A survey among physicians and nurses shows that care for the critically ill may go too far for nearly a quarter of the patients in intensive care units (ICUs).

Researchers at Ghent University Hospital (Belgium), the Hebrew University (Jerusalem, Israel), and other institutions conducted a cross-sectional evaluation survey on May 11, 2010, of 82 adult ICUs in 9 European countries and Israel. A total of 1,953 ICU nurses and physicians providing bedside care were questioned to determine the prevalence of perceived inappropriateness of care and to identify patient-related situations, personal characteristics, and work-related characteristics associated with perceived inappropriateness of care, defined as a specific situation in which the clinician acts in a manner contrary to his or her personal and professional beliefs, as assessed using a questionnaire designed for the study.

The results showed that perceived inappropriateness of care in at least one patient was reported by 439 clinicians--300 nurses (25%), 132 physicians (32%), and 26 who had a missing description of job title. The most common reports were perceived disproportionate care, of which “too much care” was reported in 89% of situations, followed by “other patients would benefit more.” Independently associated with perceived inappropriateness of care rates among both nurses and physicians were symptom control decisions directed by physicians only; involvement of nurses in end-of-life decision making; good collaboration between nurses and physicians; and freedom to decide how to perform work-related tasks. Perceived inappropriateness of care was also independently associated with higher intent to leave a job. The survey results were published in the December 28, 2011 issue of the Journal of the American Medical Association (JAMA).

“Perceived inappropriateness of care is a subjective factor that does not necessarily indicate a failure to adhere to recommendations for patient care but that may serve as a marker for inadequate communication, decision sharing, and job autonomy within the ICU,” concluded lead author Ruth Piers, MD, of Ghent University and colleagues. “Clinicians in ICUs who perceive the care they provide as inappropriate experience moral distress and are at risk for burnout. This situation may jeopardize patient quality of care and increase staff turnover.”
 

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