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Evaluation der Pflegebedingungen auf Intensivstationen: Ergebnisse einer Onlinebefragung von Intensivpflegenden



Im folgenden Artikel sollen ausgewahlte Ergebnisse einer deskriptiven Studie zur Personalausstattung, Arbeitszufriedenheit und Patientensicherheit auf Intensivstationen vorgestellt und diskutiert werden. Der Hauptfokus liegt dabei auf der Gegenuberstellung von Merkmalen der Personalausstattung und Indikatoren zur Arbeitssituation und Patientenversorgung. Grundlage der Studie ist eine Onlinebefragung unter Intensivpflegenden, die im Jahr 2017 durchgefuhrt wurde. Fur 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 hohere Risiken in der Patientenversorgung beschreiben und eine niedrigere Arbeitszufriedenheit aufzeigen als Pflegende, die in einer Betreuungsrelation von ≤ 1:2 arbeiten.
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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: 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.