Kommunikation im Team und Burnout

 

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Zusammenfassung

Fragestellung: Kommunikation über Therapiebeschränkung ist ein wesentliches Element der Zusammenarbeit im interdisziplinären Team auf Intensiv- und Palliativstationen. Ziel der Untersuchung war, Aspekte der Kommunikation im Kontext von Therapiebeschränkungen (TB) und Burnout bei den Mitarbeitern beider Stationen zu vergleichen.

Methode: Mitarbeiterbefragung auf Intensivstationen (ITS, 72 Betten) und Palliativstation (PS, 12 Betten). Der Fragebogen enthielt das Maslach Burnout Inventar (MBI) und 40 selbst entwickelte Fragen zu Kommunikation und Zusammenarbeit. Es wurde ein 2:1 Propensity Score Matching von ITS- und PS-Mitarbeitern nach demografischen Variablen durchgeführt.

Ergebnisse: Von insgesamt 191 Fragebögen (Rücklauf 60 %) und nach Matching wurden Antworten von 29 (ITS-) und 15 (PS-Mitarbeitern) analysiert. Bei 21 % der ITS-Mitarbeiter, aber keinem PS-Mitarbeiter, war ein erhöhtes Burnout-Risiko gegeben (p = 0,08). ITS-Mitarbeiter werteten die Interaktion im Team, die Rollenklarheit im Kontext von TB und die emotionale Unterstützung signifikant schlechter als PS-Mitarbeiter. Dies war vor allem darauf zurückzuführen, dass ITS-Pflegekräfte hier signifikant schlechter werteten als ITS-Ärzte, während es zwischen den PS-Ärzten und -Pflegekräften keine Unterschiede gab. Bezüglich der Kommunikation zu TB waren ITS-Mitarbeiter seltener zufrieden (42 vs. 80 %; p = 0,025), insbesondere waren ITS-Pflegekräfte seltener zufrieden als -Ärzte (11 vs. 67 %; p = 0,013), bei den PS-Mitarbeitern gab es keine Unterschiede.

Schlussfolgerungen: Die Unterschiede in der Bewertung von Aspekten der Kommunikation zwischen Ärzten und Pflegekräften nur auf der Intensivstation, nicht auf der Palliativstation, sind durch unterschiedliche Arbeitsanforderungen allein nicht zu erklären. Interventionen zur Verbesserung der Zusammenarbeit auf ITS sind zu empfehlen, die sich an der Kommunikationskultur auf Palliativstationen orientieren.

Abstract

Aim: Communication about end-of-life decisions (EOL-D) is essential for interdisciplinary teamwork on intensive care and palliative care units. The aim of this study was to compare aspects of communication in the EOL-D context and burnout of staff on these units.

Methods: Survey among staff of intensive care units (ICU, 72 beds) and a palliative care unit (PCU, 12 beds). The questionnaire consisted of the Maslach Burnout Inventory (MBI) and 40 self-developed questions on communication and teamwork. 2:1 propensity score matching of ICU and PCU staff was performed according to demographic characteristics.

Results: Response rate was 60 % (191 questionnaires). After matching, 29 (ICU) and 15 (PCU) responses were analysed. 21 % of ICU but none of the PCU staff members were at risk for burnout (p = 0.08). Work demands were similar, but interaction within the team, role clarity in the context of EOL-D and emotional support were rated worse on ICUs. This was mostly due to the fact that ICU nurses gave significantly worse ratings than ICU physicians, whereas PCU nurses and physicians gave similar ratings. Satisfaction with communication in the context of EOL-D was lower among ICU staff (42 % vs. 80 %; p = 0.025). Particularly ICU nurses where less satisfied than ICU physicians (11 % vs. 67 %, p = 0.013). There was no such difference among PCU staff.

Conclusion: The differences between nurses’ and physicians’ ratings of communication which were found on the ICU but not on the palliative care unit cannot be explained only by a different work load. To improve interdisciplinary teamwork on the ICU, interventions may be advisable which can be modelled on the communication culture practiced on palliative care units.

• Literatur

• 1 Schaufeli WB. Burnout in health care. In: Carayon P, ed. Handbook of human factors and ergonomics in health care and patient safety. Mahwah, NJ: Erlbaum; 2007: 217-232
  Google Scholar
• 2 Ramirez AJ, Graham J, Richards MA et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer 1995; 71: 1263-1269
  CrossrefPubMedGoogle Scholar
• 3 Lee RT, Lovell BL, Brotheridge ClM. Tenderness and steadiness: Relating job and interpersonal demands and resources with burnout and physical symptoms of stress in Canadian physicians. Journal of Applied Social Psychology 2010; 40: 2319-2342
  CrossrefPubMedGoogle Scholar
• 4 Meissner A, Genga KR, Studart FS et al. Epidemiology of and factors associated with end-of-life decisions in a surgical intensive care unit. Crit Care Med 2010; 38: 1060-1068
  CrossrefPubMedGoogle Scholar
• 5 Sprung CL, Cohen SL, Sjokvist P et al. End-of-life practices in European intensive care units: the Ethicus Study. JAMA 2003; 290: 790-797
  CrossrefPubMedGoogle Scholar
• 6 Azoulay E, Metnitz B, Sprung CL et al. End-of-life practices in 282 intensive care units: data from the SAPS 3 database. Intensive Care Med 2009; 35: 623-630
  CrossrefPubMedGoogle Scholar
• 7 Embriaco N, Azoulay E, Barrau K et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med 2007; 175: 686-692
  CrossrefPubMedGoogle Scholar
• 8 Poncet MC, Toullic P, Papazian L et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 2007; 175: 698-704
  CrossrefPubMedGoogle Scholar
• 9 Schaufeli WB, Enzmann D. The burnout companion to study and practice: A critical analysis. London: Taylor & Francis; 1998
  Google Scholar
• 10 Embriaco N, Papazian L, Kentish-Barnes N et al. Burnout syndrome among critical care healthcare workers. Current Opinion in Critical Care 2007; 13: 482-488
  CrossrefPubMedGoogle Scholar
• 11 Merlani P, Verdon M, Businger A et al. Burnout in ICU Caregivers A Multicenter Study of Factors Associated to Centers. Am J Respir Crit Care Med 2011; 184: 1140-1146
  CrossrefPubMedGoogle Scholar
• 12 Vachon MLS. Staff stress in hospice palliative care – a review. Palliat Med 1995; 9: 91-122
  CrossrefPubMedGoogle Scholar
• 13 Payne N. Occupational stressors and coping as determinants of burnout in female hospice nurses. J Adv Nurs 2001; 33: 396-405
  CrossrefPubMedGoogle Scholar
• 14 Mallett K, Price JH, Jurs SG et al. Relationships among burnout, death anxiety, and social support in hospice and critical care nurses. Psychol Rep 1991; 68: 1347-1359
  CrossrefPubMedGoogle Scholar
• 15 Graham J, Ramirez AJ, Finlay I et al. Job stress and satisfaction among palliative physicians. Palliat Med 1996; 10: 185-194
  PubMedGoogle Scholar
• 16 Müller M, Pfister D, Markett S et al. Wie viel Tod verträgt das Team?. Schmerz 2009; 23: 600-608
  CrossrefPubMedGoogle Scholar
• 17 Thomas EJ, Sexton JB, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med 2003; 31: 956-959
  CrossrefPubMedGoogle Scholar
• 18 Nathanson BH, Henneman EA, Blonaisz ER et al. How much teamwork exists between nurses and junior doctors in the intensive care unit?. J Adv Nurs 2011; 67: 1817-1823
  CrossrefPubMedGoogle Scholar
• 19 Puntillo KA, McAdam JL. Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: Challenges and opportunities for moving forward. Crit Care Med 2006; 34: S332-S340
  CrossrefPubMedGoogle Scholar
• 20 Jox RJ, Krebs M, Fegg M et al. Limiting life-sustaining treatment in German intensive care units: A multiprofessional survey. J Crit Care 2010; 25: 413-419
  CrossrefPubMedGoogle Scholar
• 21 Büssing A, Perrar K-M. Die Messung von Burnout. Untersuchung einer deutschen Fassung des Maslach Burnout Inventory (MBI-D). Diagnostica 1992; 38: 328-353
  PubMedGoogle Scholar
• 22 Kinzl JF, Traweger C, Biebl W et al. Burnout und Belastungsstörungen bei Intensivmedizinern. Dtsch Med Wochenschr 2006; 131: 2461-2464
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Shanafelt TD, Bradley KA, Wipf JE et al. Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program. Ann Intern Med 2002; 136: 358-367
  CrossrefPubMedGoogle Scholar
• 24 Rosenbaum PR, Rubin DB. Constructing a Control-Group Using Multivariate Matched Sampling Methods That Incorporate the Propensity Score. American Statistician 1985; 39: 33-38
  PubMedGoogle Scholar
• 25 Gayat E, Pirracchio R, Resche-Rigon M et al. Propensity scores in intensive care and anaesthesiology literature: a systematic review. Intensive Care Medicine 2010; 36: 1993-2003
  CrossrefPubMedGoogle Scholar
• 26 Büssing A, Glaser J, Höge T. Erfassen und Bewerten psychischer Belastungen bei Beschäftigten im Pflegeereich. In: Berichte aus dem Lehrstuhl für Psychologie der TU München. München: Technische Universität München; 1999
  Google Scholar
• 27 Piers RD, Azoulay E, Ricou B et al. Perceptions of Appropriateness of Care Among European and Israeli Intensive Care Unit Nurses and Physicians. Jama-Journal of the American Medical Association 2011; 306: 2694-2703
  PubMedGoogle Scholar
• 28 Embriaco N, Azoulay E, Barrau K et al. High level of burnout in intensivists – Prevalence and associated factors. Am J Respir Crit Care Med 2007; 175: 686-692
  CrossrefPubMedGoogle Scholar
• 29 Poncet MC, Toullic P, Papazian L et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 2007; 175: 698-704
  CrossrefPubMedGoogle Scholar
• 30 Quenot J, Rigaud J, Prin S et al. Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices. Intensive Care Med 2012; 38: 55-61
  CrossrefPubMedGoogle Scholar

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