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Kilburn JP, Streit SM, Luan WP, Lindly J, Honsberg A, Dawn B, Mihata RGK, Carmichael JJ, Matos RI, Lonergan TP, Walter RJ, Szalwinksi BD, Dooley SN, McCann ET, Sampson JB, Praske SP, Gurney JM, Mount CA. Beyond Trauma: High-Volume Critical Care Medicine in a Military Medical Center-Based Military-Civilian Partnership. Mil Med 2024; 189:e1129-e1135. [PMID: 37440368 DOI: 10.1093/milmed/usad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Critical Care Internal Medicine (CCIM) is vital to the U.S. Military as evidenced by the role CCIM played in the COVID-19 pandemic response and wartime operations. Although the proficiency needs of military surgeons have been well studied, this has not been the case for CCIM. The objective of this study was to compare the patient volume and acuity of military CCIM physicians working solely at Military Treatment Facilities (MTFs) with those at MTFs also working part-time in a military-civilian partnership (MCP) at the University Medical Center of Southern Nevada (UMC). MATERIALS AND METHODS We analyzed FY2019 critical care coding data from the Military Health System and UMC comparing the number of critical care encounters, the number of high-acuity critical care encounters, and the Abilities/Activity component of the Knowledge, Skills, and Abilities/Clinical Activity (KSA) score. This analysis was restricted to critical care encounters defined by Current Procedural Terminology codes for critical care (99291 and 99292). A critical care encounter was considered high acuity if the patient had ICD-10 codes for shock, respiratory failure, or cardiac arrest or had at least three codes for critical care in the same episode. RESULTS The five AF CCIM physicians in the MCP group performed 2,019 critical care encounters in 206 days, with 63.1% (1,273) being defined as high acuity. The total number of MTF critical care encounters was 16,855 across all providers and services, with 28.9% (4,864) of encounters defined as high acuity. When limited to CCIM encounters, MTFs had 6,785 critical care encounters, with 32.0% being high acuity (2,171). Thus, the five AF CCIM physicians, while working 206 days at the UMC, equated to 12.0% (2,019/16,855) of the total critical care MTF encounters, 27.2% (1,273/4,684) of the total high-acuity MTF critical care encounters, and 29.8% (2,019/6,785) of the MTF CCIM encounters, with 58.6% (1,273/2,171) of the MTF CCIM high-acuity encounters.The USAF CCIM physicians in the MCP group performed 454,395 KSAs in 206 days, with a KSA density per day of 2,206. In the MTF group, CCIM providers generated 2,344,791 total KSAs over 10,287 days, with a KSA density per day of 227.9. Thus, the five CCIM physicians at the UMC accounted for 19.38% of the MTF CCIM KSAs, with a KSA density over 10 times higher (2,206 vs. 227.9). CONCLUSIONS The volume and acuity of critical care at MTFs may be insufficient to maintain CCIM proficiency under the current system. Military-civilian partnerships are invaluable in maintaining clinical proficiency for military CCIM physicians and can be done on a part-time basis while maintaining beneficiary care at an MTF. Future CCIM expeditionary success is contingent on CCIM physicians and team members having the required CCIM exposure to grow and maintain clinical proficiency.Limitations of this study include the absence of off-duty employment (moonlighting) data and difficulty filtering military data down to just CCIM physicians, which likely caused the MTF CCIM data to be overestimated.
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Affiliation(s)
- Jeremy P Kilburn
- Office of Military Medicine, 99MDG, Mike O'Callaghan Military Medical Center, Nellis AFB, NV 89191, USA
| | - Stephanie M Streit
- Office of Military Medicine, 99MDG, Mike O'Callaghan Military Medical Center, Nellis AFB, NV 89191, USA
| | - W Patrick Luan
- Institute for Defense Analysis, Alexandria, VA 22305, USA
| | - Jamie Lindly
- Institute for Defense Analysis, Alexandria, VA 22305, USA
| | - Angelica Honsberg
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV 89106, USA
| | - Buddhadeb Dawn
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV 89106, USA
| | - Ryan G K Mihata
- Office of Military Medicine, 99MDG, Mike O'Callaghan Military Medical Center, Nellis AFB, NV 89191, USA
| | - Jonas J Carmichael
- Department of Critical Care Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Renee I Matos
- Department of Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX 78219, USA
| | - Terence P Lonergan
- Department of Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX 78219, USA
| | - Robert J Walter
- Department of Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX 78219, USA
| | - Bryan D Szalwinksi
- Department of Critical Care Medicine, Scott Air Force Base Clinic, Scott Air Force Base, IL 62225, USA
| | - Sean N Dooley
- Department of Critical Care Medicine, Landstuhl Regional Medical Center, Landstuhl 66849, Germany
| | - Edward T McCann
- Department of Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX 78219, USA
| | - James B Sampson
- Air Force Medical Readiness Agency, Headquarters United States Air force, Falls Church, VA 22042, USA
| | - Steven P Praske
- Department of Critical Care Medicine, Navy Medical Center Camp LeJeune, Camp Lejeune, NC 28547, USA
| | - Jennifer M Gurney
- Joint Trauma System, DoD Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Cristin A Mount
- Department of Critical Care Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA
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Zhao Z, Li Q, Yang C, Zhang Z, Chen Z, Yin W. Job burnout and its influencing factors among village doctors during the COVID-19 pandemic: a cross-sectional study. Front Public Health 2024; 12:1388831. [PMID: 38699414 PMCID: PMC11063315 DOI: 10.3389/fpubh.2024.1388831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Objective The aim of this study is to understand the job burnout of village doctors during the COVID-19 epidemic and its influencing factors, and to provide a reference for effectively alleviating the job burnout of village doctors. Methods A cross-sectional survey was conducted among village doctors in S province in December 2021. The survey included a general information questionnaire and the CMBI Burnout Scale. Epidata was used for dual input, and descriptive analysis, t-test, chi-square test, and binary Logistic regression for statistical analysis were used. Results A total of 993 village doctors participated in the survey. Most of them were male village doctors (62.84%), with an average age of 46.57 (SD = 7.50). Village doctors believed that the impact of the epidemic on work was serious, with a score of 3.87 ± 0.91. The economic support was small, with a score of 2.31 ± 0.99. The development space was low, with a score of 2.62 ± 0.98. The overall incidence of burnout was 53.47%. In the burnout group, 54.05% were mild, 33.14% were moderate, and 12.81% were severe. The high degree of difficulty in using WeChat (OR = 1.436, 95%CI: 1.229-1.679), high work pressure (OR = 1.857, 95%CI: 1.409-2.449), high risk of practice (OR = 1.138, 95%CI: 1.004-1.289), less economic support (OR = 0.825, 95%CI: 0.684-0.995), less technical support (OR = 0.696, 95%CI: 0.565-0.858), and poor emotional support (OR = 0.632, 95%CI: 0.513-0.780) were more likely to have job burnout. Conclusion Burnout is a common phenomenon among village doctors during the COVID-19 pandemic, which needs to be prevented and alleviated by various measures.
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Affiliation(s)
- Zixuan Zhao
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Qiusha Li
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Chunxiao Yang
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Zhongzheng Zhang
- Hepatic Biliary Pancreatic Surgery, Yidu Central Hospital of Weifang, Shandong, China
| | - Zhongming Chen
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Wenqiang Yin
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
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Strumpf Z, Miller C, Abbas KZ, Bensken WP, Matta M. Trends in Pulmonary Critical Care Fellowship Applications and Match Rates before and after the Onset of the COVID-19 Pandemic. ATS Sch 2024; 5:154-161. [PMID: 38585576 PMCID: PMC10994225 DOI: 10.34197/ats-scholar.2023-0057oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 12/21/2023] [Indexed: 04/09/2024] Open
Abstract
Background Because of the coronavirus disease (COVID-19) pandemic, fellowship interviews for pulmonary disease and critical care medicine (PCCM) switched from an in-person to virtual interview format. Objective This study aimed to examine the changes that resulted from this switch (appointment year 2021 and beyond) for both the individual applicants and the match process as a whole. Methods This cross-sectional study used longitudinal data from the Electronic Residency Application Service and the National Resident Matching Program from appointment years 2017 to 2022. Data from the Electronic Residency Application Service included the number of programs applicants applied to, and National Resident Matching Program data included the number of fellowship positions available, number entering the match, match rate, and the number of applicants who matched within the same region/program as their core residency training program. Descriptive and summary statistics and unadjusted linear models were used to identify if trends appeared in post-COVID-19 appointment years (2021 and beyond). Results The number of PCCM positions increased by 33 (95% confidence interval, 26.2, 39.8) yearly between 2017 and 2022, with almost twice as many applicants (62.6; 95% CI confidence interval, 37.8, 87.4) entering the PCCM fellowship match during that same period. There was a decrease in the percentage of applicants matched each year, a trend unchanged before and after COVID-19, by an average of -2.15%. Comparing before and after COVID-19 appointment years, there was no significant change in same-region or same-program matches. Conclusion Our analysis shows steadily rising interest in application rates for PCCM fellowships through the onset of the pandemic. However, a lack of proportionate increase in fellowship positions led to a decrease in overall match rates for applicants. To mitigate this, an increase in PCCM fellowship positions should be considered, and surveillance of these trends should continue.
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Affiliation(s)
| | - Cailey Miller
- Pulmonary, Critical Care and Sleep Medicine and
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Kaniza Zahra Abbas
- Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Maroun Matta
- Pulmonary, Critical Care and Sleep Medicine and
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Pfeifle D, Bagley B, Carlos WG. Virtual Is the New Reality: How Are We Matching Up Postpandemic? ATS Sch 2024; 5:5-7. [PMID: 38587215 PMCID: PMC10994224 DOI: 10.34197/ats-scholar.2024-0012ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Affiliation(s)
- Dan Pfeifle
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brent Bagley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - W Graham Carlos
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Garrido-Hermosilla AM, Soto-Sierra M, Díaz-Ruiz MC, Gutiérrez-Sánchez E, Rodríguez-de-la-Rúa-Franch E. Burnout syndrome in Spanish, Portuguese and Latin American ophthalmologists: a cross-sectional analysis. Int Ophthalmol 2024; 44:27. [PMID: 38326583 DOI: 10.1007/s10792-024-02977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 10/29/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE Despite the well-known consequences of burnout syndrome, there has been little research into this syndrome in the field of ophthalmology. Our objective is to determine the frequency of burnout syndrome between Spanish, Portugal and Latin-American ophthalmologists, as well as to analyse its relationship with different sociodemographic variables. METHODS This is an observational cross-sectional descriptive study including ophthalmologists from Spain, Portugal and 15 Latin American countries. Burnout syndrome was evaluated by the Maslach Burnout Inventory-Human Services Survey. Burnout syndrome was defined as high emotional exhaustion, high depersonalization or low personal accomplishment. In addition, we recorded sociodemographic variables and aspects related to the type of work. A conditional backwards stepwise multivariate binomial logistic regression analysis was run to assess the variables associated with burnout syndrome, expressed as an odds ratio (OR). RESULTS A total of 527 surveys were analysed, the majority from Spain (401; 76.1%), followed by Argentina (45; 8.5%), and Mexico (31; 5.9%). The number of ophthalmologists with burnout syndrome was 351 (66.6%). The results show the profile of a young ophthalmologist (age OR 0.985), carrying out a public activity (OR 2.118) and dedicated to general ophthalmology (OR 1.860). CONCLUSIONS The frequency detected in this study confirms a steady increase in rates of burnout among ophthalmologists. As the consequences of this are well known, it is vital for health centre managers to develop a strategic plan to allow the causes to be understood better and to implement steps to improve the situation in each medical centre.
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Affiliation(s)
- Antonio Manuel Garrido-Hermosilla
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain.
- RETICS OftaRed, Institute of Health Carlos III, Madrid, Spain.
- University of Seville, Seville, Spain.
| | - Marina Soto-Sierra
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain
| | - María Concepción Díaz-Ruiz
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain
| | - Estanislao Gutiérrez-Sánchez
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain
- RETICS OftaRed, Institute of Health Carlos III, Madrid, Spain
- University of Seville, Seville, Spain
| | - Enrique Rodríguez-de-la-Rúa-Franch
- Department of Ophthalmology, Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41009, Seville, Spain
- RETICS OftaRed, Institute of Health Carlos III, Madrid, Spain
- University of Seville, Seville, Spain
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Mileski M, McClay R, Kruse CS, Topinka JB, Heinemann K, Vargas B. Using Serenity Rooms and Similar Tools to Improve the Workplace during COVID-19: A Rapid Review. NURSING REPORTS 2024; 14:376-389. [PMID: 38391074 PMCID: PMC10885053 DOI: 10.3390/nursrep14010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
This manuscript examines using serenity rooms and similar tools to improve the workplace during COVID-19 for nurses and other practitioners. A rapid review of the literature was conducted and completed from four different databases, including PubMed, CINAHL, Science Direct, and Academic Search Complete. The literature review was completed with the use of a single-string Boolean search to maximize the number of articles returned. The resulting 14 germane articles yielded six facilitator themes and four barrier themes. Facilitator themes included: benefits, assistive adjuncts, places of relaxation, leadership required, availability, and other effects. Barrier themes included: lacking leadership, concerns regarding lack of space, holistic concerns, and negative perceptions. There is a significant lack of research in the literature in this area. Most of the literature reviewed showed widely positive results for institutions that utilized serenity rooms or similar tools for decreasing nurse and practitioner stress and burnout. The use of these tools improved nurse and practitioner compassion, retention, and resiliency.
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Affiliation(s)
- Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA
| | - Rebecca McClay
- School of Science, Technology, Engineering, and Math, American Public University System, Charles Town, WV 25414, USA
| | - Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA
| | - Joseph Baar Topinka
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA
| | - Katharine Heinemann
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA
| | - Brea Vargas
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA
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Piel J, Hörold M, Brandstetter S, Drewitz KP, Hrudey I, Schmitt R, Apfelbacher C. COVID-19 crisis management of German ICU clinicians in leadership - a metaphor analysis. Front Public Health 2023; 11:1160094. [PMID: 37663843 PMCID: PMC10470881 DOI: 10.3389/fpubh.2023.1160094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 09/05/2023] Open
Abstract
The COVID-19 pandemic coincided with an already long-standing crisis in health systems around the world characterized by economic pressure and increasing staff shortage. "Crisis" became a global metaphor to convey collective experiences of the COVID-19 threat. Little is known on how crisis metaphors influence thought and speech on crisis management and the challenging staff situation of intensive care unit (ICU) clinicians in leadership positions and how they act. Therefore, we were interested in (1) which metaphorical concepts ICU clinicians in leadership use to express experiences and strategies in dealing with coinciding crises, (2) how these change over time, and (3) how metaphors in speech reveal self-images of crisis management. We conducted a systematic metaphor analysis focusing on data from three participants of a qualitative interview study with twenty-four healthcare professionals in ICUs in Germany. The participants were interviewed at two time points between April 2020 and March 2021. We identified and reconstructed metaphorical concepts of three interviewees (ICU clinicians in leadership) with regard to the pandemic management, and developed a typology based on the dimensions of mood, modus operandi, location, and scope. The typology consists of eight self-images (protagonists) for the crisis management of ICU clinicians in leadership, such as the figure of the soldier ("to unite everyone behind this flag"), the distributor ("sometimes it is a crazy patchwork [wahnsinniges Gestückel]") or the critic ("we are the fool for everything"). They embody different qualities of a leader and refer to intra- and inter-role conflicts within multiple crisis conditions. Metaphor analysis reveals different self-images of ICU leadership clinicians in relation to crisis management. This illustrates that thinking and perceptions of crisis management may strongly differ between and within leaders and may change over the course of crises. Our findings highlight the need both to improve knowledge on challenges associated with leadership in crises and preparedness, and to support clinicians in their leadership by recognizing and addressing differences and changes in leaders' self-image.
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Affiliation(s)
- Julia Piel
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Madlen Hörold
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Karl-Philipp Drewitz
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Ilona Hrudey
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Rudolf Schmitt
- Faculty of Social Sciences, University of Applied Sciences Zittau-Görlitz, Görlitz, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Oh TK, Kim S, Song IA. Intensivist coverage and critically ill COVID-19 patient outcomes: a population-based cohort study. J Intensive Care 2023; 11:19. [PMID: 37173766 PMCID: PMC10177723 DOI: 10.1186/s40560-023-00668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Trained intensivist staffing improves survival outcomes in critically ill patients at intensive care units. However, the impact on outcomes of critically ill patients with coronavirus disease 2019 has not yet been evaluated. We aimed to investigate whether trained intensivists affect outcomes among critically ill coronavirus disease 2019 patients in South Korean intensive care units. METHODS Using a nationwide registration database in South Korea, we included adult patients admitted to the intensive care unit from October 8, 2020, to December 31, 2021, with a main diagnosis of coronavirus disease 2019. Critically ill patients admitted to intensive care units that employed trained intensivists were included in the intensivist group, whereas all other critically ill patients were assigned to the non-intensivist group. RESULTS A total of 13,103 critically ill patients were included, with 2653 (20.2%) patients in the intensivist group and 10,450 (79.8%) patients in the non-intensivist group. In the covariate-adjusted multivariable logistic regression model, the intensivist group exhibited 28% lower in-hospital mortality than that of the non-intensivist group (odds ratio: 0.72; 95% confidence interval: 0.62, 0.83; P < 0.001). CONCLUSIONS Trained intensivist coverage was associated with lower in-hospital mortality among critically ill coronavirus disease 2019 patients who required intensive care unit admission in South Korea.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Saeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea.
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
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Monti L, Marconi E, Bocci MG, Kotzalidis GD, Mazza M, Galliani C, Tranquilli S, Vento G, Conti G, Sani G, Antonelli M, Chieffo DPR. COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review. World J Psychiatry 2023; 13:191-217. [PMID: 37123099 PMCID: PMC10130962 DOI: 10.5498/wjp.v13.i4.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.
AIM To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.
METHODS We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented.
RESULTS Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.
CONCLUSION As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.
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Affiliation(s)
- Laura Monti
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Elisa Marconi
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Maria Grazia Bocci
- UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Georgios Demetrios Kotzalidis
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- NESMOS Department, Facoltà di Medicina e Psicologia, Sant’Andrea University Hospital, Rome 00189, Italy
| | - Marianna Mazza
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Carolina Galliani
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Tranquilli
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giovanni Vento
- UOC Neonatologia, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- UOC Neonatologia, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giorgio Conti
- UOC Terapia Intensiva Pediatrica e Trauma Center Pediatrico, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- UOC Terapia Intensiva Pediatrica e Trauma Center Pediatrico, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriele Sani
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Massimo Antonelli
- UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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10
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Anesi GL, Andrews A, Bai HJ, Bhatraju PK, Brett-Major DM, Broadhurst MJ, Campbell ES, Cobb JP, Gonzalez M, Homami S, Hypes CD, Irwin A, Kratochvil CJ, Krolikowski K, Kumar VK, Landsittel DP, Lee RA, Liebler JM, Lutrick K, Marts LT, Mosier JM, Mukherjee V, Postelnicu R, Rodina V, Segal LN, Sevransky JE, Spainhour C, Srivastava A, Uyeki TM, Wurfel MM, Wyles D, Evans L. Perceived Hospital Stress, Severe Acute Respiratory Syndrome Coronavirus 2 Activity, and Care Process Temporal Variance During the COVID-19 Pandemic. Crit Care Med 2023; 51:445-459. [PMID: 36790189 PMCID: PMC10012837 DOI: 10.1097/ccm.0000000000005802] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The COVID-19 pandemic threatened standard hospital operations. We sought to understand how this stress was perceived and manifested within individual hospitals and in relation to local viral activity. DESIGN Prospective weekly hospital stress survey, November 2020-June 2022. SETTING Society of Critical Care Medicine's Discovery Severe Acute Respiratory Infection-Preparedness multicenter cohort study. SUBJECTS Thirteen hospitals across seven U.S. health systems. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed 839 hospital-weeks of data over 85 pandemic weeks and five viral surges. Perceived overall hospital, ICU, and emergency department (ED) stress due to severe acute respiratory infection patients during the pandemic were reported by a mean of 43% ( sd , 36%), 32% (30%), and 14% (22%) of hospitals per week, respectively, and perceived care deviations in a mean of 36% (33%). Overall hospital stress was highly correlated with ICU stress (ρ = 0.82; p < 0.0001) but only moderately correlated with ED stress (ρ = 0.52; p < 0.0001). A county increase in 10 severe acute respiratory syndrome coronavirus 2 cases per 100,000 residents was associated with an increase in the odds of overall hospital, ICU, and ED stress by 9% (95% CI, 5-12%), 7% (3-10%), and 4% (2-6%), respectively. During the Delta variant surge, overall hospital stress persisted for a median of 11.5 weeks (interquartile range, 9-14 wk) after local case peak. ICU stress had a similar pattern of resolution (median 11 wk [6-14 wk] after local case peak; p = 0.59) while the resolution of ED stress (median 6 wk [5-6 wk] after local case peak; p = 0.003) was earlier. There was a similar but attenuated pattern during the Omicron BA.1 subvariant surge. CONCLUSIONS During the COVID-19 pandemic, perceived care deviations were common and potentially avoidable patient harm was rare. Perceived hospital stress persisted for weeks after surges peaked.
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Affiliation(s)
- George L Anesi
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adair Andrews
- Society of Critical Care Medicine, Mount Prospect, IL
| | - He Julia Bai
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Pavan K Bhatraju
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA
| | - David M Brett-Major
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE
| | - M Jana Broadhurst
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE
- Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | | | - J Perren Cobb
- Departments of Surgery and Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Sonya Homami
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA
| | - Cameron D Hypes
- Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ
| | - Amy Irwin
- Division of Infectious Diseases, Denver Health Medical Center, Denver, CO
| | | | - Kelsey Krolikowski
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | | | - Douglas P Landsittel
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - Richard A Lee
- Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, School of Medicine, Irvine, CA
| | - Janice M Liebler
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Karen Lutrick
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ
| | - Lucian T Marts
- Division of Pulmonary, Allergy, Critical Care and Sleep, School of Medicine, Emory University, Atlanta, GA
| | - Jarrod M Mosier
- Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ
| | - Vikramjit Mukherjee
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Radu Postelnicu
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Valentina Rodina
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Leopoldo N Segal
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Jonathan E Sevransky
- Division of Pulmonary, Allergy, Critical Care and Sleep, School of Medicine, Emory University, Atlanta, GA
- Emory Critical Care Center, Emory Healthcare, Atlanta, GA
| | | | - Avantika Srivastava
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Mark M Wurfel
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA
| | - David Wyles
- Division of Infectious Diseases, Denver Health Medical Center, Denver, CO
| | - Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA
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11
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"You're Socially Distant and Trying Not to Be Emotionally Distant." Physicians' Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study. Crit Care Explor 2023; 5:e0854. [PMID: 36817963 PMCID: PMC9937100 DOI: 10.1097/cce.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
To: 1) characterize how COVID-19-related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication. DESIGN We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic. SETTING We purposively selected hospital dyads from regions in the United States that experienced early and/or large surges of patients hospitalized with COVID-19. SUBJECTS We recruited a national sample of ICU physicians from Veteran Affairs (VA) Health Care Systems and their associated academic affiliate hospitals. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty-four intensivists from seven VA hospitals and six academic-affiliate hospitals participated. Intensivists noted the disproportionate impact of the pandemic on among people holding minoritized racial and ethnic identities, describing how language barriers and restrictive visitation policies exacerbated institutional mistrust and compromised physicians' ability to develop therapeutic relationships. We also identified several perceived influences on patient-clinician communication and the establishment of therapeutic relationships. Barriers included physicians' fear of becoming infected with COVID-19 and use of personal protective equipment, which created obstacles to effective physical and verbal interactions. Facilitators included the presence of on-site interpreters, use of web-based technology to interact with family members outside the ICU, and designation of a care team member or specialist service to provide routine updates to families. CONCLUSIONS The COVID-19 pandemic has threatened patient-clinician communication and the development of therapeutic relationships in the ICU, particularly among people holding minoritized racial and ethnic identities and their families. We identified several facilitators to improve patient-clinician communication as perceived by intensivists that may help improve trust and foster therapeutic alliances.
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12
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McPeake J, Kentish-Barnes N, Banse E, Anderson L, Cuzco C, Azoulay E, Quasim T, Castro P, Puxty K. Clinician perceptions of the impact of ICU family visiting restrictions during the COVID-19 pandemic: an international investigation. Crit Care 2023; 27:33. [PMID: 36681838 PMCID: PMC9862209 DOI: 10.1186/s13054-023-04318-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To guarantee the safety of the public, clinicians and patients during the COVID-19 pandemic, hospital visits were severely restricted internationally. There are limited data on the precise impact of these visiting restrictions on Intensive Care Unit clinicians. Our objectives therefore were to explore the impact of family visitation restrictions on clinicians and care delivery and describe innovation alongside areas for potential improvement. METHODS A qualitative approach using focus groups was employed. We recruited members of the multi-disciplinary team from Spain, France and the UK. Framework analysis was used to synthesize and interpret data. RESULTS In total, 28 staff from multiple international sites contributed to data across six focus groups: 12 from the UK, 9 from France and 7 from Spain. In relation to the key aims, we derived four themes: the emergence of new technologies, relationships and rapport establishment, communication challenges and end-of-life care provision. Across each theme, the overarching concepts of clinician emotional exhaustion and emotional distress emerged alongside the negative impact on job satisfaction. CONCLUSION The impact of COVID-19 family visitation restrictions is far reaching. Future research should examine the wider impact of family presence in the ICU.
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Affiliation(s)
- Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Nancy Kentish-Barnes
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Emilie Banse
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Lynne Anderson
- Department of Anaesthetics, Golden Jubilee National Hospital, Glasgow, UK
| | - Cecilia Cuzco
- Medical Lntensive Care Unit, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Elie Azoulay
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Tara Quasim
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Pedro Castro
- Medical Lntensive Care Unit, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Kathryn Puxty
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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13
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Abu Jawdeh EG, Hunt CE, Eichenwald E, Corwin MJ, McEntire B, Heeren T, Crowell LM, Ikponmwonba C, Saroufim A, Kerr S. Adverse effects of COVID-19 pandemic on a multicenter randomized controlled trial. J Perinatol 2022; 43:653-658. [PMID: 36581761 PMCID: PMC9798371 DOI: 10.1038/s41372-022-01592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Describe the effects of the COVID-19 pandemic on subject enrollment in a multicenter randomized controlled trial. STUDY DESIGN We assessed the number of eligible infants approached and consented for enrollment over five separate epochs including baseline, peak pandemic, and gradual but incomplete recovery. RESULT The pandemic had a major effect on ability to approach parents for consent. Parents approached dropped from 95.4% baseline to 13.1% in the peak pandemic epoch and has not recovered to baseline even in the just-completed post-pandemic epoch (84.9%). Despite the decrease in subjects approached, there was no significant change in the overall consent rate for the study CONCLUSION: The pandemic has significantly limited ability to approach parents of eligible infants for consent, with only partial recovery. Opportunities for interactions of investigators and study coordinators with parents continue to present challenges limiting full recovery.
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Affiliation(s)
- Elie G. Abu Jawdeh
- grid.266539.d0000 0004 1936 8438University of Kentucky, Lexington, KY USA
| | - Carl E. Hunt
- grid.265436.00000 0001 0421 5525Uniformed Services University, Bethesda, MD USA
| | - Eric Eichenwald
- grid.239552.a0000 0001 0680 8770Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA USA
| | | | | | - Timothy Heeren
- grid.189504.10000 0004 1936 7558Boston University, Boston, MA USA
| | - Lisa M. Crowell
- grid.189504.10000 0004 1936 7558Boston University, Boston, MA USA
| | | | - Ariana Saroufim
- grid.189504.10000 0004 1936 7558Boston University, Boston, MA USA
| | - Stephen Kerr
- grid.189504.10000 0004 1936 7558Boston University, Boston, MA USA
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14
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Sharifpour M, Buchman T, Hiddleson C, Jabaley CS, Raikhelkar J. Physician and Trainee Perceptions of Telecritical Care Practice and Education: Results of a Programmatic Survey. TELEMEDICINE REPORTS 2022; 3:201-205. [PMID: 36636168 PMCID: PMC9811849 DOI: 10.1089/tmr.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Telecritical care (TCC) as a telehealth modality seeks to remedy contemporary shortfalls in staffing and experience at the bedside. Physician and physician trainee perceptions of TCC practice and education can help inform programmatic and curricular decisions. The perceptions of TCC and a formalized structured TCC rotation from faculty and trainees are unknown. OBJECTIVE To evaluate perceptions of TCC practice and education among participating physicians and trainees. METHODS Survey of physicians and trainees participating in the Emory Critical Care Center's TCC unit from 2017 to 2021 was conducted, after implementation of a structured TCC educational curriculum. Items were developed with a 5-point Likert scale. RESULTS The overall response rate was 71% (43 of 61). Most respondents felt their knowledge was used appropriately and that their recommendations were well received at the bedside. The majority perceived that the TCC program improved continuity, quality, and safety of patient care. More than half of respondents would practice TCC in the future, and most would advocate for it. Most fellows were comfortable providing patient care remotely after their rotation. The majority of respondents felt TCC did not add to their level of burnout. CONCLUSIONS This programmatic evaluation identified perceived improvements in patient care. Implementation of a TCC rotation does not seem to negatively impact the educational experience of trainees.
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Affiliation(s)
- Milad Sharifpour
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Timothy Buchman
- Department of Surgery, Electronic ICU Service, Emory Healthcare, Atlanta, Georgia, USA
- Department of Surgery, Emory Critical Care Center, Atlanta, Georgia, USA
| | | | - Craig S. Jabaley
- Department of Surgery, Emory Critical Care Center, Atlanta, Georgia, USA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jayashree Raikhelkar
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
- TeleCritical Care East, Veterans Health Administration, Cincinnati, Ohio, USA
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15
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Hinzmann D, Schütte-Nütgen K, Büssing A, Boenisch O, Busch HJ, Dodt C, Friederich P, Kochanek M, Michels G, Frick E. Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:333. [PMID: 36612657 PMCID: PMC9819312 DOI: 10.3390/ijerph20010333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). AIM To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. METHODS A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). RESULTS Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants' spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants' experience in ICU/ED, and being of the male gender are further predictors of MD burden. CONCLUSIONS MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.
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Affiliation(s)
- Dominik Hinzmann
- Department of Anaesthesiology and Intensive Care, University Hospital Rechts der Isar, 81675 Munich, Germany
- School of Medicine, Technical University of Munich, 80333 München, Germany
| | | | - Arndt Büssing
- Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Olaf Boenisch
- Department of Intensive Care, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Christoph Dodt
- Emergency Department, München Klinik, 81925 Munich, Germany
| | | | - Matthias Kochanek
- Department of Intensive Care, University Hospital Cologne, 50937 Cologne, Germany
| | - Guido Michels
- Emergency Department, Sankt Antonius Hospital, 52249 Eschweiler, Germany
| | - Eckhard Frick
- School of Medicine, Technical University of Munich, 80333 München, Germany
- Spiritual Care and Psychosomatic Health, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, 80539 Munich, Germany
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16
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Anand U, Rea M, Kirshnit C, Dias S, Molla M. Checking in through the zoom window: Reducing barriers to seeking mental health care for hospitalists. J Hosp Med 2022. [PMID: 36537361 DOI: 10.1002/jhm.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Uma Anand
- Academic and Staff Assistance Program, University of California Davis Health, Sacramento, California, USA
| | - Margaret Rea
- Graduate Medical Education, University of California Davis Health, Sacramento, California, USA
| | - Carol Kirshnit
- Academic and Staff Assistance Program, University of California Davis Health, Sacramento, California, USA
| | - Sabrina Dias
- Division of Hospital Medicine, University of California Davis Health, Sacramento, California, USA
| | - Mithu Molla
- Division of Hospital Medicine, University of California Davis Health, Sacramento, California, USA
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17
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Kho ME, Reid JC. Implications of the COVID-19 Pandemic for the Well-Being of the ICU Workforce Considerations for the ICU Interprofessional Team. Chest 2022; 162:285-287. [PMID: 35940650 PMCID: PMC9353170 DOI: 10.1016/j.chest.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, and the Mohawk-McMaster Institute for Applied Health Sciences, Hamilton, ON, Canada.
| | - Julie C Reid
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, and the Mohawk-McMaster Institute for Applied Health Sciences, Hamilton, ON, Canada
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