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Wie viel Tod verträgt das Team?

Eine bundesweite Befragung der Palliativstationen in Deutschland

How many patient deaths can a team cope with?

A nationwide survey of palliative care units in Germany

Zusammenfassung

Hintergrund

Wie viele Sterbefälle die Teams auf Palliativstationen vertragen, was ihnen dabei hilft und wie sie ihre Teamzukunft sehen, wurde bisher in Deutschland nicht untersucht. Ziel der Studie war, Belastungsfaktoren und -symptome sowie Schutzfaktoren im Umgang mit dem Tod auf Palliativstationen zu erfassen sowie die kritische Zahl an Todesfällen, belastende Sterbeabfolge und Zukunftsaussichten einschätzen zu lassen.

Stichprobe und Methode

An dieser explorativen Umfrage nahmen 873 Mitarbeiter 95 deutscher Palliativstationen (60% von n=158 Palliativstationen) teil. In Faktorenanalysen konnten grundlegende Faktoren identifiziert werden. Unterschiede zwischen Berufsgruppen wurden mit Varianzanalysen überprüft.

Ergebnisse

Als stärkster belastender Faktor im Umgang mit dem Tod wurde ein nicht erfüllter Anspruch der Palliativmedizin angegeben. Ein Team reagierte meist mit Überredseligkeit auf den Tod. Als wichtigster Schutzfaktor stellte sich das Team heraus. Die kritische Zahl der Todesfälle lag bei 4,4 pro Woche. Aufeinanderfolgende Todesfälle wurden als signifikant belastender empfunden als verteilte. War das Nichterreichen des Anspruchs der Palliativmedizin sehr belastend, wurden die Zukunftsaussichten des Teams als bedeutend schlechter eingeschätzt.

Schlussfolgerung

Eine genaue Definition der Ansprüche der Palliativmedizin sowie eine Stärkung der Teamkommunikation sind wünschenswert.

Abstract

Background

How many patient deaths the teams at palliative care units can cope with, the supporting factors in coping and the future prospects of the teams have not yet been subject to research in Germany. The aim of the study was to assess burden factors, burden symptoms and protective factors, the critical number and distribution of patient deaths as well as the prospects of the teams.

Sample and Methods

A total of 873 members of palliative care teams from 95 (60% of n=158) German palliative care units took part in this explorative evaluation. Basic factors could be identified using factor analysis. Differences between professional groups were checked with analysis of variance.

Results

Results showed that not having reached the objectives of palliative care was the central burden factor. In the majority of cases a team reacted by being loquacious. The team itself was ranked as the most important protective factor. The mean critical number of deaths was 4.4 per week. Consecutive patient deaths were rated as being significantly more stressful than evenly spread deaths. Ratings for the future prospects of the team were significantly lower in teams where not meeting the objectives of palliative care was considered a high burden factor.

Conclusion

A clearer definition of the objectives of palliative care and support of team communication are desirable.

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Literatur

  1. Alexander DA, Ritchie E (1990) Stressors and difficulties in dealing with the terminal patient. J Palliat Care 6:28–33

    CAS  PubMed  Google Scholar 

  2. Barstow J (1980) Stress variance in hospice nursing. Nurs Outlook 28:751–754

    CAS  PubMed  Google Scholar 

  3. Bram PJ, Katz LF (1989) Study of burnout in nurses working in hospice and hospital oncology settings. Oncol Nurs Forum 16:550–560

    Google Scholar 

  4. Farber SJ, Egnew TR, Herman-Bertsch JL et al (2003) Issues in end-life care: patient, caregiver, and clinician perceptions. J Palliat Med 6(1):19–31

    Article  PubMed  Google Scholar 

  5. Hopkinson JB, Hallett CE, Luker KA (2005) Everyday death: how do nurses cope with caring for dying people in hospital? Int J Nurs Stud 42:125–133

    Article  PubMed  Google Scholar 

  6. Keidel GC (2002) Burnout and compassion fatigue among hospice caregivers. Am J Hosp Palliat Care 19(3):200–205

    Article  PubMed  Google Scholar 

  7. Kinsella G (1998) A review of measurement of caregiver and family burden in palliative care. J Palliat Care 14:37–45

    CAS  PubMed  Google Scholar 

  8. Lazarus RS, Folkman S (1984) Stress, appraisal and coping. Springer, New York

  9. Leiter MP, Harvie P, Frizzel C (1998) The correspondence of patient satisfaction and nurse burn out. Soc Sci 47:1611–1617

    CAS  Google Scholar 

  10. Maeyama E, Kawa M, Miyashita M et al (2003) Multiprofessional team approach in palliative care units in Japan. Support Care Cancer 11:509–515

    Article  PubMed  Google Scholar 

  11. Mallett K, Price JH, Jurs SG, Slenker S (1991) Relationships among burnout, death anxiety and social support in hospice and critical care nurses. Psychol Rep 68:1347–1359

    Article  CAS  PubMed  Google Scholar 

  12. Masterson-Allen S, Mor V, Laliberte L, Monteiro L (1985) Staff burnout in an hospice setting. Hosp J 1:1–15

    Article  CAS  PubMed  Google Scholar 

  13. McWilliam CL, Burdock J, Wamsley J (1993) The challenging experience of palliative care support-team nursing. Oncol Nurs Forum 20:770–785

    Google Scholar 

  14. Meier DE et al (2001) The inner life of physicians and care of the seriously ill. JAMA 286(23):3007–3014

    Article  CAS  PubMed  Google Scholar 

  15. Moores TS, Castle KL, Shaw KL et al (2007) Memorable patient deaths: reactions of hospital doctors and their need for support. Med Educ 41:942–946

    Article  PubMed  Google Scholar 

  16. Munley A (1985) Sources of hospice staff stress and how to cope with it. Nurs Clin North Am 20:343–355

    CAS  PubMed  Google Scholar 

  17. Payne N (2001) Occupational stressors and coping as determinants of burnout in female hospice nurses. J Adv Nurs 33(3):396–405

    Article  CAS  PubMed  Google Scholar 

  18. Ramirez A, Addington-Hall J, Richards M (1998) ABC of palliative care: the carers. BMJ 316:208–211

    CAS  PubMed  Google Scholar 

  19. Sabatowski R, Radbruch R, Nauck F (2006) Wegweiser Hospiz und Palliativmedizin Deutschland 2006/2007. der hospiz verlag, Wuppertal

  20. Schröder C, Bänsch A, Schröder H (2004) Work and health conditions of nursing staff in pallitive care and hospices in Germany. Psycho Soc Med 1:Doc08

    Google Scholar 

  21. Vachon MLS (1987) Occupational stress in the care of the critically ill, the dying and bereaved. Hemisphere, New York

  22. Vachon MLS (1988) Battle fatigue in hospice/palliative care. In: Gilmore A, Gilmore S (eds) A safer death. Plenum, New York, pp 149–160

  23. Vachon MLS (1995) Staff stress in hospice/palliative care: a review. Palliat Medicine 9:91–121

    Article  CAS  Google Scholar 

  24. Van Staa AL, Visser A, van der Zouve N (2000). Caring for caregivers: experiences and evaluation of interventions for a palliative care team. Patient Educ Couns 41:93–105

    Article  Google Scholar 

  25. World Health Organization (1990) Cancer, pain and palliative care, WHO, Geneva

  26. Yancick R (1984) Sources of work stress for hospice staff. J Psychosoc Oncol 2:21–31

    Article  Google Scholar 

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Correspondence to B. Jaspers.

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Müller, M., Pfister, D., Markett, S. et al. Wie viel Tod verträgt das Team?. Schmerz 23, 600 (2009). https://doi.org/10.1007/s00482-009-0845-y

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  • DOI: https://doi.org/10.1007/s00482-009-0845-y

Schlüsselwörter

  • Palliativstation
  • Stress
  • Burnout
  • Team
  • Tod
  • Coping

Keywords

  • Palliative care unit
  • Stress
  • Professional burn out
  • Patient care team
  • Death
  • Coping