Poncet Marie Cécile, Toullic Philippe, Papazian Laurent, Kentish-Barnes Nancy, Timsit Jean-Francçois, Pochard Frédéric, Chevret Sylvie, Schlemmer Benoît, Azoulay Elie
Medical ICU, Saint-Louis Hospital and Paris 7 University, Assistance Publique, Hôpitaux de Paris, Paris, France.
Am J Respir Crit Care Med. 2007 Apr 1;175(7):698-704. doi: 10.1164/rccm.200606-806OC. Epub 2006 Nov 16.
Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff.
To identify determinants of BOS in critical care nurses.
We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data.
Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96-0.99; p=0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52-0.91; p=0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56-0.97; p=0.03); (3) quality of working relations (1-10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16-1.30; p=0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86-0.98; p=0.02) or physicians (OR, 0.81; CI, 0.74-0.87; p=0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04-1.85; p=0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01-1.29; p=0.04).
One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.
与压力相关的职业倦怠综合征（BOS）在许多专业的医护人员中都有记录。重症监护病房（ICU）是一个压力极大的环境。对于重症护理人员的职业倦怠综合征知之甚少。
确定重症护理护士职业倦怠综合征的决定因素。
我们在法国进行了一项问卷调查。在联系参与研究的278个ICU中，165个（59.4%）有2525名护理人员，其中2392人返回了包含完整马氏职业倦怠量表数据的问卷。
在2392名受访者中（82%为女性），80%是护士，15%是护理助理，5%是护士长。790名（33%）受访者被确定有与职业倦怠综合征相关的严重症状。通过多变量分析，四个领域与严重职业倦怠综合征相关：（1）个人特征，如年龄（优势比[OR]，0.97/年；置信区间[CI]，0.96 - 0.99；p = 0.0008）；（2）组织因素，如选择休息日的能力（OR，0.69；CI，0.52 - 0.91；p = 0.009）或参与ICU研究小组（OR，0.74；CI，0.56 - 0.97；p = 0.03）；（3）工作关系质量（1 - 10分制），如与患者的冲突（OR，1.96；CI，1.16 - 1.30；p = 0.01）、与护士长的关系（OR，0.92/分；CI，0.86 - 0.98；p = 0.02）或医生的关系（OR，0.81；CI，0.74 - 0.87；p = **********）；（4）临终相关因素，如照顾临终患者（OR，1.39；CI，1.04 - 1.85；p = 0.02）以及上周放弃维持生命治疗的决定数量（OR，1.14；CI，1.01 - 1.29；p = 0.04）。
三分之一的ICU护理人员有严重的职业倦怠综合征。我们研究中确定的改进领域包括预防冲突、参与ICU研究小组以及更好地管理临终护理。需要进行干预性研究来调查这些潜在的预防策略。
