Stressful intensive care unit medical crises: How individual responses impact on team performance.

Abstract:

BACKGROUND:Intensive care units (ICUs) are recognized as stressful environments. However, the conditions in which stressors may affect health professionals' performance and well-being and the conditions that potentially lead to impaired performance and staff psychological distress are not well understood. OBJECTIVES:The purpose of this study was to determine healthcare professionals' perceptions regarding the factors that lead to stress responses and performance impairments during ICU medical crises. DESIGN:A qualitative study in a university-affiliated ICU in Canada. METHODOLOGY:We conducted 32 individual semistructured interviews of ICU nurses, staff physicians, residents, and respiratory therapists in a university-affiliated hospital. The transcripts of the audiotaped interviews were analyzed using an inductive thematic methodology. RESULTS:Increased workload, high stakes, and heavy weight of responsibility were recognized as common stressors during ICU crises. However, a high level of individual and team resources available to face such demands was also reported. When the patient's condition was changing or deteriorating unpredictably or when the expected resources were unavailable, crises were assessed by some team members as threatening, leading to individual distress. Once manifested, this emotional distress was strongly contagious to other team members. The ensuing collective anxiety was perceived as disruptive for teamwork and deleterious for individual and collective performance. CONCLUSIONS:Individual distress reactions to ICU crises occurred in the presence of unexpectedly high demands unmatched by appropriate resources and were contagious among other team members. Given the high uncertainty surrounding many ICU medical crises, strategies aimed at preventing distress contagion among ICU health professionals may improve team performance and individual well-being.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Piquette D,Reeves S,LeBlanc VR

doi

10.1097/CCM.0b013e31819c1496

subject

Has Abstract

pub_date

2009-04-01 00:00:00

pages

1251-5

issue

4

eissn

0090-3493

issn

1530-0293

journal_volume

37

pub_type

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