Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
PLoS One. 2018 Aug 22;13(8):e0201524. doi: 10.1371/journal.pone.0201524. eCollection 2018.
Strained intensive care unit (ICU) capacity represents a supply-demand mismatch in ICU care. Limited data have explored health care worker (HCW) perceptions of strain.
Cross-sectional survey of HCW across 16 Alberta ICUs. A web-based questionnaire captured data on demographics, strain definition, and sources, impact and strategies for management.
658 HCW responded (33%; 95%CI, 32-36%), of which 452 were nurses (69%), 128 allied health (19%), 45 physicians (7%) and 33 administrators (5%). Participants (agreed/strongly agreed: 94%) reported that strain was best defined as "a time-varying imbalance between the supply of available beds, staff and/or resources and the demand to provide high-quality care for patients who may become or who are critically ill"; while some recommended defining "high-quality care", integrating "safety", and families in the definition. Participants reported significant contributors to strain were: "inability to discharge ICU patients due to lack of available ward beds" (97%); "increases in the volume" (89%); and "acuity and complexity of patients requiring ICU support" (88%). Strain was perceived to "increase stress levels in health care providers" (98%); and "burnout in health care providers" (96%). The highest ranked strategies were: "have more consistent and better goals-of-care conversations with patients/families outside of ICU" (95%); and "increase non-acute care beds" (92%).
Strain is perceived as common. HCW believe precipitants represent a mix of patient-related and operational factors. Strain is thought to have negative implications for quality of care, HCW well-being and workplace environment. Most indicated strategies "outside" of ICU settings were priorities for managing strain.
紧张的重症监护病房（ICU）容量代表了 ICU 护理中的供需不匹配。有限的数据探讨了卫生保健工作者（HCW）对压力的看法。
对 16 个艾伯塔省 ICU 的 HCW 进行横断面调查。一个基于网络的问卷收集了人口统计学数据、压力定义以及压力源、影响和管理策略的数据。
658 名 HCW 做出了回应（33%；95%置信区间，32-36%），其中 452 名为护士（69%），128 名为联合健康（19%），45 名为医生（7%），33 名为管理人员（5%）。参与者（同意/强烈同意：94%）报告说，压力最好被定义为“可用床位、工作人员和/或资源的供应与为可能或已经病危的患者提供高质量护理的需求之间的时间变化失衡”；而一些人建议在定义中纳入“高质量护理”、“安全性”和“家庭”。参与者报告说，压力的主要来源是：“由于缺乏可用的病房床位，无法为 ICU 患者出院”（97%）；“工作量增加”（89%）；和“需要 ICU 支持的患者的病情和复杂性”（88%）。压力被认为会“增加医疗保健提供者的压力水平”（98%）；和“医疗保健提供者倦怠”（96%）。排名最高的策略是：“在 ICU 之外与患者/家属进行更一致和更好的目标关怀对话”（95%）；和“增加非急性护理床位”（92%）。
压力被认为是普遍存在的。HCW 认为，促成因素是患者相关因素和运营因素的混合。压力被认为对护理质量、HCW 的幸福感和工作场所环境有负面影响。大多数表示“在”ICU 之外的策略是管理压力的优先事项。
