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Evaluation der Pflegebedingungen auf Intensivstationen: Ergebnisse einer Onlinebefragung von Intensivpflegenden
Abstract
Im folgenden Artikel sollen ausgewählte Ergebnisse einer deskriptiven Studie zur Personalausstattung, Arbeitszufriedenheit und Patientensicherheit auf Intensivstationen vorgestellt und diskutiert werden. Der Hauptfokus liegt dabei auf der Gegenüberstellung von Merkmalen der Personalausstattung und Indikatoren zur Arbeitssituation und Patientenversorgung. Grundlage der Studie ist eine Onlinebefragung unter Intensivpflegenden, die im Jahr 2017 durchgeführt wurde. Für die nachfolgende Studienbeschreibung wurden insgesamt 2233 deutsche Intensivpflegende in die Auswertung eingeschlossen. Die vorgestellten Ergebnisse zeigen, dass Pflegende, die mit einer niedrigen Pflegekraft-Patienten-Relation (≥1:3) arbeiten, tendenziell höhere Risiken in der Patientenversorgung beschreiben und eine niedrigere Arbeitszufriedenheit aufzeigen als Pflegende, die in einer Betreuungsrelation von ≤1:2 arbeiten.
... Obwohl es in Deutschland, verglichen mit allen anderen europäischen Ländern, überdurchschnittlich viele Intensiv-und Intermediate-Care-Betten bezogen auf die Einwohnerzahl gibt (etwa 30 Betten pro 100.000 Einwohner; [6]), kommt es paradoxerweise in diesem Bereich immer wieder zu Engpässen in der Patientenversorgung. Diese Engpässe sind maßgeblich darauf zurückzuführen, dass sowohl die Anzahl der Intensivbetten als auch die Behandlungsfälle in Deutschland kontinuierlich gestiegen sind, während im selben Zeitraum die Anzahl an Pflegekräften und Fachpflegekräften abgenommen hat [7]. Eine geringe Personalstärke und ein geringer Qualifikationsmix erhöhen die Wahrscheinlichkeit, dass Patienten im Krankenhaus sterben [8]. ...
... Obwohl es in Deutschland, verglichen mit allen anderen europäischen Ländern, überdurchschnittlich viele Intensiv-und Intermediate-Care-Betten bezogen auf die Einwohnerzahl gibt (etwa 30 Betten pro 100.000 Einwohner; [6]), kommt es paradoxerweise in diesem Bereich immer wieder zu Engpässen in der Patientenversorgung. Diese Engpässe sind maßgeblich darauf zurückzuführen, dass sowohl die Anzahl der Intensivbetten als auch die Behandlungsfälle in Deutschland kontinuierlich gestiegen sind, während im selben Zeitraum die Anzahl an Pflegekräften und Fachpflegekräften abgenommen hat [7]. Eine geringe Personalstärke und ein geringer Qualifikationsmix erhöhen die Wahrscheinlichkeit, dass Patienten im Krankenhaus sterben [8]. ...
Background:
Agency nursing is used as a form of labour to counter vacant staff positions in hospitals. Stakeholders and nurses might view this critically for different reasons.
Aim:
The aim of this study was to evaluate what individual net income nurses in German intensive care units and intermediate care units consider "fair and acceptable" for their work. Furthermore, what influence does salary have on the willingness to change to agency nursing or back to a permanent position.
Methods:
From September-October 2020, an anonymous online survey was performed among nurses of intermediate care units, intensive care units and special care units in German-speaking countries. The results were evaluated using descriptive statistics.
Result:
Of 1203 participants, 1036 (86%) of those working in Germany could be evaluated. The question about the individual net income was answered by 1032 (99%) participants. The majority of respondents (n = 522) stated that they had an individual net income of 2000-2999 €/month. The higher the level of the net income, the lower the willingness to switch to agency work. The participants in permanent employment only perceive a net income of 3200 €/month (median 3200 €; interquartile range [IQR] 2800-3800 €) as acceptable and fair for their work. In all, 142 agency nurses stated that an individual net income of 3200 €/month (median 3200 €; IQR 3000-3950 €) would be sufficient to move from agency nursing back into permanent employment.
Conclusion:
The intensive care nurses in this survey consider a salary of 3200 €/month as acceptable and fair for their work. The salary level can be a parameter for the decision to go into agency work, but also to move back to permanent employment. Regardless of the salary, better working conditions were indicated as an essential element in terms of job satisfaction for all respondent groups.
... 20 % weniger bei der Nahrungsaufnahme unterstützt, Positionierungen, Mobilisierungen, Tubuspflege vorgenommen und verzögert auf Alarme von Infusionspumpen reagiert, im Vergleich zu einer NPR von ≤ 1:2. Kritische Zwischenfälle, wie das ungewollte Entfernen eines geblockten Blasenkatheters, eines peripher-oder zentralvenösen Zuganges waren bei einer NPR von ≥ 1:3 um 11 % bis 12 % höher im Vergleich zu einer NPR von ≤ 1:2(Isfort, 2018). Jährlich könnten auf Intensivstationen zwischen 2,2 und 13,2 Mio. ...
... The online questionnaire has previously been used as an instrument for data collection in various investigations. [37][38][39] The prevalence of PTSD observed in the present study is similar to the results of a study by Hernandez-Martinez et al 31 However, various other studies have reported a lower prevalence than those found in our study. 7,12 In a systematic review including 26 studies, a prevalence of 4% was obtained, 7 coinciding with that obtained by Yildiz et al, 12 in a systematic review with meta-analysis that included 59 studies. ...
Background: This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD).
Methods: A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period.
Results: PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58).
Conclusions: Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.
... Obwohl es in Deutschland, verglichen mit allen anderen europäischen Ländern, überdurchschnittlich viele Intensiv-und Intermediate-Care-Betten bezogen auf die Einwohnerzahl gibt (etwa 30 Betten pro 100.000 Einwohner; [6]), kommt es paradoxerweise in diesem Bereich immer wieder zu Engpässen in der Patientenversorgung. Diese Engpässe sind maßgeblich darauf zurückzuführen, dass sowohl die Anzahl der Intensivbetten als auch die Behandlungsfälle in Deutschland kontinuierlich gestiegen sind, während im selben Zeitraum die Anzahl an Pflegekräften und Fachpflegekräften abgenommen hat [7]. Eine geringe Personalstärke und ein geringer Qualifikationsmix erhöhen die Wahrscheinlichkeit, dass Patienten im Krankenhaus sterben [8]. ...
Background
Temporary contract workers are used for the nursing care of intensive care patients, usually by service providers in the sense of temporary employment. If or how temporary contract work has an impact on patient care has scarcely been investigated so far.AimThe aim of this systematic review is to describe the available research results on the use of temporary workers in nursing care in intensive and intermediate care units and to summarize the prospective effects on patient outcomes.Method
Seven databases were systematically searched for English and German language articles using Boolean operators and evaluated according to the PRISMA schema. References of included studies were included in the search and the quality of all included studies was evaluated according to the Hawker criteria.ResultFrom a total of 630 datasets viewed, 1 qualitative and 2 quantitative studies were identified and analyzed. The findings of the quantitative studies indicated that the probability of the occurrence of catheter-associated infections can increase with the use of temporary workers, but is more dependent on the size of the unit: For each additional bed, the probability of VAP increases by 14.8% (95%-CI = 1.032–1.277, p = 0.011). However, trends for a decrease in the sepsis rate as soon as fewer temporary workers (hours/patient) were deployed in the intensive care unit (ICU) could not be confirmed.Conclusion
In the few available studies no evidence was found that the use of temporary workers in intensive care units (ICU) and intermediate care units (IMC) has a significant impact on patient outcomes; however, evidence was found that individual qualifications and working conditions have an influence on outcomes. Further studies should consider what ratio of permanent to temporary workers should be considered uncritical, what qualifications temporary workers should have and to what extent these can be checked.
... In der aktuellen Befragung von Isfort war eine pflegerische Betreuungsrelation von ≥1:3 bei >60 % der Intensivstationen die Regel und war im Vergleich mit einer Betreuungsrelation von ≤1:2 mit einer gesteigerten Wahrnehmung von Risiken in der Patientenversorgung und einer ge-ringeren Arbeitszufriedenheit assoziiert [19]. ...
Die Vergütung intensivmedizinischer und pflegerischer Leistungen erfolgt seit dem Jahr 2004 im deutschen Gesundheitssystem weitgehend über Fallpauschalen (German-diagnosis-related-groups[G-DRG]-System). Da in Deutschland eine übergeordnete Krankenhausstrukturplanung weitgehend fehlt, sind die Vorgaben des G‑DRG-Systems inzwischen zum wichtigsten (Fehl‑)Steuerungsfaktor im Gesundheitswesen geworden. Die deutsche Intensivmedizin lässt sich im internationalen Vergleich inzwischen durch folgende Merkmale charakterisieren: viele Intensivbetten, niedrige Personalausstattung pro Patient, fehlende Einstufung von Intensivstationen in eine Versorgungshierarchie sowie eine minimale Erhebung von intensivmedizinischen Strukturdaten. Unter den gegebenen Bedingungen stellt ein zunehmender Personalmangel die wichtigste Bedrohung für die Patientenversorgung dar. Zur Behebung dieser Schwächen schlagen die Autoren folgende Maßnahmen vor: 1) eine Eingliederung der Intensivstationen in das geplante Stufensystem der Notfallversorgung, 2) eine verpflichtende Erhebung eines strukturierten Datensatzes von allen Intensivstationen mit Erfassung von Qualitätskriterien, 3) eine Reform der Vergütung intensivmedizinischer und pflegerischer Leistungen unter Berücksichtigung der personellen Vorhaltekosten, 4). Maßnahmen zur Personalbindung, -rekrutierung und -qualifikation.
Background
Agency work in nursing is used as a form of labor to counter vacant staff positions in hospitals. Both hospital owners and nurses view this critically for different reasons.
Aim
The aim of this study was to assess what personal net income nurses in German intensive care units and intermediate care units consider “fair and sufficient” for their work (addressed in Part 1 of the survey) and what influence—aside from the salary—the working conditions have on the willingness to change to temporary work or back to a permanent position.
Methods
From September to October 2020, an anonymous online survey was conducted among nurses of intermediate care units, intensive care units, and special care units in German-speaking countries. Descriptive statistics were used for the analysis.
Result
Of 1203 participants, 86% ( n = 1036) could be evaluated. None of the job satisfaction factors queried received four or five stars (maximum five stars) from those participating in the survey. The most unsatisfied group proved to be regularly employed nurses with an additional part-time job. Key job satisfaction factors differed markedly between the groups, with regular employees favoring consistency and stability. Agency workers prefer gaining experience in a broader range of tasks. Unreliable duty rosters and poor nurse to patient ratios were common points of criticism.
Conclusion
For job satisfaction, making nurses feel appreciated and respected is essential. This includes a guaranteed nurse to patient ratio and reliable duty rosters that also include tasks outside direct patient care. In order for nurses to leave agency work, it is necessary to take into account the differences in interests in terms of the focus of activity.
Zusammenfassung
Ziel Es werden Anforderungen, Motivationen und Herausforderungen bei der pandemiebedingten Rückkehr von ausgebildeten Pflegefachkräften in den Pflegeberuf analysiert, um Erkenntnisse zu Berufsidentitäten von Pflegefachkräften in Krisensituationen abzuleiten und Handlungsansätze für eine gelingende Rückkehr – vorübergehend oder dauerhaft – in den Pflegeberuf zu formulieren.
Methodik Auf der Grundlage des Diskrepanz-Modells nach Heinzer et al. [11] und einer strukturierenden qualitativen Inhaltsanalyse [13] wurden 15 Expert*inneninterviews mit Pflegefachkräften durchgeführt und analysiert.
Ergebnisse Die Ergebnisse zeigen auf, dass sich Pflegefachkräfte, die beabsichtigen zeitweise in den Pflegeberuf zurückzukehren oder bereits wieder in der Pflege arbeiten, in Zwiespälten befinden, die sich in Kontinuen zwischen Pflichtgefühl, kollegialer Hilfsbereitschaft, Fürsorge und Selbstfürsorge bewegen.
Schlussfolgerungen Um Pflegefachkräften den Wiedereinstieg in den Pflegeberuf zu erleichtern, bedarf es einer transparenten Kommunikation von Zugängen und einer Verringerung von Barrieren, einem wertschätzenden Umgang und Möglichkeiten der Mitgestaltung von Arbeitsbedingungen.
Noninvasive ventilation (NIV) is established as an integral part of intensive care therapy for respiratory insufficiency. However, it is associated with restrictions on patient autonomy and comfort. A successful course of therapy is largely dependent on the acceptance and adherence of the patients concerned. Intensive care nurses can have a significant influence on the success of the therapy by dealing with the subjective experience of the patients and by maintaining close contact with them. The prerequisite for this is profound knowledge of the different technical aspects of therapy and equipment as well as positive and negative factors influencing NIV tolerance in order to be able to offer and implement an individual intervention.
Definition of the problemThe COVID-19 pandemic poses a considerable challenge to the capacity and functionality of intensive care. This concerns not only resources but, above all, the physical and psychological boundaries of nursing professionals. The question of how care for others and self-care of nurses in intensive care units are related to each other in the context of the COVID-19 pandemic has not been addressed in public and scientific discourse so far.ArgumentsThe present contribution reflects this relationship with reference to the Code of Ethics of the International Council of Nurses, particularly considering principlism and the Care Ethics according to Joan Tronto. As a result, it shows a corridor of ethically justifiable care with several borders, above all: (1) self-care must not be given up completely for the benefit of care for others, and (2) a categorical subordination of care for others to self-care is ethically not justifiable.Conclusion
The article makes an important contribution to a differentiated ethical consideration of the rights and responsibilities of intensive care nurses as moral actors within the pandemic in Germany. It, thus, provides a first starting point for a broad social and political discourse which is urgently needed not only during but also after the pandemic in order to improve the situation of intensive care nurses and those who are cared for.
Zur Behandlung des schwersten Lungenversagens und des kardiogenen Schocks werden im letzten Jahrzehnt zunehmend extrakorporale Organersatzverfahren (ECMO) eingesetzt, auch wenn die zugrunde liegende wissenschaftliche Evidenz immer noch gering ist und die Verfahren trotz aller technischer Verbesserungen weiterhin ein hohes Komplikationsrisiko aufweisen. Die Selektion der Patienten, die von einem solchen Organersatzverfahren am wahrscheinlichsten profitieren, stellt daher für Intensivmediziner und die anderen beteiligten Fachdisziplinen immer noch eine große Herausforderung dar. Neben dem Schweregrad des akuten Organversagens sollten hier die Ätiologie und Behandlungsmöglichkeiten der Grunderkrankung, die Komorbiditäten und der funktionelle Status des Patienten vom interdisziplinären Behandlungsteam umfassend evaluiert werden. Dabei sind auch ethische Herausforderungen zu bewältigen. Aufgrund der Komplexität der Verfahren und der hohen organisatorischen Anforderungen ist es sinnvoll, ECMO-Therapien in dafür besonders qualifizierten Zentren zu konzentrieren und eine umfassende wissenschaftliche Auswertung der Behandlungsdaten zu fördern.
Background:
Compared to other countries, Germany has the highest number of intensive care unit (ICU) beds, but, despite this, a shortage in ICU care is evident. Currently, little comprehensive data on ICU staffing and on subsequent closure of ICU beds are available. The current survey therefore aimed to systematically investigate the closure of ICU beds.
Method:
A survey was performed among authorized professional trainers in ICU medicine.
Results:
Overall, a shortage of ICU beds following bed closure was evident in 76% of all ICU floors with 22% reporting daily ICU bed closure. In 47%, two ICU beds were not available. Emergency care was unrestricted in only 18%, while restrictions were reportedly frequent or even constant in 30%. The main reasons for ICU bed closure were the unavailability of ICU nurses (44%) and the co-existing unavailability of nurses and physicians (19%). On average, the nurse/patient ratio was 1:2.5 in the morning, 1:2.6 in the afternoon, and 1:3.1 in the night shift.
Conclusions:
ICU bed closure regularly occurs in Germany. The underlying main reason has been identified to be the unavailability of ICU nursing staff. This is suggested to directly interfere with emergency care. For this reason, an action plan is urgently needed.
Zur Behandlung des schwersten Lungenversagens und des kardiogenen Schocks werden im letzten Jahrzehnt zunehmend extrakorporale Organersatzverfahren (ECMO) eingesetzt, auch wenn die zugrunde liegende wissenschaftliche Evidenz immer noch gering ist und die Verfahren trotz aller technischer Verbesserungen weiterhin ein hohes Komplikationsrisiko aufweisen. Die Selektion der Patienten, die von einem solchen Organersatzverfahren am wahrscheinlichsten profitieren, stellt daher für Intensivmediziner und die anderen beteiligten Fachdisziplinen immer noch eine große Herausforderung dar. Neben dem Schweregrad des akuten Organversagens sollten hier die Ätiologie und Behandlungsmöglichkeiten der Grunderkrankung, die Komorbiditäten und der funktionelle Status des Patienten vom interdisziplinären Behandlungsteam umfassend evaluiert werden. Dabei sind auch ethische Herausforderungen zu bewältigen. Aufgrund der Komplexität der Verfahren und der hohen organisatorischen Anforderungen ist es sinnvoll, ECMO-Therapien in dafür besonders qualifizierten Zentren zu konzentrieren und eine umfassende wissenschaftliche Auswertung der Behandlungsdaten zu fördern.
Introduction. Nurses and physicians working in the intensive care unit (ICU) may be exposed to considerable job stress. The study aim was to assess the level of and the relationship between (1) job satisfaction, (2) job stress, and (3) burnout symptoms. Methods. A cross-sectional study was performed at ICUs at Oslo University Hospital. 145 of 196 (74%) staff members (16 physicians and 129 nurses) answered the questionnaire. The following tools were used: job satisfaction scale (scores 10-70), modified Cooper's job stress questionnaire (scores 1-5), and Maslach burnout inventory (scores 1-5); high score in the dimension emotional exhaustion (EE) indicates burnout. Personality was measured with the basic character inventory. Dimensions were neuroticism (vulnerability), extroversion (intensity), and control/compulsiveness with the range 0-9. Results. Mean job satisfaction among nurses was 43.9 (42.4-45.4) versus 51.1 (45.3-56.9) among physicians, P < 0.05. The mean burnout value (EE) was 2.3 (95% CI 2.2-2.4), and mean job stress was 2.6 (2.5-2.7), not significantly different between nurses and physicians. Females scored higher than males on vulnerability, 3.3 (2.9-3.7) versus 2.0 (1.1-2.9) (P < 0.05), and experienced staff were less vulnerable, 2.7 (2.2-3.2), than inexperienced staff, 3.6 (3.0-4.2) (P < 0.05). Burnout (EE) correlated with job satisfaction (r = -0.4, P < 0.001), job stress (r = 0.6, P < 0.001), and vulnerability (r = 0.3, P = 0.003). Conclusions. The nurses were significantly less satisfied with their jobs compared to the physicians. Burnout mean scores are relatively low, but high burnout scores are correlated with vulnerable personality, low job satisfaction, and high degree of job stress.
Background Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon.
Aim The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors.
Methods Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study.
Results Across European hospitals, the most frequent nursing care activities left undone included ‘Comfort/talk with patients’ (53%), ‘Developing or updating nursing care plans/care pathways’ (42%) and ‘Educating patients and families’ (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone.
Conclusions Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.
There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure-'missed care'.
To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment.
Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England.
Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of 'missed care' (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as 'failing' on patient safety, compared with 2.4 where patient safety was rated as 'excellent' (p <0. 001).
Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of 'missed care' as an early warning measure to identify wards with inadequate nurse staffing.
Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement.
A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making.
Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs.
Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.
Background:
Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes.
Objectives:
To determine the association between nurse staffing, nurse work environments, and IHCA survival.
Research design:
Cross-sectional study of data from: (1) the American Heart Association's Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics.
Subjects:
A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey).
Results:
Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio=0.95; 95% confidence interval, 0.91-0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio=0.84; 95% confidence interval, 0.71-0.99) than patients cared for in hospitals with better work environments.
Conclusions:
Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA.
Intensiv- und Anasthesiepflegende, die sich fur Fachweiterbildungen entscheiden,
tun dies aus ganz unterschiedlichen Grunden, zum Beispiel, um sich auf die
steigenden Anforderungen im Beruf vorzubereiten oder um bessere Chancen auf dem
Arbeitsmarkt zu haben. Unsere Autoren haben den Einfluss der
Fachweiterbildung auf Arbeitsinhalte, Berufs- und Arbeitszufriedenheit
von Intensivpflegekraften genauer untersucht und stellen hier ihre Ergebnisse
vor.
The patient burden in intensive care units (ICU) has continually increased worldwide over the past decades. Age, co-morbidities and an increasing complexity of conditions and treatments increase the number of patients who are either colonized or infected with antibiotic-resistant pathogens. To prevent nosocomial infections, hygiene guidelines play an important role. In this paper, we investigate the time needed for nursing of five hypothetical critically ill patients in the intensive care unit. The results show that current staffing is not sufficient under the given hygiene guidelines and that a nurse to patient ratio of one will be necessary to meet the requirements. In a national survey of university hospitals, however, we found that the current nurse to patient ratio is 1: 2.47 in German intensive care units. The apparent staffing shortage is compensated by an extraordinary personal commitment of nurses caring for patients in the ICU.
© Georg Thieme Verlag KG Stuttgart · New York.
Mitarbeiter, die den Wunsch nach einem Arbeitgeberwechsel äußern, können ganz unterschiedliche Beweggründe haben. Wer zufrieden ist, wechselt eher nicht. Was bedeutet das aber für die Führungskräfte einer Abteilung? Anhand einer Literaturanalyse werden die Einflussfaktoren auf die berufliche Verweildauer von Intensivpflegefachkräften auf Intensivstationen herausgearbeitet und Empfehlungen zur Erhöhung der Berufszufriedenheit abgeleitet.
Matching healthcare staff resources to patient needs in the ICU is a key factor for quality of care. We aimed to assess the impact of the staffing-to-patient ratio and workload on ICU mortality.
We performed a multicenter longitudinal study using routinely collected hospital data.
Information pertaining to every patient in eight ICUs from four university hospitals from January to December 2013 was analyzed.
A total of 5,718 inpatient stays were included.
None.
We used a shift-by-shift varying measure of the patient-to-caregiver ratio in combination with workload to establish their relationships with ICU mortality over time, excluding patients with decision to forego life-sustaining therapy. Using a multilevel Poisson regression, we quantified ICU mortality-relative risk, adjusted for patient turnover, severity, and staffing levels. The risk of death was increased by 3.5 (95% CI, 1.3-9.1) when the patient-to-nurse ratio was greater than 2.5, and it was increased by 2.0 (95% CI, 1.3-3.2) when the patient-to-physician ratio exceeded 14. The highest ratios occurred more frequently during the weekend for nurse staffing and during the night for physicians (p < 0.001). High patient turnover (adjusted relative risk, 5.6 [2.0-15.0]) and the volume of life-sustaining procedures performed by staff (adjusted relative risk, 5.9 [4.3-7.9]) were also associated with increased mortality.
This study proposes evidence-based thresholds for patient-to-caregiver ratios, above which patient safety may be endangered in the ICU. Real-time monitoring of staffing levels and workload is feasible for adjusting caregivers' resources to patients' needs.
In this article selected results of a descriptive study on personnel staffing and patient care in German intensive care units are presented and discussed. The main focus is on comparing features of personnel staffing with indicators of the job situation and patient care. The study is based on a standardized survey of nursing managers from 535 intensive care units carried out in 2011. The results show that a low nurse-patient ratio in intensive care units has a tendency to caue higher risks in patient care and also in other stress indicator situations, such as absenteeism.
In stressed and high-throughput systems, periodic overcrowding (high bed occupancy) and understaffing (low nurse:patient ratio) are widely described risk factors for nosocomial infections.
The impact of bed occupancy (patient:bed ratio), nurse:patient ratio and nurse:ventilated patient ratio on nosocomial bloodstream infections (BSI) and pneumonia were investigated in 182 intensive care units (ICU).
The ICUs reported monthly data on device use and nosocomial device-associated infections to the German hospital surveillance system for nosocomial infections in 2007. Information on the number of healthcare workers on the ward per 24h in 2007 and structure parameters was obtained by questionnaires. The association between occupancy or staff parameters and the number of nosocomial infections per month was analysed using generalized estimating equation models.
In total, 1313 cases of pneumonia and 513 cases of BSI were reported from 182 ICUs with 1921 surveillance months and 563,177 patient-days. Fewer nosocomial infections were associated with a higher nurse:ventilated patient ratio [adjusted incidence rate ratio 0.42 (95% confidence interval 0.32-0.55) for months with nurse:ventilated patient ratios >75th percentile compared with ≤ 25 th percentile]. Interestingly, the nurse:patient ratio was not a significant parameter with respect to the occurrence of BSI and pneumonia. High bed occupancy (>75th percentile) was associated with fewer nosocomial infections.
A staffing parameter that reflects the intensity of care, such as the nurse:ventilated patient ratio, may enable better evaluation of workload and resources, especially at a time when nursing resources are being reduced but nosocomial infections are increasing.
We construct national estimates of the cost of increasing hospital nurse staffing and associated reductions in days, deaths, and adverse outcomes. Raising the proportion of nursing hours provided by registered nurses (RNs) without increasing total nursing hours is associated with a net reduction in costs. Increasing nursing hours, with or without increasing the proportion of hours provided by RNs, reduces days, adverse outcomes, and patient deaths, but with a net increase in hospital costs of 1.5 percent or less at the staffing levels modeled. Whether or not staffing should be increased depends on the value patients and payers assign to avoided deaths and complications.
Wegen Personalmangel geschlossen
- P Nydahl
- R Dubb
- A Kaltwasser
- A Becker
- U Beck
Becker A, Beck U (2010) Personalausstattung und
Ergebnisqualität. Schwest Pfleg 49(1):1-12
Berufsausstieg bei Pflegepersonal. Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (Ü15)
- H-M Hasselhorn
- B H Müller
- P Tackenberg
Hasselhorn H-M, Müller BH, Tackenberg P et
al (2005) Berufsausstieg bei Pflegepersonal.
Schriftenreihe der Bundesanstalt für Arbeitsschutz
und Arbeitsmedizin (Ü15). Bundesanstalt für
Arbeitsschutz und Arbeitsmedizin, Dortmund,
Berlin, Dresden
Einfluss der Personalausstattung auf Pflege und Patientenversorgung in deutschen Intensivstationen. Deskriptive Studie zu Aspekten der Patientensicherheit und Belastungsindikatoren der Pflege
- M Isfort
Isfort M (2013) Einfluss der Personalausstattung
auf Pflege und Patientenversorgung in deutschen
Intensivstationen. Deskriptive Studie zu Aspekten
der Patientensicherheit und Belastungsindikatoren der Pflege. Med Klin Intensivmed Notfmed
108(1):71-77
Pflege-Thermometer 2012. Deutsches Institut für angewandte Pflegeforschung e
- M Isfort
- F Weidner
- D Gehlen
- G Jorch
- S Kluge
- F König
Isfort M, Weidner F, Gehlen D (2012) Pflege-Thermometer 2012. Deutsches Institut für angewandte
Pflegeforschung e.V., Köln
8. Jorch G, Kluge S, König F et al (2010)
Empfehlungen zur Struktur und Ausstattung von Intensivstationen -Hintergrundtexte. http://www.divi.de/images/Dokumente/
Empfehlungen/Strukturempfehlungen/2011_
Personalbedarf einer Intensivstation unter Berücksichtigung geltender Hygienerichtlinien--Eine explorative Analyse
- M Kochanek
- B Boll
- A Shimabukuro-Vornhagen
Kochanek M, Boll B, Shimabukuro-Vornhagen A
et al (2015) Personalbedarf einer Intensivstation
unter Berücksichtigung geltender Hygienerichtlinien--Eine explorative Analyse. Dtsch Med
Wochenschr 140(14):e136-e141
- I Müller
- M Nairz
- D Deufert
Müller I, Nairz M, Deufert D (2012) Zufriedenheit ist
Trumpf. intensiv 20(05):235-239
- P Nydahl
- R Dubb
- A Kaltwasser
Nydahl P, Dubb R, Kaltwasser A (2017) Wegen
Personalmangel geschlossen. Schwest Pfleg
56(1):88-92
Decisional responsibility for mechanical ventilation and weaning: an international survey
- Rosel
- Blackwoodb
RoseL,BlackwoodB,EgerodIetal(2011)Decisional
responsibility for mechanical ventilation and
weaning: an international survey. Crit Care
15(6):R295
Understaffing, overcrowding, inappropriate nurse
- F Schwab
- E Meyer
- C Geffers
Schwab F, Meyer E, Geffers C et al (2012)
Understaffing, overcrowding, inappropriate nurse.
J Hosp Infect 80(2):133-139
Care left undone’ during nursing shifts: associations with workload and perceived quality of care
- J E Ball
- T Murrells
- A M Rafferty
- JE Ball