[Evaluation of care conditions in intensive care units : Results of an online questionnaire of critical care nurses]

Noise exposure among staff in intensive care units and the effects of unit-based noise management: a monocentric prospective longitudinal study

BACKGROUND

Intensive care units (ICUs) are often too noisy, exceeding 70-80 dBA, which can have negative effects on staff. The corresponding recommendation of the World Health Organization (average sound pressure level below 35 dBA) is often not achieved. To date there is a lack of intervention studies examining the extent to which unit-based noise management in ICUs contributes to a reduction in noise exposure for the staff. The study therefore aims to provide answers to 1) how unit-based noise management sustainably reduces the subjective noise exposure among staff, and 2) how this intervention affects other noise-related topics.

METHODS

We performed a monocentric prospective longitudinal study with three measurement points in a German university hospital in three ICUs. We collected data from different healthcare professionals and other professional groups between October 2021 and August 2022 using an online questionnaire. Data were analyzed using descriptive and inference statistics.

RESULTS

A total of n = 179 participants took part in the surveys. The majority of participants were nurses or pediatric nurses. Most participants worked more than 75% full-time equivalent. Staff on the three ICUs reported high levels of noise exposure. No significant changes in noise exposure over time were observed. Participants were already aware of the topic and believed that a behavior change could positively influence the noise environment.

CONCLUSIONS

This study provides an initial insight into how a unit-based noise management could contribute to a reduction in the subjective noise exposure among staff in ICUs. The results of this study highlight the importance of this topic. Future studies should aim to research aspects of adherence and their facilitators or barriers, which promote the sustained implementation of noise-reducing measures by staff.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00025835; Date of registration: 12.08.2021.

Influence of working conditions and salary on agency work for intermediate and intensive care units

Background

Agency work in nursing is used as a form of labor to counter vacant staff positions in hospitals. Both hospital owners and nurses view this critically for different reasons.

Aim

The aim of this study was to assess what personal net income nurses in German intensive care units and intermediate care units consider “fair and sufficient” for their work (addressed in Part 1 of the survey) and what influence—aside from the salary—the working conditions have on the willingness to change to temporary work or back to a permanent position.

Methods

From September to October 2020, an anonymous online survey was conducted among nurses of intermediate care units, intensive care units, and special care units in German-speaking countries. Descriptive statistics were used for the analysis.

Result

Of 1203 participants, 86% (n = 1036) could be evaluated. None of the job satisfaction factors queried received four or five stars (maximum five stars) from those participating in the survey. The most unsatisfied group proved to be regularly employed nurses with an additional part-time job. Key job satisfaction factors differed markedly between the groups, with regular employees favoring consistency and stability. Agency workers prefer gaining experience in a broader range of tasks. Unreliable duty rosters and poor nurse to patient ratios were common points of criticism.

Conclusion

For job satisfaction, making nurses feel appreciated and respected is essential. This includes a guaranteed nurse to patient ratio and reliable duty rosters that also include tasks outside direct patient care. In order for nurses to leave agency work, it is necessary to take into account the differences in interests in terms of the focus of activity.

Einfluss der Arbeitsbedingungen und des Gehalts auf die Leiharbeit für Intermediate-Care- und Intensivstationen

Hintergrund

Leiharbeit in der Pflege wird als Arbeitsform verwendet, um offenen Personalstellen in Kliniken zu begegnen. Sowohl Krankenhausträger als auch Pflegekräfte sehen dies aus unterschiedlichen Gründen kritisch.

Ziel

Zweck dieser Untersuchung war es herauszufinden, welches persönliche Nettoeinkommen Pflegekräfte von deutschen Intensivstationen und Intermediate-Care-Stationen als „gerecht und ausreichend“ für ihre Tätigkeit empfinden und welchen Einfluss das Gehalt auf die Wechselwilligkeit in die Leih‑/Zeitarbeit bzw. wieder zurück in eine Festanstellung haben.

Methode

Von September bis Oktober 2020 wurde eine anonymisierte Onlineumfrage unter Pflegenden von Intermediate-Care-Stationen, Intensivstationen und Funktionsbereichen im deutschsprachigen Raum durchgeführt. Die Auswertung erfolgte mittels deskriptiver Statistik.

Ergebnis

Von 1203 Teilnehmer_innen (TN) konnten 1036 (86 %) in Deutschland Arbeitende ausgewertet werden. Die Frage nach dem persönlichen Nettoeinkommen wurde von 1032 (99 %) TN beantwortet. Der überwiegende Anteil der Befragten (n = 522) gibt an, über ein persönliches Nettoeinkommen von 2000–2999 €/Monat zu verfügen. Der Wunsch, in die Leiharbeit zu gehen, ist in der untersuchten Stichprobe geringer, je höher das persönliche Nettoeinkommen ist. Die TN in Festanstellung ohne Nebenerwerb empfinden ein persönliches Nettoeinkommen von 3200 €/Monat (Median 3200 €; IQR 2800–3800 €) als ausreichend und gerecht für ihre Tätigkeit. Von den Leiharbeiter_innen gaben 142 Personen an, dass ein persönliches Nettoeinkommen von 3200 €/Monat (Median 3200 €; Interquartilsabstand 3000–3950 €) ausreichend wäre, um von der Leiharbeit zurück in eine Festanstellung zu wechseln.

Schlussfolgerung

Die Intensivpflegenden dieser Umfrage empfinden ein Gehalt von 3200 €/Monat netto als ausreichend und gerecht für ihre Tätigkeit. Die Gehaltshöhe kann ein Parameter für die Entscheidung sein, in die Leiharbeit zu gehen, aber auch um wieder in die Festanstellung zu wechseln. Unabhängig vom Gehalt wurden bessere Arbeitsbedingungen für alle befragten Gruppen als essenzieller Bestandteil in Bezug auf die Arbeitszufriedenheit angegeben.

Obstetric factors associated with postpartum post-traumatic stress disorder after spontaneous vaginal birth

BACKGROUND

This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD).

METHODS

A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period.

RESULTS

PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58).

CONCLUSIONS

Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.

[Influence of nurses on the experience of noninvasive ventilation]

Noninvasive ventilation (NIV) is established as an integral part of intensive care therapy for respiratory insufficiency. However, it is associated with restrictions on patient autonomy and comfort. A successful course of therapy is largely dependent on the acceptance and adherence of the patients concerned. Intensive care nurses can have a significant influence on the success of the therapy by dealing with the subjective experience of the patients and by maintaining close contact with them. The prerequisite for this is profound knowledge of the different technical aspects of therapy and equipment as well as positive and negative factors influencing NIV tolerance in order to be able to offer and implement an individual intervention.

[Between care for others and self-care: intensive care nursing in times of the COVID-19 pandemic]

DEFINITION OF THE PROBLEM

The COVID-19 pandemic poses a considerable challenge to the capacity and functionality of intensive care. This concerns not only resources but, above all, the physical and psychological boundaries of nursing professionals. The question of how care for others and self-care of nurses in intensive care units are related to each other in the context of the COVID-19 pandemic has not been addressed in public and scientific discourse so far.

ARGUMENTS

The present contribution reflects this relationship with reference to the Code of Ethics of the International Council of Nurses, particularly considering principlism and the Care Ethics according to Joan Tronto. As a result, it shows a corridor of ethically justifiable care with several borders, above all: (1) self-care must not be given up completely for the benefit of care for others, and (2) a categorical subordination of care for others to self-care is ethically not justifiable.

CONCLUSION

The article makes an important contribution to a differentiated ethical consideration of the rights and responsibilities of intensive care nurses as moral actors within the pandemic in Germany. It, thus, provides a first starting point for a broad social and political discourse which is urgently needed not only during but also after the pandemic in order to improve the situation of intensive care nurses and those who are cared for.

[Agency work in intensive care : Impact of temporary contract work on patient care in intermediate care and intensive care units]

Hintergrund

Leiharbeiter werden, meist im Sinne einer Arbeitnehmerüberlassung, zur pflegerischen Versorgung von Intensivpatienten eingesetzt. Ob bzw. wie sich Leiharbeit in der Pflege auf die Patientenversorgung auswirkt, wurde bislang kaum untersucht.

Ziel

Zweck dieser systematischen Übersichtsarbeit ist es, die verfügbaren Forschungsergebnisse über den Einsatz von Leiharbeitern in der pflegerischen Versorgung auf Intensiv- und Überwachungsstationen zu beschreiben und die potenziellen Auswirkungen auf das Patientenoutcome zusammenzufassen.

Methode

Es wurde in sieben Datenbanken mit booleschen Operatoren systematisch nach englisch- und deutschsprachigen Studien recherchiert und in Anlehnung an das PRISMA-Schema ausgewertet. Referenzen der Studien wurden ebenfalls in die Suche inkludiert und die Qualität aller eingeschlossenen Studien nach Hawker-Kriterien bewertet.

Ergebnis

Von insgesamt N = 630 gesichteten Datensätzen konnten jeweils eine qualitative und zwei quantitative Studien identifiziert und in die Auswertung einbezogen werden. Die Ergebnisse der qualitativen Studien gaben nicht signifikant an, dass Leiharbeiter zu einem schlechteren Patientenoutcome beitragen können. Die Ergebnisse der quantitativen Studien zeigten, dass die Wahrscheinlichkeit für das Auftreten von katheterassoziierten Infektionen mit dem Einsatz von Leiharbeitern steigen kann, aber eher von der Stationsgröße anhängig ist: Je zusätzlichem Bett steigt die Wahrscheinlichkeit für eine VAP um 14,8 % (95 %-CI = 1,032–1,277, p = 0,011). Allerdings konnten Tendenzen für einen Rückgang der Sepsisrate, sobald weniger Leiharbeiter (Stunden/Patient) auf der Intensivstation eingesetzt wurden, nicht bestätigt werden.

Schlussfolgerung

In den wenigen auswertbaren Studien wurden keine Hinweise dafür gefunden, dass der Einsatz von Leiharbeitern auf Intensiv- (ITS) und Überwachungsstationen (IMC) einen signifikanten Einfluss auf das Patientenoutcome hat. Es wurden allerdings Hinweise gefunden, dass individuelle Qualifikationen und die Arbeitsbedingungen einen Einfluss auf das Outcome haben. Weitere Studien sollten betrachten, welches Verhältnis von Festangestellten zu Leiharbeitern als unkritisch anzusehen ist, welche Qualifikationen temporäre Mitarbeiter vorweisen sollten und inwieweit diese überprüft werden können.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00063-020-00753-5) enthält die vollständige Suchstrategie je Datenbank. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

[Impact of nursing staff shortage on intensive care medicine capacity in Germany]

BACKGROUND

Compared to other countries, Germany has the highest number of intensive care unit (ICU) beds, but, despite this, a shortage in ICU care is evident. Currently, little comprehensive data on ICU staffing and on subsequent closure of ICU beds are available. The current survey therefore aimed to systematically investigate the closure of ICU beds.

METHOD

A survey was performed among authorized professional trainers in ICU medicine.

RESULTS

Overall, a shortage of ICU beds following bed closure was evident in 76% of all ICU floors with 22% reporting daily ICU bed closure. In 47%, two ICU beds were not available. Emergency care was unrestricted in only 18%, while restrictions were reportedly frequent or even constant in 30%. The main reasons for ICU bed closure were the unavailability of ICU nurses (44%) and the co-existing unavailability of nurses and physicians (19%). On average, the nurse/patient ratio was 1:2.5 in the morning, 1:2.6 in the afternoon, and 1:3.1 in the night shift.

CONCLUSIONS

ICU bed closure regularly occurs in Germany. The underlying main reason has been identified to be the unavailability of ICU nursing staff. This is suggested to directly interfere with emergency care. For this reason, an action plan is urgently needed.

[Organ assist devices in the future : Limits and perspectives]

In the last decade, extracorporeal organ assist devices (extracorporeal membrane oxygenation [ECMO]) have been increasingly applied to treat the most severe forms of respiratory failure and cardiogenic shock, although the underlying scientific evidence is still limited and the methods carry a high risk of complications despite all technical improvements. The selection of those patients who most benefit from these devices is still a great challenge for intensivists and all other involved disciplines. Besides the severity of the acute organ failure, it is important to thoroughly evaluate etiology and treatment options of the underlying disease, comorbidities, and the functional status of the patients in an interdisciplinary team. This also includes ethical challenges. Because of the complexity of the treatment and the high organizational demands it is reasonable to concentrate ECMO treatments in specifically qualified centers and to promote a comprehensive scientific analysis of the treatment data.

[Reimbursement of intensive care services in the German DRG system : Current problems and possible solutions]

The reimbursement of intensive care and nursing services in the German health system is based on the diagnosis-related groups (G-DRG) system. Due to the lack of a central hospital planning, the G‑DRG system has become the most important influence on the development of the German health system. Compared to other countries, intensive care in Germany is characterized by a high number of intensive care beds, a low nurse-to-patient ratio, no official definition of the level of care, and a minimal available data set from intensive care units (ICUs). Under the given circumstances, a shortage of qualified intensive care nurses and physicians is currently the largest threat for intensive care in Germany. To address these deficiencies, we suggest the following measures: (1) Integration of ICUs into the levels of care which are currently developed for emergency centers at hospitals. (2) Mandatory collection of structured data sets from all ICUs including quality criteria. (3) A reform of intensive care and nursing reimbursement under consideration of adequate staffing in the individual ICU. (4) Actions to improve ICU staffing and qualification.