Université Lyon 1, EA 4129 Santé-Individu-Société, Lyon, France.
Curr Opin Crit Care. 2010 Dec;16(6):654-65. doi: 10.1097/MCC.0b013e32834044f0.
Conflicts occur frequently in the ICU. Research on ICU conflicts is an emerging field, with only few recent studies being available on intrateam and team-family conflicts. Research on communication in the ICU is developing at a faster pace.
Recent findings come from one multinational epidemiological survey on intrateam conflicts and one qualitative study on the causes and consequences of conflicts. Advances in research on communication with families in the ICU have improved our understanding of team-family and intrateam conflicts, thus suggesting targets for improvement.
Data about ICU conflicts depend on conflict definition, study designs (qualitative versus quantitative), patient case-mix, and detection bias. Conflicts perceived by caregivers are frequent and consist mainly in intrateam conflicts. The two main sources of conflicts in the ICU are end-of-life decisions and communication issues. Conflicts negatively impact patient safety, patient/family-centered care, and team welfare and cohesion. They generate staff burnout and increase healthcare costs. Further qualitative studies rooted in social-science theories about workplace conflicts are needed to better understand the typology of ICU conflicts (sources and consequences) and to address complex ICU conflicts that involve systems as opposed to people. Conflict prevention and resolution are complex issues requiring multimodal interventions. Clinical research in this field is insufficiently developed, and no guidelines are available so far. Prevention strategies need to be developed along two axes: improved understanding of family experience, preferences, and values, as well as evidence-based communication may reduce team-family conflicts and organizational measures including restoring leadership, multidisciplinary teamwork, and improved communication within the team may prevent intrateam conflicts in the ICU.
重症监护病房（ICU）中经常发生冲突。ICU 冲突研究是一个新兴领域，仅有少数近期研究涉及团队内和团队-家庭冲突。ICU 内沟通的研究发展较快。
近期发现来自一项关于团队内冲突的多中心流行病学调查和一项关于冲突原因和后果的定性研究。在 ICU 中与家属沟通方面的研究进展提高了我们对团队-家庭和团队内冲突的理解，从而为改进提供了目标。
有关 ICU 冲突的数据取决于冲突定义、研究设计（定性与定量）、患者病例组合和检测偏差。护理人员感知到的冲突很常见，主要是团队内冲突。ICU 中冲突的两个主要来源是临终决策和沟通问题。冲突对患者安全、以患者/家庭为中心的护理以及团队福利和凝聚力产生负面影响。它们会导致员工倦怠和增加医疗保健成本。需要进一步开展基于社会科学理论关于工作场所冲突的定性研究，以更好地了解 ICU 冲突的类型学（来源和后果），并解决涉及系统而非人员的复杂 ICU 冲突。冲突预防和解决是复杂的问题，需要多模式干预。该领域的临床研究不够发达，目前尚无指南。预防策略需要沿着两个轴展开：更好地了解家庭的经历、偏好和价值观，以及基于证据的沟通，这可能会减少团队-家庭冲突；而包括恢复领导力、多学科团队合作和改善团队内沟通在内的组织措施可能会预防 ICU 内的团队内冲突。
