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Purpose: Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.Methods: Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.Results: Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.Conclusion: This is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL. [ABSTRACT FROM AUTHOR]

Background Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). Objectives To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. Methods Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups. Results Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner. Conclusions The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions. [ABSTRACT FROM AUTHOR]

A reliable assessment of drought return periods is essential to help decision makers in setting effective drought preparedness and mitigation measures. However, often an inferential approach is unsuitable to model the marginal or joint probability distributions of drought characteristics, such as drought duration and accumulated deficit, due to the relatively limited number of drought events that can be observed in the historical records of the hydrological variables of interest. As an alternative, the marginal and multivariate probability cdf's of drought characteristics can be derived as functions of the parameters of the cdf of the underlying variable (e.g. precipitation), whose sample series is usually long enough to obtain trustworthy estimates in a statistical sense. In this study, the latter methodology is applied to investigate space-time variability of drought occurrences over Europe by using the CRU TS3.10.01 precipitation dataset for the period 1901-2009. In particular, a methodology able to take into account autocorrelation in the underlying precipitation series is adopted. First, a spatial analysis of historical droughts at European level is carried out. Then, the joint probability distributions of drought duration and accumulated deficit are derived for each cell, with reference to both historical and design drought events. Finally, the corresponding bivariate drought return periods are computed, as the expected values of the interarrival time between consecutive critical droughts.Results show that several heavy drought episodes have widely affected the continent. Among the most recent events, drought occurred during the period 1985-1995 was the worst in terms of extent of the regions characterized by return periods greater than 250 years. Besides Euro-Mediterranean regions, North Western and Central Eastern regions appear more drought prone than the rest of Europe, in terms of low values of return periods. [ABSTRACT FROM AUTHOR]