Page Bethan, Irving Dulcie, Carthey Jane, Welch John, Higham Helen, Vincent Charles
Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
Cicely Saunders Institute, King's College London, London, Greater London, UK.
BMJ Qual Saf. 2025 Jan 28;34(2):81-91. doi: 10.1136/bmjqs-2024-017385.
Healthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed to identify and describe the types of everyday pressures in intensive care and the adaptive strategies staff use to respond, with the longer-term aim of developing practical and coordinated strategies for managing under pressure.
We conducted qualitative semi-structured interviews with 20 senior multidisciplinary healthcare professionals from intensive care units (ICUs) in 4 major hospitals in the UK. The interviews explored the everyday pressures faced by intensive care staff and the strategies they use to adapt. A thematic template analysis approach was used to analyse the data based on our previously empirically developed taxonomy of pressures and strategies.
The principal source of pressure described was a shortage of staff with the necessary skills and experience to care for the increased numbers and complexity of patients which, in turn, increased staff workload and reduced patient flow. Strategies were categorised into anticipatory (in advance of anticipated pressures) and on the day. The dynamic and unpredictable demands on ICUs meant that strategies were mostly deployed on the day, most commonly by flexing staff, prioritisation of patients and tasks and increasing modes of communication and support.
ICU staff use a wide variety of adaptive strategies at times of pressure to minimise risk and maintain a reasonable standard of care for patients. These findings provide the foundation for a portfolio of strategies, which can be flexibly employed when under pressure. There is considerable potential for training clinical leaders and teams in the effective use of adaptive strategies.
医疗保健系统正面临巨大压力。临床医生和管理人员不断进行调整，这些调整通常是临时的、高度可变的，且各团队之间缺乏协调。本研究旨在识别和描述重症监护中日常压力的类型以及工作人员用来应对的适应性策略，其长期目标是制定实用且协调一致的压力管理策略。
我们对英国4家主要医院重症监护病房（ICU）的20名高级多学科医疗专业人员进行了定性半结构化访谈。访谈探讨了重症监护工作人员面临的日常压力以及他们用来适应的策略。基于我们之前根据经验开发的压力和策略分类法，采用主题模板分析方法对数据进行分析。
所描述的主要压力源是缺乏具备必要技能和经验的工作人员来照顾数量增加且病情复杂的患者，这反过来又增加了工作人员的工作量并减少了患者流量。策略分为预期性策略（在预期压力之前）和当天策略。对ICU动态且不可预测的需求意味着策略大多在当天部署，最常见的方式是灵活调配工作人员、对患者和任务进行优先级排序以及增加沟通和支持方式。
ICU工作人员在面临压力时会使用多种适应性策略，以将风险降至最低并为患者维持合理的护理标准。这些发现为一系列策略奠定了基础，在压力下可灵活运用这些策略。培训临床领导者和团队有效使用适应性策略具有很大潜力。
