Potential sources of conflict in intensive care units - a questionnaire study.

BACKGROUND: Conflicts occur in intensive care units (ICUs), and an international multicentre study conducted in 2008, including 323 ICUs from 24 European countries, confirmed the occurrence of this phenomenon. There are no data in Poland. The aim of the study was to analyse the frequency of the occurrence of conflicts in ICUs in Polish hospitals, and their most frequent sources. METHODS: The study was based on an original questionnaire performed in 12 ICUs in the Pomeranian Voivodship. The respondents were asked questions regarding the frequency, type, and lines of conflicts between employees, as well as potential causes of conflicts. RESULTS: Completed surveys were received from 232 employees, including 79 doctors and 153 nurses. The phenomenon of occurrence of conflicts was confirmed by about 30% of the staff, providing answer that conflicts occur "often". About 43% of staff estimated that conflicts "sometimes" occur and 25% chose the answer "rarely". Analysis of the answers made it possible to identify the most common potential causes of conflict. CONCLUSIONS: The main sources of conflicts in ICUs appear to be external factors such a financial issues and physical overload. The hospital policy and the health policy of the state are also important. The perceived conflicts require careful and constant monitoring. The frequency of hidden conflicts requires thorough assessment of their impact on the quality of work.

[The relationship between family members of intensive therapy unit patients and medical staff]. / Komunikacja pomiedzy personelem a rodzinami chorych leczonych w oddziale intensywnej terapii ­ badania wstepne.

BACKGROUND: The satisfaction of family members with the care provided in Polish intensive therapy units has arisen as an important factor in assessing of the overall outcome of treatment. The opinions received from various ITUs were different, but showed a generally low level of satisfaction regarding the availability of physicians for regular discussion. The purpose of this study was to evaluate the levels of satisfaction arising from contact between ITU staff and patients' families. METHODS: Fifty-nine relatives of ITU patients, treated at the Gdansk Medical University, were asked to complete questionnaires based on the following: general conditions and privacy during information sessions, the accessibility and quality of information, and the readiness for participation in the care of their relatives. RESULTS: Families rated the accessibility of information highly (76.3%). The information provided was deemed to be understandable 84.7% of the time, becoming more comprehensive over time (91.5%). In 84.7% of cases, respondents considered that there was consistency in the information given to other members of family. 66% of those questioned were informed by the chief physician, but only 30.5% were able to talk with physicians together with other family members, in a specially designated room. 87% of those questioned were ready to participate actively in the ITU care of their relative. CONCLUSIONS: The study showed that the present system of informing patients' relatives in the ITU was satisfactory, but only in terms of the accessibility and quality of information. The conditions provided for meetings with ITU physicians were far from being satisfactory, and families received information from too many physicians.

[Significance of measuring family satisfaction in the intensive therapy unit]. / Rola i znaczenie badania satysfakcji rodzin chorych leczonych w oddzialach intensywnej terapii.

Recently, numerous studies have been devoted to the issues of satisfaction of ITU patients and their families. Good relationships between the medical personnel and family members are essential for interpersonal communication built by both parties. The knowledge of rules ensuring proper relations with patients and their families is an important element of the medical staff education. To date, neither the medical curriculum nor additional training have focused on this issue. Good communication between the patients` families and physicians, thus the feeling of safety and satisfaction with the intensive care provided, should be based on controlled paternalism, provision of reliable information, confidence moulded, by mutual understanding and respect, elimination of impulsive reactions.

[The use of heart rate variability analysis to determine changes in autonomic nervous system activity induced by laryngoscopy and endotracheal intubation]. / Zastosowanie analizy zmiennosci rytmu serca do oceny zmian aktywnosci autonomicznego ukladu nerwowego wywolanych laryngoskopia i intubacja dotchawicza.

BACKGROUND: Laryngoscopy and intubation are associated with marked autonomic system activation that can be assessed by heart rate variability analysis (HRV)--a new method, comparing R-R intervals in 12-lead continuous ECG recording. METHODS: Fifty-two ASA I and II adults patients of both sexes were enrolled in the study. Patients were induced with fentanyl and thiopental, paralysed with vecuronium, and intubated. Continuous ECG was recorded and selected time-domain parameters (RMSSD, SDNN, NN50 and pNN50) were analyzed before and after intubation at 5- min intervals. RESULTS: Endotracheal intubation resulted in transient supraventricular and ventricular extrasystoles in six patients. Seven patients developed transient bigeminy. Equivocal changes of RMSSD, SDNN, NN50 and pNN50 were observed. CONCLUSION: Because of the large incidence of cardiac rhythm disturbances, the HRV proved to be useless for assessment of autonomic system changes.

[Perioperative assessment of body temperature in elderly patients during thoracic surgery]. / Sródoperacyjna ocena cieploty ciala u chorych w podeszlym wieku poddanych operacjom torakochirurgicznym.

Within the last years there is observed the increase in number of elder patients operated in planned terms. Perioperative disorders of thermoregulation are strongly expressed in the group of patients, and the number of complications rises significantly during inadvertent perioperative hypothermia. The aim of this study was estimation of body temperature in patients subjected to thoracosurgical operations. The study was performed in 23 patients older than 65 years, which were divided into 2 groups. In the group I (12 persons) we used usual methods of heat loss prevention. In group II there were used: passive methods of protection against heat loss as well as Hotline blood and fluids warmer with the possibility of intravenous fluids warming. The body temperature was estimated every 30 minutes. The temperature detectors were located on plantar surface of hallux and in nasopharynx. We observed statistically significant decrease in body temperature values in group I. We conclude that there is the necessarity of the using of accessory methods of heat loss prevention in elder patients subjected to thoracosurgery.

Effect of hydroxyethyl starch (HAES) on degree and kinetics of erythrocyte aggregation studied with dielectric spectroscopy method.

BACKGROUND: Colloidal fluids, e.g. hydroxyethyl starch (HAES), used as blood plasma substitutes during acute controlled normovolemic hemodilution may cause erythrocyte aggregation. The aim of the presented study was to assess the degree and rate of erythrocyte aggregation in the media containing different concentrations of HAES. MATERIAL/METHODS: The experiments were carried out on heparinized venous blood and on erythrocyte suspension in 0.9% NaCl. RESULTS: Under stationary conditions, an increase of blood and erythrocyte suspension relative electric permitivity (e), with an increase of HAES concentration in the sample, was observed after HAES supplementation. Sample flow through a measuring chamber resulted in decrease of the eL value (determined for 100 kHz). Stopping the flow led to non-linear increase of eL values in the function of time, where two components - characterized by rapid and slow variability, respectively, could be distinguished. The increase was characterized by t1 and t2 relaxation times, which can be related respectively to the process of erythrocyte rouleaux formation and to the formation of 3-D network aggregates. CONCLUSIONS: 1) The values of eL are differentiated by the degree of erythrocyte aggregation due to the presence of HAES, both in whole blood and in erythrocyte suspension in 0.9% NaCl solution, 2) The degree of erythrocyte disaggregation due to flow increases with the increase of flow intensity and correlates with decreasing eL value, 3) t1 and t2, which characterize the kinetics of erythrocyte aggregation, indicate a difference between aggregation processes taking place in whole blood and after hemodilution with HAES.