1
|
Fazio M, Jabbour E, Patel S, Bertelle V, Lapointe A, Lacroix G, Gravel S, Cabot M, Piedboeuf B, Beltempo M. Association of Shift-Level Organizational Factors with Nosocomial Infection in the Neonatal Intensive Care Unit. JOURNAL OF PEDIATRICS. CLINICAL PRACTICE 2024; 13:200112. [PMID: 38948384 PMCID: PMC11214522 DOI: 10.1016/j.jpedcp.2024.200112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024]
Abstract
Objective To evaluate the association between shift-level organizational data (unit occupancy, nursing overtime ratios [OTRs], and nursing provision ratios [NPRs]) with nosocomial infection (NI) among infants born very preterm in the neonatal intensive care unit (NICU). Study design This was a multicenter, retrospective cohort study, including 1921 infants 230/7-326/7 weeks of gestation admitted to 3 tertiary-level NICUs in Quebec between 2014 and 2018. Patient characteristics and outcomes (NIs) were obtained from the Canadian Neonatal Network database and linked to administrative data. For each shift, unit occupancy (occupied/total beds), OTR (nursing overtime hours/total nursing hours), and NPR (number of actual/number of recommended nurses) were calculated. Mixed-effect logistic regression models were used to calculate aOR for the association of organizational factors (mean over 3 days) with the risk of NI on the following day for each infant. Results Rate of NI was 11.5% (220/1921). Overall, median occupancy was 88.7% [IQR 81.0-94.6], OTR 4.4% [IQR 1.5-7.6], and NPR 101.1% [IQR 85.5-125.1]. A greater 3-day mean OTR was associated with greater odds of NI (aOR 1.08, 95% CI 1.02-1.15), a greater 3-day mean NPR was associated lower odds of NI (aOR 0.96, 95% CI 0.95-0.98), and occupancy was not associated with NI (aOR, 0.99, 95% CI 0.96-1.02). These findings were consistent across multiple sensitivity analyses. Conclusions Nursing overtime and nursing provision are associated with the adjusted odds of NI among infants born very preterm in the NICU. Further interventional research is needed to infer causality.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Quebec investigators of the Canadian Neonatal Network (CNN)∗
- McGill University, Montréal, QC, Canada
- Université de Sherbrooke, Sherbrooke, QC, Canada
- Université de Montréal, Montréal, QC, Canada
- Université Laval, Quebec, QC, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
- CHU de Québec, Québec, QC, Canada
| |
Collapse
|
2
|
Hines-Stellisch K, Gawlik KS, Teall AM, Tucker S. Implementation of Coaching to Address Burnout in Emergency Clinicians. J Emerg Nurs 2024:S0099-1767(24)00167-3. [PMID: 39046399 DOI: 10.1016/j.jen.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Factors including sleep disturbances, shift work, secondary traumatization, and workplace violence make emergency nurses uniquely susceptible to burnout. A recent study cited nearly half of emergency registered nurses (49.3%) experienced moderate to severe burnout. There is an urgent need for evidence-based solutions to address burnout and turnover in emergency nurses. The objective of this quality improvement project was to determine the effectiveness of a wellness coaching program for reducing burnout and turnover in emergency nurses and advanced practice providers. METHODS Baseline assessments of burnout and turnover intention were measured at the beginning of the coaching program and measured again upon completion of the coaching program. INTERVENTION Eight registered nurses and 2 advanced practice providers from an emergency department in a west coast community hospital completed 6 to 8 weeks of wellness coaching led by a board-certified nurse coach. The wellness coaching program was an evidence-based, modular curriculum in which participants chose the number and length of sessions. RESULTS An average of 6 hours of individualized, 1-on-1 wellness coaching was completed over 7.5 weeks. The project resulted in a large reduction in emotional exhaustion and turnover intention, no effect on depersonalization, and a small reduction in lack of personal achievement (Cohen's d = 0.79, 1.53, -0.18, and -0.35). Ninety percent of clinicians agreed or strongly agreed that coaching helped improve their burnout and said they would consider it again in the future. CONCLUSION This quality improvement project demonstrates wellness coaching was an evidence-based solution for improving burnout and turnover in emergency nurses. More investigation is needed to determine duration of reduction of these outcomes.
Collapse
Affiliation(s)
| | | | - Alice M Teall
- The Ohio State University College of Nursing, Columbus, OH
| | - Sharon Tucker
- Helene Fuld Health National Trust Institute for EBP in Nursing and Healthcare, The Ohio State University College of Nursing, Columbus, OH
| |
Collapse
|
3
|
Zhang Z, Hu Y, Liu S, Feng X, Yang J, Cheng LJ, Ramazanu S, Wu XV. The effectiveness of e-mental health interventions on stress, anxiety, and depression among healthcare professionals: a systematic review and meta-analysis. Syst Rev 2024; 13:144. [PMID: 38816879 PMCID: PMC11138032 DOI: 10.1186/s13643-024-02565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Many healthcare professionals are experiencing psychological distress. Electronic mental health (e-mental health) interventions are convenient and multifunctional. This review aimed to examine the effectiveness of e-mental health interventions in enhancing the well-being of healthcare professionals and to identify moderating factors. METHODS A comprehensive and systematic retrieval of randomized controlled trial (RCT) studies was conducted across eight databases. Population, intervention, comparison, and outcome (PICO) were used to define eligibility criteria. Stress, anxiety, and depression were included as the main outcomes. The overall effect was calculated based on the random effect model, and the effect size was presented using the standardized mean difference. The characteristics of the research design, intervention object, and intervention design were further selected as potential moderating factors for subgroup analysis. Meta-regression analyses were finally performed, incorporating intervention duration and sample size as independent variables. RESULTS A total of 20 studies were included in the systematic review, and 17 were included in the meta-analysis. A large effect on relieving stress and anxiety and a small-to-medium effect on reducing depression were observed. Subgroup analyses showed that features including mindfulness approaches, online courses, computer use, group interventions, and professional guidance were more favorable in the design of services. Meta-regression revealed that intervention duration only affected anxiety symptoms. Caution should be exercised, as some subgroups had fewer studies and higher heterogeneity. For the secondary outcomes, a large effect on emotional exhaustion and a small-to-medium effect on well-being were observed. CONCLUSION In general, e-mental health interventions significantly improve the psychological health of healthcare staff. Future high-quality, large-scale studies targeting healthcare professionals and specific intervention scenarios are warranted.
Collapse
Affiliation(s)
- Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiandong Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhong Yang
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sheena Ramazanu
- School of Nursing and Health Studies, The Jockey Club Institute of Healthcare (IOH), Hong Kong Metropolitan University, Hong Kong, China
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
4
|
Profit J, Cui X, Tawfik D, Adair KC, Sexton JB. "WISER" intervention to reduce healthcare worker burnout - 1 year follow up. J Perinatol 2024:10.1038/s41372-024-01993-5. [PMID: 38734802 DOI: 10.1038/s41372-024-01993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Test sustainability of Web-based Implementation for the Science of Enhancing Resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) emotional exhaustion (EE), a key component of burnout. DESIGN One-year follow-up of WISER RCT using two cohorts (one waitlist control with shortened intervention period) of HCWs of four NICUs each, to improve HCW well-being (primary outcome: EE). RESULTS In Cohorts 1 and 2, 194 and 312 WISER initiators were identified by 1-year, and 99 and 80 completed 1-year follow-up, respectively. Combined cohort results showed that relative to baseline, at 1-year WISER decreased EE (-7.07 (95%CI: -10.22, -3.92), p < 0.001), depression (-4.49 (-6.81, -2.16), p = <0.001), and improved work-life integration (6.08 (4.25, 7.90), p = <0.001). EE continued to decline between 6-month and 1-year follow-up (p = 0.022). The percentage of HCWs reporting concerning outcomes was significantly decreased for EE (-10.9% (95%CI: -17.9%, -4.9%); p < 0.001), and secondary outcomes depression and work-life integration. CONCLUSION WISER improves HCW well-being for at least 1 year. CLINICAL TRIALS NUMBER NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133.
Collapse
Affiliation(s)
- Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
| | - Xin Cui
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Daniel Tawfik
- Division of Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Kathryn C Adair
- Department of Psychiatry, Duke University School of Medicine; Duke University Health System, Durham, NC, USA
- Duke Center for the Advancement of Well-being Science, Duke University Health System, Durham, NC, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine; Duke University Health System, Durham, NC, USA
- Duke Center for the Advancement of Well-being Science, Duke University Health System, Durham, NC, USA
| |
Collapse
|
5
|
Powell M, Sexton B, Adair KC. Self-compassion letter tool for healthcare worker well-being: a qualitative descriptive analysis. BMJ Open 2024; 14:e078784. [PMID: 38580364 PMCID: PMC11002434 DOI: 10.1136/bmjopen-2023-078784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/10/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE This qualitative study aimed to identify categories within therapeutic self-compassion letters written by healthcare workers. Resulting categories were assessed for their relevance to the construct of self-compassion. DESIGN This was a qualitative descriptive study that used summative content analysis and inductive coding. SETTING A US-based academic healthcare system. PARTICIPANTS Healthcare workers who attended a self-compassion webinar were recruited. INTERVENTION The online self-compassion tool asked participants to write a letter to themselves from the perspective of a friend providing support and encouragement. RESULTS 116 letters were analysed. Five major categories emerged: Looking Forward, Reaffirming Self, Reaffirming Reminders, Hardships and Self-Disparagement. Respondents' letters were mostly positively framed and forward thinking, including their hopes of improving themselves and their lives in the future. Negative content generally described hardships and often served to provide self-validation or perspective on obstacles that had been overcome. CONCLUSION The writing prompt elicited content from the writers that reflected the core elements of self-compassion (ie, self-kindness, common humanity, mindfulness). Continued research to further understand, refine and improve the impact of therapeutic letter writing to enhance well-being is warranted to reduce burnout and promote quality patient care.
Collapse
Affiliation(s)
- Melissa Powell
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Bryan Sexton
- Duke Center for the Advancement of Well-Being Science, Duke University, Durham, North Carolina, USA
| | - Kathryn C Adair
- Duke Center for the Advancement of Well-Being Science, Duke University, Durham, North Carolina, USA
| |
Collapse
|
6
|
Arcos D, Russo LN, Kazmierski KFM, Zhou E, Montiel GI, Bracho A, Mejia N, Borelli JL. A Relationship-Based Resilience Program for Promotores: Protocol for a Randomized Controlled Waitlist Trial. JMIR Res Protoc 2023; 12:e51427. [PMID: 38113093 PMCID: PMC10762607 DOI: 10.2196/51427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Community service providers (CSPs) play an integral role in the health care of low-income Hispanic or Latinx (HL) communities. CSPs have high-stress frontline jobs and share the high-risk demographics of their communities. Relational savoring (RS) has been associated with lower cardiovascular reactivity and psychosocial benefits, with particular promise among HL participants. In this study, we aim to identify RS's potential in promoting CSPs' cardiometabolic health and, in so doing, having broader impacts on the community they serve. OBJECTIVE This randomized controlled waitlist study aims to examine the effect of an RS intervention on (1) CSPs' cardiometabolic health (cardiometabolic risk factors and outcomes) and (2) CSPs' threats to leaving the workforce. METHODS We will recruit a sample of 80 CSPs from community health agencies serving low-income HL populations. Participating CSPs will be randomized into an experimental or a waitlist control. Participants will complete 1 or 2 baseline assessment batteries (before the intervention), depending on the assigned group, and then complete 2 more assessment batteries following the 4-week RS intervention (after the intervention and at a 3-mo follow-up). The RS intervention consists of guided reflections on positive moments of connection with others. Electrocardiogram data will be obtained from a wearable device (Polar Verity Sense or Movisens) to measure heart rate variability. The primary outcome is cardiometabolic health, consisting of cardiometabolic risk (obtained from heart rate variability) and cardiometabolic health behaviors. The secondary outcomes include CSPs' threats to leaving the workforce (assessed via psychological well-being), intervention acceptability, and CSPs' delivery of cardiometabolic health programming to the community (exploratory). Analyses of covariance will be used to examine the effects of RS on cardiometabolic health and on CSPs' threats to leaving the workforce, comparing outcomes at baseline, postintervention, and at follow-up across participants in the experimental versus waitlist group. RESULTS The study has been approved by the University of California, Irvine, Institutional Review Board and is currently in the data collection phase. By May 2023, 37 HL CSPs have been recruited: 34 have completed the baseline assessment, 28 have completed the 4 intervention sessions, 27 have completed the posttreatment assessment, and 10 have completed all assessments (including the 3-mo follow-up). CONCLUSIONS This study will provide valuable information on the potential of RS to support cardiometabolic health in HL CSPs and, indirectly, in the communities they serve. TRIAL REGISTRATION ClinicalTrials.gov NCT05560893; https://clinicaltrials.gov/study/NCT05560893. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51427.
Collapse
Affiliation(s)
- Daniela Arcos
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
| | - Lyric N Russo
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
| | - Kelly F M Kazmierski
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
| | - Elayne Zhou
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | | | | | - Nancy Mejia
- Latino Health Access, Santa Ana, CA, United States
| | - Jessica L Borelli
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
| |
Collapse
|
7
|
Min YS, Lee HA, Kwon SC, Lee I, Kim K, Kim JS, Han JH, Lee HY. Occupational and Psychological Factors Associated With Burnout in Night Shift Nurses. Psychiatry Investig 2023; 20:904-911. [PMID: 37899213 PMCID: PMC10620334 DOI: 10.30773/pi.2023.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/12/2023] [Accepted: 06/16/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE Providing inpatient nursing care inevitably involves night shift work. However, night shift work nurses often face psychiatric health problems such as burnout. If night shift work is an essential work type for nurses, it is necessary to select personnel suitable for night shift work or establish improvement measures such as psychiatric intervention through psychiatric evaluation. The objective of this study was to identify factors that could be interventional among factors affecting burnout in shift-working nurses. METHODS A total of 231 night shift female nurses participated in this study. A questionnaire survey was given to assess their general characteristics. To assess burnout, the Maslach Burnout Inventory-General Survey Korean version was adopted. In addition, several mental health scales were used to identify individual psychological characteristics. To identify variables associated with the presence of burnout, odds ratios were calculated using a logistic regression model taking three dimensions of burnout as a dependent variable after adjusting for psychological and occupational factors. RESULTS High resilience was a significant preventive factor in the three dimensions of burnout. Regarding occupational factor, the longer the duration of employment, the higher depersonalization, but the professional efficacy was good. CONCLUSION Our results indicate that resilience and social support could be prevention factors for burnout. This study is meaningful in examining items that require active intervention and support for burnout targeting night shift nurses who are indispensable for patient care.
Collapse
Affiliation(s)
- Young-Sun Min
- Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hyeon-Ah Lee
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Soon-Chan Kwon
- Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Inho Lee
- Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Kiseok Kim
- Department of Occupational and Environmental Medicine, Cheonan Woori Hospital, Cheonan, Republic of Korea
| | - Ji Sun Kim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jae Hyun Han
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hwa-Young Lee
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| |
Collapse
|
8
|
Iyadurai L, Highfield J, Kanstrup M, Markham A, Ramineni V, Guo B, Jaki T, Kingslake J, Goodwin GM, Summers C, Bonsall MB, Holmes EA. Reducing intrusive memories after trauma via an imagery-competing task intervention in COVID-19 intensive care staff: a randomised controlled trial. Transl Psychiatry 2023; 13:290. [PMID: 37658043 PMCID: PMC10474101 DOI: 10.1038/s41398-023-02578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/03/2023] Open
Abstract
Intrusive memories (IMs) after traumatic events can be distressing and disrupt mental health and functioning. We evaluated the impact of a brief remotely-delivered digital imagery-competing task intervention on the number of IMs for intensive care unit (ICU) staff who faced repeated trauma exposure during the COVID-19 pandemic using a two-arm, parallel-group, single-blind randomised controlled trial, with the comparator arm receiving delayed access to active treatment (crossover). Eligible participants worked clinically in a UK NHS ICU during the pandemic and had at least 3 IMs of work-related traumatic events in the week before recruitment. Participants were randomly assigned (1:1) to immediate (weeks 1-4) or delayed (weeks 5-8) intervention access. Sequential Bayesian analyses to optimise the intervention and increase trial efficiency are reported elsewhere [1]. The primary endpoint for the pre-specified frequentist analysis of the final study population compared the number of IMs experienced in week 4 between the immediate and delayed access arms. Secondary outcomes included clinical symptoms, work functioning and wellbeing. Safety was assessed throughout the trial by scheduled questions and free report. All analyses were undertaken on an intention-to-treat basis (86 randomised participants). There were significantly fewer intrusive memories during week 4 in the immediate (median = 1, IQR = 0-3, n = 43), compared to the comparator delayed arm (median = 10, IQR = 6-17, n = 43), IRR 0.31, 95% CI: 0.20-0.48, p < 0.001. After crossover, the delayed arm also showed a significant reduction in IMs at week 8 compared to week 4. There were convergent findings for symptoms of PTSD, insomnia and anxiety, work engagement and burnout, general functioning and quality of life. The intervention was found safe and acceptable to participants. All adverse events were unrelated to the study. Our study provides the first evidence of a benefit on reducing IMs, improving other clinical symptoms, work functioning and wellbeing, as well as safety of a brief remotely-delivered digital imagery-competing task intervention. An efficacy trial with an active control and longer follow-up is warranted. The trial is registered at ClinicalTrials.gov (NCT04992390).
Collapse
Affiliation(s)
| | | | - Marie Kanstrup
- Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden
| | | | - Varsha Ramineni
- P1vital Products Ltd, Wallingford, Oxfordshire, UK
- Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden
| | - Boliang Guo
- NIHR ARC East Midlands, University of Nottingham, Nottingham, UK
| | - Thomas Jaki
- MRC Biostatistics Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
- University of Regensburg, Regensburg, Bavaria, Germany
| | | | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - Charlotte Summers
- Heart and Lung Research Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Michael B Bonsall
- Department of Biology, University of Oxford, Oxford, Oxfordshire, UK
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden.
| |
Collapse
|
9
|
Shiri R, Nikunlaakso R, Laitinen J. Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials. Healthcare (Basel) 2023; 11:1792. [PMID: 37372909 DOI: 10.3390/healthcare11121792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.
Collapse
Affiliation(s)
- Rahman Shiri
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| | - Risto Nikunlaakso
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| | - Jaana Laitinen
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| |
Collapse
|
10
|
Sexton JB, Frankel A. Leaders That Listen Meet Essential Psychological Needs of the Workforce. Mayo Clin Proc 2023; 98:823-825. [PMID: 37270268 DOI: 10.1016/j.mayocp.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 06/05/2023]
Affiliation(s)
- J Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Durham, NC; Duke Center for the Advancement of Well-being Science, Durham, NC; Duke University Health System, Durham, NC.
| | | |
Collapse
|
11
|
Tamminga SJ, Emal LM, Boschman JS, Levasseur A, Thota A, Ruotsalainen JH, Schelvis RM, Nieuwenhuijsen K, van der Molen HF. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev 2023; 5:CD002892. [PMID: 37169364 PMCID: PMC10175042 DOI: 10.1002/14651858.cd002892.pub6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions. OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms. SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. SELECTION CRITERIA We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour); 2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise); 3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended). MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention. A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar. AUTHORS' CONCLUSIONS Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.
Collapse
Affiliation(s)
- Sietske J Tamminga
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lima M Emal
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Julitta S Boschman
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Alice Levasseur
- Faculté des sciences de l'éducation, Université Laval, Québec, Canada
| | | | - Jani H Ruotsalainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Roosmarijn Mc Schelvis
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Body@Work, Research Center on Work, Health and Technology, TNO/VUmc, Amsterdam, Netherlands
| | - Karen Nieuwenhuijsen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| |
Collapse
|
12
|
Almeida C, Poeira AF. Burnout in Nurses of an Intensive Care Unit during COVID-19: A Pilot Study in Portugal. Healthcare (Basel) 2023; 11:healthcare11091233. [PMID: 37174776 PMCID: PMC10177748 DOI: 10.3390/healthcare11091233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND This study aimed to evaluate burnout in intensive care unit nurses and describe the relationship between burnout dimensions and sociodemographic and professional variables. METHODS A pilot study was carried out with 29 intensive care nurses during the COVID-19 pandemic. The data were collected using an online questionnaire consisting of a sociodemographic characterization and the Maslach Burnout Inventory Human Services Survey. In the comparative statistical analysis, the nonparametric Mann-Whitney and Kruskal-Wallis tests were used (p < 0.05). RESULTS The Emotional Exhaustion dimension represented an average of 27.9 ± 10.4, and the Personal Fulfillment of 30.8 ± 7.0 was considered high. Regarding Depersonalization, medium-level results (8.1 ± 6.0) were found. There was a prevalence of 41.3% of high levels of burnout. There was no statistically significant difference in the comparison between the three dimensions and sociodemographic and professional variables (p > 0.05). CONCLUSIONS The global results point to high levels of burnout in nurses, with greater expression in the Emotional Exhaustion and Professional Fulfillment domains. There were no differences between groups, demonstrating homogeneity in the team's level of burnout. The incidence of burnout in this study was higher than that identified in other studies carried out in Portugal with health professionals. This pilot study will allow the defining of strategies for reducing burnout and, consequently, a proposed extension of the study to other organization wards.
Collapse
Affiliation(s)
| | - Ana Filipa Poeira
- Instituto Politécnico de Setúbal, ESS, NURSE'IN-UIESI, 2900 Setúbal, Portugal
| |
Collapse
|
13
|
Green J, Berdahl CT, Ye X, Wertheimer JC. The impact of positive reinforcement on teamwork climate, resiliency, and burnout during the COVID-19 pandemic: The TEAM-ICU (Transforming Employee Attitudes via Messaging strengthens Interconnection, Communication, and Unity) pilot study. J Health Psychol 2023; 28:267-278. [PMID: 35723168 PMCID: PMC9982400 DOI: 10.1177/13591053221103640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Burnout is an internationally recognized occupational phenomenon that negatively impacts the healthcare workforce and its recipients. The aim of this pilot study was to test whether positive reinforcement and integrating a language of support among co-workers can enhance resiliency, facilitate psychological wellness, and encourage hope. This embedded mixed methods prospective, behavioral, interventional study evaluated the effects of positive feedback on wellness among intensive care unit clinicians during the COVID-19 pandemic in a single center, quaternary care medical center. The deliberate positive feedback paradigm has the potential to augment resiliency and improve attitudes toward a teamwork climate. The routine use of deliberate positivity may represent a scalable, low-cost initiative to enhance wellness in a healthcare organization.
Collapse
Affiliation(s)
| | | | - Xin Ye
- Cedars-Sinai Medical Center, USA
| | | |
Collapse
|
14
|
Shanafelt TD, Larson D, Bohman B, Roberts R, Trockel M, Weinlander E, Springer J, Wang H, Stolz S, Murphy D. Organization-Wide Approaches to Foster Effective Unit-Level Efforts to Improve Clinician Well-Being. Mayo Clin Proc 2023; 98:163-180. [PMID: 36603944 DOI: 10.1016/j.mayocp.2022.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023]
Abstract
Health care delivery organizations are positioned to have a tremendous impact on addressing the variables in the practice environment that contribute to occupational distress and that, when optimized, can promote clinician well-being. Many organizations are committed to this work and have clarity on how to address general, system-wide issues and provide resources for individual clinicians. While such top of the organization elements are essential for success, many of the specific improvement efforts that are necessary must address local challenges at the work unit level (department, division, hospital ward, clinic). Uncertainty of how to address variability and the unique needs of different work units is a barrier to effective action for many health care delivery systems. Overcoming this challenge requires organizations to recognize that unit-specific improvement efforts require a system-level approach. In this manuscript, we outline 7 steps for organizations to consider as they establish the infrastructure to improve professional well-being and provide a description of application and evidence of efficacy from a large academic medical center. Such unit-level efforts to address the unique needs of each specialty and occupation at the work unit level have the ability to address many of the day-to-day issues that drive clinician well-being. An enterprise approach is necessary to systematically advance such unit-level action.
Collapse
Affiliation(s)
- Tait D Shanafelt
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA.
| | - David Larson
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bryan Bohman
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Rachel Roberts
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mickey Trockel
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Eva Weinlander
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jill Springer
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Hanhan Wang
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Sherilyn Stolz
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Daniel Murphy
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
15
|
Belz FF, Adair KC, Proulx J, Frankel AS, Sexton JB. The language of healthcare worker emotional exhaustion: A linguistic analysis of longitudinal survey. Front Psychiatry 2022; 13:1044378. [PMID: 36590605 PMCID: PMC9800594 DOI: 10.3389/fpsyt.2022.1044378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Importance Emotional exhaustion (EE) rates in healthcare workers (HCWs) have reached alarming levels and been linked to worse quality of care. Prior research has shown linguistic characteristics of writing samples can predict mental health disorders. Understanding whether linguistic characteristics are associated with EE could help identify and predict EE. Objectives To examine whether linguistic characteristics of HCW writing associate with prior, current, and future EE. Design setting and participants A large hospital system in the Mid-West had 11,336 HCWs complete annual quality improvement surveys in 2019, and 10,564 HCWs in 2020. Surveys included a measure of EE, an open-ended comment box, and an anonymous identifier enabling HCW responses to be linked across years. Linguistic Inquiry and Word Count (LIWC) software assessed the frequency of one exploratory and eight a priori hypothesized linguistic categories in written comments. Analysis of covariance (ANCOVA) assessed associations between these categories and past, present, and future HCW EE adjusting for the word count of comments. Comments with <20 words were excluded. Main outcomes and measures The frequency of the linguistic categories (word count, first person singular, first person plural, present focus, past focus, positive emotion, negative emotion, social, power) in HCW comments were examined across EE quartiles. Results For the 2019 and 2020 surveys, respondents wrote 3,529 and 3,246 comments, respectively, of which 2,101 and 1,418 comments (103,474 and 85,335 words) contained ≥20 words. Comments using more negative emotion (p < 0.001), power (i.e., references relevant to status, dominance, and social hierarchies, e.g., own, order, and allow) words (p < 0.0001), and words overall (p < 0.001) were associated with higher current and future EE. Using positive emotion words (p < 0.001) was associated with lower EE in 2019 (but not 2020). Contrary to hypotheses, using more first person singular (p < 0.001) predicted lower current and future EE. Past and present focus, first person plural, and social words did not predict EE. Current EE did not predict future language use. Conclusion Five linguistic categories predicted current and subsequent HCW EE. Notably, EE did not predict future language. These linguistic markers suggest a language of EE, offering insights into EE's etiology, consequences, measurement, and intervention. Future use of these findings could include the ability to identify and support individuals and units at high risk of EE based on their linguistic characteristics.
Collapse
Affiliation(s)
- Franz F. Belz
- Duke School of Medicine, Duke University, Durham, NC, United States
| | - Kathryn C. Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| | - Joshua Proulx
- Safe and Reliable Healthcare, Evergreen, CO, United States
| | | | - J. Bryan Sexton
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| |
Collapse
|
16
|
Sexton JB, Adair KC, Cui X, Tawfik DS, Profit J. Effectiveness of a bite-sized web-based intervention to improve healthcare worker wellbeing: A randomized clinical trial of WISER. Front Public Health 2022; 10:1016407. [PMID: 36568789 PMCID: PMC9773843 DOI: 10.3389/fpubh.2022.1016407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
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).
Collapse
Affiliation(s)
- J. Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States,*Correspondence: J. Bryan Sexton
| | - Kathryn C. Adair
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| | - Xin Cui
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States,California Perinatal Quality Care Collaborative, Palo Alto, CA, United States
| | - Daniel S. Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States,California Perinatal Quality Care Collaborative, Palo Alto, CA, United States
| |
Collapse
|
17
|
McClafferty HH, Hubbard DK, Foradori D, Brown ML, Profit J, Tawfik DS. Physician Health and Wellness. Pediatrics 2022; 150:189767. [PMID: 36278292 DOI: 10.1542/peds.2022-059665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.
Collapse
Affiliation(s)
- Hilary H McClafferty
- Department of Pediatrics, Section Chief, Pediatric Emergency Medicine, Tucson Medical Center, Tucson, Arizona
| | - Dena K Hubbard
- Children's Mercy Kansas City, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Dana Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Melanie L Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel S Tawfik
- Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | |
Collapse
|
18
|
Sexton JB, Adair KC, Proulx J, Profit J, Cui X, Bae J, Frankel A. Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021. JAMA Netw Open 2022; 5:e2232748. [PMID: 36129705 PMCID: PMC9494188 DOI: 10.1001/jamanetworkopen.2022.32748] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- J. Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
- Duke University Health System, Durham, North Carolina
| | - Kathryn C. Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
- Duke University Health System, Durham, North Carolina
| | - Joshua Proulx
- Safe & Reliable Healthcare, LLC, Evergreen, Colorado
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
- California Perinatal Quality Care Collaborative, Palo Alto, California
| | - Xin Cui
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
- California Perinatal Quality Care Collaborative, Palo Alto, California
| | - Jon Bae
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
- Duke University Health System, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Allan Frankel
- Safe & Reliable Healthcare, LLC, Evergreen, Colorado
| |
Collapse
|
19
|
Joshi SP, Wong AKI, Brucker A, Ardito TA, Chow SC, Vaishnavi S, Lee PJ. Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231917. [PMID: 36121655 PMCID: PMC9486450 DOI: 10.1001/jamanetworkopen.2022.31917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress. OBJECTIVE To assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period. DESIGN, SETTING, AND PARTICIPANTS This single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group). INTERVENTIONS The TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources. MAIN OUTCOMES AND MEASURES The primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale). RESULTS Among 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (-5.6 points vs -3.8 points; between-group difference, -1.8 points; 95% CI, -4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: -8.0 points vs -2.6 points; between-group difference, -5.4 points; 95% CI, -9.2 to -1.6 points; P = .006), insomnia (Insomnia Severity Scale score: -4.1 points vs -1.9 points; between-group difference, -2.2 points; 95% CI, -4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: -3.1 points vs -0.9 points; between-group difference, -2.2 points; 95% CI, -3.8 to -0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04632368.
Collapse
Affiliation(s)
- Sangeeta P. Joshi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - An-Kwok Ian Wong
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Amanda Brucker
- Section of Pulmonary and Critical Care, Durham Veterans Administration Medical Center, Durham, North Carolina
| | - Taylor A. Ardito
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sandeep Vaishnavi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
- Mindpath Health, Raleigh, North Carolina
| | - Patty J. Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
- Section of Pulmonary and Critical Care, Durham Veterans Administration Medical Center, Durham, North Carolina
| |
Collapse
|
20
|
Grunberg VA, Vranceanu AM, Lerou PH. Caring for our caretakers: building resiliency in NICU parents and staff. Eur J Pediatr 2022; 181:3545-3548. [PMID: 35804198 PMCID: PMC9395886 DOI: 10.1007/s00431-022-04553-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED The neonatal intensive care unit (NICU) is a high-acuity, stressful unit for both parents and staff. Up to 50% of mothers and partners experience emotional distress (i.e., depression, anxiety, or posttraumatic stress) during NICU hospitalization and 30-60% continue to experience distress after discharge. Similarly, up to 50% of NICU staff report burnout and emotional distress. Although healthcare providers have developed interdisciplinary guidelines to enhance psychosocial resources for parents and staff, standardized psychosocial services are lacking. The purpose of this short communication is to describe: (1) the need for psychosocial interventions for NICU parents and staff; (2) existent psychosocial programs and their gaps and limitations; and (3) future directions for psychosocial care in NICU settings. We reviewed the current literature and propose a new conceptual model to inform psychosocial interventions for the NICU. We argue that brief, evidence-based, resiliency, and relationship-based programs are needed to enhance parent and staff outcomes and, ultimately, child development and the NICU unit culture. CONCLUSION Given the lack of standardized psychosocial care, new interventions for NICU families and staff are needed more than ever. Resiliency, relationship-based interventions that leverage multidisciplinary support may be an innovative way to enhance NICU outcomes and care. WHAT IS KNOWN • 40-50% of parents in the NICU report elevated emotional distress and 30-50% of staff report burnout. • Psychosocial interventions for parents and staff are needed, yet lacking. WHAT IS NEW • Interventions that focus on resiliency and relationships may improve the culture of the NICU. • New multidisciplinary collaborations and approaches are needed to improve implementation.
Collapse
Affiliation(s)
- Victoria A. Grunberg
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Harvard Medical School, Boston, MB USA ,Division of Newborn Medicine, MassGeneral for Children, Harvard Medical School, Boston, MA USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Harvard Medical School, Boston, MB USA
| | - Paul H. Lerou
- Division of Newborn Medicine, MassGeneral for Children, Harvard Medical School, Boston, MA USA
| |
Collapse
|