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Limitations, arrêts des thérapeutiques actives et soins de fin de vie en réanimation (étude d'autoévaluation des pratiques dans deux services de réanimation adulte : un service de réanimation chirurgicale et un service de réanimation médicale)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Conflicts and communication gaps in the intensive care unit

Conflicts occur frequently in the ICU. Research on ICU conflicts is an emerging field, with only few recent studies being available on intrateam and team-family conflicts. Research on communication in the ICU is developing at a faster pace

Effect of an interprofessional simulation program on patient safety competencies of healthcare professionals in Switzerland ::a before and after study

Purpose: This study aimed to identify the effects of a 12-week interprofessional simulation program, operated between February 2020 and January 2021, on the patient safety competencies of healthcare professionals in Switzerland. Methods: The simulation training was based on 2 scenarios of hospitalized patients with septic shock and respiratory failure, and trainees were expected to demonstrate patient safety competencies. A single-group before and after study was conducted after the intervention—simulation program, using a measurement tool (the Health Professional Education in Patient Safety Survey) to measure the perceived competencies of physicians, nurses, and nursing assistants. Out of 57 participants, 37 answered the questionnaire surveys 4 times: 48 hours before the training, followed by post-surveys at 24 hours, 6 weeks, and 12 weeks after the training. The linear mixed effect model was applied for the analysis. Results: Four components out of 6 perceived patient safety competencies improved at 6 weeks but returned to a similar level before training at 12 weeks. Competencies of “communicating effectively,” “managing safety risks,” “understanding human and environmental factors that influence patient safety,” and “recognize and respond to remove immediate risks of harm” are statistically significant both overall and in the comparison between before the training and 6 weeks after the training. Conclusion: Interprofessional simulation programs contributed to developing some areas of patient safety competencies of healthcare professionals, but only for a limited time. Interprofessional simulation programs should be repeated and combined with other forms of support, including case discussions and debriefings, to ensure lasting effects

Comment évaluer l’impact des revues de morbi-mortalité sur la qualité et la sécurité des soins en réanimation ?

Étudier l’impact des revues de morbi-mortalité (RMM) sur la qualité des soins et la sécurité des patients en réanimation

Care at the end of life in critically ill patients: the European perspective

Purpose of review: Care surrounding end-of-life has become a major topic in the intensive care medicine literature. Cultural and regional variations are associated with transatlantic debates about decisions to forego life-sustaining therapies and lead to recent international statements. The aim of this review is to provide insight into the decisions to forego life sustaining therapies and end-of-life care in Europe. Recent findings: Although decisions to forego life-sustaining therapies are increasingly made in European countries, frequency and characteristics of end-of-life care are still heterogeneous. Moreover, even though many determinants of these variations have been identified, epidemiologic and interventional studies still provide additional information. In agreement with public opinions, recent European laws have emphasized the patient’s autonomy. In real life, advance care planning is rarely used. Decisions are often made by caregivers (physicians and nurses) or families, these latter being less involved than in North America. Not only ethic divergences between physicians but also cultural variations account for this disparity. Summary: To optimize end-of-life care in the intensive care unit, there is an urgent need for the development of palliative and multidisciplinary care in Europe. Furthermore, it highlights the need for culturally competent care, adapted to needs and values of every single patient and family. In addition, a lack of communication with families and within the medical team, an uninformed public about end-of-life issues, and insufficient training of intensive care unit staff are crucial barriers to end-of-life care development. Special awareness of professionals and innovative research are needed to promote a high-standard of end-of-life care in the intensive care unit