Emotional contagion and burnout among nurses and doctors: Do joy and anger from different sources of stakeholders matter?

Night Physician-Nurse Collaboration: Developing the Scale of Physicians' Difficulties and Exploring Related Factors in Acute Care Hospitals

Background

Responding to inpatient deterioration is less favorable at night than during the day, and this may be related to barriers in collaboration between physicians and nurses. However, there had been no way to assess the problem. This study aimed to develop a scale for physicians to measure difficulties in nighttime collaboration with nurses in response to deteriorating inpatients and to identify factors associated with the developed scale scores.

Methods

We developed a draft scale of Nighttime Collaboration Difficulties between Nurses and Physicians for Physicians (NCDNP-P) based on key informant interviews with physicians. Psychometric validations, including structural validity, criterion-related validity, and reliability tests, were conducted among physicians who worked on night duty or on call in acute-care hospitals in Japan using a cross-sectional web-based questionnaire. Multiple linear regression analyses were performed using independent variables including individual backgrounds, style of working at night, and facility characteristics.

Results

By performing exploratory factor analysis, we confirmed the structural validity of the NCDNP-P, consisting of seven items and two domains (Domain 1: Dissatisfaction with reporting, Domain 2: Barriers to working with nurses). Cronbach's alpha and McDonald's omega coefficients were 0.81-0.84 and 0.81-0.89, respectively. The criterion-related validity for interprofessional collaboration was confirmed. Multiple regression analysis revealed that the variables employment status, number of night shifts, frequency of nighttime calls about patients under another physician's charge, and handover between physicians before changing shifts were statistically significantly associated with NCDNP-P scores.

Conclusion

We developed the NCDNP-P, confirming its reliability and validity. Identified factors reflect physicians' characteristics and the problems experienced working at night and may be associated with barriers in nighttime collaboration. The NCDNP-P can highlight issues in clinical settings and lead to the consideration of initiatives to address such issues.

A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study

Background

Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives.

Objective(s)

Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety.

Design

Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation.

Setting and methods

Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool.

Participants

A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews.

Interventions

Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions.

Results

Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere.

Limitations

Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results.

Conclusions

WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review.

Future work

The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context.

Study registration

This study is registered as ISRCTN14470430.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Emotional Exhaustion and Emotional Contagion: Navigating Turnover Intention of Healthcare Personnel

Purpose

This study aimed to examine the role of personal emotions and emotional contagion within organizations on the behavior and attitudes of healthcare personnel. This study is expected to provide a theoretical foundation for reducing resignation behaviors and improving healthcare quality.

Materials and Methods

This study adopted a quantitative research method with a cross-sectional survey through an online questionnaire. The bootstrap method with 5000 iterations was used to validate the role of variables within a 95% confidence interval. SPSS 26.0 and Model 5 in Process 3.4 for SPSS were used for the data analysis.

Results

This research involved 459 healthcare personnel, whose levels of role overload (3.821±0.925), emotional exhaustion (3.436±1.189), and turnover emotional contagion (3.110±1.099) were notably high. Role overload was positively related to turnover intention, with emotional exhaustion as a mediator. Notably, turnover emotional contagion exerted a positive moderating effect.

Conclusion

This study emphasizes the adverse effects of emotional exhaustion and turnover emotional contagion in the Chinese context, offering practical recommendations for medical organizational managers to navigate turnover intention among healthcare personnel. This study suggests paying attention to the emotional state of healthcare personnel and providing adequate support resources. Managers should routinely assess and track turnover emotional contagion within the organization, fostering a positive emotional atmosphere.

Physician exhaustion and work engagement during the COVID-19 pandemic: A longitudinal survey into the role of resources and support interventions

BACKGROUND

Physicians increasingly show symptoms of burnout due to the high job demands they face, posing a risk for the quality and safety of care. Job and personal resources as well as support interventions may function as protective factors when demands are high, specifically in times of crisis such as the COVID-19 pandemic. Based on the Job Demands-Resources theory, this longitudinal study investigated how monthly fluctuations in job demands and job and personal resources relate to exhaustion and work engagement and how support interventions are associated with these outcomes over time.

METHODS

A longitudinal survey consisting of eight monthly measures in the period 2020-2021, completed by medical specialists and residents in the Netherlands. We used validated questionnaires to assess job demands (i.e., workload), job resources (e.g., job control), personal resources (e.g., psychological capital), emotional exhaustion, and work engagement. Additionally, we measured the use of specific support interventions (e.g., professional support). Multilevel modeling and longitudinal growth curve modeling were used to analyze the data.

RESULTS

378 medical specialists and residents were included in the analysis (response rate: 79.08%). Workload was associated with exhaustion (γ = .383, p < .001). All job resources, as well as the personal resources psychological capital and self-judgement were associated with work engagement (γs ranging from -.093 to .345, all ps < .05). Job control and psychological capital attenuated the workload-exhaustion relationship while positive feedback and peer support strengthened it (all ps < .05). The use of professional support interventions (from a mental health expert or coach) was related to higher work engagement (estimate = .168, p = .032) over time. Participation in organized supportive group meetings was associated with higher exhaustion over time (estimate = .274, p = .006).

CONCLUSIONS

Job and personal resources can safeguard work engagement and mitigate the risk of emotional exhaustion. Professional support programs are associated with higher work engagement over time, whereas organized group support meetings are associated with higher exhaustion. Our results stress the importance of professional individual-level interventions to counteract a loss of work engagement in times of crisis.

Burn-out and relationship with the learning environment among psychiatry residents: a longitudinal study

OBJECTIVES

Recent research suggests that burn-out is high and appears to be rooted in system-level factors including the local learning environment (LE). While most studies on this topic have been cross-sectional, our aim was to explore the relationship between burn-out and the LE over time within psychiatry residents. We hypothesised that burn-out is a significant predictor of learner perception of overall and all subdomains of LE within residents.

DESIGN

This was a repeated measures questionnaire study.

SETTING

We surveyed psychiatry residents in Singapore between January 2016 and December 2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Oldenburg Burnout Inventory and the Postgraduate Hospital Education Environment Measure (PHEEM) were used to assess burn-out and resident perception of the LE, respectively. Linear mixed modelling was used to examine changes in PHEEM scores over time while taking into account burn-out status.

PARTICIPANTS

Overall, 93 residents (response rate 89.4%) took part.

RESULTS

The average difference between initial PHEEM total scores for residents with and without burn-out was significant (p<0.001). Burn-out status was a significant predictor of lower overall and all subdomain PHEEM scores at baseline (all p<0.001). PHEEM Teaching scores showed a significant increase over time for all residents regardless of burn-out status (p<0.05). However, PHEEM Total, Role Autonomy, Social Support scores did not change significantly over time or change significantly between residents with or without burn-out.

CONCLUSIONS

Perceptions of LE among psychiatry residents at baseline are inversely associated with burn-out status. That only the Teaching subdomain score increased over time could be accounted for by the fact that it is a more tangible and visible aspect of the LE compared with perceived role autonomy or social support subdomains. Our findings underscore the importance of attending to the well-being and improving the LE of our residents so as to optimise learning during training.

The Critical Need for a Meaning-Centered Team-Level Intervention to Address Healthcare Provider Distress Now

COVID-19 has unveiled and amplified the burnout, grief, and other forms of distress among healthcare providers (HCPs) that long preceded the pandemic. The suffering of the healthcare workforce cannot be simply and sufficiently addressed with a single psychotherapeutic intervention. Nevertheless, the National Academies of Sciences, Engineering, and Medicine Studies recommended prioritizing interventions that generate an increased sense of meaning in life and in work to reduce burnout and cultivate clinician wellbeing. Despite their guidance, there is a dearth of interventions for HCPs specifically targeting meaning and purpose as an avenue to reduce HCP distress. In a time when such an intervention has never been more essential, Meaning-Centered Pyschotherapy (MCP), a brief, evidence-based intervention designed for patients with advanced cancer may be key. This piece describes the principles underlying MCP and how it might be adapted and applied to ameliorate burnout among HCPs while providing a rationale to support future empirical studies in this area. Importantly, the systemic factors that contribute to the emotional and mental health burdens of HCPs are discussed, emphasizing the need for systems-level changes that are needed to leverage the potential outcomes of MCP for HCPs.

The association between stress attributed to information systems and the experience of workplace aggression: a cross-sectional survey study among Finnish physicians

Background

Physicians commonly suffer from workplace aggression and its negative consequences. Previous studies have shown that stressors such as job demands increase the risk of inappropriate treatment at workplace. Poorly functioning, and constantly changing information systems form a major work stressor for physicians. The current study examined the association between physicians’ stress attributed to information systems (SAIS) and their experiences of workplace aggression. Workplace aggression covered physical and non-physical aggression, perpetrated by coworkers, patients, patient’s relatives, or supervisors.

Methods

A cross-sectional survey study was conducted. The participants included 2786 physicians (67.4% women) who were sampled randomly from the registry of Finnish Medical Association, which covers almost all of the Finnish physician population. First, bivariate associations were studied among participant characteristics, SAIS and workplace aggression. Logistic regression analysis was then used to further determine how SAIS was associated with the likelihood of experiencing different types of aggression.

Results

Higher levels of SAIS were associated with higher likelihood of aggression with regard to all types of aggression, except non-physical aggression perpetrated by patients or relatives. The demographic factors (work-sector, gender, age) did not have a noticeable influence on the association between SAIS and aggression.

Conclusions

The present results build on previous evidence on the prevalence of SAIS and its negative effects on healthcare workers. Since SAIS may increase the risk of experiencing aggression, it is possible that SAIS also endangers the wellbeing of physicians and thereby the quality of patient care. Resourcing time and training during introduction of a new IS could alleviate time pressure and thus stress attributed to managing new information systems. The role of organizational climate and general workload in arousing SAIS and aggression should be examined in future studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08116-w.

Happiness and Moral Courage Among Iranian Nurses During the COVID-19 Pandemic: The Role of Workplace Social Capital

Background

COVID-19 has become a major global health problem, and healthcare professionals are facing lot of pressure and stress. Accumulated resources and energy obtained via interpersonal relationships is called social capital, which can reduce the negative effects of pressure and stress related to the workplace by impacting happiness and moral courage. This study explored the effect of workplace social capital on moral courage and happiness in nurses working in the COVID-19 wards.

Methods

In this cross-sectional study, using a random sampling method, 169 nurses from three hospitals in East Mazandaran province, Iran, participated who worked in COVID-19 wards. The Onyx and Bullen Social Capital Questionnaire, the Sekerka's Moral Courage Scale, and the Oxford Happiness Inventory were used in this study. Descriptive analysis, Pearson correlation analyses, and stepwise multiple regression were performed for data analysis.

Results

The mean age of nurses was 31.38 ± 6.82 years. Socio-demographic factors such as age, gender, educational level, and employment status were significant predictors of workplace social capital. Social capital was positively correlated with moral courage (r = 0.29, p < 0.01) and happiness (r = 0.32, p < 0.01). In addition, social capital explained 6.8 and 8.6% variance in predicting moral courage and happiness, respectively.

Conclusions

Workplace social capital is a vital organizational phenomenon affecting nurses' moral courage and happiness, especially during the COVID-19 pandemic. Thus, hospitals should be aware of the importance of social capital; they should ensure that all the practices and policies are in place to develop and increase it.

Reducing midwife burnout at organisational level - Midwives need time, space and a positive work-place culture

BACKGROUND

Maternity care organisations have a responsibility to ensure the health and welfare of their staff. Rates of burnout are high in midwifery compared to other professionals. Therefore, exploring how it can be reduced is imperative.

AIM

To explore with midwives the contributors to burnout and how best to reduce burnout in a maternity hospital in Ireland.

METHODS

A Participatory Action Research study involving Co-operative Inquiry meetings (n = 5) with practising midwives (n = 21) between October 2018 and March 2019, in a large, urban teaching maternity hospital in Ireland. The transcribed data were analysed using Thematic Network Analysis.

FINDINGS

Several recommendations were made for maternity organisations, to reduce or prevent burnout. These include improving workplace culture, increasing support and acknowledgement, offering time and space for debriefing and reflection and regular rotation of staff. Consistent staff shortages are, however, a barrier to adhering to these recommendations.

CONCLUSION

This study is the first of its kind to offer an in-depth exploration with midwives into the main contributors of burnout and what can be done at an organisational level to reduce burnout among midwives. The findings of this study highlighted the importance of working relationships. Additionally, owing to the nature of midwifery practice, time and space need to be created for midwives to debrief and reflect. However, there is an urgent need for healthcare systems to combat staffing shortages in order for these strategies to be successful.

A cross-sectional study to assess job strain of emergency healthcare workers by Karasek questionnaire: The SEEK study

BACKGROUND

Emergency healthcare workers (eHCWs) are particularly at risk of stress, but data using the gold standard questionnaire of Karasek are scarce. We assessed the level of stress of eHCWs and aimed to compare it with the general population.

METHODS

This is a cross-sectional nationwide study in French Emergency Departments (EDs), using the job-content questionnaire of Karasek, compared with the 25,000 answers in the French general population (controls from the SUMER study). The descriptions of job demand, job control, and social support were described as well as the prevalence of job strain and isostrain. Putative factors were searched using mixed-method analysis.

RESULTS

A total of 166 eHCWs (37.9 ± 10.5 years old, 42% men) from five French EDs were included: 53 emergency physicians and 104 emergency paramedics, compared to 25,000 workers with other occupations. Job demand was highest for physicians (28.3 ± 3.3) and paramedics (25.9 ± 3.8), compared to controls (36.0 ± 7.2; p < 0.001). Job control was the lowest for physicians (61.2 ± 5.8) and paramedics (59.1 ± 6.8), compared to controls (70.4 ± 11.7; p < 0.001). Mean social support did not differ between groups (23.6 ± 3.4 for physicians, 22.6 ± 2.9 for paramedics, and 23.7 ± 3.6 for controls). The prevalence of job strain was massively higher for physicians (95.8%) and paramedics (84.8%), compared to controls (23.9%; p < 0.001), as well as for isostrain (45.1% for physicians, 56.8% for paramedics, and 14.3% for controls, p < 0.001). We did not find any significant impact of sociodemographic characteristics on job control, job demand, or social support.

CONCLUSION

Emergency healthcare workers have a dramatic rate of job strain, necessitating urgent promotion of policy to take care of them.

The Moderating Role of Personal Resources Between Demands and Ill-Being of Romanian Healthcare Professionals in the COVID-19 Pandemic

Background and Objectives: The illness caused by the new coronavirus (COVID-19) triggered considerable mental consequences for the medical staff. Our aim was to research whether frontline healthcare workers' positive psychological state-PsyCap-impacts the relationship between anxiety/depression and burnout/mental health complaints. Material and Methods: One hundred twenty-six medical professionals working on the frontline at the Intensive Care Unit and Emergency Department in Romania took validated surveys between March and April 2020. All information was collected online after accessing a link that was received in an email message. The inclusion criteria concerned the categories of healthcare professionals who came into direct contact with patients during the COVID-19 global epidemic through the performed medical act, as well as time spent in the medical field of ICU an EM, namely at least 1 year in the department. We excluded from the research other categories of employees and auxiliary staff, as well as healthcare workers with <1-year experience in the medical field. The moderating role of personal resources (PsyCap) between demands (such as anxiety and depression) and ill-being (burnout and mental health complaints) of healthcare professionals were tested via hierarchical multiple regressions. Results: We tested the moderating role of PsyCap on the relation between anxiety and ill-being. The results indicated that high anxiety predicts lower emotional exhaustion and a low level of mental health complaints about Romanian healthcare professionals when PsyCap is high. The moderating role of PsyCap on the relation between depression and ill-being was tested in the second hypothesis. The results indicated that high depression predicts lower inefficacy and a low level of mental health complaints about Romanian healthcare professionals when PsyCap is increased. Conclusions: PsyCap is a crucial variable that may decrease the impact of anxiety and depression on psychological outcomes such as emotional exhaustion, inefficacy, and psychological problems among Romanian medical professionals working on the frontline during the COVID-19 global epidemic. Thus, psychological interventions that help medical staff gain personal resources are appropriate in the context of the COVID-19 pandemic.

Empathy, friend or foe? Untangling the relationship between empathy and burnout in helping professions

The relationship between empathy and burnout in helping professions has been debated extensively, with some arguing the tendency to vicariously experience the emotions of another is a risk factor for burnout and others arguing that this disposition protects against burnout. We sought to aid this debate by assessing the relationship between two empathy facets, positive and negative, and burnout across three samples of helping professionals: practicing clinicians (N = 59), medical students (N = 76), and teaching assistants (N = 77). Results across all three samples consistently revealed that one's tendency to share in the positive emotions of another (i.e., positive empathy) was related to lower levels of burnout, even after controlling for several potential confounding factors. Beyond discussing the utility of the emerging study of positive empathy, we offer potential avenues for reducing burnout in helping professions by emphasizing the importance of sharing in the positive emotions of others.

What is the prevalence and risk factors of burnout among pediatric intensive care staff (PICU)? A review

Staff in the paediatric intensive care unit work with children and their families in an area of high acuity, mortality, and morbidity. There is complexity due to technological advancements and confronting psychosocial situations. With increasing reports of the threat of burnout to healthcare professionals it is imperative to understand the prevalence of burnout and the determinants of risk factors for staff to work in the paediatric intensive care unit (PICU) in order to inform interventions that reduce risk and support growth and wellbeing of this specialised workforce. We conducted electronic searches of PUBMED, Medline, CINAHL and PsychINFO. Studies meeting eligibility inclusion criteria comprised English text, publication dates 1995 to 2019, use of standardized measures to assess prevalence and risk factors for burnout where the PICU staff data was reported separately and contained sample sizes ≥10 PICU staff. Two reviewers independently identified and extracted citations and assessed the quality of papers using two standardised reporting tools. Twenty studies were included in the final review. Due to the heterogeneity of the included studies a descriptive account of the studies was developed. Outcomes reported included prevalence and levels of burnout reported across professional disciplines, reported scoring criteria for burnout, risk and protective factors for burnout, comparative populations, systems and social context associated with burnout and study strengths and limitations. Most studies were cross-sectional, used a single measure of burnout and focussed on either physicians or nurses. Of the 20 studies reported 62% reported high burnout, 19% moderate burnout, and 19% reported low levels of burnout. Inconsistency was identified in adherence to recommended cut-off scores or reporting for the categorisation of burnout, which contributed to a lack of clarity in the interpretation of prevalence and severity. Reports of factors associated with increased risk and likely protective factors for burnout were often contradictory suggesting that burnout may be situational; dependent upon personal, environmental, leadership, cultural and patient factors within the PICU. This review revealed that determining levels and risk of burnout in PICU staff remains problematic. Further research which examines the experiences of all members of the multidisciplinary team and identification of factors that affect the development of burnout, including those which are protective, is required.

Development and validation of film stimuli to assess empathy in the work context

A growing body of research suggests that empathy predicts important work outcomes, yet limitations in existing measures to assess empathy have been noted. Extending past work on the assessment of empathy, this study introduces a newly developed set of emotion-eliciting film clips that can be used to assess both cognitive (emotion perception) and affective (emotional congruence and sympathy) facets of empathy in vivo. Using the relived emotions paradigm, film protagonists were instructed to think aloud about an autobiographical, emotional event from working life and relive their emotions while being videotaped. Subsequently, protagonists were asked to provide self-reports of the intensity of their emotions during retelling their event. In a first study with 128 employees, who watched the film clips and rated their own as well as the protagonists’ emotions, we found that the film clips are effective in eliciting moderate levels of emotions as well as sympathy in the test taker and can be used to calculate reliable convergence scores of emotion perception and emotional congruence. Using a selected subset of six film clips, a second two-wave study with 99 employees revealed that all facet-specific measures of empathy had moderate-to-high internal consistencies and test–retest reliabilities, and correlated in expected ways with other self-report and test-based empathy tests, cognition, and demographic variables. With these films, we expand the choice of testing materials for empathy in organizational research to cover a larger array of research questions.

Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic

BACKGROUND

We investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France.

METHODS

This cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses.

RESULTS

In total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues (p < 0.001), and higher levels of overall perceived stress (p < 0.001), compared to low-intensity zones. Factors associated with higher overall perceived stress were female sex (B = 0.13; 95% confidence interval [CI] = 0.08-0.17), having a relative at risk of COVID-19 (B = 0.14; 95%-CI = 0.09-0.18) and working in high-intensity zones (B = 0.11; 95%-CI = 0.02-0.20). Perceived stress mediated the impact of the crisis context on mental health (B = 0.23, 95%-CI = 0.05, 0.41) and the impact of stress on mental health was moderated by positive thinking, b = - 0.32, 95% CI = - 0.54, - 0.11.

CONCLUSION

COVID-19 negatively impacted the mental health of ICU professionals. Professionals working in zones where the epidemic was of high intensity were significantly more affected, with higher levels of perceived stress. This study is supported by a grant from the French Ministry of Health (PHRC-COVID 2020).

Anxiety amongst physicians during COVID-19: cross-sectional study in Pakistan

BACKGROUND

Ensuring safety and wellbeing of healthcare providers is crucial, particularly during times of a pandemic. In this study, we aim to identify the determinants of anxiety in physicians on duty in coronavirus wards or quarantine centers.

METHODS

We conducted a cross-sectional quantitative survey with an additional qualitative item. Five constructs of workload, exhaustion, family strain, feeling of protection, and anxiety were measured using items from two validated tools. Modifications were made for regional relevance. Factor analysis was performed showing satisfactory Cronbach alpha results. Overall, 103 physicians completed the questionnaire.

RESULTS

T-test results revealed significant associations between gender and anxiety. Structural equation modeling identified that high workload contributed to greater exhaustion (β = 0.41, R² = 0.17, p < 0.001) and greater family strain (β = 0.47, R² = 0.22, p < 0.001). Exhaustion (β = 0.17, p < 0.005), family strain (β = 0.34, p < 0.001), and feelings of protection (β = - 0.30, p < 0.001) significantly explained anxiety (R² = 0.28). Qualitative findings further identified specific needs of physicians with regard to protective equipment, compensation, quarantine management, resource allocation, security and public support, governance improvement, and health sector development.

CONCLUSIONS

It is imperative to improve governmental and social support for physicians and other healthcare providers during the corona pandemic. Immediate attention is needed to reduce anxiety, workload, and family strain in frontline practitioners treating coronavirus patients, and to improve their (perceptions of) protection. This is a precondition for patient safety.

Red tape and psychological capital: a counterbalancing act for professionals in street-level bureaucracies

Assuming that red tape is inevitable in institutions, and drawing on positive organizational behavior, we compare the impact of individual psychological capital on the ability of street-level bureaucrats (SLBs) with different professional backgrounds to work within the confines of red tape. The two SLB professions investigated here are nurses and local government employees; and the work outcomes of interest to this study are well-being and engagement. The findings show that red tape has a different impact on each professional group but, encouragingly, they also indicate that psychological capital has a compensatory effect. Implications include nurses requiring more psychological resources than local government employees to counteract the negative impact of red tape. A practical implication for managers is that, if perception of red tape in organizations is set to increase or to stay constant, enhancing the psychological capital of professionals in SLB roles, through specific interventions, may be beneficial to professionals and organizations alike.

Novice nurse's transitioning to emergency nurse during COVID-19 pandemic: A qualitative study

AIM

To explore the experiences and perceptions of recent nursing graduates working in emergency departments during the COVID-19 outbreak.

BACKGROUND

Overcrowding in emergency departments has been one of the most prominent issues arising in these units for more than 20 years. However, it has become even more problematic due to the novelty of the coronavirus pandemic, which has forced hospitals to recruit larger numbers of beginner nursing staff as the number of quarantined health professionals increases.

METHODS

Sixteen semi-structured interviews were conducted in Spanish emergency departments, which were analysed and synthesized using content analysis.

RESULTS

Three major themes emerged from the data analysis: (a) Fears and concerns, (b) Organisational issues and (c) Support for novice nurses.

CONCLUSIONS

Our findings may help to understand how shadowing periods as a learning programme for nurses, continuing professional development, evidence-based apps and better planning are needed to ensure both novice nurses' confidence in emergency departments and expert emergency room nurses' ability to cope with complications in critical situations.

IMPLICATIONS FOR NURSING MANAGEMENT

Training periods that include shadowing expert emergency room nurses, along with evidence-based technology, provide an opportunity to support novice nurses' transition into the workplace. These measures would provide a safety net and would increase novice nurses' confidence as well as high-quality care.

The role of workplace social capital on the relationship between perceived stress and professional identity among clinical nurses during the COVID-19 outbreak

AIM

Workplace social capital refers to relationship networks formed by individuals in an organization through long-term mutually beneficial interactions and cooperation with members. These relationship networks can create value and resources for organizations and individuals. This current study aimed to explore the potential impact of workplace social capital on the association between perceived stress and professional identity in clinical nurses during the COVID-19 outbreak.

METHODS

In this cross-sectional study, 308 Chinese clinical nurses filled out the Chinese Workplace Social Capital Scale, the Chinese Perceived Stress Scale, and the Chinese Nurse's Professional Identity Scale. Descriptive analysis, independent samples t test, analysis of variance, Pearson correlation analyses, and bootstrap method were performed to analyze the data.

RESULTS

Perceived stress was negatively correlated with professional identity (r = -0.455, p < .001). Workplace social capital was not found to moderate the relationship between perceived stress and professional identity (95% CI -0.03 to- 0.06, p = .47 > .05). Instead, it mediated that relationship (95% CI -0.61 to -0.19, p < .05), and its mediating effect was -0.37.

CONCLUSIONS

In the early stages of the COVID-19 outbreak, workplace social capital among the investigated clinical nurses failed to buffer the negative impact of perceived stress on professional identity, but it did play a part in mediating perceived stress and professional identity. A healthy workplace should be provided to clinical nurses to improve their professional identity, while lowering perceived stress.

Economic stress, emotional contagion and safety outcomes: A cross-country study

BACKGROUND

Economic instability produced by financial crises can increase employment-related (i.e., job insecurity) and income-related (i.e., financial stress) economic stress. While the detrimental impact of job insecurity on safety outcomes has been extensively investigated, no study has examined the concurrent role of financial stress let alone their emotion-related predictors.

OBJECTIVE

The present cross-country research sought to identify the simultaneous effects of affective job insecurity and financial stress in predicting employee safety injuries and accidents under-reporting, and to examine the extent to which emotional contagion of positive/negative emotions at work contribute to the level of experienced economic stress.

METHODS

We performed multi-group measurement and structural invariance analyses.

RESULTS

Data from employees in the US (N = 498) and Italy (N = 366) suggest that financial stress is the primary mediator between emotional contagion and poor safety outcomes. Moreover, greater anger-contagion predicted higher levels of financial strain and job insecurity whereas greater joy-contagion predicted reduced economic stress.

CONCLUSIONS

Our findings support the relevance of considering the concurrent role of income-and employment-related stressors as predictors of safety-related outcomes. Theoretical and practical implications for safety are discussed in light of the globally increasing emotional pressure and concerns of income- and employment-related economic stress in today's workplace, particularly given the recent pandemic spread of the coronavirus disease (COVID-19).

Three Good Tools: Positively reflecting backwards and forwards is associated with robust improvements in well-being across three distinct interventions

Burnout in healthcare workers (HCWs) is costly, consequential, and alarmingly high. Many HCWs report not having enough time or opportunities to engage in self-care. Brief, engaging, evidence-based tools have unique potential to alleviate burnout and improve well-being. Three prospective cohort studies tested the efficacy of web-based interventions: Three Good Things (n = 275), Gratitude Letter (n = 123), and the Looking Forward Tool (n = 123). Metrics were emotional exhaustion, depression, subjective happiness, work-life balance, emotional thriving, and emotional recovery. Across all studies, participants reported improvements in all metrics between baseline and post assessments, with two exceptions in study 1 (emotional thriving and happiness at 6 and 12-month post) and study 3 (optimism and emotional thriving at day 7). The Three Good Things, Gratitude Letter, and Looking Forward tools appear promising interventions for the issue of HCW burnout.

Building capacity in the healthcare sector: A strengths-based approach for increasing employees' well-being and organisational resilience

This study uses Appreciative Inquiry (AI) as a lens for informing the process for building on employees' existing wellbeing within one Australian organisation, using the ‘discovery, dreaming, designing, and achieving destiny’ process. Using POSH as a theoretical framework, we worked with a large Not-For-Profit healthcare organisation as part of the ‘discovery’ phase to identify elements of what was positive, flourishing, and life-giving in the practices of their employees. During the ‘dreaming’ process, employees' wellbeing was identified as a strength. During the ‘designing’ phase, a training program was co-designed to build on employees' existing levels of wellbeing. This paper reports outcomes as part of the ‘achieving destiny component’ of the AI process. In particular, the outcomes show that employees' knowledge of, and ability to use positive emotions increased, which is a positive first step for increasing employees' wellbeing and organisational resilience.

Supporting Others Through Stressful Organizational Change

The purpose of the article is to explore the nature of support given to staff undergoing stressful organizational change and to determine the forms, antecedents, targets, and consequences of this support. Interviews in a wider study of changes in a New Zealand public health care authority produced the surprising finding that although 31 participants were asked about receiving support, 17 volunteered information on giving support to others. Various forms of support were given to different targets for various reasons and produced positive and negative outcomes for those providing support. Given that studies focusing on offering support during organizational change are extremely rare, our article, and the model it contains, makes a contribution to the literature on change, well-being, and support. The implications for practice are that organizations need to be aware of change’s potentially stressful impacts and make an extra effort to provide support without draining the resources of its employees.

A mixed methods study of emotional exhaustion: Energizing and depleting work within an innovative healthcare team

This mixed methods study documents emotional exhaustion experiences among care team members during the development of an innovative team approach for caring for adults with serious illness. A mixed methods study design was employed to examine depleting work experiences that may produce emotional exhaustion, and energizing aspects of the work that may increase meaningfulness of work, thus reducing emotional exhaustion. The population studied included team members involved in care for adults with serious illness (n = 18). Team members were surveyed quarterly over an 18-month period using the Maslach Burnout Inventory (MBI). The MBI measures burnout, defined as the inability to continue work because of the interactional toll of the work. Analyses of MBI data show that although overall levels of burnout are low, 89% of team members reported moderate/high levels of emotional exhaustion during at least one survey period. In order to understand the kinds of work experiences that may produce or ameliorate emotional exhaustion, qualitative interviews were also conducted with team members at the end of the 18-month period. Major qualitative findings indicate that disputes within the team, environmental pressures, and standardisation of meaningful work leave team members feeling depleted. Having authentic relationships with patients, working as a team, believing in the care model, and practicing autonomy and creativity help team members to restore their emotional energy. Supports for team members' well-being are critical for continued innovation. We conclude with recommendations for improving team members' well-being.