Prevalence and factors of intensive care unit conflicts: the conflicus study.
BACKGROUND
Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs.


OBJECTIVE
To record the prevalence, characteristics, and risk factors for conflicts in ICUs.


METHODS
One-day cross-sectional survey of ICU clinicians. Data on perceived conflicts in the week before the survey day were obtained from 7,498 ICU staff members (323 ICUs in 24 countries).


RESULTS
Conflicts were perceived by 5,268 (71.6%) respondents. Nurse-physician conflicts were the most common (32.6%), followed by conflicts among nurses (27.3%) and staff-relative conflicts (26.6%). The most common conflict-causing behaviors were personal animosity, mistrust, and communication gaps. During end-of-life care, the main sources of perceived conflict were lack of psychological support, absence of staff meetings, and problems with the decision-making process. Conflicts perceived as severe were reported by 3,974 (53%) respondents. Job strain was significantly associated with perceiving conflicts and with greater severity of perceived conflicts. Multivariate analysis identified 15 factors associated with perceived conflicts, of which 6 were potential targets for future intervention: staff working more than 40 h/wk, more than 15 ICU beds, caring for dying patients or providing pre- and postmortem care within the last week, symptom control not ensured jointly by physicians and nurses, and no routine unit-level meetings.


CONCLUSIONS
Over 70% of ICU workers reported perceived conflicts, which were often considered severe and were significantly associated with job strain. Workload, inadequate communication, and end-of-life care emerged as important potential targets for improvement.
Azoulay
Elie
E
AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France. elie.azoulay@sls.ap-hop-paris.fr
Timsit
Jean-François
JF
Sprung
Charles L
CL
Soares
Marcio
M
Rusinová
Katerina
K
Lafabrie
Ariane
A
Abizanda
Ricardo
R
Svantesson
Mia
M
Rubulotta
Francesca
F
Ricou
Bara
B
Benoit
Dominique
D
Heyland
Daren
D
Joynt
Gavin
G
Français
Adrien
A
Azeivedo-Maia
Paulo
P
Owczuk
Radoslaw
R
Benbenishty
Julie
J
de Vita
Michael
M
Valentin
Andreas
A
Ksomos
Akos
A
Cohen
Simon
S
Kompan
Lidija
L
Ho
Kwok
K
Abroug
Fekri
F
Kaarlola
Anne
A
Gerlach
Herwig
H
Kyprianou
Theodoros
T
Michalsen
Andrej
A
Chevret
Sylvie
S
Schlemmer
Benoît
B
D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000453:epidemiology / Q000523:psychology; D003142:Communication; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006282:Health Personnel / Q000523:psychology / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007398:Interpersonal Relations; D008297:Male; D010465:Perception; D015995:Prevalence; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data; D016526:Workload / Q000523:psychology