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Impact of perceived inappropiate cardiopulmonary resuscitation on emergency clinicians' intention to leave the job: Results from a cross-sectional survey in 288 centres across 24 countries
P. Druwé, KG. Monsieurs, J. Gagg, S. Nakahara, MN. Cocchi, G. Élő, H. van Schuppen, EA. Alpert, A. Truhlář, SA. Huybrechts, N. Mpotos, P. Paal, C. BjØrshol, T. Xanthos, LM. Joly, M. Roessler, C. Deasy, H. Svavarsdóttir, J. Nurmi, R. Owczuk, PP....
Language English Country Ireland
Document type Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Adult MeSH
- Cardiopulmonary Resuscitation * MeSH
- Physicians * MeSH
- Humans MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Intention MeSH
- Emergency Service, Hospital MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
INTRODUCTION: Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. METHODS: A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals. RESULTS: Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]). CONCLUSION: Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
Akureyri Hospital and University of Akureyri Akureyri Iceland
Amsterdam UMC University of Amsterdam Department of Anesthesiology Amsterdam The Netherlands
Department of Anaesthesiology and Intensive Therapy Medical University of Gdansk Gdansk Poland
Department of Anaesthesiology and Intensive Therapy Semmelweis University Budapest Hungary
Department of Anaesthesiology University Medical Centre Göttingen Göttingen Germany
Department of Emergency Medicine Cork University Hospital Cork Ireland
Department of Emergency Medicine Ghent University Hospital Ghent Belgium
Department of Emergency Medicine Rouen University Hospital Rouen France
Department of Geriatric Medicine Ghent University Hospital Ghent Belgium
Department of Intensive Care Medicine Ghent University Hospital Ghent Belgium
Emergency Department Shaare Zedek Medical Center Jerusalem Israel
European University Nicosia Cyprus
Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
Hellenic Society of Cardiopulmonary Resuscitation Athens Greece
Hospital General Universitario Reina Sofia Murcia Spain
Pontificia Universidad Católica de Chile Santiago Chile
Serbian Resuscitation Council Novi Sad Serbia
Teikyo University School of Medicine Tokyo Japan
University of Medicine and Pharmacy Gr T Popa and Emergency County Hospital Sf Spiridon Iasi Romania
References provided by Crossref.org
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- $a Druwé, Patrick $u Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: patrick.druwe@ugent.be
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- $a Impact of perceived inappropiate cardiopulmonary resuscitation on emergency clinicians' intention to leave the job: Results from a cross-sectional survey in 288 centres across 24 countries / $c P. Druwé, KG. Monsieurs, J. Gagg, S. Nakahara, MN. Cocchi, G. Élő, H. van Schuppen, EA. Alpert, A. Truhlář, SA. Huybrechts, N. Mpotos, P. Paal, C. BjØrshol, T. Xanthos, LM. Joly, M. Roessler, C. Deasy, H. Svavarsdóttir, J. Nurmi, R. Owczuk, PP. Salmeron, D. Cimpoesu, PA. Fuenzalida, V. Raffay, J. Steen, J. Decruyenaere, P. De Paepe, R. Piers, DD. Benoit, REAPPROPRIATE study group
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- $a INTRODUCTION: Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. METHODS: A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals. RESULTS: Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]). CONCLUSION: Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
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