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Tamminga SJ, Emal LM, Boschman JS, Levasseur A, Thota A, Ruotsalainen JH, Schelvis RM, Nieuwenhuijsen K, van der Molen HF. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev 2023; 5:CD002892. [PMID: 37169364 PMCID: PMC10175042 DOI: 10.1002/14651858.cd002892.pub6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions. OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms. SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. SELECTION CRITERIA We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour); 2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise); 3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended). MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention. A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar. AUTHORS' CONCLUSIONS Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.
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Affiliation(s)
- Sietske J Tamminga
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lima M Emal
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Julitta S Boschman
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Alice Levasseur
- Faculté des sciences de l'éducation, Université Laval, Québec, Canada
| | | | - Jani H Ruotsalainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Roosmarijn Mc Schelvis
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Body@Work, Research Center on Work, Health and Technology, TNO/VUmc, Amsterdam, Netherlands
| | - Karen Nieuwenhuijsen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Becker DR, Shelly S, Kavalieratos D, Maira C, Gillespie AI. Immediate Effects of Mindfulness Meditation on the Voice. J Voice 2022:S0892-1997(22)00342-3. [PMID: 36428173 DOI: 10.1016/j.jvoice.2022.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The benefits of mindfulness meditation are well documented. This study evaluated the immediate effects of mindfulness meditation (MM) on the voice and voice user. STUDY DESIGN Prospective experimental study. METHODS Participants: 19 vocally healthy (VH) individuals, and 26 individuals with common voice disorders (CVD; benign lesions and hyperfunctional muscle tension) deemed stimulable for voice therapy. Exclusionary criteria: prior training or regular meditation practice. Participants recorded speech samples before and after a 11.5-minute prerecorded session of MM. PRIMARY OUTCOMES phonatory aerodynamics and participants' self-reported experience of voice. SECONDARY OUTCOMES self-reported anxiety, vocal acoustics, speech breathing patterns, and auditory-perceptual outcomes. Baseline self-reported measures of voice (Voice Handicap Index-10 - VHI-10), breathing (Dyspnea Index - DI), stress (Perceived Stress Scale - PSS), and trait mindfulness (Cognitive and Mindfulness Scale - Revised, CAMS-R, Five Facet Mindfulness Questionnaire - FFMQ) were compared between groups. RESULTS At baseline, CVD had significantly higher VHI-10 (P< 0.001) and DI (P= 0.0014), and lower trait mindfulness (CAMS-R, P= 0.02). No difference between groups for PSS or FFMQ. Changes postMM: decreased CPP for all-voiced sentences for VH (P= 0.003), decreased mean SPL (P= 0.012) on sustained vowel for VH, increased mean phonatory airflow during sustained vowel for CVD (P = 0.012). VH demonstrated a decrease in CPP on the all-voice sentence, and CVD demonstrated an increase, resulting in a significant between group difference (P= 0.013). Participants reported improvements in voice, emotional and physical states. State anxiety decreased for both groups (= < 0.001). No other objective outcomes reached significance. CONCLUSIONS After a brief MM, participants experienced improvement in physical, emotional, and cognitive states, and in their perceptions of their voice. Results indicate that a brief, single session of MM may be beneficial for some, but not sufficient to override habitual voice and speech patterns. Given the benefits of MM, future work should evaluate MM in a standard voice therapy protocol.
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Affiliation(s)
| | - Sandeep Shelly
- Emory Healthcare, Department of Otolaryngology, Atlanta, Geogia
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Geogia
| | - Carissa Maira
- Emory Healthcare, Department of Otolaryngology, Atlanta, Geogia
| | - Amanda I Gillespie
- Emory Healthcare, Department of Otolaryngology, Atlanta, Geogia; Department of Otolaryngology, Emory University School of Medicine, Atlanta, Geogia
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Melnyk BM, Hsieh AP, Tan A, Teall AM, Weberg D, Jun J, Gawlik K, Hoying J. Associations Among Nurses' Mental/Physical Health, Lifestyle Behaviors, Shift Length, and Workplace Wellness Support During COVID-19: Important Implications for Health Care Systems. Nurs Adm Q 2022; 46:5-18. [PMID: 34551423 PMCID: PMC8647526 DOI: 10.1097/naq.0000000000000499] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Work cultures supportive of wellness and shorter shift length have been associated with better mental/physical health outcomes in nurses, but how the coronavirus disease-19 (COVID-19) pandemic impacted such outcomes is not known. This study's aims were to (1) describe the mental/physical health, well-being, and healthy lifestyle behaviors of nurses during the pandemic; (2) explore the pandemic's impact on their health and healthy lifestyle behaviors; and (3) determine the associations of perceived workplace wellness support and shift length with nurses' health, well-being, and healthy lifestyle behaviors. A cross-sectional descriptive design was used with 264 nurses associated with Trusted Health. Nurses completed a survey containing valid and reliable scales measuring depression, anxiety, burnout and quality of life, perceived wellness culture, and healthy lifestyle behaviors. Results indicated that more than 50% of nurses had worsening mental/physical health relating to the pandemic. Compared with nurses whose workplaces provided little/no wellness support, nurses with workplaces that supported their wellness were 3 to 9 times as likely to have better mental/physical health, no/little stress, no burnout, and high quality of life. Nurses who worked longer shifts had poorer health outcomes. These findings indicate that workplace wellness support and shorter shifts positively impacted nurse mental/physical health and professional quality of life amidst the pandemic.
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Affiliation(s)
- Bernadette Mazurek Melnyk
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics (Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San Francisco, California (Dr Weberg)
| | - Andreanna Pavan Hsieh
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics (Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San Francisco, California (Dr Weberg)
| | - Alai Tan
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics (Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San Francisco, California (Dr Weberg)
| | - Alice M. Teall
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics (Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San Francisco, California (Dr Weberg)
| | - Dan Weberg
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics (Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San Francisco, California (Dr Weberg)
| | - Jin Jun
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics (Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San Francisco, California (Dr Weberg)
| | - Kate Gawlik
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics (Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San Francisco, California (Dr Weberg)
| | - Jacqueline Hoying
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics (Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San Francisco, California (Dr Weberg)
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Klatt MD, Bawa R, Gabram O, Westrick A, Blake A. The Necessary Thread of Mindfulness Intervention Fidelity Assurance: Enabling an Organizational Strategy to Promote Health Care Professional Well-Being. Glob Adv Health Med 2021; 11:21649561211052902. [PMID: 34733583 PMCID: PMC8559172 DOI: 10.1177/21649561211052902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose A growing waitlist for Mindfulness in Motion (MIM), an evidence-based worksite mindfulness-based intervention, necessitated a training system with built in fidelity assurance to meet program demand. MIM was delivered as part of an organizational strategy in a large academic health center to enhance Health Care Professional (HCP) well-being. In order to ensure that the intervention was being delivered the same way to each cohort, a process to ensure intervention fidelity was developed for MIM. Method The core components of MIM informed the development of a detailed fidelity monitoring system to ensure consistent intervention delivery. Each MIM cohort was conducted with both trained facilitators and trained intervention fidelity monitors. Results Across 11 cohort offerings of MIM, each 8 weeks in length, there was a mean adherence rate of 0.9886, SD = 0.0012. Conclusion The fidelity monitoring system allowed for a reliable expansion of MIM offerings to HCPs and for a seamless pivot to fully virtual MIM delivery, necessitated by COVID-19.
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Affiliation(s)
- Maryanna D Klatt
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Rani Bawa
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Olivia Gabram
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alexis Westrick
- Gabbe Health and Wellness, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amanda Blake
- Gabbe Health and Wellness, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Bartlett L, Buscot MJ, Bindoff A, Chambers R, Hassed C. Mindfulness Is Associated With Lower Stress and Higher Work Engagement in a Large Sample of MOOC Participants. Front Psychol 2021; 12:724126. [PMID: 34566805 PMCID: PMC8461060 DOI: 10.3389/fpsyg.2021.724126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to understand the associations between mindfulness, perceived stress, and work engagement in a very large sample of English-speaking adults, from 130 different countries. It also aimed to assess participants' self-reported changes following a 6-week mindfulness massive open online course (MOOC). Methods: Participants in the 6-week MOOC were invited to complete pre-post online surveys. Cross-sectional associations were assessed using univariate linear models, followed by structural equation models to test mediation pathways in baseline data (N = 16,697). Self-reported changes in mindfulness, stress and engagement following training were assessed using paired t-tests (n = 2,105). Results: Each standard deviation unit increase in mindfulness was associated with a 0.52 standard deviation unit decrease in perceived stress, and with 0.06 standard deviation unit increment in work engagement. 73% of the influence of mindfulness on engagement was direct. Following the mindfulness MOOC, participants reported higher mindfulness (d = 1.16), reduced perceived stress (d = 1.00) and a small improvement in work engagement (d = 0.29). Conclusions: Mindfulness was associated with lower perceived stress and higher work engagement in both cross-sectional and longitudinal analyses. These findings support mindfulness as a potentially protective and modifiable personal resource. The MOOC format offers a low cost, highly accessible means for extending the reach and potential benefits of mindfulness training to large numbers of people.
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Affiliation(s)
- Larissa Bartlett
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Aidan Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia
| | - Richard Chambers
- Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
| | - Craig Hassed
- Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Klatt M, Bawa R, Gabram O, Westrick A, Blake A. Synchronous Mindfulness in Motion Online: Strong Results, Strong Attendance at a Critical Time for Health Care Professionals (HCPs) in the COVID Era. Front Psychol 2021; 12:725810. [PMID: 34489830 PMCID: PMC8416491 DOI: 10.3389/fpsyg.2021.725810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Mindfulness in Motion (MIM) is an organizationally-sponsored mindfulness program for employees at a large academic health center that consistently produces significant reductions in burnout and perceived stress, alongside significant increases in work engagement and resilience. This study compared outcome measures of a synchronous virtual delivery of MIM, necessitated by COVID-19, to traditional in-person delivery of MIM. Outcome measures from the virtual COVID (AU20, WI21, SP21) MIM cohorts (n = 99) were compared with the in-person Pre-COVID (SP19, AU19, WI20) MIM cohorts (n = 124). Both Pre-COVID and COVID cohorts had similar attendance rates with an average attendance of 84 and 80%, respectively. Qualitative analysis of COVID cohorts reported community support during COVID as a substantial intervention benefit, which was important at a time when isolation dominated the healthcare professional experience. Total burnout was determined by scores on the subscales of the Maslach Burnout Inventory (MBI). There were no significant differences in depersonalization (p = 0.3876) and personal accomplishment (p = 0.1519) changes between Pre-COVID and COVID cohorts, however there was a significant difference in emotional exhaustion (p = 0.0315), with COVID cohorts improving more. In both Pre, and COVID cohorts, the percentage of people meeting burnout criteria from pre to post between groups were similar, yielding a non-significant difference (p = 0.2950). The Connor Davidson Resiliency Scale (CDRS) and Utrecht Work Engagement Scale (UWES) also produced no significant differences between groups (p = 0.4259, p = 0.1984, respectively). The Perceived Stress Scale (PSS) though yielded significant differences in reduction between groups (p = 0.0405), again with COVID cohorts showing greater improvement. Results of the first synchronous, virtually delivered MIM cohorts reflect that participants achieved very similar results and that MIM created a community in a time when it was greatly needed due to pandemic healthcare professional stress.
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Affiliation(s)
- Maryanna Klatt
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Rani Bawa
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Olivia Gabram
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Alexis Westrick
- Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Amanda Blake
- Wexner Medical Center, The Ohio State University, Columbus, OH, United States
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