Intensive Care Unit Professionals Research Articles

Postintensive care syndrome: Development and psychometric validation of a knowledge test.

Postintensive care syndrome (PICS) is a combination of short-, medium-and long-term morbidities that occur in patients discharged from the Intensive care unit (ICU). ICU professionals have a crucial role in managing and understanding the PICS. This study aimed to develop the PICS Knowledge Test (PICS-KT), which measures ICU professionals'awareness and knowledge levels regarding PICS, and to determine its validity and reliability. The databases were searched in detail, scientific research related to PICS was analyzed, and the draft scale was created accordingly. A total of 117 doctors and nurses who had been working in the ICU for at least 6 months were included in the study. For the validity and reliability analysis of the test, content validity ratio, item difficulty index, item discrimination index values and Cronbach α were examined. The Cronbach's α reliability coefficient for the 46-item PICS-KT is 0.93, indicating high reliability. Scores range from 0 to 46, with 32 or higher considered successful, suggesting adequate knowledge of PICS among ICU professionals. Scores of 14 or less indicate minimal knowledge. Those with scores between 14 and 32 possess some knowledge but need improvement. PICS-KT assesses knowledge in four main areas: general information, risk factors/causes, symptoms and findingsand interventions. ICU professionals show high awareness of interventions for preventing and treating PICS, as indicated by a high mean score in the interventions subdimension. The PICS-KT is crucial in assessing healthcare professionals'understanding of the various short-, medium-and long-term morbidities associated with PICS. The study ensures that the test is a robust and dependable instrument for evaluating ICU professionals'knowledge about PICS.

Therapeutic healthcare professional staffing requirements in intensive care units

Therapeutic healthcare professionals in the multiprofessional intensive care unit (ICU) team are important for early mobilization, dysphagia therapy, and psychosocial care of critically ill patients. Despite the high relevance of therapeutic healthcare professions for care in ICUs, there are no recommendations on the specific staffing of therapists in ICUs. Considering the main areas of activity of the individual professional groups and based on productivity time, arequirements analysis for staffing ICUs of different care levels with physiotherapists, occupational therapists, speech therapists, and psychologists was performed. For every 10beds in the highest care level (LoC3), 1.28full-time equivalent (FTE) physiotherapists, 0.91FTE occupational therapists and speech therapists, and 0.80FTE psychologists should be employed. In order to implement multiprofessional patient treatment and support for relatives in the ICU, it is essential to employ aproportionate number of therapeutic healthcare professionals.

Personality Traits, Burnout, and Psychopathology in Healthcare Professionals in Intensive Care Units-A Moderated Analysis.

This study explored the associations between personality dimensions, burnout, and psychopathology in healthcare professionals in intensive care units (ICUs). This study further aimed to discern the differences in these relationships when considering the variables of critical care experience (less than 5 years, 5-10 years, and more than 10 years), profession (nurses versus intensivists), and the urban size of the city where the ICU is located (metropolitan cities versus smaller urban cities). This cross-sectional investigation's outcomes are based on data from 503 ICU personnel, including 155 intensivists and 348 nurses, in 31 ICU departments in Greece. Participants underwent a comprehensive assessment involving a sociodemographic questionnaire, the Eysenck Personality Questionnaire (EPQ), the Maslach Burnout Inventory (MBI), and the Symptom Checklist-90 (SCL-90). To analyze the interplay among critical care experience, burnout status, and psychopathology, a moderation analysis was conducted with personality dimensions (i.e., psychoticism, extraversion, and neuroticism) serving as the mediator variable. Profession and the urban size of the ICU location were considered as moderators influencing these relationships. Male healthcare professionals showed higher psychoticism levels than females, aligning with prior research. Experienced nurses reported lower personal achievement, hinting at potential motivation challenges for professional growth. Psychoticism predicted high depersonalization and low personal achievement. Neuroticism and psychoticism negatively impacted ICU personnel's mental well-being, reflected in elevated psychopathology scores and burnout status. Psychoticism appears to be the primary factor influencing burnout among the three personality dimensions, particularly affecting intensivists. In contrast, nurses are more influenced by their critical care experience on their mental health status.

Applying Human Factors and Systems Simulation Methods to Inform a Multimillion-Dollar Healthcare Decision.

This article describes a case study of a collaborative human factors (HF) and systems-focused simulation (SFS) project to evaluate potential patient and staff safety risks associated with a multimillion-dollar design and construction decision. The combined integration of HF and SFS methods in healthcare related to testing and informing the design of new environments and processes is underutilized. Few realize the effectiveness of this integration in healthcare to reduce risk and improve decision-making, safety, design, efficiency, patient experience, and outcomes. This project showcases how the combined use of HF and SFS methods can provide objective evidence to help inform decisions. The project was initiated by a healthcare executive team looking for an objective, user informed analysis of a current connector passageway between two existing buildings. The goal was to understand the implications of keeping the current route for simultaneous use for public and patients service flow versus building and financing a new passageway for separate flow and transport. An interprofessional team of intensive care unit professionals participated in two simulations designed to test the current connector. A failure mode and effects analysis and qualitative debrief feedback was used to evaluate risks and potential failures. The evaluation resulted in data that enabled informed executive decision making for the most effective, efficient, and safest option for public, staff, and patient transport between two buildings. This evaluation resulted in the decision to go forward with building a multimillion-dollar new connector passageway to improve integrated care and transport.

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

BackgroundTo assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units.MethodsPubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality, bias, and level of evidence were assessed using established tools.ResultsSeventy-five studies with 139,533 healthcare workers from 32 countries were included. The overall median frequency of violence was 51% (IQR 37–75%). Up to 97% of healthcare workers experienced verbal violence, and up to 82% were victims of physical violence. Meta-analysis of frequency revealed an average frequency of 31% (95% CI 22–41%) for physical violence, 57% for verbal violence (95% CI 48–66%), and 12% for sexual violence (95% CI 4–23%). Heterogeneity was high according to the I2 statistics. Patients were the most common perpetrators (median 56%), followed by visitors (median 22%). Twenty-two studies reported increased risk ratios of up to 2.3 or odds ratios of up to 22.9 for healthcare workers in the ICU compared to other healthcare workers. Risk factors for experiencing violence included young age, less work experience, and being a nurse. Patients who exhibited violent behavior were often male, older, and physically impaired by drugs. Violence was underreported in up to 80% of cases and associated with higher burnout rates, increased anxiety, and higher turnover intentions. Overall the level of evidence was low.ConclusionsWorkplace violence is frequent and underreported in intensive care units, with potential serious consequences for healthcare workers, calling for heightened awareness, screening, and preventive measures. The potential risk factors for violence should be further investigated.Systematic review registration: The protocol for this review was registered with Prospero on January 15, 2023 (ID CRD42023388449).

Evaluating the use of casuistry during moral case deliberation in the ICU: A multiple qualitative case study

Intensive care unit (ICU) professionals engage in ethical decision making under conditions of high stakes, great uncertainty, time-sensitivity and frequent irreversibility of action. Casuistry is a way by which actionable knowledge is obtained through comparing a patient case to previous cases from experience in clinical practice. However, within the field of study as well as in practice, evidence-based medicine is the dominant epistemic framework. This multiple case study evaluated the use of casuistic reasoning by intensive care unit (ICU) professionals during moral case deliberation. It took place in two Dutch hospitals between June 2020 and June 2022. Twentyfive moral case deliberations from ICU practice were recorded and analyzed using discourse analysis. Additionally, 47 interviews were held with ICU professionals who participated in these deliberations, analyzed using thematic analysis. We found that ICU professionals made considerable use of case comparisons when discussing continuation, withdrawal or limitation. Analogies played a role in justifying or complicating moral judgements, and also played a role in addressing moral distress. The language of case-based arguments is most often not overtly normative. Rather, the data shows that casuistic reasoning deals with the medical, ethical and contextual elements of decisions in an integrated manner. Facilitators of MCD have an essential role in (supporting ICU professionals in) scrutinizing casuistic arguments. The data shows that during MCD, actual reasoning often deviated from principle- and rule-based reasoning which ICU professionals preferred themselves. Evidence-based arguments often gained the character of analogical arguments, especially when a patient-at-hand was seen as highly unique from the average patients in the literature. Casuistic arguments disguised as evidence-based arguments may therefore provide ICU professionals with a false sense of certainty. Within education, we should strive to train clinicians and ethics facilitators so that they can recognize and evaluate casuistic arguments.

Link of Infection Prevention Climate to Patient-Centered Care: Role of Workplace Safety and Risk Mitigation.

Healthcare-associated infections pose a substantial threat to the quality of healthcare services. Consequently, it is imperative for hospital organizations to actively support an infection prevention climate, fostering workplace safety and risk mitigation, thereby promoting patient-centered care. This study aims to explore the interconnectedness between the infection prevention climate, workplace safety, risk mitigation, and patient-centered care. A cross-sectional study design was employed, utilizing a questionnaire administered to 235 healthcare professionals in intensive care and inpatient units at Bandung Kiwari Regional General Hospital. Data analysis was conducted using partial least squares structural equation modeling (PLS-SEM) with SmartPLS 4 and SPSS 25. The study revealed several significant relationships, including (1) between infection prevention climate and patient-centered care; (2) infection prevention climate and workplace safety; (3) workplace safety and patient-centered care; (4) infection prevention climate and patient-centered care mediated by workplace safety; (5) infection prevention climate and risk mitigation; (6) risk mitigation and patient-centered care; (7) and the relationship between infection prevention climate and patient-centered care mediated by risk mitigation. Infection prevention climate emerges as a crucial intangible value that hospital organizations can cultivate to shape workplace safety. This, in turn, encourages healthcare workers' compliance in implementing infection prevention controls as a form of risk mitigation, ultimately contributing to the provision of patient-centered care.

Hand hygiene compliance in a Brazilian COVID-19 unit: the impact of moments and contact precautions

BackgroundHealthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU).MethodsAn observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use.ResultsWe observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments “before” tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments “after” tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed.ConclusionsHH compliance was very low. Inappropriate glove use was associated with low compliance and the unit’s infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety.

Assessment of Hand Hygiene Practices Among Healthcare Professionals in the Surgical Intensive Care Unit

Amaç: Bu çalışmanın amacı, cerrahi yoğun bakım ünitesinde görev yapan sağlık çalışanlarının, hastane enfeksiyonlarının kontrolü ve önlenmesinde önemli ve etkili bir yol olan el yıkama durumlarını belirlemektir. Gereç ve Yöntem: Tanımlayıcı tipte olan çalışmaya 12 hekim ve 17 hemşire olmak üzere toplam 29 sağlık çalışanı dahil edildi. Araştırmanın verileri anket ve gözlem formları ile toplandı. Toplanan veriler SPSS 16 programı kullanılarak nicel analiz yöntemleri ile değerlendirildi. Bulgular: Sağlık çalışanlarının ünite içinde el yıkamalarını etkileyen nedenler çok sık yıkamanın zaman alması (%27,1), kişi başına düşen hasta sayısının fazla olması (%24,1), araç-gereç eksikliği (%20,7) ve ihmaldir (%20,7). %86,2’si el yıkama konusunda eğitim almış olan çalışanların tamamı el yıkamada izlenmesi gereken sıralamayı bilmemektedir. %62,1’i ünite içinde, %51,7’si ünite içinde el yıkama süresini bilmemektedir. Çalışanların %34,8’inin üniteye ilk girişte ellerini hiç yıkamadığı, yalnızca %32,6’sının uygun teknikle ellerini yıkadığı belirlenmiştir. Ünite içinde ise el yıkama gerektiren durumların %51,1’inde ellerin yıkanmadığı görülmüştür. Uygun teknikle el yıkama oranı ise %29,1 olmuştur. Sonuç: Sağlık çalışanlarının el yıkama durumları istenen düzeyde değildir. Bu sonuçlar doğrultusunda el hijyeni eğitimlerinin gerçekleştirilmesi gibi çalışmaların sağlık çalışanlarının el yıkama durumlarına olumlu yönde önemli katkılar sağlayacağını düşünmekteyiz.

A multicomponent intervention program to Prevent and Reduce AgItation and phySical rEstraint use in the ICU (PRAISE): study protocol for a multicenter, stepped-wedge, cluster randomized controlled trial

BackgroundPhysical restraints remain to be commonly used in agitated intensive care unit (ICU) patients worldwide, despite a lack of evidence on efficacy and safety and reports of detrimental short and long-term consequences, such as prolonged delirium and a longer ICU length of stay. Physical restraint minimization approaches have focused mainly on educational strategies and other non-pharmacological interventions. Combining these interventions with goal-directed light sedation therapy if needed may play an important contributory role in further reducing the use of physical restraints. The aim of the study is to determine the effectiveness of a multicomponent intervention (MCI) program, combining person-centered non-pharmacological interventions with goal-directed light sedation, compared to physical restraints.MethodsA multicenter stepped-wedge cluster randomized controlled trial will be conducted in six Dutch ICUs. A power calculation based total of 480 (expected to become) agitated adult patients will be included in 26 months with a subsequent 2-year follow-up. Patients included in the control period will receive standard care with the current agitation management protocol including physical restraints. Patients included in the intervention period will be treated with the MCI program, consisting of four components, without physical restraints: education of ICU professionals, identification of patients at risk for agitation, formulation of a multidisciplinary person-centered care plan including non-pharmacological and medical interventions, and protocolized goal-directed light sedation using dexmedetomidine. Primary outcome is the number of days alive and outside of the ICU within 28 days after ICU admission. Secondary outcomes include length of hospital stay; 3-, 12-, and 24-month post-ICU quality of life; physical (fatigue, frailty, new physical problems), mental (anxiety, depression, and post-traumatic stress disorder), and cognitive health; and 1-year cost-effectiveness. A process evaluation will be conducted.DiscussionThis will be the first multicenter randomized controlled trial determining the effect of a combination of non-pharmacological interventions and light sedation using dexmedetomidine compared to physical restraints in agitated ICU patients. The results of this study, including long-term patient-centered outcomes, will provide relevant insights to aid ICU professionals in the management of agitated patients.Trial registrationNCT05783505, registration date 23 March 2023.

Tension between continuous and deep sedation and assistance in dying: a national survey of intensive care professionals’ perceptions

IntroductionThe situation in France is unique, having a legal framework for continuous and deep sedation (CDS). However, its use in intensive care units (ICU), combined with the withdrawal of life-sustaining therapies, still raises ethical issues, particularly its potential to hasten death. The legalization of assistance in dying, i.e., assisted suicide or euthanasia at the patient’s request, is currently under discussion in France. The objectives of this national survey were first, to assess whether ICU professionals perceive CDS administered to ICU patients as a practice that hastens death, in addition to relieving unbearable suffering, and second, to assess ICU professionals’ perceptions of assistance in dying. MethodsA national survey with online questionnaires for ICU physicians and nursesaddressed through the French Society of Anesthesiology and Critical Care Medicine. ResultsA total of 956 ICU professionals responded to the survey (38% physicians and 62% nurses). Of these, 22% of physicians and 12% of nurses (p < 0.001) felt that the purpose of CDS was to hasten death. For 20% of physicians, CDS combined with terminal extubation was considered an assistance in dying. For 52% of ICU professionals, the current framework did not sufficiently cover the range of situations that occur in the ICU. A favorable opinion on the potential legalization of assistance in dying was observed in 83% of nurses and 71% of physicians (p < 0.001), with no preference between assisted suicide and euthanasia. ConclusionOur findings highlight the tension between CDS and assisted suicide/euthanasia in the specific context of intensive care and suggest that ICU professionals would be supportive of a legislative evolution.

Psychological Symptoms Among Iranian Healthcare Workers During COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic affected working conditions in healthcare systems and caused occupational stress and challenges for the majority of healthcare workers (HCWs). Objectives: This study aimed to examine the prevalence of anxiety, depression, burnout, and career resilience and assess the personal and occupational risk factors contributing to psychological symptoms in Iranian HCWs during the COVID-19 pandemic. Methods: Through a cross-sectional study, HCWs were surveyed within January to February 2022 to evaluate the prevalence of anxiety and depression (using the Hospital Anxiety and Depression Scale [HADS]), burnout (using the Maslach burnout inventory health services survey for medical personnel [MBI-HSS-MP]), and career resilience (using the Career Resilience Questionnaire [CRQ]). The correlation between demographic-occupational factors and psychological symptoms was analyzed. A total of 610 complete responses were received from Iranian HCWs. Results: Approximately 87.9% of HCWs had symptoms of both anxiety and depression (HADS score ≥ 11). The results indicated that most HCWs experienced various signs of burnout (i.e., emotional exhaustion, decreased sense of personal accomplishment, and depersonalization, respectively). The mean score for career resilience reported by the participants was appropriate; however, a fifth of the HCWs had poor career resilience. The highest scores of burnout, anxiety, and depression, in addition to the lowest scores of career resilience, were reported by intensive care unit (ICU) professionals. Conclusions: Marital status, long daily working hours, night shift work, access to personal protective equipment (PPE), and direct exposure to patients with COVID-19 had a significant impact on the anxiety, depression, burnout, and resilience of the HCWs.

The Prevalence and Contributing Factors of Burnout Among Anesthesiologists and Intensive Care Unit Staff in Morocco: A Cross-Sectional Analysis.

Introduction Burnout is a common issue in the medical field, particularly in specialties like anaesthesiology and intensive care. It carries significant personal and professional consequences for healthcare providers and can impact the relationship between caregivers and patients. Despite its seriousness, there's been limited research on its causes in North Africa. In this study, our aim was straightforward: we wanted to find out how prevalent burnout is among Moroccan healthcare workers in anaesthesiology and intensive care and identify the main factors contributing to it. Methods To achieve this, we conducted a comprehensive multicenter cross-sectional study that included hospitals from different regions of Morocco. We focused on anesthesiologists and nurse anesthetists currently practicing in these settings. We measured burnout using the French version of the Maslach Burnout Inventory. Results We distributed 500 questionnaires and received and analyzed 396 of them, accounting for an 84% response rate. The results were striking: 48% of participants experienced high emotional exhaustion, 43.2% had a significant level of depersonalization, and 21% exhibited a low sense of personal accomplishment. When we looked at various factors, such as age, income, on-call duties, years of experience, and work location, our analysis showed statistically significant differences in all three dimensions of burnout. In our more complex multivariate analysis, we found that the risk factors for all three dimensions of burnout were practicing for 5 to 15 years and participating in on-call rotations. Surprisingly, practicing for over 25 years seemed to be a protective factor against all dimensions of burnout. Conclusion Our study clearly indicates that burnout is a shared issue among healthcare professionals in anaesthesiology and intensive care units in Morocco. Importantly, we've pinpointed specific risk factors that should be the foundation for a national strategy to prevent burnout in these critical healthcare sectors.

COVID-19 crisis management of German ICU clinicians in leadership - a metaphor analysis.

The COVID-19 pandemic coincided with an already long-standing crisis in health systems around the world characterized by economic pressure and increasing staff shortage. "Crisis" became a global metaphor to convey collective experiences of the COVID-19 threat. Little is known on how crisis metaphors influence thought and speech on crisis management and the challenging staff situation of intensive care unit (ICU) clinicians in leadership positions and how they act. Therefore, we were interested in (1) which metaphorical concepts ICU clinicians in leadership use to express experiences and strategies in dealing with coinciding crises, (2) how these change over time, and (3) how metaphors in speech reveal self-images of crisis management. We conducted a systematic metaphor analysis focusing on data from three participants of a qualitative interview study with twenty-four healthcare professionals in ICUs in Germany. The participants were interviewed at two time points between April 2020 and March 2021. We identified and reconstructed metaphorical concepts of three interviewees (ICU clinicians in leadership) with regard to the pandemic management, and developed a typology based on the dimensions of mood, modus operandi, location, and scope. The typology consists of eight self-images (protagonists) for the crisis management of ICU clinicians in leadership, such as the figure of the soldier ("to unite everyone behind this flag"), the distributor ("sometimes it is a crazy patchwork [wahnsinniges Gestückel]") or the critic ("we are the fool for everything"). They embody different qualities of a leader and refer to intra- and inter-role conflicts within multiple crisis conditions. Metaphor analysis reveals different self-images of ICU leadership clinicians in relation to crisis management. This illustrates that thinking and perceptions of crisis management may strongly differ between and within leaders and may change over the course of crises. Our findings highlight the need both to improve knowledge on challenges associated with leadership in crises and preparedness, and to support clinicians in their leadership by recognizing and addressing differences and changes in leaders' self-image.

Perceptions, feelings, and attitudes towards death for Intensive Care Units professionals

Perceptions, feelings, and attitudes towards death for Intensive Care Units professionals

Intensive care unit professionals' responses to a new moral conflict assessment tool: A qualitative study.

Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach-moral conflict assessment (MCA)-to characterize moral distress and to facilitate the development of interventions for this problem. To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. In this qualitative study, we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. The main causes of moral distress related to goals of care, communication, teamwork, respect for patient's preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions.

Moral distress among intensive care unit professions in the UK: a mixed-methods study

ObjectiveTo assess the experience of moral distress among intensive care unit (ICU) professionals in the UK.DesignMixed methods: validated quantitative measure of moral distress followed by purposive sample of respondents who...

High-level burnout in physicians and nurses working in adult ICUs: a systematic review and meta-analysis.

The prevalence of burnout in intensive care unit (ICU) professionals is difficult to establish due to the variety of survey instruments used, the heterogeneity of the targeted population, the design of the studies, and the differences among countries regarding ICU organization. We performed a systematic review and meta-analysis examining the prevalence of high-level burnout in physicians and nurses working in adult ICUs, including only studies that use the Maslach Burnout Inventory (MBI) as a tool to evaluate burnout and involving at least 3 different ICUs. Twenty-five studies with a combined population of 20,723 healthcare workers from adult ICUs satisfied the inclusion criteria. Combining 18 studies including 8187 ICU physicians, 3660 of them reported a high level of burnout (prevalence 0.41, range 0.15-0.71, 95% CI [0.33; 0.5], I2 97.6%, 95% CI [96.9%; 98.1%]). The heterogeneity can be at least in part explained by the definition of burnout used and the response rate as confirmed by the multivariable metaregression done. In contrast, there was no significant difference regarding other factors such as the study period (before or during the coronavirus disease 2019 (COVID-19) pandemic), the income of the countries, or the Healthcare Access and Quality (HAQ) index. Combining 20 studies including 12,536 ICU nurses, 6232 of nurses were reporting burnout (prevalence 0.44, range 0.14-0.74, [95% CI 0.34; 0.55], I2 98.6% 95% CI [98.4%; 98.9%]). The prevalence of high-level burnout in ICU nurses for studies performed during the COVID-19 pandemic was higher than that reported for studies performed before the COVID-19 pandemic (0.61 [95% CI, 0.46; 0.75] and 0.37 [95% CI, 0.26; 0.49] respectively, p = 0.003). As for physicians, the heterogeneity is at least in part explained by the definition used for burnout using the MBI but not by the number of participants. When compared, the prevalence of high-level burnout was not different between ICU physicians and ICU nurses. However, the proportion of ICU nurses with a high level of emotional exhaustion was higher than for ICU physicians (0.42 [95% CI, 0.37; 0.48] and 0.28 [0.2; 0.39], respectively, p = 0.022). According to this meta-analysis, the prevalence of high-level burnout is higher than 40% in all ICU professionals. However, there is a great heterogeneity in the results. To evaluate and to compare preventive and therapeutic strategies, there is the need to use a consensual definition of burnout when using the MBI instrument.

Error disclosure in neonatal intensive care: a multicentre, prospective, observational study

ImportanceSurveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose...

Construction and Evaluation of a Realistic Low-Cost Model for Training in Chest-Tube Insertion.

Emergency thoracostomy is applied in life-threatening situations. Simulation plays a pivotal role in training in invasive techniques used mainly in stressful situations. Currently available commercial simulation models for thoracostomy have various drawbacks. We designed a thoracostomy phantom from discarded hospital materials and pigskin with underlying flesh. The phantom can be used alone for developing technical skills or mounted on an actor in simulation scenarios. Medical students, intensive care unit (ICU) and emergency department teams, and thoracostomy experts evaluated its technical fidelity and usefulness for achieving learning objectives in workshops. The materials used to construct the phantom cost €47. A total of 12 experts in chest-tube placement and 73 workshop participants (12 ICU physicians and nurses, 20 emergency physicians and nurses, and 41 fourth-year medical students) evaluated the model. All groups rated the model's usefulness and the sensation of perforating the pleura highly. Experts rated the air release after pleura perforation lower than other groups. Lung reexpansion was the lowest rated item in all groups. Ratings of the appearance and feel of the model correlated strongly among all groups and experts. The ICU professionals rated the resistance encountered in introducing the chest drain lower than the other groups. This low-cost, reusable, transportable, and highly realistic model is an attractive alternative to commercial models for training in chest-tube insertion skills.