Associations Between a New Disruptive Behaviors Scale and Teamwork, Patient Safety, Work-Life Balance, Burnout, and Depression

Well-Being Outcomes of Health Care Workers After a 5-Hour Continuing Education Intervention: The WELL-B Randomized Clinical Trial

Importance

Compromised well-being in health care workers (HCWs) is detrimental to the workforce, organizations, and patients.

Objective

To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program to deliver brief, evidence-based, reflective, psychological interventions to improve 4 dimensions of HCW well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration).

Design, Setting, and Participants

A randomized clinical trial (RCT) of US inpatient and outpatient HCWs randomized 1:1 was conducted from January 3 through May 31, 2023, using a web-based intervention. Cohort 1 received 5 hours of WELL-B over 8 days; cohort 2 acted as the control group and received WELL-B after the end of the RCT. Eligibility criteria were US HCWs aged 18 years or older, including clinical (physician, nurse, and respiratory therapist) and nonclinical (administrative, information technology, and finance) roles.

Interventions

Continuing education sessions exposed participants to positive psychology interventions (gratitude letter, work-life integration, self-compassion and cultivating awe).

Main Outcomes and Measures

The primary outcome was emotional exhaustion on day 8; secondary outcomes included emotional thriving, emotional recovery, and work-life integration. All outcomes were measured using psychometrically valid scales previously reported in well-being RCTs and were assessed on days 1 and 8 (primary end point). Differences in outcome measures between the WELL-B intervention group and controls were assessed using t tests. Baseline-adjusted multiple linear regression models were evaluated to examine the association between the WELL-B intervention and the outcome measures after adjusting for additional covariates (sex, race and ethnicity, age, HCW role, and discipline). Intention-to-treat analysis was performed.

Results

The cohorts were similar at baseline, mostly female (528 [89%]) and nurses (177 [30%]). A total of 643 respondents participated in the study. In cohort 1, 331 participants initiated WELL-B, and 262 (71%) completed the day 8 follow-up; in cohort 2, 312 participants initiated WELL-B and 291 (77%) completed the day 8 follow-up. Compared with the control cohort, WELL-B significantly improved emotional exhaustion (estimate: -9.0; 95% CI, -13.1 to -4.9; P < .001), emotional thriving (estimate: 6.6; 95% CI, 3.2-10.0; P < .001), emotional recovery (estimate: 5.5; 95% CI, 2.0-9.0; P = .002), and work-life integration (estimate: -5.0; 95% CI, -8.2 to -1.9; P = .002). After adjusting for baseline outcome measures, sex, race and ethnicity, age, HCW role, and discipline, the linear regression model showed WELL-B improved day 8 emotional exhaustion (estimate: -9.6; 95% CI, -12.5 to -6.6; P < .001) compared with the control group. Favorable impressions of WELL-B were reported by more than 90% of the participants.

Conclusions and Relevance

In this RCT, brief well-being activities delivered during continuing education sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration, with and without adjusting for covariates. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention.

Trial Registration

ClinicalTrials.gov Identifier: NCT05636072.

Work-life balance Twitter insights: A social media analysis before and after COVID-19 pandemic

This research examines the perceptions of Twitter users regarding the prevalent topics within Work-Life Balance communication before and after the COVID-19 pandemic. The pressing questions surrounding current labour market drivers are addressed, particularly regarding the ongoing Fourth Industrial Revolution and the COVID-19 pandemic's impact on communicated themes, particularly in the Human Resource Management field, where Work-Life Balance has emerged as a key concept. Social media platforms like Twitter are pivotal in fostering discussions on Work-Life Balance in society. Over the past decade, Twitter has evolved into a significant research platform researchers utilise in more than ten thousand research articles. The online discourse on Twitter raises awareness of the importance of balancing work and personal life. The COVID-19 pandemic has unveiled new facets of Work-Life Balance, with social media as a key platform for discussing these issues. This research uses Social Media Analysis based on the Hashtag Research framework. A total of 1,768,628 tweets from 499,574 users were examined, and frequency, topic, and sentiment analysis were conducted. Pre-pandemic, the most communicated Work-Life Balance topics were performance and time management, while recruitment and employee development were identified post-pandemic. Pre-pandemic, the highest proportion of negative sentiment was time management and mental health prevention, shifting to time, employee development, and mental health prevention post-pandemic. Despite the limitations of our research, a proposed redefinition of the concept is also presented, including a design for an integrated Work-Life Balance model based on topics communicated by Twitter users. Given the need for a more robust approach to redefining the concept and developing an integrative Work-Life Balance model, the article provides fresh insights for future research.

Issues and Perspectives for the Study of Disruptive Clinician Behavior

This article discusses issues and perspectives related to the study of disruptive clinician behavior (DCB) to improve patient safety and healthcare professionals' work environments. Multiple terminologies and ambiguous definitions have resulted in conceptual confusion in studies on DCB. In addition, subjective classifications have led the attributes of DCB to overlap and fluctuate. Therefore, we share Rosenberg's definition of DCB as "any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse to physical and sexual harassment." It is recommended that DCB be understood as a hierarchical structure identified through statistical analysis of field survey data. Furthermore, a recurring list of items is duplicated across existing studies on DCB triggers, contributing factors, and influences. These items can be organized into separate path models based on their mutual relationships. Given these assumed models, we believe that further studies on DCB can shift toward elucidating the mechanisms of occurrence and impact. Finally, based on the path models, we recommend improving healthcare professionals' psychological and social states through a policy shift from "zero-tolerance" to "to err is human" as a priority issue for DCB prevention and countermeasures.

The Relationship Between Restrictive Regulation of Midwives, Practice Environment, and Professional Burnout: A 7-State Mixed-Methods Comparison of Autonomous and Restrictive State Regulation

PURPOSE

The purpose of the study was to investigate the relationship between state regulation of the midwifery workforce, practice environment, and burnout.

BACKGROUND

Burnout threatens the US midwifery workforce, with over 40% of certified nurse-midwives meeting criteria. Burnout can lead to poorer physical and mental health and withdrawal from the workforce. Burnout in midwives has been associated with lack of control and autonomy. In the United States, midwives' autonomy is restricted through state-level regulation that limits scope of practice and professional independence.

METHODS

A mixed-methods study was conducted using an explanatory sequential approach. Quantitative and qualitative data were collected by online surveys and analyzed in a 2-stage process, followed by data integration.

RESULTS

State regulation was not found to be independently associated with burnout (n = 248; P = .250); however, mediation analysis showed a significant association between state regulation, practice environment, and burnout. Qualitative analysis mirrored the importance of practice environment and expanded on its features.

CONCLUSION

For midwives, unrestrictive practice regulation may not translate to burnout prevention without supportive practice environments.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Interventions should focus on promoting job flexibility, realistic demands, and professional values. While midwives' commitment to patients and the profession can help bolster the workforce, it can also amplify negative experiences of the practice environment.

Differences in the resident encounter of disruptive behavior by gender

This study aimed to investigate the prevalence of gender-based differences in disruptive behaviors (DBs) among trainee physicians to shed light on the extent and nature of the problem. Using a national cross-sectional design, data were collected through a web-based, self-administered questionnaire administered to post-graduate first-year (PGY1) and second-year (PGY2) residents participating in the General Medicine Intermittent Examination (GM-ITE). A total of 5,403 participants, representing a response rate of 71.9%, were included in the study. Of these, approximately 35% of residents reported encounters with DBs in the past year. A gender-based comparison revealed that 38.4% of male residents faced DBs from physicians, compared to 27.6% of their female counterparts (p < 0.001). Conversely, a higher proportion of male residents (35.8%) experienced DBs from nurses than did female residents (32.9%; p = 0.037). After adjusting for factors such as hospital size, hospital type, urban location, age, and PGY, male residents exhibited an increased likelihood of experiencing DB from both physicians (adjusted OR 1.59, 95% CI 1.40-1.81) and nurses (adjusted OR 1.17, 95% CI 1.03-1.32) relative to women. Moreover, the study provides valuable insight into the prevalence of various types of DBs experienced by trainee physicians, including disrespectful behavior, exclusion from patient discussions, and reprimands. Understanding and addressing the gender-based differences in DBs among trainee physicians is crucial for improving the educational environment and promoting respectful behavior in healthcare settings. These findings highlight the need for targeted interventions based on gender to mitigate the negative impact of DBs on patient care and the well-being of medical residents.

Characterizing burnout and resilience among nurses: A latent profile analysis of emotional exhaustion, emotional thriving and emotional recovery

AIMS

To identify subgroups of nurses with distinct profiles of burnout (emotional exhaustion) and resilience (emotional thriving and emotional recovery) and describe nurse characteristics associated with each profile.

DESIGN

Cross-sectional, correlational design.

METHODS

Data were collected via electronic survey from 2018 to 2019. Latent profile analysis was used to identify subgroups of nurses with distinct profiles of emotional exhaustion, emotional thriving and emotional recovery, with each measured on a 0-100 scale. Bivariate statistics were used to determine profile differences in nurse sociodemographic, professional and psychological characteristics.

RESULTS

Four distinct profile subgroups were identified: (1) "exhausted" (14% with very high emotional exhaustion, low emotional thriving and moderate emotional recovery), (2) "exhausted with thriving" (6% with high emotional exhaustion, moderate-high emotional thriving and low emotional recovery), (3) "exhausted with thriving and recovery" (52% with moderate-high emotional exhaustion, emotional thriving and emotional recovery), and (4) "thriving and recovery" (27% with low emotional exhaustion and very high emotional thriving and emotional recovery). Nurses in the "exhausted" and "exhausted with thriving" profiles reported greater depression and poorer work-life integration. Nurses in "exhausted" profile were more likely to work in an inpatient setting. Nurses in the "exhausted with thriving and recovery" and "thriving and recovery" profiles reported more positive emotions, more well-being behaviours, and better work-life integration, with the "thriving and recovery" subgroup having the highest levels of these characteristics, lower depression scores and greater racial minority representation.

CONCLUSION

Approaches designed to improve nurse well-being should be tailored to the nurses' profile of emotional exhaustion, thriving and recovery to maximize effectiveness.

IMPACT

Given the growing shortage of nurses in healthcare systems, it is critical that multilevel strategies be investigated to retain nursing staff that consider the intersectionality and complexity of the different aspects of burnout and resilience experienced by the nurse.

NO PATIENT OR PUBLIC CONTRIBUTION

The aim was to assess burnout and resilience among nurses.

Pilot Study Using Cognitive Rehearsal, Simulation, and Biomarker Data to Address Workplace Incivility

BACKGROUND

Workplace incivility poses a threat to patient safety. This intervention pilot study used simulation and biomarker data with newly graduated nurses to explore the impact of incivility on patient care and tested whether cognitive rehearsal could mitigate the effects of workplace incivility.

METHOD

A clinical scenario and script were used by actors to deliver either an uncivil or a hurried but not uncivil handoff report to participants before they conducted a focused patient assessment and administered medications to a standardized patient.

RESULTS

Participants identified gaps in understanding of both handoff reports that resulted in compromised patient care. Quantitative trends showed lower resilience scores and higher stress appraisal scores for participants who received the uncivil handoff report.

CONCLUSION

Although participants expressed confidence using cognitive rehearsal as an intervention before the simulation, responses indicated that a 60-minute session was insufficient to adequately prepare them to effectively address an uncivil nurse encounter. [J Contin Educ Nurs. 2023;54(2):79-88.].

Experiencing and witnessing disruptive behaviors toward nurses in COVID-19 teams, patient safety, and errors in care

BACKGROUND

Nurse managers and team co-workers' disruptive behaviors (DBs) are negatively associated with a perceived safe climate. Moreover, DBs are a risk factor for patients' safety. Yet, it remains unknown whether and to what extent these effects were prevalent in COVID-19 wards and among witnesses of DBs.

DESIGN

A cross-sectional study.

METHODS

A questionnaire was distributed on social networks and completed by nurses in various Israeli healthcare organizations using snowball sampling between October and December 2021. The questionnaire included seven previously published measures and a question checking whether the participants had worked in a COVID-19 ward. The minimal sample size for any analysis was 236. Hypotheses were tested with correlations and structural equation modeling.

RESULTS

DBs of nurse managers and team co-workers toward nurses were higher in COVID-19 teams. As hypothesized, DBs were negatively correlated with a safe climate and positively with patient safety (fewer errors). The data were consistent with a model suggesting that a safe climate is related to fewer DBs and DBs largely mediate the effects of safe climate on errors. Surprisingly and importantly, the strongest predictor of errors, including preventable mortality, is witnessing DBs and not being a victim of DBs.

CONCLUSIONS

DBs may impede open communication and collaboration among co-workers, particularly in COVID-19 teams. This study shows the links between nurse shaping of a safe climate, DBs toward nurses, and patient safety.

CLINICAL RELEVANCE

Nurse managers who create a safe climate and show zero tolerance for DBs could reduce the risk of errors in care.

Effectiveness of a bite-sized web-based intervention to improve healthcare worker wellbeing: A randomized clinical trial of WISER

Importance

Problems with the wellbeing of healthcare workers (HCWs) are widespread and associated with detrimental consequences for the workforce, organizations, and patients.

Objective

This study tested the effectiveness of the Web-based Implementation for the Science of Enhancing Resilience (WISER) intervention, a positive psychology program, to improve six dimensions of the wellbeing of HCWs.

Design

We conducted a randomized controlled trial of HCWs between 1 April 2018 and 22 July 2019. Cohort 1 received WISER daily for 10 days. Cohort 2 acted as a waitlist control before receiving WISER.

Setting

Web-based intervention for actively employed HCWs across the United States.

Participants

Eligibility criteria included being ≥18 years old and working as a HCW. Each participant was randomized to start the intervention or serve as a waitlist control for 14 days before starting the intervention.

Interventions

Cohorts received links via 10 texts exposing them to introductory videos and positive psychology exercises (3 good things, cultivating awe, random acts of kindness, cultivating relationships, and gratitude letters).

Main outcomes and measures

The primary outcome was emotional exhaustion; secondary outcomes included depressive symptoms, work-life integration, happiness, emotional thriving, and emotional recovery. All outcomes were assessed at baseline, 1-week post-intervention (primary endpoint), and 1, 6, and 12-month post-intervention. Outcomes were measured using six validated wellbeing instruments, rescaled to 100-point scales for comparison. Six items assessed participants' WISER experience. The analysis employed mixed-effects models.

Results

In cohorts 1 and 2, 241 and 241 initiated WISER, and 178 (74%) and 186 (77%) completed the 6-month follow-up, respectively. Cohort populations were similar at baseline, mostly female (81; 76%) and nurses (34; 32%) or physicians (22; 23%), with 1-10 years of experience in their current position (54; 52%). Relative to control, WISER significantly improved depressive symptoms [-7.5 (95%CI: -11.0, -4.0), p < 0.001], work-life integration [6.5 (95%CI: 4.1, 8.9), p < 0.001], happiness [5.7 (95%CI: 3.0, 8.4), p < 0.001], emotional thriving [6.4 (95%CI: 2.5, 10.3), p = 0.001], and emotional recovery [5.3 (95%CI: 1.7, 8.9), p = 0.004], but not emotional exhaustion [-3.7 (95%CI: -8.2, 0.8), p = 0.11] at 1 week. Combined cohort results at 1, 6, and 12 months showed that all six wellbeing outcomes were significantly improved relative to baseline (p < 0.05 for all). Favorable impressions of WISER were reported by 87% of participants at the 6-month post-assessment.

Conclusion and relevance

WISER improved HCW depressive symptoms, work-life integration, happiness, emotional thriving, and emotional recovery. Improvements in all HCW wellbeing outcomes endured at the 1-, 6-, and 12-month follow-ups. HCW's impressions of WISER were positive.

Clinical trials number

https://clinicaltrials.gov/ct2/show/, identifier: NCT02603133. Web-based Implementation for the Science of Enhancing Resilience Study (WISER).

Cross-Cultural Adaptation of the Instrument "Nurse-Physician Relationship Survey: Impact of Disruptive Behavior in Patient Care" to the Spanish Context

Disruptive behavior in the healthcare context has an impact on patient care, healthcare personnel, and the health organization, and it also influences the therapeutic relationship, communication process, and adverse events. However, there is a lack of instruments that could be used for its analysis in the hospital care environment in the Spanish context. The objective of the study was to culturally adapt and perform a content validation of the tool “Nurse−Physician Relationship Survey: Impact of Disruptive Behavior on Patient Care”, to the Spanish content (Spain). An instrumental study was conducted, which included an analysis of conceptual and semantic equivalence. A panel of experts analyzed the translations, by analyzing the Content Validity Index (CVI) of the group of items in the scale through the Relevance Index (RI) and the Pertinence Index (PI). Only a single item obtained an RI value of 0.72, although with PI value of 0.81, with consensus reached for not deleting this item. The CVI of all the items was >0.80 for the mean value of the RI, as well as the PI. The instrument was adapted to the Spanish context and is adequate for evaluating the disruptive behaviors on nurse−physician relationships and its impact on patient care. However, the importance of continuing the analysis of the rest of the psychometric properties in future studies is underlined.

Radiography Managers’ Perspectives on the Strategies to Mitigate Disruptive Behaviours: A Qualitative Exploratory Study

Disruptive behaviours (DBs) are not normally in the scope of legal sanctions, notwithstanding their undesirable effects. Hence, many healthcare organizations still have difficulty in dealing with them in an effective manner. Several studies suggest that few organizations have tailor-made policies or procedures for evaluating, proving and mitigating these behaviours. However, evidence shows that mitigating DBs is critical to empowering healthcare workers to focus on providing superior, affordable and safe patient care. The aim of this study was to explore radiography managers’ perspectives on the strategies to mitigate DBs involving radiographers. An exploratory qualitative study employing one-on-one semi-structured in-depth interviews was carried out between March and April 2021. Eleven radiography managers at central hospitals in Harare Metropolitan Province were selected by criterion-purposive sampling. The interview data were analyzed using Tesch’s method of qualitative analysis. The data were first manually coded and then entered into Nvivo (QSR International Version 11) for further analysis. Three themes emerged from the interview data including awareness of DBs, willingness to address DBs, and conflict resolution. Context-specific strategies to mitigate DBs should be identified and implemented to guarantee a healthy work environment for radiographers so that they focus on providing excellent and safe patient care.

Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021

IMPORTANCE

Extraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being.

OBJECTIVE

To determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point.

DESIGN, SETTING, AND PARTICIPANTS

This survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US.

EXPOSURES

Safety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate.

MAIN OUTCOMES AND MEASURES

The percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree); neutral or higher scores were counted as "percent concerning" for exhaustion.

RESULTS

Electronic surveys were returned by 37 187 (of 49 936) HCWs in 2019, 38 460 (of 45 268) in 2020, and 31 475 (of 41 224) in 2021 to 2022 for overall response rates of 74.5%, 85.0%, and 76.4%, respectively. The overall sample comprised 107 122 completed surveys. Nursing was the most frequently reported role (n = 43 918 [40.9%]). A total of 17 786 respondents (16.9%) reported less than 1 year at their facility, 59 226 (56.2%) reported 1 to 10 years, and 28 337 (26.9%) reported 11 years or more. From September 2019 to September 2021 through January 2022, overall %EE increased from 31.8% (95% CI, 30.0%-33.7%) to 40.4% (95% CI, 38.1%-42.8%), with a proportional increase in %EE of 26.9% (95% CI, 22.2%-31.8%). Physicians had a decrease in %EE from 31.8% (95% CI, 29.3%-34.5%) in 2019 to 28.3% (95% CI, 25.9%-31.0%) in 2020 but an increase during the second year of the pandemic to 37.8% (95% CI, 34.7%-41.3%). Nurses had an increase in %EE during the pandemic's first year, from 40.6% (95% CI, 38.4%-42.9%) in 2019 to 46.5% (95% CI, 44.0%-49.1%) in 2020 and increasing again during the second year of the pandemic to 49.2% (95% CI, 46.5%-51.9%). All other roles showed a similar pattern to nurses but at lower levels. Intraclass correlation coefficients revealed clustering of exhaustion within work settings across the 3 years, with coefficients of 0.15 to 0.17 for emotional exhaustion and 0.22 to 0.24 for emotional exhaustion climate, higher than the .10 coefficient typical of organizational climate (a medium effect for shared variance), suggestive of a social contagion effect of HCW exhaustion.

CONCLUSIONS AND RELEVANCE

This large-scale survey study of HCWs spanning 3 years offers substantial evidence that emotional exhaustion trajectories varied by role but have increased overall and among most HCW roles since the onset of the pandemic. These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions.

A formative measurement model and development of quality of work-life scale based on two-factor theory: evidence from Indian private industries

Purpose

This study examines the quality of work-life (QoWL) as a formative construct and validates the scale in an Indian context. Taking a cue from the two-factor (Herzberg) theory, the study developed and validated a formative assessment model of QoWL in the current scenario.

Design/methodology/approach

Cross-sectional data and a self-administered questionnaire were used to analyze the QoWL scale based on a sample of 841 respondents from IT/ITES, BFSI, CPG and manufacturing sectors. Indicators/items of QoWL were considered a first-order reflective construct, and factors of QoWL were considered second-order formative construct in the study. Embedded two-stage approach was used to assess the antecedent construct in the model in which QoWL was measured with seven formative indicators in stage one, and all the constructs of the QoWL are measured with a single item (Global_QWL, i.e. the essence of all constructs) in stage two.

Findings

The study found QoWL as a formative construct with seven significant dimensions; namely, hygiene factors included fairness in compensation (FC), job security (JS), interpersonal relationship (IR), health and wellbeing (HWB), where motivational factors had rewards and career growth (RG), work-life balance (WLB) and learning and development (LD). The study also indicated the strong association of a single item (global_QWL) with all constructs of QoWL. The study findings conceptualize a QoWL as a formative construct within the mentioned sector and can be generalized and extended to other sectors of the economy as well.

Research limitations/implications

Future researchers can take guidance to deal with the formative construct in the development and validation of scale in various topics in the field of HRM. Future researchers can extend the study across cities and different sectors.

Practical implications

In this VUCA world, employees have to be constantly on their toes to ensure their organization remains relevant. In this context, the least organization can do for their employees is to offer a conducive environment and favorable QoWL. This study aims to assist the key decision-makers in applying the QoWL index as a formative construct and aiding them in improving the quality of their decisions.

Social implications

Researcher believes that applying the QoWL index as a formative construct can aid decision-makers in improving the quality of their decisions by equipping them with relevant inputs and knowledge. Government can focus on the employees' welfare and introduce the current motivational and hygiene factors in the area of quality of life of the Indians.

Originality/value

Formative assessment measurement of QoWL model was validated with the two-factor theory to understand the work environment of India in the private sector across different sectors. The unique finding of the study was a single item (global_QWL) to conclude the QoWL index as a formative construct by redundancy analysis.

Factors associated with burnout among medical laboratory professionals in Ontario, Canada: An exploratory study during the second wave of the COVID‐19 pandemic

Objective

The objective of this study was to examine factors associated with burnout among medical laboratory technologists (MLT) in Ontario, Canada during the second wave of coronavirus disease 2019 pandemic.

Methods

We employed a cross‐sectional design and used a self‐reported questionnaire designed for MLT in Ontario, Canada.

Results

There were 441 (47.5% response rate) MLT who were included in the analytic sample. Most of the respondents were women, with a mean age of 43.1 and a standard deviation of 11.7. The prevalence of experiencing burnout was 72.3% for MLT. In the adjusted demographic model, those ≥50 (OR = 0.36, 95% CI: 0.22–0.59) were 0.36 or about one third as likely to experience burnout as those under 50. Similarly, those who held a university degree were less likely to experience burnout compared with high school degree (OR = 0.35, 95% CI: 0.15–0.79). In the adjusted occupational model, high quantitative demands (OR = 2.15, 95% CI: 1.21–3.88), high work pace (OR = 2.21, 95% CI: 1.25–3.98), high job insecurity (OR = 2.56, 95% CI: 1.39–4.82), high work life conflict (OR = 5.08, 95% CI: 2.75–9.64) and high job satisfaction (OR = 0.43, 95% CI: 0.20–0.88), high self‐rated health (OR = 0.32, 95% CI: 0.17–0.56) were significant.

Conclusion

This study provides preliminary evidence regarding the factors associated with burnout in MLT. Additional research is needed to understand their relationship with workers health and well‐being and in the delivery of health services.

This study examined burnout among medical laboratory technologist in Ontario

medical laboratory technologists (MLT) experience high rates of burnout during the pandemic

Demographic factors associated with burnout include education attainment and age

Occupational factors associated with burnout include high work demands, job demands, low job satisfaction and high self‐regulated health

Disruptive Behavior at Hospitals and Factors Associated to Safer Care: A Systematic Review

Disruptive behavior creates a dysfunctional culture that has a negative impact on work relations and influences the quality of care and safety of the patient. The objective of the present work is to provide the best methodological quality scientific evidence available on disruptive behavior at a hospital, the aspect associated with the safety of the patient, and its impact on quality of care. For this, we included studies that addressed the prevalence of disruptive behaviors observed in the area of hospital health and its professionals. The selection, eligibility, data extraction and evaluation of the risk of bias stages were conducted by two researchers, and any discrepancies were solved by a third researcher. The data presented show that disruptive behaviors are frequently observed in the daily life of health professionals, and compromise the quality of care, the safety of the patient, and can lead to adverse effects. The results presented indicate that the appearance of disruptive behaviors compromises the quality of care, the safety of the patient, and the appearance of adverse effects, and can also affect the physical and mental health of the health professionals. PROSPERO registration number: CRD42021248798.

Randomized controlled trial of the "WISER" intervention to reduce healthcare worker burnout

OBJECTIVE

Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout.

DESIGN

RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control.

RESULTS

Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (-5.27 (95% CI: -10.44, -0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (-6.3% (95%CI: -11.6%, -1.0%); p = 0.008), and secondary outcomes depression (-5.2% (95%CI: -10.8, -0.4); p = 0.022) and work-life integration (-11.8% (95%CI: -17.9, -6.1); p < 0.001). Improvements endured at 6 months.

CONCLUSION

WISER appears to durably improve HCW well-being.

CLINICAL TRIALS NUMBER

NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133.

The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being

CONTEXT.—

Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover.

OBJECTIVE.—

To describe the state of the science regarding HCW well-being, including how it is measured, what outcomes it predicts, and what institutional and individual interventions appear to reduce it.

DATA SOURCES.—

Peer review articles as well as multiple large data sets collected within our own research team are used to describe the nature of burnout, associations with institutional resources, and individual tools to improve well-being.

CONCLUSIONS.—

Rates of HCW burnout are alarmingly high, placing the health and safety of patients and HCWs at risk. To help address the urgent need to help HCWs, we summarize some of the most promising early interventions, and point toward future research that uses standardized metrics to evaluate interventions (with a focus on low-cost institutional and personal interventions).

Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds

BACKGROUND

Interventions to decrease burnout and increase well-being in health care workers (HCWs) and improve organizational safety culture are urgently needed. This study was conducted to determine the association between Positive Leadership WalkRounds (PosWR), an organizational practice in which leaders conduct rounds and ask staff about what is going well, and HCW well-being and organizational safety culture.

METHODS

This study was conducted in a large academic health care system in which senior leaders were encouraged to conduct PosWR. The researchers used data from a routine cross-sectional survey of clinical and nonclinical HCWs, which included a question about recall of exposure of HCWs to PosWR: "Do senior leaders ask for information about what is going well in this work setting (e.g., people who deserve special recognition for going above and beyond, celebration of successes, etc.)?"-along with measures of well-being and safety culture. T-tests compared work settings in the first and fourth quartiles for PosWR exposure across SCORE (Safety, Communication, Operational Reliability, and Engagement) domains of safety culture and workforce well-being.

RESULTS

Electronic surveys were returned by 10,627 out of 13,040 possible respondents (response rate 81.5%) from 396 work settings. Exposure to PosWR was reported by 63.1% of respondents overall, with a mean of 63.4% (standard deviation = 20.0) across work settings. Exposure to PosWR was most commonly reported by HCWs in leadership roles (83.8%). Compared to work settings in the fourth (< 50%) quartile for PosWR exposure, those in the first (> 88%) quartile revealed a higher percentage of respondents reporting good patient safety norms (49.6% vs. 69.6%, p < 0.001); good readiness to engage in quality improvement activities (60.6% vs. 76.6%, p < 0.001); good leadership accessibility and feedback behavior (51.9% vs. 67.2%, p < 0.001); good teamwork norms (36.8% vs. 52.7%, p < 0.001); and good work-life balance norms (61.9% vs. 68.9%, p = 0.003). Compared to the fourth quartile, the first quartile had a lower percentage of respondents reporting emotional exhaustion in themselves (45.9% vs. 32.4%, p < 0.001), and in their colleagues (60.5% vs. 47.7%, p < 0.001).

CONCLUSION

Exposure to PosWR was associated with better HCW well-being and safety culture.

Being present: Examining the efficacy of an Internet Mantram Program on RN-delivered patient-centered care

Background

The COVID-19 pandemic highlighted nurses’ compassionate presence during stressful conditions. Strategies to reduce workplace stress are needed.

Purpose

The purpose of this study was to evaluate a stress reduction strategy, an Internet-based Mantram Repetition Program (MRP), for nurses caring for hospitalized Veterans.

Methods

A one group pre-/post-test design was used to assess change in nurses’ perceived outcomes after participating in the MRP. A post-test-only design was used to assess hospitalized Veterans’ perceptions of nursing presence and satisfaction with care. Qualitative interviews were used to supplement quantitative data.

Findings

Patients perceived high levels of presence and satisfaction with care. Post MRP, nurses perceived increased mindfulness, compassion satisfaction, spiritual well-being, and nursing presence. Increased mindfulness was associated with greater compassion satisfaction and less burnout.

Discussion

For nurses working on the front lines of patient care, the potential for experiencing stress and burnout is a reality. Participating in a MRP could lessen these effects and facilitate nursing presence.

Maternal and neonatal health care worker well-being and patient safety climate amid the COVID-19 pandemic

OBJECTIVE

To assess maternal and neonatal healthcare workers (HCWs) perspectives on well-being and patient safety amid the COVID-19 pandemic.

STUDY DESIGN

Anonymous survey of HCW well-being, burnout, and patient safety over the prior conducted in June 2020. Results were analyzed by job position and burnout status.

RESULT

We analyzed 288 fully completed surveys. In total, 66% of respondents reported symptoms of burnout and 73% felt burnout among their co-workers had significantly increased. Workplace strategies to address HCW well-being were judged by 34% as sufficient. HCWs who were "burned out" reported significantly worse well-being and patient safety attributes. Compared to physicians, nurses reported higher rates of unprofessional behavior (37% vs. 14%, p = 0.027) and difficulty focusing on work (59% vs. 36%, p = 0.013).

CONCLUSION

Three months into the COVID-19 pandemic, HCW well-being was substantially compromised, with negative ramifications for patient safety.

Sustainability in Higher Education: The Relationship between Work-Life Balance and XR E-Learning Facilities

Nowadays, collaborative learning is proving to offer solutions to new inclusivity research challenges, and most importantly, can help ensure sustainable education. Collaborative learning can strengthen positive attitudes towards learning, improve performance in academic results, and enhance self-esteem, by promoting interaction and mutual support among young people. Extended reality (XR), associated with collaborative learning, offers a further advantage by facilitating deep comprehensive learning. An online survey was conducted to investigate respondents’ views on the impact and influence of virtual technologies on work, study, and social life. Respondents (n = 1032) were recruited from Serbia, Romania, and Hungary, from five public and private universities. The study reveals students’ perceptions of e-learning and XR immersion. The data were analyzed by using a combination of descriptive techniques from PSPP (GNU open source SPSS—Statistical Package for the Social Sciences, Free Software Foundation, Boston, MA, USA), and by designing a regression model to evaluate the work-life balance. This regression model shows that the work-life balance is positively influenced by the inclusion of XR facilities in the e-learning process, along with an increased level of culture and living standard. The higher living standard of a student is associated with higher digital competence and more financial resources available to invest in technology.

A descriptive study of faculty-to-faculty incivility in nursing programs in the United States

BACKGROUND

Incivility has become a major societal issue and over the last two decades more researchers have examined the incidence and prevalence of incivility in higher education. There has been significant research on faculty and student incivility in nursing programs (Atmiller, 2012; Clark, 2008a, 2008b, 2008c), but literature is lacking on faculty-to-faculty incivility in nursing programs.

PURPOSE

This descriptive study examined the incidence of faculty-to-faculty incivility in nursing programs in the United States. Additionally, this study sought to determine the physical and emotional effects of faculty-to-faculty incivility.

METHODS

Originally the study participants were recruited using a stratified cluster sampling, but this resulted in a low response rate. A new methodology used a convenience sample to enlist participants attending a nursing education conference. The Workplace Incivility/Civility Survey collected data on the incidence and prevalence of faculty-to-faculty incivility. Open-ended questions were added to the survey to capture the emotional and physical responses to acts of incivility.

RESULTS

Analysis of the data indicated that workplace incivility is perceived as a moderate to severe problem. The participants shared their experience with faculty-to-faculty incivility and the emotional and physical effects that resulted from the incident.

CONCLUSION

Faculty-to-faculty incivility continues to be an issue in nursing education. The number of studies that have examined incivility in nursing education continues to grow. It is important to examine this issue as it impacts the ability to address the nursing shortage and meet the health care needs of the nation. Further research is needed to identify if there is a relationship among faculty-to-faculty incivility and job satisfaction or intent to leave.

Predictors and triggers of incivility within healthcare teams: a systematic review of the literature

OBJECTIVES

To explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous.

DESIGN

Systematic literature review of quantitative and qualitative empirical studies.

DATA SOURCES

Database searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020.

ELIGIBILITY CRITERIA

Original empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care.

DATA EXTRACTION AND SYNTHESIS

Of the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020.

RESULTS

Based on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership.

CONCLUSIONS

Although a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.