1
|
Månsson Sandberg H, Landstad BJ, Tjulin Å, Brulin E. COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study. BMC PRIMARY CARE 2023; 24:269. [PMID: 38087223 PMCID: PMC10717449 DOI: 10.1186/s12875-023-02228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors. METHODS Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors. RESULTS The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion. CONCLUSIONS COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.
Collapse
Affiliation(s)
- Helena Månsson Sandberg
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Bodil J Landstad
- Faculty of Human Sciences, Mid Sweden University, Östersund, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | - Åsa Tjulin
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Emma Brulin
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Peebles ER, Pack R, Goldszmidt M. From helplessness to transformation: An analysis of clinician narratives about the social determinants of health and their implications for training and practice. MEDICAL EDUCATION 2023; 57:1054-1067. [PMID: 37621235 DOI: 10.1111/medu.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/15/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Medical curricula are attempting to prepare trainees to address the social determinants of health, however the life circumstances of patients are often beyond physician control. Little is known about how physicians cope with this dilemma; we sought to examine their perspectives when faced with this challenge to help better prepare trainees for practice. METHODS We undertook a critical analysis of physician narratives from January 2018 to June 2020. In total, 268 physician-written narrative social determinant of health pieces from four high impact medical journals were screened and 47 met the inclusion criteria and were analysed. RESULTS We identified four storylines that described the physician experience and strategies for coping with the social determinants of health. While Helplessness stories described authors' experiences of emotional distress when unable to support their patients, the other story types described ways they could make a difference. In Shortcoming and Transformation stories, the realisations about shortcomings led to transformation. In Doctor-patient relationship stories, authors described its importance in theirs and patients' lives, and in System advocacy stories, they described the need for greater advocacy to help change broken systems. CONCLUSIONS Current approaches to teaching the social determinants of health often focus on the role of physicians in recognising and altering social circumstances. However, the realities of practice do not easily allow physicians to do so and, for some, may lead to distress and burnout. There are other ways to cope and make a difference by improving ourselves, investing in getting to know our patients, and advocating. These results can help better support trainees and physicians for the realities of practice.
Collapse
Affiliation(s)
- Erin R Peebles
- Division of General Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Rachael Pack
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mark Goldszmidt
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Division of General Internal Medicine, Department of Medicine, Western University, London, ON, Canada
| |
Collapse
|
3
|
Zarowsky Z, Rashid T. Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19. INTERNATIONAL JOURNAL OF APPLIED POSITIVE PSYCHOLOGY 2022; 8:1-36. [PMID: 36196257 PMCID: PMC9523176 DOI: 10.1007/s41042-022-00078-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.
Collapse
Affiliation(s)
- Zachary Zarowsky
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trial, Toronto, ON M1C 1A4 Canada
| | - Tayyab Rashid
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trial, Toronto, ON M1C 1A4 Canada
- Centre for Wellbeing Science, Melbourne Graduate School of Education, Melbourne, Australia
| |
Collapse
|
4
|
Greco E, Graziano EA, Stella GP, Mastrodascio M, Cedrone F. The impact of leadership on perceived work-related stress in healthcare facilities organisations. JOURNAL OF ORGANIZATIONAL CHANGE MANAGEMENT 2022. [DOI: 10.1108/jocm-07-2021-0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PurposeEmployees in the private, public, and third sectors have experienced an increase in stress over the years. Amongst the sectors, people working in hospitals and other healthcare facilities were put under severe stress during the COVID-19 pandemic. Indeed, the World Health Organisation has clearly stated that defending people's mental health at this particular time of restless pandemic growth is an absolute necessity. The purpose of this article is to assess the perceived work-related stress (WRS) of healthcare workers (HCWs) as a result of the spread of COVID-19, as well as how a leadership role can help to reduce WRS.Design/methodology/approachBased on a multiple case study approach applied to two Italian health-care facilities, the questionnaire results were subjected to a regression analysis.FindingsThe results show an association in HCWs between the perception of supportive leadership and the perception of negative psychosocial risks whose exposure can lead to manifestation of WRS during COVID-19 pandemic.Originality/valueThe study addresses the role that the perception of supportive leadership can play in reducing exposure to occupational psychosocial risks in a sample of healthcare professionals.
Collapse
|
5
|
Kandula UR, Wake AD. Magnitude and Factors Affecting Parental Stress and Effective Stress Management Strategies Among Family Members During COVID-19. Psychol Res Behav Manag 2022; 15:83-93. [PMID: 35027855 PMCID: PMC8752870 DOI: 10.2147/prbm.s341299] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/15/2021] [Indexed: 01/09/2023] Open
Abstract
The pandemic outbreak, coronavirus disease 2019 (COVID-19) threatens proper family patterns by disrupting normal day-to-day activities, such as working patterns of parents by working from home, online children’s education rather than regular school, a dilemma in children’s education and health constrained movement by complete or partial home lockdowns to prevent disease spread, anxiety of disease spread, failure of home quarantine due to insufficient home situation and reduced personal protective equipment usage due to the extra financial burden, reduced social communications, increased health burdens than usual along with enormous toil with dependent family members, demands of financial burdens by multiple factors, reduced monthly income during pandemics, lack of employment or job insecurity, deviations in mental health among family members such as fear, anxiety, insomnia, severe depression, hetero aggression, child verbal or physical abuses, increased alcohol consumption and substance abuse or drug addictions, aggressive behavior, self-blaming or injury, unintentional suicidal tendencies, mood disorders, posttraumatic stress disorder and failure to meet health demands due to a lack of health facilities. Many contributing factors are affecting the normal family status than usual circumstances such as reduced hospital equipment or resources which is due to pandemic effects, social isolation due to outside quarantine measures, insecurity of the future and ongoing pandemic situation, fear of vaccination side effects, and so on. Therefore, we hope to raise awareness about the magnitude of parental stress levels and contributing factors. Moreover, these findings would encourage effective stress management to overcome the factors that contribute to parenteral stress and to improve coping skills to face the coming darkness with ease. It supports the preservation of physical, mental, and social well-being in families as well as minimizing or overcoming stressors, maintaining strong familial ties, and improving life expectancy globally during this pandemic.
Collapse
Affiliation(s)
- Usha Rani Kandula
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Oromia Regional State, Ethiopia
| | - Addisu Dabi Wake
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Oromia Regional State, Ethiopia
| |
Collapse
|
6
|
McKinley T. Toward Useful Interventions for Burnout in Academic Medical Faculty: The Case for Unit-Specific Approaches. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:e69-e74. [PMID: 34609350 DOI: 10.1097/ceh.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Despite a plethora of research on the topic of physician burnout, drivers and interventions are poorly understood. This study aimed to create a holistic picture of burnout drivers in academic medical faculty within a single department of a large, research university to better inform organization-sponsored interventions. METHODS The author used interpretive phenomenological analysis and the Job Demands-Resources model in this qualitative study. Full-time academic medical faculty completed two semistructured interviews approximately 6 months apart. Transcripts were coded using deductive and inductive coding. RESULTS Twenty-two faculty members participated in both interviews. Factors affecting burnout depended on individual and unit-level context, but interpersonal factors such as relationships with colleagues and interaction with learners created meaning for faculty or drove intention to leave the university. All participants reported personal coping mechanisms, and none participated in organization-sponsored, individual-level interventions. DISCUSSION In striving for meaningful burnout interventions, organizations should promote interpersonal factors (relationships with colleagues and meaningful interaction with learners) and provide protected time for faculty for their own personal coping. Research has suggested moving toward a universal burnout driver and intervention plan, but these data point toward the need for unit-specific study and interventions.
Collapse
Affiliation(s)
- Tara McKinley
- Dr. McKinley: LEAD, College of Education and Human Development, Louisville, KY
| |
Collapse
|
7
|
Dennis D, van Heerden PV, Khanna R, Knott CI. Behavioural responses of Intensivists to stressors in Intensive Care. Occup Med (Lond) 2021; 71:343-345. [PMID: 34729608 DOI: 10.1093/occmed/kqab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The hospital intensive care unit (ICU) environment encompasses sick patients who present for care in health crisis. Healthcare in this setting is complex, often involving the co-ordination of multiple professional teams, all under significant time pressures. The sequelae for staff interacting in this dynamic and often volatile setting are variable, depending upon their coping skillset and their familiarity with the stressors. AIMS The primary aim of this study was to describe and in doing so, normalize the behavioural responses expressed by ICU doctors (Intensivists) in response to stressful workplace events. The secondary aim was to identify those responses that contributed to resilience. METHODS A prospective qualitative study of senior Intensivists using a semi-scripted iterative interview. Data were transcribed and thematically analysed with verbatim quotations selected to support coding choices. RESULTS Nineteen experienced Intensivists from three sites in Australia and Israel participated. Clinicians described conscious, physiological and professional responses to stressors, including sense-making and taking time to process information with appropriate support. Two of the most important mitigation processes revealed were the use of reflective learning and preventative practice changes to prevent future errors. These were overlaid with the importance of disclosure and transparency in clinical work. CONCLUSIONS Repeated exposure to stressful events potentiates burnout, wherein staff no longer experience satisfaction and enjoyment in what they do. This paper presents the behavioural responses that experienced Intensivists described in relation to stressful events in the ICU, including steps taken to mitigate the effects of these events on their personal well-being.
Collapse
Affiliation(s)
- D Dennis
- Department of Intensive Care and Physiotherapy Department, Sir Charles Gairdner Hospital, Perth 6009, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Perth 6102, Western Australia, Australia
| | - P V van Heerden
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - R Khanna
- Department of Psychiatry, Phoenix Australia, University of Melbourne, Melbourne 3010, Victoria, Australia.,Division of Mental Health, Austin Health, Heidelberg 3084, Victoria, Australia
| | - C I Knott
- Department of Intensive Care, Bendigo Health, Bendigo 3550, Victoria, Australia.,Monash Rural Health Bendigo, Monash University, Victoria 3552, Australia.,Rural Clinical School, University of Melbourne, Victoria 3010, Australia.,Department of Intensive Care, Austin Health, Heidelberg, Victoria 3084, Australia
| |
Collapse
|
8
|
Lu Y, Liu Q, Yan H, Gao S, Liu T. Job burnout and its impact on work ability in biosafety laboratory staff during the COVID-19 epidemic in Xinjiang. BMC Psychiatry 2021; 21:543. [PMID: 34732164 PMCID: PMC8563825 DOI: 10.1186/s12888-021-03555-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has increased the physical and psychological stress of medical workers. This study was designed to investigate the prevalence and risk factors of job burnout and its impact on work ability among Biosafety Laboratory (BSL) staffs during the COVID-19 epidemic in Xinjiang. METHODS A total of 7911 qualified BSL staffs in Xinjiang were investigated by electronic questionnaires. The Maslach Burnout Inventory-General Survey (MBI-GS) was used for job burnout survey. Work Ability Index (WAI) was used for work ability survey. The prevalence and risk factors of job burnout in BSL staffs were analyzed through chi square test, t-test and one-way ANOVA. And then, the influence of demographic and job-related variables, i.e., confounding factors, were eliminated to the greatest extent by the propensity score analysis (PSA) method, to investigate the impact of job burnout on work ability in BSL staffs. RESULTS A total of 67.6% BSL staffs experienced job burnout. There were significant differences in the detection rate of job burnout among demographic and job-related variables, including gender, age, ethnicity, education, working years, professional title, marital status, number of night shift per month and overall sleep condition (all P < 0.05). The detection rate of job burnout in female was higher than that in male. The detection rates of job burnout in 45-50 years old, Han ethnicity, education of postgraduate or above, 11-20 years of working, intermediate professional title, married, staff with many night shifts per month and poor overall sleep condition were higher than that of other groups. The average burnout scores of the Emotional Exhaustion (EE), Cynicism (CY), Reduced Personal Accomplishment (PA) scale were 10.00 ± 5.99, 4.64 ± 4.59 and 15.25 ± 8.16, respectively. Multiple logistic regression analysis showed that the three dimensions of job burnout, i.e., EE, CY, PE, were negatively correlated with work ability and significantly affected the work ability of BSL staffs (all P < 0.001). CONCLUSIONS Our results suggest that the prevalence of job burnout is extremely common among BSL staffs. In addition, the work ability decreases with the increase of job burnout and the improvement of job burnout can enhance work ability among BSL staffs.
Collapse
Affiliation(s)
- Yaoqin Lu
- grid.13394.3c0000 0004 1799 3993Department of Toxicology, School of Public Health, Xinjiang Medical University, Urumqi, 830011 Xinjiang China ,Urumqi Center for Disease Control and Prevention, Urumqi, 830026 Xinjiang China
| | - Qi Liu
- grid.13394.3c0000 0004 1799 3993Department of Toxicology, School of Public Health, Xinjiang Medical University, Urumqi, 830011 Xinjiang China
| | - Huan Yan
- grid.13394.3c0000 0004 1799 3993Department of Nutrition and Food Hygiene, College of Public Health, Xinjiang Medical University, Urumqi, 830011 Xinjiang China ,Xinjiang Engineering Technology Research Center for Green Processing of Nature Product Center, Xinjiang Autonomous Academy of Instrumental Analysis, Urumqi, Xinjiang China
| | - Sunyujie Gao
- Urumqi Center for Disease Control and Prevention, Urumqi, 830026 Xinjiang China
| | - Tao Liu
- Department of Toxicology, School of Public Health, Xinjiang Medical University, Urumqi, 830011, Xinjiang, China.
| |
Collapse
|
9
|
Htay MNN, Marzo RR, Bahari R, AlRifai A, Kamberi F, El-Abasiri RA, Nyamache JM, Hlaing HA, Hassanein M, Moe S, Abas AL, Su TT. How healthcare workers are coping with mental health challenges during COVID-19 pandemic? - A cross-sectional multi-countries study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 11:100759. [PMID: 33977169 PMCID: PMC8103713 DOI: 10.1016/j.cegh.2021.100759] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 01/02/2023] Open
Abstract
Background The coronavirus pandemic (COVID-19) has a social and psychological impact among healthcare workers worldwide and appropriate coping strategies are essential to avoid the negative mental health effects. This study aimed to investigate the coping strategies among the healthcare workers from different countries and their attitude towards teamwork during the COVID-19 pandemic. Methods A cross-sectional study was conducted by using an online, web-based questionnaire, which was distributed to healthcare workers from 32 countries during April and May 2020. The respondents were recruited by the non-random convenience sampling method. Results A total of 2166 respondents responded to the survey and the majority were working in low- and middle-income countries. Among them, 36% were doctors, 24% were nurses and 40% worked in other healthcare sectors. More than 70% of the respondents answered that “getting family support” and “positive thinking” were coping methods for them during the COVID-19 pandemic. Approximately half of the respondents worshiped according to their belief and conducted prayers (58.4%) and had adequate sleep and food intake (48.2%). The significant associations were observed between attitude score towards interprofessional teamwork and gender (p = 0.009), age (31–45 years) (p < 0.001), marital status (p < 0.001), occupation (p < 0.001), working experience (2–5 years) (p = 0.005), current workplace (clinics) (p = 0.002). Conclusion The local healthcare authorities should promote coping methods and develop an innovative way to encourage practicing among healthcare workers. Digital mental health support interventions or workplace mental health support teams should be accessible to protect mental wellbeing among healthcare workers.
Collapse
Affiliation(s)
- Mila Nu Nu Htay
- Department of Community Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Roy Rillera Marzo
- Department of Public Health, Faculty of Medicine, Asia Metropolitan University, Johor, Malaysia.,Department of Community Medicine, International Medical School, Management and Science University, Selangor, Malaysia
| | - Rafidah Bahari
- Department of Psychiatry, Faculty of Medicine, University of Cyberjaya, Cyberjaya, Malaysia
| | - Ayesha AlRifai
- Birzeit University & Arab American University in Palestine, Palestine
| | - Fatjona Kamberi
- Research Centre of Public Health, Faculty of Health, University of Vlore "Ismail Qemali", Vlore, Albania
| | - Radwa Abdullah El-Abasiri
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, Cairo, Egypt
| | - Jeldah Mokeira Nyamache
- North Star Alliance, Kenya.,North Star Alliance, Uganda.,North Star Alliance, Tanzania.,North Star Alliance, Zimbabwe.,North Star Alliance, Mozambique.,North Star Alliance, South Africa
| | - Htet Aung Hlaing
- Senior Resident Medical Officer (General Practitioner), Pun Hlaing Siloam Hospital, Yangon, Myanmar
| | - Mayada Hassanein
- Maternal and Child Health Unit, Alexandria Fever Hospital, Alexandria, Egypt
| | - Soe Moe
- Department of Community Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Adinegara Lutfi Abas
- Department of Community Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| |
Collapse
|
10
|
Søvold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, Münter L. Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front Public Health 2021; 9:679397. [PMID: 34026720 PMCID: PMC8137852 DOI: 10.3389/fpubh.2021.679397] [Citation(s) in RCA: 223] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/12/2021] [Indexed: 12/27/2022] Open
Abstract
The COVID-19 pandemic has had an unprecedented impact on health systems in most countries, and in particular, on the mental health and well-being of health workers on the frontlines of pandemic response efforts. The purpose of this article is to provide an evidence-based overview of the adverse mental health impacts on healthcare workers during times of crisis and other challenging working conditions and to highlight the importance of prioritizing and protecting the mental health and well-being of the healthcare workforce, particularly in the context of the COVID-19 pandemic. First, we provide a broad overview of the elevated risk of stress, burnout, moral injury, depression, trauma, and other mental health challenges among healthcare workers. Second, we consider how public health emergencies exacerbate these concerns, as reflected in emerging research on the negative mental health impacts of the COVID-19 pandemic on healthcare workers. Further, we consider potential approaches for overcoming these threats to mental health by exploring the value of practicing self-care strategies, and implementing evidence based interventions and organizational measures to help protect and support the mental health and well-being of the healthcare workforce. Lastly, we highlight systemic changes to empower healthcare workers and protect their mental health and well-being in the long run, and propose policy recommendations to guide healthcare leaders and health systems in this endeavor. This paper acknowledges the stressors, burdens, and psychological needs of the healthcare workforce across health systems and disciplines, and calls for renewed efforts to mitigate these challenges among those working on the frontlines during public health emergencies such as the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - John A Naslund
- Department of Global Health and Social Medicine and Harvard Medical School, Boston, MA, United States
| | | | - Shekhar Saxena
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, MA, United States
| | | | - Christoffel Grobler
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Lars Münter
- Danish Committtee for Health Education, Copenhagen, Denmark
| |
Collapse
|
11
|
Petrini LA, Thottathil P, Shih G, Henderson A, Pasquariello C, Black SA. Ask the question, be the solution: Fostering well-being through contextualized assessment and strategy development. Paediatr Anaesth 2021; 31:68-73. [PMID: 33217761 DOI: 10.1111/pan.14087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
In recent years, optimizing provider well-being and mitigating the effects of physician burnout have become increasingly important in the field of medicine. These efforts are in part of consequence because of significant costs associated with provider burnout, for both individuals and their workplace. Accordingly, robust work has focused on development of strategies to decrease the incidence of burnout or mitigate its effects, including both individual efforts and systematic organizational change. This article describes the development and implementation of a unique assessment strategy to identify the driving factors hindering well-being in our general anesthesiology division. We describe how collected data allowed us to identify important areas for improvement, build community, and target novel interventions to ultimately improve the well-being of our division for all members. This manuscript does not describe survey results in any detail, but rather aims to present a creative application of the Hawthorne Effect as it applies to understanding physician well-being.
Collapse
Affiliation(s)
- Laura A Petrini
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Princy Thottathil
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Grace Shih
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alicia Henderson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carol Pasquariello
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Stephanie A Black
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
12
|
Kader N, Elhusein B, Al Abdulla S, Hamza AH, Al Maslamani M, Chandra P, Perayil R, Vincent J, Gunashekaran J, Alabdulla M. Risk Perception and Psychological Impact of COVID-19 Pandemic Among Healthcare Workers in Primary and Secondary Healthcare Settings in Qatar: A National Study. J Prim Care Community Health 2021; 12:21501327211039714. [PMID: 34392716 PMCID: PMC8366132 DOI: 10.1177/21501327211039714] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic, primary and secondary healthcare workers (HCWs) have faced unprecedented stress, jeopardizing their mental well-being. AIMS To compare risk perception and psychological distress between primary and secondary HCWs. METHOD A cross-sectional web-based survey was conducted with HCWs in Qatar from April 5 to July 5, 2020. Psychological distress and risk perception were assessed using the Kessler Psychological Distress Scale, a perceived COVID-19 risk questionnaire, and a sociodemographic questionnaire. RESULTS Of the 4417 participating HCWs, 3421 (90.3%) felt that their job increased their risk of COVID-19 exposure, 3759 (90.9%) accepted this as part of their job, and 3440 worried that this also increased the risk of exposure to their families. Moreover, 2911 (84.8%) believed that their employer would look after their needs if they contracted COVID-19. Moderate to severe psychological distress was present in 1346 (30.5%) HCWs. Primary HCWs were less likely to experience moderate to severe psychological distress than secondary HCWs (adjusted OR, 0.48; 95% CI 0.29-0.77, P = .003). Secondary HCWs who worked in COVID-19 designated areas had greater psychological distress. CONCLUSIONS HCWs' exposure to outbreaks has various psychological effects, which may have long-term consequences and affect their decision-making capacity. Strategies to enhance the mental well-being of HCWs exposed to COVID-19 should be introduced immediately.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Majid Alabdulla
- Hamad Medical Corporation, Doha, Qatar
- Qatar University, Doha, Qatar
| |
Collapse
|
13
|
Ewen AM, Gittus N, Higgins MCSS, Palma S, Whitley K, Schneider JI. Program Administrator Burnout in Graduate Medical Education: a Longitudinal Study. J Gen Intern Med 2020; 35:3248-3253. [PMID: 32399913 PMCID: PMC7661571 DOI: 10.1007/s11606-020-05853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about the level of burnout among program administrators (PAs) in medical education and its impact on the trainee environment. OBJECTIVE To investigate variations in burnout levels over a 1-year period among a national cohort of PAs and examine any associations between perceived support and isolation. DESIGN A 1-year longitudinal study conducted to assess burnout levels among PAs across the USA. The Copenhagen Burnout Inventory (score range, 0-100) was used to measure burnout over one academic year (July 2017-June 2018). The generalized estimating equations model was used to measure changes in burnout levels from the start of the academic year. To explore the differences in burnout scores across question response levels, a one-way ANOVA test was utilized and reported as least squares means ± SD. PARTICIPANTS Individuals who self-identified as PAs in a graduate medical education training program. Among the 1084 persons nationwide who expressed interest, 904 (83%) completed the baseline survey; 29 of the 42 (69%) local administrators completed the survey. "Clients" defined as interns, residents/fellows, and medical students. MAIN MEASURES Change in burnout score using the validated tool. Hypothesis formulated prior to data collection. KEY RESULTS Among the 931 participants, the 3rd quarter (March 2018) marked the lowest average personal burnout score (change from the start of academic year, - 3.67; p < 0.001, 95% CI - 5.77 to - 1.58) and work-related burnout score (change, - 3.03; p < 0.001, 95% CI - 5.01 to - 1.06). Client-related burnout was the lowest in September 2017 (change, - 1.46; p = 0.491; 95% CI - 3.54 to 0.62). June 2018: those who strongly agreed to feeling isolated in their current position had an increased personal (69.1 ± 18.4 SD), work-related (72.5 ± 20.8 SD), and client-related (42.3 ± 23.7 SD) burnout score. CONCLUSIONS PA burnout levels fluctuate over the academic year and are shown to increase as feelings of isolation grow.
Collapse
Affiliation(s)
- Alana M Ewen
- Graduate Medical Education, Boston Medical Center, Boston, MA, USA
| | - Natalie Gittus
- Medical Education, Baylor University Medical Center, Dallas, TX, USA
| | - Mikhail C S S Higgins
- Division of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sandra Palma
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathryn Whitley
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jeffrey I Schneider
- Graduate Medical Education, Boston Medical Center, Boston, MA, USA.
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA.
| |
Collapse
|
14
|
Heath C, Sommerfield A, von Ungern-Sternberg BS. Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review. Anaesthesia 2020; 75:1364-1371. [PMID: 32534465 PMCID: PMC7323405 DOI: 10.1111/anae.15180] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. The longevity of the crisis and disruption to normality is unknown. With COVID-19 set to be a chronic health crisis, clinicians will be required to maintain a state of high alert for an extended period. The support received before and during an incident is likely to influence whether clinicians experience psychological growth or injury. An abundance of information is emerging on disease epidemiology, pathogenesis and infection control prevention. However, literature on interventions for supporting the psychological well-being of healthcare workers during disease outbreaks is limited. This article summarises the available management strategies to increase resilience in healthcare workers during the COVID-19 pandemic and beyond. It focuses on self-care and organisational justice. It highlights various individual as well as organisational strategies. With the success of slowing disease spread in many countries to date, and reduced work-load due to limitations on elective surgery in many institutions, there is more time and opportunity to be pro-active in implementing measures to mitigate or minimise potential adverse psychological effects and improve, restore and preserve the well-being of the workforce now and for years to come. The purpose of this review is to review available literature on strategies for minimising the psychological impact of the COVID-19 pandemic on clinicians and to identify pro-active holistic approaches which may be beneficial for healthcare workers both for the current crisis and into the future.
Collapse
Affiliation(s)
- C Heath
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Department of Peri-operative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - B S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
15
|
Deng D, Naslund JA. Psychological Impact of COVID-19 Pandemic on Frontline Health Workers in Low- and Middle-Income Countries. HARVARD PUBLIC HEALTH REVIEW (CAMBRIDGE, MASS.) 2020; 28:http://harvardpublichealthreview.org/wp-content/uploads/2020/10/Deng-and-Naslund-2020-28.pdf. [PMID: 33409499 PMCID: PMC7785092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Healthcare systems in many countries have been overwhelmed by the coronavirus disease (COVID-19) pandemic, with increasing demands to contain and respond to the virus. The result has been increased pressure on frontline health workers. As the pandemic unfolds, the impact on health systems in low-income and middle-income countries (LMICs) is becoming apparent. In lower resource settings, the detrimental effects on frontline health workers will likely be significant due to fragmented infrastructure, low compensation, and significant shortages of necessary resources such as personal protective equipment. These high stress conditions, coupled with risk of infection and fears and anxieties among patients, can result in grave psychosocial consequences for frontline health workers, who play a vital role in delivering the bulk of primary care services in LMICs. In this narrative review, we consider the psychological impact of the COVID-19 pandemic on frontline health workers in LMICs. We describe the important role of frontline health workers, summarize existing literature on burnout and risks to mental health in this essential workforce, and consider how public health emergencies exacerbate these concerns to showcase their vulnerability to mental health impacts of COVID-19. We explore emerging research on the detrimental effects of the COVID-19 pandemic on health workers and consider possible approaches to mitigate these consequences. This review draws from existing studies and emerging evidence to highlight the critical need to consider the wellbeing of frontline health workers, and to address these challenges as health systems respond to the pandemic.
Collapse
Affiliation(s)
- Davy Deng
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
16
|
Gogo A, Osta A, McClafferty H, Rana DT. Cultivating a way of being and doing: Individual strategies for physician well-being and resilience. Curr Probl Pediatr Adolesc Health Care 2019; 49:100663. [PMID: 31564630 DOI: 10.1016/j.cppeds.2019.100663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The practice of medicine is rewarding on many levels, but demands of the work can result in mental and emotional exhaustion, self-isolation, burnout, depression, suicidal ideation and tragically, completed suicide. It is critical to have effective strategies to address the unique stressors of a medical career, mitigate burnout, and buffer the physiologic toll of chronic stress. Using Zwack and Schweitzer's widely published description of approaches to maintaining resilience and approaches to wellness, we have organized these strategies into three broad domains relevant to medical practice: (1) gratification (connection and communication, meaning and purpose); (2) resilience building practices (self-reflection, time for oneself, self-compassion, spirituality); and (3) useful attitudes (acceptance, flexibility, self-awareness). Several techniques are described including mindfulness-based stress reduction, narrative medicine, skillful communication, and practices in self-compassion, gratitude, and spirituality. The focus of the work is to introduce a spectrum of resilience strategies for individual consideration that can be tailored and combined to meet a physician's changing needs over the course of medical training and practice.
Collapse
Affiliation(s)
- Albina Gogo
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, California, United States.
| | - Amanda Osta
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, Illinois, United States
| | - Hilary McClafferty
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Deborah T Rana
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, San Diego, California, United States
| |
Collapse
|
17
|
Levi E. Managing oneself before managing others: a health advocacy core competency. ANZ J Surg 2019; 89:1494-1496. [PMID: 31679178 DOI: 10.1111/ans.15545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Eric Levi
- Department of Otolaryngology Head and Neck Surgery, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Head and Neck Surgery Unit, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
18
|
Oettgen B, Ruch-Ross H, Barrett HA, Bennett-Tejes D, Palmer K, Hobson WL. The Community Access to Child Health (CATCH) Program: A 25-Year Retrospective. Pediatrics 2019; 143:peds.2018-2551. [PMID: 31142579 DOI: 10.1542/peds.2018-2551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 01/17/2023] Open
Abstract
For 25 years, the American Academy of Pediatrics (AAP) Community Access to Child Health (CATCH) program has supported pediatricians in collaborating within their communities to advance the health of all children. CATCH grants support pediatric residents and pediatricians in planning or implementing community-based child health initiatives. The CATCH program has provided almost 10 million dollars through 842 planning, 585 resident, and 305 implementation grants to >1700 pediatricians. Urban, rural, suburban, and tribal communities in every state as well as the District of Columbia and Puerto Rico have benefited from CATCH-funded projects. Collaborations with community partners such as schools, homeless shelters, and mental health centers have led to programs serving children and families, especially those living in poverty and in minority groups. The most recent program data reveal that 87.5% of the projects are operating 2 years after funding. Many CATCH projects have not only sustained themselves but have grown into larger programs with funding from other sources. CATCH has influenced pediatricians' careers by providing important skills, networking opportunities, career legitimacy, mentoring opportunities, and increased engagement with the AAP. More than 350 pediatricians have served the AAP as CATCH facilitators, the network of physicians that provides technical assistance to applicants and reviews grant applications. Responding to changing trends, CATCH leaders have looked at other funding models and recently launched the CATCH-On initiative. CATCH-On creates and provides templates from successful CATCH projects to busy pediatricians who can then implement the project in their communities with minimal funding.
Collapse
Affiliation(s)
| | | | | | | | - Karla Palmer
- American Academy of Pediatrics, Itasca, Illinois; and
| | - Wendy L Hobson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| |
Collapse
|
19
|
Babineau T, Thomas A, Wu V. Physician Burnout and Compassion Fatigue: Individual and Institutional Response to an Emerging Crisis. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40746-019-00146-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Affiliation(s)
- Henry S Levine
- Department of Psychiatry and Behavioral Sciences, University of Washington, Bellingham
| |
Collapse
|
21
|
Robins JLW. Should We Meditate While We Wait? J Womens Health (Larchmt) 2019; 28:109-110. [DOI: 10.1089/jwh.2018.7576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jo Lynne W. Robins
- Department of Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, Virginia
| |
Collapse
|