Background
Phase 1: identification of stressors
Method
Participants
Canada | Spain | France | Italy | Total | |
---|---|---|---|---|---|
Number of participants | 42 | 40 | 43 | 40 | 165 |
Nurses | 22 (52.4) | 20 (50) | 22 (51.2) | 20 (50) | 84 (50.9) |
Physicians | 20 (47.6) | 20 (50) | 21 (48.8) | 20 (50) | 81 (49.1) |
Female/male ratio | 20/22 | 22/18 | 26/17 | 26/14 | 94/71 |
Mean age | 38.7 ± 10.9 | 38.1 ± 8.8 | 36 ± 7.5 | 33.1 ± 6.8 | 36.4 ± 8.8 |
Mean years since professional qualification | 10.5 ± 10 (median: 8; IQR = 2.6–19) | 13.1 ± 8.1 (median: 10.8; IQR: 8.2–18.8) | 6 ± 5.7 (median: 3.8; IQR: 3–7) | 8.5 ± 5.9 (median: 7.5; IQR: 3.9–11.8) | 9.5 ± 8 (median: 7; IQR: 3–13.6) |
Mean years in ICU | 7.7 ± 4.6 (median: 5; IQR: 3.5–8) | 8.6 ± 9.3 (median: 4; IQR: 1.3–14) | 5.1 ± 5.8 (median: 2.5; IQR: 1.1–6) | 8.2 ± 6.8 (median: 5.8; IQR: 2.8–14) | 7.3 ± 7.8 (median: 4; IQR: 1.5–10.9) |
Procedure
Interview analysis
Results
Phase 2: item elaboration and selection
Method
Participants
Procedure
Analysis
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Floor effect (percentage of response in categories “0” and “1”) ≥ 50%
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Ceiling effect (percentage of response in category “4”) ≥ 50%
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Mean score < 1.5
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Missing data > 20%
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Relevance (Yes/No): < 70% of “Yes.”
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Importance (Not at all/A little/Fairly/Very): > 20% of “Not at all”
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Clarity (Yes/No): < 70% of “Yes”.
Results
Total | |
---|---|
Number of participants | 70 |
Canada | 11 (15.7) |
Spain | 18 (25.7) |
France | 22 (31.4) |
Italy | 19 (27.2) |
Occupational status | |
Nurses | 40 (57.1) |
Physicians | 30 (42.9) |
Female/male ratio | 44/26 |
Mean age | 35.65 ± 8.99 |
Mean years since professional qualification | 9.8 ± 7.7 median: 8; IQR: 4.7–12.25) |
Mean years in ICU | 8.7 ± 7.6 median: 7.1; IQR: 3–12) |
Phase 3: validity of the PS-ICU scale
Method
Participants
Measures
Procedure
Statistical analysis
Results
Overall population | France | Italy | Spain | p value | |||||
---|---|---|---|---|---|---|---|---|---|
(n = 497) | (n = 220) | (n = 178) | (n = 99) | ||||||
n | % | n | % | n | % | n | % | ||
Gender | 0.06 | ||||||||
Male | 166 | 33.40 | 78 | 35.45 | 65 | 36.52 | 23 | 23.23 | |
Female | 331 | 66.60 | 142 | 64.55 | 113 | 63.48 | 76 | 76.77 | |
Age | < 0.001 | ||||||||
Mean (SD) | 38.4 (9.94) | 34.3 (8.07) | 42.3 (9.90) | 40.6 (10.3) | |||||
Missing | 32 | 13 | 11 | 8 | |||||
Marital status | < 0.001 | ||||||||
Single | 113 | 23.35 | 38 | 17.51 | 61 | 35.41 | 14 | 14.74 | |
In a relationship | 345 | 71.28 | 171 | 78.8 | 102 | 59.3 | 72 | 75.79 | |
Separated/divorced | 23 | 4.75 | 8 | 3.69 | 8 | 4.65 | 7 | 7.37 | |
Widowed | 3 | 0.62 | 0 | 0 | 1 | 0.58 | 2 | 2.11 | |
Missing | 13 | 3 | 6 | 4 | |||||
Timing of work | < 0.001 | ||||||||
Day | 64 | 12.9 | 12 | 5.45 | 14 | 7.87 | 38 | 38.78 | |
Night | 14 | 2.82 | 6 | 2.73 | 0 | 0 | 8 | 8.16 | |
Both | 418 | 84.27 | 202 | 91.82 | 164 | 92.13 | 52 | 53.06 | |
Missing | 1 | 0 | 0 | 1 | |||||
Job | < 0.001 | ||||||||
Nurse | 252 | 50.7 | 142 | 64.55 | 63 | 35.39 | 47 | 47.47 | |
Physician | 245 | 49.3 | 78 | 35.45 | 115 | 64.61 | 52 | 52.53 | |
Work quota | 0.002 | ||||||||
Full time | 405 | 81.98 | 170 | 77.27 | 160 | 91.43 | 75 | 75.76 | |
Part time | 72 | 14.57 | 42 | 19.09 | 12 | 6.86 | 18 | 18.18 | |
Other | 17 | 3.44 | 8 | 3.64 | 3 | 1.71 | 6 | 6.06 | |
Years since diploma | < 0.001 | ||||||||
Mean (SD) | 13 (9.57) | 9 (7.63) | 16 (9.54) | 16 (10.29) | |||||
Missing | 7 | 6 | 1 | 0 | |||||
Years in ICU | < 0.001 | ||||||||
Mean (SD) | 10 (8.73) | 7 (7.15) | 12 (8.88) | 14 (9.15) | |||||
Missing | 0 | 0 | 0 | 0 | |||||
Years since starting in this unit | < 0.001 | ||||||||
Mean (SD) | 8 (7.67) | 5 (6.29) | 9 (8.03) | 11 (8.31) | |||||
Missing | 2 | 2 | 0 | 0 |
Items | Factors (F) | ||||||
---|---|---|---|---|---|---|---|
F1 | F2 | F3 | F4 | F5 | F6 | ||
9 | Disagreement and/or lack of coordination with other units concerning a patient’s treatment | 0.668 | |||||
10 | Family conflict or disagreement concerning the patient’s treatment plan | 0.554 | |||||
26 | Family whose beliefs or lifestyle are contradictory with my values or the functioning of the unit | 0.537 | |||||
27 | Family’s misunderstanding of the gravity of the diagnosis or the prognosis of the patient | 0.533 | |||||
42 | Uncertainty concerning the diagnosis or the therapy project of the patient | 0.486 | |||||
6 | Shortage of beds in the unit | 0.465 | |||||
4 | Contradictory information given by other healthcare professionals to the family | 0.464 | |||||
35 | Family which does not trust me or does not trust the team | 0.393 | |||||
41 | Caring for a patient who should not be treated by the ICU | 0.375 | |||||
15 | Lack of support from the administration | 0.302 | |||||
34 | Death of a patient with whom I had developed special ties | 0.626 | |||||
28 | Series of patient deaths in the unit over a short period | 0.615 | |||||
45 | Having to announce a bad diagnosis to the patient or his/her family or be present when such a diagnosis is announced | 0.581 | |||||
29 | Patient who makes me think of someone close to me or of myself | 0.540 | |||||
1 | Socially isolated end-of-life patient or one with no immediate family | 0.509 | |||||
49 | Decision to stop or reduce treatment | 0.476 | |||||
7 | Families’ distress or emotions | 0.402 | |||||
5 | Caring for young patients or who have young children | 0.363 | |||||
44 | Patient suffering physically or psychologically | 0.347 | |||||
18 | Having to execute care tasks quickly in emergency cases | 0.709 | |||||
40 | Treating complex or serious pathologies | 0.622 | |||||
16 | Risk of error, fear of doing a poor job | 0.596 | |||||
37 | Having to perform tasks for which I have neither knowledge nor skills | 0.509 | |||||
25 | Patient who deteriorates in an unexpected or unexplained manner | 0.405 | |||||
20 | Working pace or working hours hardly compatible with family or social life | 0.745 | |||||
23 | Schedule changes, overtime | 0.714 | |||||
36 | Continuous and heavy workload | 0.574 | |||||
50 | Being on call or working nights | 0.520 | |||||
48 | Accumulated workloads resulting from clinical activity, training, research or teaching | 0.405 | |||||
24 | Working while experiencing difficult personal events | 0.309 | 0.351 | ||||
32 | Lack of staff | 0.347 | 0.344 | ||||
46 | Lack of equality in the distribution of tasks among healthcare professionals | 0.326 | |||||
13 | Difficulty to find my place, have my skills recognized, or voice my opinion within the team | 0.623 | |||||
38 | Assessed or judged by the other members of the team | 0.54 | |||||
17 | Negative atmosphere prevailing in the team, gossip, rumors within the team | 0.432 | |||||
3 | Lack of recognition (from the patient, the family, the team, the hierarchy) | 0.425 | |||||
21 | Conflicts with members of the healthcare team | 0.327 | 0.356 | ||||
8 | Inadequate or under-equipped healthcare space or defective materials | 0.44 | |||||
33 | Non-supportive, aggressive or delirious patient | 0.394 | |||||
12 | Incomprehensible or unnecessary care relative to the patient’s situation | 0.385 | |||||
2 | Colleague not doing his/her work properly | 0.380 | |||||
19 | Plaintive patient who makes many requests | 0.364 | 0.374 | ||||
11 | Too many professionals around the patient in an emergency situation | 0.339 | |||||
Eigen values | 3.71 | 3 | 3.24 | 2.24 | 1.92 | ||
% of variance explained | 8.62 | 6.98 | 7.55 | 5.2 | 4.47 |
PS-ICU T1 scores (with Cronbach’s alpha in parentheses) | |||||||
---|---|---|---|---|---|---|---|
Factor 1 (α = 0.83; ω = 0.84) | Factor 2 (α = 0.83; ω = 0.83) | Factor 3 (α = 0.79; ω = 0.80) | Factor 4 (α = 0.81; ω = 0.82) | Factor 5 (α = 0.76; ω = 0.77) | Factor 6 (α = 0.80; ω = 0.80) | General factor (α = 0.95; ω = 0.95) | |
Correlation between factors (T1 test scores) | |||||||
Factor 2 (/4) | 0.57*** | – | |||||
Factor 3 (/4) | 0.33*** | 0.49*** | – | ||||
Factor 4 (/4) | 0.61*** | 0.56*** | 0.44*** | – | |||
Factor 5 (/4) | 0.51*** | 0.49*** | 0.44*** | 0.54*** | – | ||
Factor 6 (/4) | 0.61*** | 0.57*** | 0.48*** | 0.58*** | 0.54*** | – | |
Test–retest reliability (intraclass correlations with T2 retest scores) | |||||||
Without significant event only (n = 197) | 0.83 | 0.85 | 0.85 | 0.90 | 0.87 | 0.83 | 0.90 |
With significant event only (n = 67) | 0.85 | 0.88 | 0.91 | 0.89 | 0.89 | 0.84 | 0.91 |
Convergent validity (correlations with the JCQ) (n = 233) | |||||||
Psychological demands (/36) | 0.240*** | 0.241*** | 0.303*** | 0.438*** | 0.355*** | 0.333*** | 0.409*** |
Decisional latitude (/36) | − 0.149** | − 0.117* | − 0.118* | − 0.200*** | − 0.258*** | − 0.227*** | − 0.228*** |
Colleagues’ support (/24) | − 0.191*** | − 0.122* | 0.050 | − 0.182*** | − 0.308*** | − 0.120* | − 0.193*** |
Hierarchical support (/20) | − 0.084 | − 0.082 | − 0.082 | − 0.214*** | − 0.289*** | − 0.141** | − 0.192*** |
Concurrent validity (correlations with the MBI-HSS) (n = 249) | |||||||
Emotional exhaustion (/54) | 0.365*** | 0.386*** | 0.356*** | .586*** | 0.469*** | 0.324*** | 0.539*** |
Depersonalization (/30) | 0.201*** | 0.067 | 0.208*** | 0.193*** | 0.193*** | 0.172*** | 0.226*** |
Personal accomplishment (/48) | − 0.094 | − 0.004 | − 0.207*** | − 0.085 | − 0.195*** | − 0.117* | − 0.143** |
Predictors (PS-ICU subscales) | Dependent variables (MBI-HSS scores) | ||
---|---|---|---|
Emotional exhaustion | Depersonalization | Personal accomplishment | |
F1 Lack of fit with families and organizational functioning | − 0.12 | 1.23* | − 0.61 |
F2 Patient- and family-related emotional load | 0.73 | − 1.57** | 2.25*** |
F3 Complex/at risk situations and skill-related issues | 1.44* | 1.22** | − 2.07*** |
F4 Workload and human resource management issues | 6.78*** | 0.59 | 0.23 |
F5 Difficulties related to team working | 2.84*** | 0.56 | − 1.43** |
F6 Suboptimal care situations | − 1.97* | 0.17 | − 0.13 |