Nature of conflict in the care of pediatric intensive care patients with prolonged stay

Title

Nature of conflict in the care of pediatric intensive care patients with prolonged stay

Creator

Studdert DM; Burns JP; Mello MM; Puopolo AL; Truog RD; Brennan T

Publisher

Pediatrics

Date

2003

Subject

Female; Humans; infant; Male; Intensive Care Units; Physician-Patient Relations; Prospective Studies; Communication Barriers; Dissent and Disputes; Predictive Value of Tests; Case-Control Studies; infant; Family/psychology; Newborn; ICU Decision Making; Patient Satisfaction/statistics & numerical data; Withholding Treatment/trends; Length of Stay/trends; Patient Care Planning/trends; Pediatric Nursing/trends; Pediatric/trends

Description

OBJECTIVE: To determine the frequency, types, sources, and predictors of conflict surrounding the care of pediatric intensive care unit (PICU) patients with prolonged stay. SETTING: A tertiary care, university-affiliated PICU in Boston. PARTICIPANTS: All patients admitted over an 11-month period whose stay exceeded 8 days (the 85th percentile length of stay for the PICU under study), and intensive care physicians and nurses who were responsible for their care. METHODS: We prospectively identified conflicts by interviewing the treating physicians and nurses at 2 stages during the patients' PICU stay. All conflicts detected were classified by type (team-family, intrateam, or intrafamily) and source. Using a case-control design, we then identified predictors of conflict through bivariate and multivariate analyses. RESULTS: We enrolled 110 patients based on the length-of-stay criterion. Clinicians identified 55 conflicts involving 51 patients in this group. Hence, nearly one half of all patients followed had a conflict associated with their care. Thirty-three of the conflicts (60%) were team-family, 21 (38%) were intrateam, and the remaining 1 was intrafamily. The most commonly cited sources of team-family conflict were poor communication (48%), unavailability of parents (39%), and disagreements over the care plan (39%). Medicaid insurance status was independently associated with the occurrence of conflict generally (odds ratio = 4.97) and team-family conflict specifically (odds ratio = 7.83). CONCLUSIONS: Efforts to reduce and manage conflicts that arise in the care of critically ill children should be sensitive to the distinctive features of these conflicts. Knowledge of risk factors for conflict may also help to target such interventions at the patients and families who need them most.
2003

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

553-558

Issue

3

Volume

112

Citation

Studdert DM; Burns JP; Mello MM; Puopolo AL; Truog RD; Brennan T, “Nature of conflict in the care of pediatric intensive care patients with prolonged stay,” Pediatric Palliative Care Library, accessed October 16, 2021, https://pedpalascnetlibrary.omeka.net/items/show/12652.

Social Bookmarking