German Intensive Care Research Articles

Triggers of intensive care patients with palliative care needs from nurses’ perspective: a mixed methods study

PurposeTriggers have been developed internationally to identify intensive care patients with palliative care needs. Due to their work, nurses are close to the patient and their perspective should therefore be included. In this study, potential triggers were first identified and then a questionnaire was developed to analyse their acceptance among German intensive care nurses.MethodsFor the qualitative part of this mixed methods study, focus groups were conducted with intensive care nurses from different disciplines (surgery, neurosurgery, internal medicine), which were selected by convenience. Data were analysed using the “content-structuring content analysis” according to Kuckartz. For the quantitative study part, the thus identified triggers formed the basis for questionnaire items. The questionnaire was tested for comprehensibility in cognitive pretests and for feasibility in a pilot survey.ResultsIn the qualitative part six focus groups were conducted at four university hospitals. From the data four main categories (prognosis, interprofessional cooperation, relatives, patients) with three to 15 subcategories each could be identified. The nurses described situations requiring palliative care consults that related to the severity of the disease, the therapeutic course, communication within the team and between team and patient/relatives, and typical characteristics of patients and relatives. In addition, a professional conflict between nurses and physicians emerged. The questionnaire, which was developed after six cognitive interviews, consists of 32 items plus one open question. The pilot had a response rate of 76.7% (23/30), whereby 30 triggers were accepted with an agreement of ≥ 50%.ConclusionIntensive care nurses see various triggers, with interprofessional collaboration and the patient's prognosis playing a major role. The questionnaire can be used for further surveys, e.g. interprofessional triggers could be developed.

COVID-19: Die Rolle der Intensivmedizin

Zusammenfassung Die COVID-19 Pandemie führt zu einer erheblichen Anzahl an kritisch Kranken, die intensivmedizinischer Therapie bedürfen. Vorbestehende strukturelle und personelle Probleme der deutschen Intensivmedizin werden aggraviert. Die Neuartigkeit der Infektionserkrankung und bisher unverstandene Pathophysiologie erschweren die Therapie, die einem raschen Entwicklungsprozess unterliegt. Studiendaten für Dexamethason und Heparin belegen eine Mortalitätssenkung in einigen Patientenkollektiven, während Remdesivir die Krankheitsdauer verkürzen kann.

End-of-Life Decision Making in Pediatric Oncology and Intensive Care in Germany – Results of a Multi-professional Questionnaire Study

Objective: In modern medicine, not all possible treatments are in the best interest of a patient. Decisions to withhold or withdraw therapies should be based on the patient’s or guardian's wishes and on the medical indication. To define the latter medical teams have to find decisions themselves, which involves not only physicians, but in particular nurses and psychologists – and in case of disagreements emotional conflicts may result. Methods: We asked how end-of-life decisions are made in German pediatric oncology and intensive care units, and what problems were observed. An online questionnaire was sent to team members of 42 hospitals, covering 32 items, including personal data, the process of decision-making talks itself, and finally, whether they were a burden for teams or led to conflicts within them. Data were studied by a descriptive analysis. Results: From 282 questionnaires, we received 77 answers (27.30%; i.e. 59 physicians, 6 nurses, 10 psychologists/others). In most cases, 4-5 participants were involved in end-of-life decision talks, always including physicians, often nurses or other professional groups. A standard procedure was used only by a minority, in particular in intensive care units, as were cooperation with a clinical ethics committee or with a neutral observer. Many respondents reported moderately burdening talks, and conflicts in decision making were a burden to the teams. These conflicts took place on all levels. The feeling of being ignored or neglected in an end-of-life decision talk was described by some respondents. Conclusion: We conclude that standard operation procedures may be of some help; particularly regarding the participation of nurses, there still is some room for improvement. Whether ethical committees or external experts are helpful remains open. However, as conclusion, our impression is that the status quo is not too bad.

Qualitätsmanagement im Krankenhaus - Prozesse und Ergebnisse kontinuierlich verbessern

What is quality, what is quality management? Who is responsible for quality management in a hospital? Which tools, communication instruments and which instruments for feed back are necessary for institutions to control its tasks in a multi-disciplinary environment? Are there various requirements concerning quality management systems in different hospitals or departments? Which tools of quality management are used in German anaesthesia and intensive care departments? This paper gives an introduction to quality management systems in hospitals and an overview of current models in anaesthesia and intensive care medicine.