[Every life counts : suicide by anesthetists]

Predictors of Quality of Work Life in Health Care Workers at Adult Critical Care Units: A Cross-sectional Study

Aim and background

Satisfaction with the quality of work life reflects the inadequate distribution of the workforce in critical care units and is not enough; on many occasions, they work in precarious conditions and with high levels of physical, emotional, spiritual, and social demands, impacting the quality of care.

Aim

To identify predictors of the quality of work life of healthcare workers in adult critical care units (ACCU).

Materials and methods

Quantitative study, cross-sectional analytical design with stratified two-stage sampling; three instruments were applied to 209 healthcare professionals in adult critical care units in different sites in a region of Colombia, concerning Quality of Life at Work-GOHISALO, Copenhagen Psychosocial Questionnaire-COPSOQ and Professional Quality of Life-ProQoL V. Multiple ordinal logistic regression was performed with exposure variables from the COPSOQ and ProQoL domains; the outcome variables were the dimensions of the Quality of Work Life instrument. Ethical standards for research involving human subjects were ensured.

Results

According to the results of the multiple logistic models, quality of work life is predicted by job integration and predictability (OR = 6.93; 95% CI = 3.6-13.9), leisure time management and double presence (OR = 4.5; 95% CI = 1.22-8.79). Both job satisfaction and job security are related to leadership quality (OR=3.82; 95% CI = 2.27-6.55 and OR = 3.18; 95% CI = 1.22-8.79), respectively.

Conclusions

The quality of work life of healthcare workers in adult intensive care units is predicted by quantitative demands, double presence, emotional demands, work pace, predictability, vertical trust, and quality of leadership.

How to cite this article

Quinones-Rozo LP, Canaval-Erazo GE, Sandoval-Moreno LM. Predictors of Quality of Work Life in Health Care Workers at Adult Critical Care Units: A Cross-sectional Study. Indian J Crit Care Med 2024;28(4):355-363.

[Professional gratification crisis, overcommitment, and burnout among Ukrainian anesthesiologists and intensive care physicians during the SARS-CoV-2 pandemic]

Background

Mental stress of anesthesiologists and intensive care physicians is varied and complex. Overcommitment (OC) is characterized by an excessive tendency to professional commitment, which can lead to psychological stress and consequently to psychological disorders, such as burnout. The prevalence of burnout among intensive care physicians is internationally widespread. The aim of this study was to determine OC and gratification among Ukrainian anesthesia and intensive care physicians during the SARS-CoV‑2 pandemic and to analyze the risk of burnout in this professional group, and the associations between OC and burnout.

Methods

A total of 73 Ukrainian male (47.9%) and female (52.1%) intensive care physicians participated in the survey. The mean age was 39.8 ± 10.94 years (range 23-78 years). In addition to sociodemographic and occupational data, occupational gratification was collected using the effort-reward imbalance (ERI) questionnaire with additional questions on OC, and the Maslach burnout inventory (MBI). Participants were classified and compared into groups with different OC (< 16 points and ≥ 16 points).

Results

Of the participants 75% (55) could be classified into a group with OC < 16 points, and 18 presented an elevated OC. A significant difference in effort (13.9 ± 4.1 vs. 17.2 ± 3.6 points; p = 0.003) and ERI ratio (0.58 ± 0.2 vs. 0.77 ± 0.2; p = 0.006) was found between these two groups. In the group with OC ≥ 16 points, 50% of participants reported high emotional exhaustion (vs. 12.7% with OC < 16 points; p = 0.002), but also high performance (61.1% vs. 32.7%; p = 0.005). Overall, a burnout prevalence of 2.7% was found in the total sample, with both subjects represented in the OC < 16 points group. Higher emotional exhaustion was associated with higher OC, higher effort, and lower reward.

Discussion

The study results showed high emotional exhaustion among subjects with high overcommitment and three quarters of the respondents showed symptoms of burnout. For this reason, health promotion measures and prevention should be offered to counteract the high stresses during the pandemic. These should include relationship and behavioral prevention.

First Results of Peer Training for Medical Staff-Psychosocial Support through Peer Support in Health Care

BACKGROUND

In view of the increasing strain on health workers, psychosocial support measures are becoming more important. The core of a sustainable concept is the establishment of peer support teams. Two aspects are central: first, target group-specific training content, and second, suitable staff members who are trained as peers. The goal of the study was to obtain a first look at what content can be taught in peer training for medical staff, how the training is evaluated by the target group, and which people are interested in training from peers.

METHODS

During the period 2017-2022, Peer Training for medical staff was developed by a non-profit institution in Germany with state funding and the support of a medical professional association and evaluated during the project. Participants (N = 190) in the Peer Training course were interviewed in advance about their experiences and stresses at work using an anonymous questionnaire. After completing the training modules, the participants filled out an evaluation form.

RESULTS

The participants of the Peer Training were predominantly female (70.5%) and middle-aged (between 31 and 50 years old). Most (80.3%) experienced stressful events themselves, mostly without any preparation (93.5%) or follow-up (86.8%) by the employer. The participants estimate their workload in the medium range. The proportion of stressed individuals among the participants was below that of various comparison groups as available reference values. The training module itself was evaluated very positively.

CONCLUSIONS

The content and framework parameters of the training were rated very well. There is a high degree of fit with the requirements in the health sector. The participants in the Peer Training seem to represent a good cross-section of the target group medical staff, also regarding their own experiences, seem to have a good psychological constitution and are therefore very suitable to work as peers after the training.

Occupational Stress and Mental Health among Anesthetists during the COVID-19 Pandemic

Anesthetist-intensivists who treat patients with coronavirus disease 19 (COVID-19) are exposed to significant biological and psychosocial risks. Our study investigated the occupational and health conditions of anesthesiologists in a COVID-19 hub hospital in Latium, Italy. Ninety out of a total of 155 eligible workers (59%; male 48%) participated in the cross-sectional survey. Occupational stress was assessed with the Effort Reward Imbalance (ERI) questionnaire, organizational justice with the Colquitt Scale, insomnia with the Sleep Condition Indicator (SCI), and mental health with the Goldberg Anxiety and Depression Scale (GADS). A considerable percentage of workers (71.1%) reported high work-related stress, with an imbalance between high effort and low rewards. The level of perceived organizational justice was modest. Physical activity and meditation—the behaviors most commonly adopted to increase resilience—decreased. Workers also reported insomnia (36.7%), anxiety (27.8%), and depression (51.1%). The effort made for work was significantly correlated with the presence of depressive symptoms (r = 0.396). Anesthetists need to be in good health in order to ensure optimal care for COVID-19 patients. Their state of health can be improved by providing an increase in individual resources with interventions for better work organization.

Consolidation of working hours and work-life balance in anaesthesiologists - A cross-sectional national survey

Currently, healthcare management fosters a maximization of performance despite a relative shortage of specialists. We evaluated anaesthesiologists’ workload, physical health, emotional well-being, job satisfaction and working conditions under increased pressure from consolidated working hours. A nationwide cross-sectional survey was performed in Austrian anaesthesiologists (overall response rate 41.0%). Three hundred and ninety four anaesthesiologists (280 specialists, 114 anaesthesiology trainees) participated. Anaesthesiologists reported frequently working under time pressure (95%CI: 65.6–74.6), at high working speed (95%CI: 57.6–67.1), with delayed or cancelled breaks (95%CI: 54.5–64.1), and with frequent overtime (95%CI: 42.6–52.4). Perceived work climate correlated with task conduct (manner of work accomplishment, the way in which tasks were completed), participation (decision-making power in joint consultation and teamwork), psychosocial resources, uncertainty, task variability and time tolerance (authority in time management and control over operating speed) (all P <0.001). Having not enough time for oneself (95%CI: 47.6–57.4), for sleep (95%CI: 45.6–55.4) or for one’s partner and children (95%CI: 21.8–30.4) was common. One-third of the participants reported frequent feelings of being unsettled (95%CI: 33.4–43.0) and difficulty talking about their emotions (95%CI: 27.3–36.5). Frequent dissatisfaction with life was reported by 11.4% (95%CI: 8.7–14.9) of the respondents. Strong time pressure and little decision-making authority during work along with long working hours and frequent work interruptions constitute the basis for occupational stress in anaesthesiologists. We conclude that increased pressure to perform during work hours contributes to emotional exhaustion and poor work-life balance. Changes in the work schedule of anaesthesiologists are required to avoid negative effects on health and emotional well-being.

[Patron saints of anesthesia]

Patron saints act as facilitators between God and humans. Humans appeal to patron saints for support in devastating, often futile situations in life. Patron saints may intercede for trade and professional guilds, every so often they hold a protective hand over objects. Saint Barbara is venerated as the patron saint of surgeons. In anesthesia she also oversees barbiturates, protects anesthetized patients, anesthetists and anesthesia nursing personnel. Within the Anglo-American language area Saint René is venerated by anesthetists and anesthesia nursing personnel. During anesthesia or critical care treatment patient safety and welfare are entirely in the hands of anesthetists and intensivists. Especially in the borderland of critical illness and imminent death, it may be reassuring for religiously or spiritually orientated physicians and nurses that they can turn to "their" patron saints to intercede so that upcoming anesthetic procedures or intensive care interventions will meet with success. Hereby, the heavy burden of responsibility may be borne more easily and equanimously.

[Life-threatening fentanyl and propofol addiction: interview with a survivor]

Anesthesiologists have a well-known increased risk of substance abuse including the intravenous administration of opioids and propofol. However, katamnestic reports from the point of view of propofol-addicted anesthesiologists themselves are missing which would aid a better understanding of the dynamics and progress of addiction. This article presents an interview with a formerly addicted female anesthesiologist who after long-term abuse with oral tilidine combined with naloxone switched to intravenous administration of fentanyl and later on propofol. Several life-threatening incidents occurred but after some severe setbacks occupational rehabilitation outside the field of anesthesiology was successful following inpatient treatment. This case shows exemplarily in accordance with the current literature that warning signs in addicted physicians are often ignored by colleagues and supervisors and rehabilitation is possible under professional therapy and continuous surveillance. Additionally, this case emphasizes the necessity of controlling the distribution of propofol to reduce the life-threatening professional risk to anesthesiologists.

Evaluation of tetrahydrobiopterin pathway in operating room workers: changes in biopterin status and tryptophan metabolism

The aim of the study was to evaluate the effect of anesthetics as operating room contaminants on tetrahydrobiopterin pathway in 40 operating room personnel and 30 healthy controls by measuring biopterin, dihydrobiopterin reductase, tryptophan, kynurenine and serotonin. Biopterin concentrations were 124 ± 12.3 µmol/mol creatinine in workers and 88 ± 5.7 µmol/mol creatinine in controls whereas kynurenine concentrations were 1.75 ± 0.09 µM and 1.95 ± 0.06 µM, respectively (both, p < 0.05). It can be claimed that enhanced biopterin and diminished kynurenine levels may play a triggering role in disruption of metabolic events in operating room personnel.