对不适当心肺复苏的认知对急诊临床医生离职意向的影响：来自24个国家288个中心的横断面调查结果
Impact of perceived inappropiate cardiopulmonary resuscitation on emergency clinicians' intention to leave the job: Results from a cross-sectional survey in 288 centres across 24 countries.
作者信息
Druwé Patrick, Monsieurs Koenraad G, Gagg James, Nakahara Shinji, Cocchi Michael N, Élő Gábor, van Schuppen Hans, Alpert Evan Avraham, Truhlář Anatolij, Huybrechts Sofie A, Mpotos Nicolas, Paal Peter, BjØrshol Conrad, Xanthos Theodoros, Joly Luc-Marie, Roessler Markus, Deasy Conor, Svavarsdóttir Hildigunnur, Nurmi Jouni, Owczuk Radoslaw, Salmeron Pascual Piñera, Cimpoesu Diana, Fuenzalida Pablo Aguilera, Raffay Violetta, Steen Johan, Decruyenaere Johan, De Paepe Peter, Piers Ruth, Benoit Dominique D
机构信息
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
出版信息
Resuscitation. 2021 Jan;158:41-48. doi: 10.1016/j.resuscitation.2020.10.043. Epub 2020 Nov 20.
INTRODUCTION
Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians.
METHODS
A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals.
RESULTS
Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]).
CONCLUSION
Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
引言
对预后不良的患者进行心肺复苏（CPR）会增加医护人员认为治疗不当的风险，进而导致道德困扰。我们评估了对不适当心肺复苏的认知是否与急诊医护人员离职意愿相关。
方法
在24个国家进行了一项横断面多中心调查。采用条件逻辑回归模型分析与离职意愿相关的因素。结果以比值比及95%置信区间表示。
结果
在5099名接受调查的急诊医护人员中，1836名（36.0%）为医生，1313名（25.7%）为护士，1950名（38.2%）为急诊医疗技术人员。1721名（33.8%）医护人员表示有离职意愿，3403名（66.7%）经常思考复苏尝试的适当性，2955名（58.0%）报告因不适当的心肺复苏导致道德困扰。在对其他协变量进行调整后，经常思考复苏尝试适当性的医护人员（1.43 [1.23 - 1.67]）、经历相关道德困扰的医护人员（1.44 [1.24 - 1.66]）以及年龄在30 - 44岁之间的医护人员（与<30岁相比为1.53 [1.21 - 1.92]）离职意愿风险更高。当医护人员感到被团队重视时（0.53 [0.42 - 0.66]）、团队领导认可团队付出的努力时（0.61 [0.49 - 0.75]）以及团队进行事后总结时（0.70 [0.60 - 0.80]），风险较低。
结论
医护人员认为不适当的复苏尝试以及随之而来的道德困扰与离职意愿增加相关。跨专业协作、团队合作和定期的跨学科事后总结与较低的离职意愿风险相关。ClinicalTrials.gov；编号：NCT02356029。
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