICU clinicians, perceptions of inappropriate care were frequently reported and were inversely associated with factors indicating good teamwork. ©2011 American Medical Association. All rights reserved.en_GB
dc.language.isoenen_GB
dc.publisherAmerican Medical Associationen_GB
dc.rightsinfo:eu-repo/semantics/restrictedAccessen_GB
dc.subjectIntensive care units -- Case studiesen_GB
dc.subjectIntensive care units -- Evaluationen_GB
dc.subjectHealth services research -- Europeen_GB
dc.subjectHealth services research -- Israelen_GB
dc.subjectMedical care -- Quality controlen_GB
dc.titlePerceptions of appropriateness of care among European and Israeli intensive care unit nurses and physiciansen_GB
dc.typearticleen_GB
dc.rights.holderThe copyright of this work belongs to the author(s)/publisher. The rights of this work are as defined by the appropriate Copyright Legislation or as modified by any successive legislation. Users may access this work and can make use of the information contained in accordance with the Copyright Legislation provided that the author must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the prior permission of the copyright holder.en_GB
dc.description.reviewedpeer-revieweden_GB
dc.identifier.doi10.1001/jama.2011.1888-
dc.publication.titleJamaen_GB
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