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Mujuru C, Peisah C. Beyond error: A qualitative study of human factors in serious adverse events. J Healthc Risk Manag 2024. [PMID: 39259610 DOI: 10.1002/jhrm.21583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/26/2024] [Accepted: 08/06/2024] [Indexed: 09/13/2024]
Abstract
The field of healthcare quality and safety has been informed by the study of Human Factors contributing to adverse events. Hitherto, much of the study of Human Factors has been focused on a narrow lens of human error, identifying cognitive-based or knowledge-based errors and cognitive processes such as loss of situational awareness contributing to error. While these factors are important, this narrow approach fails to consider the complexity of relational and systemic factors that also contribute to adverse events. We aimed to explore the relational and systemic human factors, including shared clinician attitudes and behavior, that contribute to serious adverse patient events in a public health setting. The study, set in a metropolitan local health district in New South Wales, Australia, was conducted using a retrospective qualitative multi-incident content analysis design. Serious adverse event reviews (SAER) over 6 months (2022-2023) were subject to qualitative content analysis until data saturation was reached. Data saturation reached at 20 reports. Emergent themes related to human factors in serious adverse events included: (i) delays and inertia-with a subtheme of inertia of ageism; (ii) "All-or-nothing" approach to end-of-life care and planning; (iii) communication lapses; and (iv) implementation gap between standards and practice. Error-based incidents accounted for only 35% of the serious adverse events examined. The sample studied involved mostly (65%) male patients, with a mean age of 69 (70% aged >65), managed across the gamut of specialties, with the most common incident being the management of acutely deteriorating patients. In conclusion, there is more to Human Factors in adverse events than cognitive or knowledge-based error. While identifying and correcting errors is absolutely essential, we need adjunctive "soft measures" to address clinical attitudes, behaviors, and relationships in health care, particularly in increasingly complex, fraught, and stressful health care environments.
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Affiliation(s)
| | - Carmelle Peisah
- Faculty of Medicine and Health, Psychiatry Specialty, University of Sydney, Sydney, Australia
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
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2
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Dean W, Morris D, Llorca PM, Talbot SG, Fond G, Duclos A, Boyer L. Moral Injury and the Global Health Workforce Crisis - Insights from an International Partnership. N Engl J Med 2024; 391:782-785. [PMID: 39216090 DOI: 10.1056/nejmp2402833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Wendy Dean
- From Moral Injury of Healthcare, Carlisle, PA (W.D.); the Centre for Developmental and Complex Trauma, St. Andrew's Healthcare, Northampton, United Kingdom (D.M.); the Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand (P.-M.L.), the FondaMental Foundation, Créteil (P.-M.L.), the Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille (G.F., L.B.), and Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon (A.D.) - all in France; and the Division of Plastic Surgery, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.G.T.)
| | - Deborah Morris
- From Moral Injury of Healthcare, Carlisle, PA (W.D.); the Centre for Developmental and Complex Trauma, St. Andrew's Healthcare, Northampton, United Kingdom (D.M.); the Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand (P.-M.L.), the FondaMental Foundation, Créteil (P.-M.L.), the Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille (G.F., L.B.), and Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon (A.D.) - all in France; and the Division of Plastic Surgery, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.G.T.)
| | - Pierre-Michel Llorca
- From Moral Injury of Healthcare, Carlisle, PA (W.D.); the Centre for Developmental and Complex Trauma, St. Andrew's Healthcare, Northampton, United Kingdom (D.M.); the Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand (P.-M.L.), the FondaMental Foundation, Créteil (P.-M.L.), the Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille (G.F., L.B.), and Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon (A.D.) - all in France; and the Division of Plastic Surgery, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.G.T.)
| | - Simon G Talbot
- From Moral Injury of Healthcare, Carlisle, PA (W.D.); the Centre for Developmental and Complex Trauma, St. Andrew's Healthcare, Northampton, United Kingdom (D.M.); the Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand (P.-M.L.), the FondaMental Foundation, Créteil (P.-M.L.), the Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille (G.F., L.B.), and Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon (A.D.) - all in France; and the Division of Plastic Surgery, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.G.T.)
| | - Guillaume Fond
- From Moral Injury of Healthcare, Carlisle, PA (W.D.); the Centre for Developmental and Complex Trauma, St. Andrew's Healthcare, Northampton, United Kingdom (D.M.); the Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand (P.-M.L.), the FondaMental Foundation, Créteil (P.-M.L.), the Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille (G.F., L.B.), and Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon (A.D.) - all in France; and the Division of Plastic Surgery, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.G.T.)
| | - Antoine Duclos
- From Moral Injury of Healthcare, Carlisle, PA (W.D.); the Centre for Developmental and Complex Trauma, St. Andrew's Healthcare, Northampton, United Kingdom (D.M.); the Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand (P.-M.L.), the FondaMental Foundation, Créteil (P.-M.L.), the Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille (G.F., L.B.), and Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon (A.D.) - all in France; and the Division of Plastic Surgery, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.G.T.)
| | - Laurent Boyer
- From Moral Injury of Healthcare, Carlisle, PA (W.D.); the Centre for Developmental and Complex Trauma, St. Andrew's Healthcare, Northampton, United Kingdom (D.M.); the Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand (P.-M.L.), the FondaMental Foundation, Créteil (P.-M.L.), the Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille (G.F., L.B.), and Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon (A.D.) - all in France; and the Division of Plastic Surgery, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.G.T.)
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Cunningham AT, Waters A, Shah D, Arefi P, Sifri RD. Primary Care Provider and Staff Wellness and Burnout Levels and Suggestions to Improve Wellness: Analysis of Survey Findings. Am J Med Qual 2024; 39:209-219. [PMID: 39268904 DOI: 10.1097/jmq.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Primary care provider and staff burnout is high, although less research exists comparing burnout by role. The objectives of this study were to characterize primary care provider and staff wellness and burnout and provide suggestions to improve wellness in a large network. Survey items included demographics, the Perceived Stress Reactivity Subscale, abbreviated Maslach Burnout Inventory, Mini-Z burnout survey, self-reported wellness, and one open-ended question asking what would improve their work-related wellness. Surveys were disseminated in February 2021, October 2021, and June 2022. Responses were analyzed by demographic categories. Open-ended responses were coded. In total 1015 responses were recorded (29.5% response rate). Burnout varied by role and campus. The 677 open-ended comments had six main themes for improving wellness: Staffing, Health System, Practice, Training, Incentives, and Miscellaneous. Primary care providers/staff reported varying, consistent levels of burnout. They suggested practice and system-level changes including increased staffing, schedule changes and improved communication.
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Affiliation(s)
- Amy T Cunningham
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Zuniga JM, Prachniak C, Policek N, Magula N, Gandhi A, Anderson J, Diallo DD, Lima VD, Ravishankar S, Acharya S, Achrekar A, Adeleke M, Aïna É, Baptiste S, Barrow G, Begovac J, Bukusi E, Castel A, Castellanos E, Cestou J, Chirambo G, Crowley J, Dedes N, Ditiu L, Doherty M, Duncombe C, Durán A, Futterman D, Hader S, Kounkeu C, Lawless F, Lazarus JV, Lex S, Lobos C, Mayer K, Mejia M, Moheno HR, d'Arminio Monforte A, Morán-Arribas M, Nagel D, Ndugwa R, Ngunu C, Poonkasetwattana M, Prins M, Quesada A, Rudnieva O, Ruth S, Saavedra J, Toma L, Wanjiku Njenga L, Williams B. IAPAC-Lancet HIV Commission on the future of urban HIV responses. Lancet HIV 2024; 11:e607-e648. [PMID: 39043198 DOI: 10.1016/s2352-3018(24)00124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 07/25/2024]
Affiliation(s)
- José M Zuniga
- International Association of Providers of AIDS Care, Washington, DC, USA; Fast-Track Cities Institute, Washington, DC, USA.
| | | | | | | | - Anisha Gandhi
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Solange Baptiste
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | | | | | - Elizabeth Bukusi
- Kenya Medical Research Institute, Nairobi, Kenya; University of Nairobi, Nairobi, Kenya
| | | | | | - Jorge Cestou
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | | | | | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Chris Duncombe
- International Association of Providers of AIDS Care, Washington, DC, USA
| | - Adriana Durán
- Ministry of Health, City of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Chyrol Kounkeu
- Cameroonian Association for the Development and Empowerment of Vulnerable People, Yaoundé, Cameroon
| | - Fran Lawless
- Mayor's Office of Health Policy, New Orleans, LA, USA
| | - Jeffrey V Lazarus
- University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | | | | | - Kenneth Mayer
- Fenway Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Carol Ngunu
- Nairobi City County Department of Health, Nairobi, Kenya
| | | | - Maria Prins
- Academic Medical Center, Amsterdam, Netherlands
| | - Amara Quesada
- Action for Health Initiatives, Quezon City, Philippines
| | | | - Simon Ruth
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Lance Toma
- San Francisco Community Health Center, San Francisco, CA, USA
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Wocial LD, Miller G, Montz K, LaPradd M, Slaven JE. Evaluation of Interventions to Address Moral Distress: A Multi-method Approach. HEC Forum 2024; 36:373-401. [PMID: 37428252 PMCID: PMC11283389 DOI: 10.1007/s10730-023-09508-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/11/2023]
Abstract
Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs' perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants' moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and explored participants' perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses.
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Affiliation(s)
- Lucia D Wocial
- Medstar Washington Hospital Center, John J. Lynch, MD Center for Ethics, 110 Irving Street, NW EB 310, Washington, DC, 20002, USA.
- Fairbanks Center for Medical Ethics, Charles Warren, Indianapolis, IN, USA.
| | - Genina Miller
- Fairbanks Center for Medical Ethics, Charles Warren, Indianapolis, IN, USA
- Indiana University Health, Indianapolis, IN, USA
| | - Kianna Montz
- Fairbanks Center for Medical Ethics, Charles Warren, Indianapolis, IN, USA
- Indiana University Health, Indianapolis, IN, USA
| | | | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University, Bloomington, IN, USA
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Pescosolido BA. A network frame offers a promising transdisciplinary tool for understanding complex health and health care system problems like suicide. Proc Natl Acad Sci U S A 2024; 121:e2402194121. [PMID: 39136988 PMCID: PMC11348096 DOI: 10.1073/pnas.2402194121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/08/2024] [Indexed: 08/29/2024] Open
Abstract
As health and health care systems continue to face massive challenges from local to global well-being, understanding the processes that lead to improvement or deterioration in human health has embraced a broad range of forces from genes to national cultures. Despite the many efforts to deploy a common framework that captures diverse drivers at scale, the common missing element is the absence of a flexible mechanism that can guide research within and across levels. This hinders both the cumulation of knowledge and the development of a scientific foundation for multiplex interventions. However, studies across disciplines using a wide variety of methods and measures have converged on "connectedness" as crucial to understanding how factors operate in the health space. More formally, a focus on the critical role of the network structure and content of key elements and how they interact, rather than just on the elements themselves, offers both a generalized theory of active factors within levels and the potential to theorize interactions across levels. One critical contemporary health crisis, suicide, is deployed to illustrate the Network Embedded Symbiome Framework. The wide range of health and health care research where networks have been implicated supports its potential but also cautions against inevitable limits that will require creative theorizing and data harmonization to move forward.
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Affiliation(s)
- Bernice A. Pescosolido
- Department of Sociology, Indiana University, Bloomington, IN47405
- Irsay Institute for Sociomedical Sciences, Indiana University, Bloomington, IN47405
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Brophy JT, Keith MM, Hurley M, Slatin C. Running on Empty: Ontario Hospital Workers' Mental Health and Well-Being Deteriorating Under Austerity-Driven System. New Solut 2024:10482911241267347. [PMID: 39113552 DOI: 10.1177/10482911241267347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
The well-being of health care workers (HCWs) and the public in Ontario, Canada is at risk as the province's health care system is strained by neoliberal restructuring and an aging population. Deteriorating working conditions that preceded the COVID-19 pandemic further declined as the added challenges took their toll on the work force, physically and mentally. The pandemic-weary hospital staff, predominantly women, many racialized, are facing unprecedented challenges. They are experiencing stress, anxiety, and burnout from staffing shortages and the resulting increased workloads, long hours, and violence. Comprehensive telephone interviews were conducted with 26 HCWs from less highly paid occupations in a range of hospitals across the province. Thematic analysis reveals a critical need for policies and legislation ensuring increased funding, hospital capacity, and reduced wait times while providing HCWs with fair and equitable wages, increased staffing, mental health supports, greater respect and acknowledgment, and strong protections from violence and other workplace hazards.
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Affiliation(s)
- James T Brophy
- Sociology and Criminology, University of Windsor, Windsor, Canada
- Sociology, Athabasca University, Athabasca, Canada
| | - Margaret M Keith
- Sociology and Criminology, University of Windsor, Windsor, Canada
| | - Michael Hurley
- Ontario Council of Hospital Unions/Canadian Union of Public Employees, Toronto, Canada
| | - Craig Slatin
- Public Health, University of Massachusetts Lowell, Lowell, USA
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Barak-Corren Y, Wolf R, Rozenblum R, Creedon JK, Lipsett SC, Lyons TW, Michelson KA, Miller KA, Shapiro DJ, Reis BY, Fine AM. Harnessing the Power of Generative AI for Clinical Summaries: Perspectives From Emergency Physicians. Ann Emerg Med 2024; 84:128-138. [PMID: 38483426 DOI: 10.1016/j.annemergmed.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 04/14/2024]
Abstract
STUDY OBJECTIVE The workload of clinical documentation contributes to health care costs and professional burnout. The advent of generative artificial intelligence language models presents a promising solution. The perspective of clinicians may contribute to effective and responsible implementation of such tools. This study sought to evaluate 3 uses for generative artificial intelligence for clinical documentation in pediatric emergency medicine, measuring time savings, effort reduction, and physician attitudes and identifying potential risks and barriers. METHODS This mixed-methods study was performed with 10 pediatric emergency medicine attending physicians from a single pediatric emergency department. Participants were asked to write a supervisory note for 4 clinical scenarios, with varying levels of complexity, twice without any assistance and twice with the assistance of ChatGPT Version 4.0. Participants evaluated 2 additional ChatGPT-generated clinical summaries: a structured handoff and a visit summary for a family written at an 8th grade reading level. Finally, a semistructured interview was performed to assess physicians' perspective on the use of ChatGPT in pediatric emergency medicine. Main outcomes and measures included between subjects' comparisons of the effort and time taken to complete the supervisory note with and without ChatGPT assistance. Effort was measured using a self-reported Likert scale of 0 to 10. Physicians' scoring of and attitude toward the ChatGPT-generated summaries were measured using a 0 to 10 Likert scale and open-ended questions. Summaries were scored for completeness, accuracy, efficiency, readability, and overall satisfaction. A thematic analysis was performed to analyze the content of the open-ended questions and to identify key themes. RESULTS ChatGPT yielded a 40% reduction in time and a 33% decrease in effort for supervisory notes in intricate cases, with no discernible effect on simpler notes. ChatGPT-generated summaries for structured handoffs and family letters were highly rated, ranging from 7.0 to 9.0 out of 10, and most participants favored their inclusion in clinical practice. However, there were several critical reservations, out of which a set of general recommendations for applying ChatGPT to clinical summaries was formulated. CONCLUSION Pediatric emergency medicine attendings in our study perceived that ChatGPT can deliver high-quality summaries while saving time and effort in many scenarios, but not all.
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Affiliation(s)
- Yuval Barak-Corren
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Rebecca Wolf
- Emergency Medicine Boston Children's Hospital, Boston, MA
| | - Ronen Rozenblum
- Harvard Medical School Boston, MA; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Jessica K Creedon
- Emergency Medicine Boston Children's Hospital, Boston, MA; Harvard Medical School Boston, MA
| | - Susan C Lipsett
- Emergency Medicine Boston Children's Hospital, Boston, MA; Harvard Medical School Boston, MA
| | - Todd W Lyons
- Emergency Medicine Boston Children's Hospital, Boston, MA; Harvard Medical School Boston, MA
| | | | - Kelsey A Miller
- Emergency Medicine Boston Children's Hospital, Boston, MA; Harvard Medical School Boston, MA
| | - Daniel J Shapiro
- Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, CA
| | - Ben Y Reis
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA; Harvard Medical School Boston, MA
| | - Andrew M Fine
- Emergency Medicine Boston Children's Hospital, Boston, MA; Harvard Medical School Boston, MA
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Brooks Carthon JM, Brom H, Maye A, Iroegbu C, Gil J, Rizzo J, Amenyedor K, Montalvo W, Villarruel AM. Burnout and psychological distress among Hispanic nurses across Illinois and New York hospitals: Implications for structural and person-centered solutions. Nurs Outlook 2024; 72:102234. [PMID: 38991236 DOI: 10.1016/j.outlook.2024.102234] [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: 03/06/2024] [Revised: 06/17/2024] [Accepted: 06/22/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Despite high levels of burnout and psychological distress among nurses, few studies have evaluated these outcomes among Hispanic nurses. PURPOSE To evaluate the differences in job-related and psychological well-being outcomes for Hispanic and non-Hispanic White nurses and the association of nurse work environments. METHODS Cross-sectional analysis of the 2021 RN4CAST-New York-Illinois nurse survey. Multilevel logistic regression models examined the association between nurse ethnicity and job-related outcomes and psychological well-being. DISCUSSION Our sample included 798 (10.7%) Hispanic and 6,642 (89.3%) non-Hispanic White nurses in 249 hospitals. In unadjusted models, Hispanic ethnicity was associated with higher odds of burnout (odds ratio (OR) 1.21, 95% confidence interval (CI): 1.03-1.42), which diminished when considering the work environment (OR 1.16, 95% CI: 1.01-1.35) and nurse characteristics (i.e., age) (OR 1.01, 95% CI: 0.83-1.21). CONCLUSION Equity-driven solutions to support the well-being of Hispanic nurses should consider a focus on the needs of young Hispanic nurses and include increased support in work environments.
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Affiliation(s)
- J Margo Brooks Carthon
- University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Heather Brom
- University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Alexandra Maye
- University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Christin Iroegbu
- University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Jennifer Gil
- University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - John Rizzo
- University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | | | - Wanda Montalvo
- National Association of Community Health Centers, Bethesda, MD
| | - Antonia M Villarruel
- University of Pennsylvania School of Nursing, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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10
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O’Brien BC, Collins S, Haddock LM, Sani S, Rivera JA. More Than Maintaining Competence: A Qualitative Study of How Physicians Conceptualize and Engage in Lifelong Learning. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:380-391. [PMID: 38974779 PMCID: PMC11225866 DOI: 10.5334/pme.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 06/19/2024] [Indexed: 07/09/2024]
Abstract
Purpose Physicians have a professional responsibility to engage in lifelong learning. Some of this lifelong learning is required to maintain licensure and certification. Yet, this conceptualization captures only a small portion of the content areas and learning processes that physicians need to engage with to ensure quality patient care. Additionally, purposes beyond regulatory requirements and professional obligations likely drive physicians lifelong learning, though these purposes have not been explored. Given the centrality of lifelong learning to quality patient care, our study explores how physicians conceptualize and engage in lifelong learning. Method We conducted a qualitative interview study using an interpretivist approach. In 2019, we recruited 34 academic physicians from one institution. We analyzed our data to identify themes related to conceptualization of purposes, content areas, and processes of lifelong learning and actual lifelong learning practices. Results We interpreted participants' descriptions and examples of lifelong learning as serving three purposes: maintaining competence, supporting personal growth and fulfillment, and engaging in professional stewardship. Much of participants' discussion of lifelong learning centered around keeping up to date with medical knowledge and clinical/procedural skills, though some also mentioned efforts to improve communication, leadership, and teamwork. Participants engaged in lifelong learning through contextual, social, and individual processes. Discussion Academic physicians engage in lifelong learning for reasons beyond maintaining competence. Medical knowledge and clinical/procedural skills receive most attention, though other areas are recognized as important. Our findings highlight opportunities for a broader, more comprehensive approach to lifelong learning that spans all areas of medical practice.
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Affiliation(s)
- Bridget C. O’Brien
- Professor in the Department of Medicine and an education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California, US
| | - Sally Collins
- Research associate with the Center for Faculty Educators, University of California, San Francisco, California, US
| | - Lindsey M. Haddock
- Clinical assistant professor in the Section of Geriatrics, Division of Primary Care and Population Health, Department of Medicine at Stanford University School of Medicine, Stanford, California, US
| | - Sara Sani
- Assistant clinical professor in the Divisions of Hospital and Emergency Medicine, Department of Medicine, San Francisco Veterans Affairs, San Francisco, California, US
| | - Josette A. Rivera
- Professor in the Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, US
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O'Grady E, Johnson J, Hassmiller S. The Nurse as Coach: Building High Performing Teams. Nurs Adm Q 2024; 48:218-224. [PMID: 38848483 DOI: 10.1097/naq.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
The provision of modern health care in the United States faces significant challenges, as evidenced by multiple national reports of a workforce in distress. In response to these challenges, the practice of coaching emerges as a transformative skill, recommended for individuals in high-stress environments. Coaching in health care focuses on developing nurses and building teams by fostering self-understanding, deploying strengths, improving relational strategies, and gaining moral clarity. It serves as a potent strategy for nurse leaders to navigate the complexities of their systems. This paper explores the practice of coaching as an important mindset and skill. A coaching mindset is characterized by trust, deep listening, curiosity, embracing both/and thinking, discernment over judgment, and fosters an environment where nurses can flourish. It promotes a shift from telling to asking, empowering individuals to contribute innovative ideas and solutions. Additionally, the paper provides guidance for coaching and tools for maintaining a coaching mindset in the face of chronic stress. By fostering a coaching mindset, employing powerful questions, and using tools to sustain emotional integrity, leaders can empower nurses to thrive in complexity, enhance workplace well-being, and contribute to a resilient health care culture.
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Affiliation(s)
- Eileen O'Grady
- Mid-Atlantic Wellness Institute(Dr O'Grady); George Washington University Medical Center (Dr Johnson); and Sulu Coaching, Health Professions Leadership/Nursing, Cary, North Carolina (Dr Hassmiller)
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Couser GP, Newcomb RD, Swift MD, Hagen PT, Cowl CT. Physician Health Series, Part 3: Physician Mental Health. Mayo Clin Proc 2024; 99:1178-1186. [PMID: 38960499 DOI: 10.1016/j.mayocp.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/09/2023] [Accepted: 01/30/2024] [Indexed: 07/05/2024]
Abstract
This article is the third of 3 articles in a series about managing the care of physicians as patients. In part 1, the authors reviewed unique characteristics of physicians as patients with some general guidance for how to approach their care. Part 2 highlighted role clarity for the treating physician with discussion of the physical and cognitive issues that commonly arise when treating physician-patients along with licensure issues and reporting requirements. This final installment will focus on physician mental health and work-related stress.
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Affiliation(s)
- Greg P Couser
- Physician Health Center, Division of Public Health, Infectious Diseases, and Occupational Medicine. Mayo Clinic, Rochester, MN
| | - Richard D Newcomb
- Physician Health Center, Division of Public Health, Infectious Diseases, and Occupational Medicine. Mayo Clinic, Rochester, MN
| | - Melanie D Swift
- Physician Health Center, Division of Public Health, Infectious Diseases, and Occupational Medicine. Mayo Clinic, Rochester, MN
| | - Philip T Hagen
- Physician Health Center, Division of Public Health, Infectious Diseases, and Occupational Medicine. Mayo Clinic, Rochester, MN
| | - Clayton T Cowl
- Physician Health Center, Division of Public Health, Infectious Diseases, and Occupational Medicine. Mayo Clinic, Rochester, MN
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Dyrbye LN, Satele D, West CP. A Pragmatic Approach to Assessing Supervisor Leadership Capability to Support Healthcare Worker Well-Being. J Healthc Manag 2024; 69:280-295. [PMID: 38976788 DOI: 10.1097/jhm-d-23-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
GOAL We sought to build upon previous studies that have demonstrated how healthcare workers' ratings of their immediate supervisor's leadership capabilities relate to their well-being and job satisfaction. METHODS In 2022, we analyzed cross-sectional data from 1,780 physicians and 39,896 allied health professionals (collected in 2017) and 729 residents (collected in 2019), as well as longitudinal data from 1,632 physicians (collected from 2015 to 2017), to identify a psychometrically strong, broadly applicable, actionable, and low-burden approach to assessing supervisor leadership capability to support healthcare worker well-being. PRINCIPAL FINDINGS The magnitude of association between our 1-, 2-, 3-, and 9-item leadership indexes and burnout, and between our 1-, 2-, 3-, and 9-item leadership indexes and satisfaction with the organization were similar to each other in the cross-sectional and longitudinal cohorts and across diverse groups of healthcare workers, including physicians, residents, and allied health professionals. The likelihood ratio for a high leadership score increased with an increasing score for each leadership measure. The area under the receiver operating characteristic curve for the 1-, 2-, and 3-item measures for a high leadership score was 0.9349, 0.9672, and 0.9819, respectively. PRACTICAL APPLICATIONS A single item assessing perceptions of leadership capability efficiently provides useful information about leadership qualities of healthcare workers' immediate supervisors. The inclusion of this item in healthcare worker surveys may be useful for evaluating interventions and galvanizing organizational action to support healthcare worker well-being.
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Affiliation(s)
| | - Daniel Satele
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Smith DC, Thumm EB, Anderson J, Kissler K, Reed SM, Centi SM, Staley AW, Hernandez TL, Barton AJ. Sudden Shift to Telehealth in COVID-19: A Retrospective Cohort Study of Disparities in Use of Telehealth for Prenatal Care in a Large Midwifery Service. J Midwifery Womens Health 2024; 69:522-530. [PMID: 38111228 PMCID: PMC11182882 DOI: 10.1111/jmwh.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/26/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid-March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider-patient messaging, telephone visits, and video visits) during the COVID-19 pandemic among those receiving care in a large, academic nurse-midwifery service. METHODS We conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse-midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in-person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID-19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors. RESULTS When comparing pre-COVID-19 (before March 2020) with during COVID-19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (P < .001). The increase was driven by telehealth encounters; there were no significant differences for in-person prenatal visit counts before and during the pandemic period. Direct patient-provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression. DISCUSSION No differences in the frequency of in-person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in-person encounters. Spanish-speaking patients were least likely to use telehealth-delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload.
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Affiliation(s)
- Denise C. Smith
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - E. Brie Thumm
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Jessica Anderson
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Katherine Kissler
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Sean M. Reed
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Sophia M. Centi
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Alyse W. Staley
- Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, Colorado, USA
- University of Colorado Cancer Center, Biostatistics Core, Aurora, Colorado, USA
| | - Teri L. Hernandez
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism, & Diabetes, Aurora, Colorado, USA
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amy J. Barton
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
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Boyer L, Wu AW, Fernandes S, Tran B, Brousse Y, Nguyen TT, Yon DK, Auquier P, Lucas G, Boussat B, Fond G. Exploring the fear of clinical errors: associations with socio-demographic, professional, burnout, and mental health factors in healthcare workers - A nationwide cross-sectional study. Front Public Health 2024; 12:1423905. [PMID: 38989124 PMCID: PMC11233687 DOI: 10.3389/fpubh.2024.1423905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Background The fear of clinical errors among healthcare workers (HCW) is an understudied aspect of patient safety. This study aims to describe this phenomenon among HCW and identify associated socio-demographic, professional, burnout and mental health factors. Methods We conducted a nationwide, online, cross-sectional study targeting HCW in France from May to June 2021. Recruitment was through social networks, professional networks, and email invitations. To assess the fear of making clinical errors, HCW were asked: "During your daily activities, how often are you afraid of making a professional error that could jeopardize patient safety?" Responses were collected on a 7-point Likert-type scale. HCW were categorized into "High Fear" for those who reported experiencing fear frequently ("once a week," "a few times a week," or "every day"), vs. "Low Fear" for less often. We used multivariate logistic regression to analyze associations between fear of clinical errors and various factors, including sociodemographic, professional, burnout, and mental health. Structural equation modeling was used to explore how this fear fits into a comprehensive theoretical framework. Results We recruited a total of 10,325 HCW, of whom 25.9% reported "High Fear" (95% CI: 25.0-26.7%). Multivariate analysis revealed higher odds of "High Fear" among males, younger individuals, and those with less professional experience. High fear was more notable among physicians and nurses, and those working in critical care and surgery, on night shifts or with irregular schedules. Significant associations were found between "High Fear" and burnout, low professional support, major depressive disorder, and sleep disorders. Conclusions Fear of clinical errors is associated with factors that also influence patient safety, highlighting the importance of this experience. Incorporating this dimension into patient safety culture assessment could provide valuable insights and could inform ways to proactively enhance patient safety.
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Affiliation(s)
- Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Albert W Wu
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sara Fernandes
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Bach Tran
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Yann Brousse
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
| | - Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Pascal Auquier
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Guillaume Lucas
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
| | - Bastien Boussat
- TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, National Center for Scientific Research, Université Grenoble-Alpes, Grenoble, France
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Moskowitz JT, Jackson KL, Cummings P, Addington EL, Freedman ME, Bannon J, Lee C, Vu TH, Wallia A, Hirschhorn LR, Wilkins JT, Evans C. Feasibility, acceptability, and efficacy of a positive emotion regulation intervention to promote resilience for healthcare workers during the COVID-19 pandemic: A randomized controlled trial. PLoS One 2024; 19:e0305172. [PMID: 38913665 PMCID: PMC11195972 DOI: 10.1371/journal.pone.0305172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/23/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Burnout poses a substantial, ongoing threat to healthcare worker (HCW) wellbeing and to the delivery of safe, quality healthcare. While systemic and organization-level changes in healthcare are critically important, HCWs also need individual-level skills to promote resilience. The objective of this trial is to test feasibility, acceptability, and efficacy of PARK, an online self-guided positive affect regulation intervention, in a sample of healthcare workers during the COVID-19 pandemic. DESIGN AND METHODS In the context of the unprecedented rise in burnout during the COVID-19 pandemic, we conducted a randomized waitlist-controlled trial of the Positive Affect Regulation sKills (PARK) program-a five-week, online, self-guided coping skills intervention nested within an ongoing cohort of HCWs. N = 554 healthcare workers were randomly assigned to receive the intervention immediately or to receive the intervention after approximately 12 weeks. Outcomes included change in burnout, emotional wellbeing (positive affect, meaning and purpose, depression, anxiety) and sleep over approximately 12 weeks. Analyses included mixed-effects linear regression models comparing change over time in outcomes between intervention and control conditions. RESULTS One third (n = 554) of the participants in the cohort of HCWs consented to participate and enrolled in PARK in April 2022. Compared to those who did not enroll, participants in the trial reported higher burnout, poorer emotional wellbeing, and poorer sleep at baseline (April, 2022; all ps < .05). Intent-to-treat analyses showed that participants randomly assigned to the intervention immediately (PARK-Now) improved significantly on anxiety (within-group change on PROMIS T-score = -0.63; p = .003) whereas those in the waitlist (PARK-Later) did not (within group T-score change 0.04, p = 0.90). The between-group difference in change, however, was not statistically significant (B = -0.67 p = 0.10). None of the other wellbeing outcomes changed significantly in the intervention group compared to the waitlist. Additional as-treated analyses indicated that those participants who completed all 5 of the weekly online lessons (N = 52; 9.4%) improved significantly more on the primary outcome of positive affect compared to those who enrolled in PARK but completed zero lessons (n = 237; 42.8%; B = 2.85; p = .0001). CONCLUSIONS Online self-guided coping skills interventions like PARK can be effective in targeted samples and future work will focus on adaptations to increase engagement and tailor PARK for HCWs who could most benefit.
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Affiliation(s)
- Judith Tedlie Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Kathryn L. Jackson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Peter Cummings
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Elizabeth L. Addington
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Melanie E. Freedman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Jacquelyn Bannon
- Institute for Public Health and Medicine, Center for Education in Health Sciences, Northwestern University, Chicago, IL, United States of America
| | - Cerina Lee
- Institute for Public Health and Medicine, Center for Education in Health Sciences, Northwestern University, Chicago, IL, United States of America
| | - Thanh Huyen Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Amisha Wallia
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Institute for Public Health and Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - John T. Wilkins
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Charlesnika Evans
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United States of America
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Howard-Anderson JR, Gottlieb LB, Beekmann SE, Polgreen PM, Jacob JT, Uslan DZ. Implementation of contact precautions for multidrug-resistant organisms in the post-COVID-19 pandemic era: An updated national Emerging Infections Network (EIN) survey. Infect Control Hosp Epidemiol 2024; 45:703-708. [PMID: 38351872 PMCID: PMC11102826 DOI: 10.1017/ice.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To understand how healthcare facilities employ contact precautions for patients with multidrug-resistant organisms (MDROs) in the post-coronavirus disease 2019 (COVID-19) era and explore changes since 2014. DESIGN Cross-sectional survey. PARTICIPANTS Emerging Infections Network (EIN) physicians involved in infection prevention or hospital epidemiology. METHODS In September 2022, we sent via email an 8-question survey on contact precautions and adjunctive measures to reduce MDRO transmission in inpatient facilities. We also asked about changes since the COVID-19 pandemic. We used descriptive statistics to summarize data and compared results to a similar survey administered in 2014. RESULTS Of 708 EIN members, 283 (40%) responded to the survey and 201 reported working in infection prevention. A majority of facilities (66% and 69%) routinely use contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) respectively, compared to 93% and 92% in 2014. Nearly all (>90%) use contact precautions for Candida auris, carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter baumannii. More variability was reported for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing gram-negative organisms. Compared to 2014, fewer hospitals perform active surveillance for MRSA and VRE. Overall, 90% of facilities used chlorhexidine gluconate bathing in all or select inpatients, and 53% used ultraviolet light or hydrogen peroxide vapor disinfection at discharge. Many respondents (44%) reported changes to contact precautions since COVID-19 that remain in place. CONCLUSIONS Heterogeneity exists in the use of transmission-based precautions and adjunctive infection prevention measures aimed at reducing MDRO transmission. This variation reflects a need for updated and specific guidance, as well as further research on the use of contact precautions in healthcare facilities.
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Affiliation(s)
- Jessica R. Howard-Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lindsey B. Gottlieb
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Susan E. Beekmann
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Philip M. Polgreen
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jesse T. Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel Z. Uslan
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California– Los Angeles, Los Angeles, California
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Radhakrishnan AK, Hunter JJ, Radhakrishnan D, Silveira JM, Soklaridis S. Adaptive Mentoring Networks and Compassionate Care: A Qualitative Exploration of Mentorship for Chronic Pain, Substance Use Disorders and Mental Health. JOURNAL OF CME 2024; 13:2361405. [PMID: 38831940 PMCID: PMC11146240 DOI: 10.1080/28338073.2024.2361405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
This study undertook an exploration of how Adaptive Mentoring Networks focusing on chronic pain, substance use disorders and mental health were supporting primary care providers to engage in compassionate care. The study utilised the Cole-King & Gilbert Compassionate Care Framework to guide qualitative semi-structured interviews of participants in two Adaptive Mentoring Networks in Ontario, Canada. Fourteen physician participants were interviewed including five mentors (psychiatrists) and nine mentees (family physicians) in the Networks. The Cole-King & Gilbert Framework helped provide specific insights on how these mentoring networks were affecting the attributes of compassion such as motivation, distress-tolerance, non-judgement, empathy, sympathy, and sensitivity. The findings of this study focused on the role of compassionate provider communities and the development of skills and attitudes related to compassion that were both being supported in these networks. Adaptive Mentoring Networks can support primary care providers to offer compassionate care to patients with chronic pain, substance use disorders, and mental health challenges. This study also highlights how these networks had an impact on provider resiliency, and compassion fatigue. There is promising evidence these networks can support the "quadruple aim" for healthcare systems (improve patient and provider experience, health of populations and value for money) and play a role in addressing the healthcare provider burnout and associated health workforce crisis.
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Affiliation(s)
| | | | | | - Jose M. Silveira
- Department of Psychiatry, University of Toronto, Toronto, Ont, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Toronto, Ont, Canada
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Norful AA, Albloushi M, Zhao J, Gao Y, Castro J, Palaganas E, Magsingit NS, Molo J, Alenazy BA, Rivera R. Modifiable work stress factors and psychological health risk among nurses working within 13 countries. J Nurs Scholarsh 2024. [PMID: 38816945 DOI: 10.1111/jnu.12994] [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: 02/07/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Nurses are identified as having higher work stress and poor mental health risk among health care workforce globally. It remains unclear which modifiable stress factors pose the greatest risk for poor psychological health among nursing workforce and needed to inform targeted practice and policy change. To determine which occupation-related or personal stress factors precipitate higher risk for burnout, depression, anxiety, job satisfaction or intention to leave one's position among nurses globally. DESIGN A cross-sectional anonymous survey was administered via email using a snowball recruitment strategy. METHODS Academic researchers and clinical industry leaders across 3 global regions collaborated to generate an email listserv of professional nursing contacts for survey distribution. The survey included valid and reliable measures to scale stress factors (Work Stress Questionnaire), and screen for burnout (single item), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2), resilience (Brief Resilience Scale) and intention to leave one's job (single item). We used logistic regression, first unadjusted and then adjusted for personal and professional characteristics, to determine associations between stress factors and psychological health risk. RESULTS The final sample consisted of responses from 2864 nurses working across 13 countries. Most respondents reported working as a clinical nurse in the Philippines (n = 2275), United States (n = 424) and Saudi Arabia (n = 104). One third of nursing respondents endorsed high burnout and intention to leave their job. Those reporting work conflict had significantly higher odds of burnout (odds ratio 3.18; 95% CI 2.22-4.54) and three times more likely to screen positive for depression (odds ratio 3.02; 95% CI 1.36-6.72) and anxiety (odds ratio 2.92; 95% CI 1.57-5.43). Those endorsing difficulty sleeping were 15 times more likely to screen positive for depression (odds ratio 15.63; 95% CI 2.09-117.06). Lack of social support was significantly associated to higher risk for burnout, job dissatisfaction, depression, anxiety, and intention to leave one's position. CONCLUSIONS Nurses remain at risk for burnout and poor psychological health stemming from work stress. Factors such as clear workplace goals and assignments, increased engagement, good sleep health and social support may serve as protective factors against suboptimal psychological health, and in-turn poor workforce retention. CLINICAL RELEVANCE Nurses reporting conflict in the workplace are three times more likely to screen positive for burnout, depression, and anxiety. Nurses reporting difficulty sleeping are 15 times more likely to screen positive for depression. Several modifiable factors can be targeted to reduce poor psychological health and high workforce turnover among nurses across countries.
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Affiliation(s)
| | | | - Jiawen Zhao
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Yuandi Gao
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Janelle Castro
- University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
| | | | | | - Jocelyn Molo
- University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
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20
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Singh N, Giannitrapani KF, Gamboa RC, O’Hanlon CE, Fereydooni S, Holdsworth LM, Lindvall C, Walling AM, Lorenz KA. What Patients Facing Cancer and Caregivers Want From Communication in Times of Crisis: A Qualitative Study in the Early Months of the COVID-19 Pandemic. Am J Hosp Palliat Care 2024; 41:558-567. [PMID: 37390466 PMCID: PMC10315453 DOI: 10.1177/10499091231187351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Interpersonal communication is a cornerstone of patient-centered care. We aimed to identify what patients with cancer and caregivers may want from communication during a public health crisis. METHODS We interviewed 15 patients (8 Veteran, 7 non-Veteran) and caregivers from regionally, racially, and ethnically diverse backgrounds across the US about serious illness care and quality of care during the COVID-19 pandemic Using an iterative, inductive and deductive process, 2 coders analyzed content associated with the code "Communication," which appeared 71 times, and identified 5 themes. RESULTS Participants identified as White (10), Latino/a (3), Asian (1), and Black (1). (1) Help patients and caregivers prepare for care during crisis by communicating medical information directly and proactively. (2) Explain how a crisis might influence medical recommendations and impact on recovery from illness. (3) Use key messengers to improve communication between primary teams, patients, and caregivers. (4) Include caregivers and families in communication when they cannot be physically present. (5) Foster bidirectional communication with patients and families to engage them in shared decision-making during a vulnerable time. CONCLUSION Communication is critical during a public health crisis yet overwhelmed clinicians may not be able to communicate effectively. Communicating with caregivers and family, transparent and timely communication, ensuring diverse providers are on the same page, and effective listening are known gaps even before the COVID-19 pandemic. Clinicians may need quick interventions, like education about goals of care, to remind them about what seriously ill patients and their caregivers want from communication and offer patient-centered care during crises.
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Affiliation(s)
- Nainwant Singh
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Karleen F. Giannitrapani
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Raziel C. Gamboa
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | | | | | | | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anne M. Walling
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Karl A. Lorenz
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
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21
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Sprague C. HIV Inequities, the Therapeutic Alliance, Moral Injury, and Burnout: A Call for Nurse Workforce Participation and Action. J Assoc Nurses AIDS Care 2024:00001782-990000000-00098. [PMID: 38563450 DOI: 10.1097/jnc.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
ABSTRACT Health inequities for those living with HIV have persisted for key populations in the United States and globally. To address these inequities, in accordance with Goals 2 and 3 of the National HIV/AIDS Strategy for the United States, the evidence indicates that the therapeutic alliance could be effective in addressing impediments that undermine HIV outcomes. Nonetheless, the therapeutic alliance relies on health care providers, particularly nurses, reporting burnout and moral injury, further exacerbated by COVID-19. Burnout and moral injury have forced the systemic undervaluing of nurses as a social-cultural norm to the fore-in part a legacy of the economic model that underpins the health care system. Given a looming health workforce shortage and negative effects for key populations with HIV already experiencing health inequities, historic opportunities now exist to advance national institutional reforms to support nurses and other health professionals. This opportunity calls for concerted attention, multisectoral dialogue, and action, with nurses participating in and leading policy and interventions.
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Affiliation(s)
- Courtenay Sprague
- Courtenay Sprague, PhD, MA, is an Associate Professor of Global Health, Department of Conflict Resolution, Human Security & Global Governance, and Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, USA
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Sayer NA, Kaplan A, Nelson DB, Wiltsey Stirman S, Rosen CS. Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies. JAMA Netw Open 2024; 7:e246858. [PMID: 38630477 PMCID: PMC11024738 DOI: 10.1001/jamanetworkopen.2024.6858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/19/2024] [Indexed: 04/19/2024] Open
Abstract
Importance Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear. Objective To evaluate the association between clinician burnout and the outcomes of patients receiving of guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD). Design, Setting, and Participants This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023. Exposures Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more. Main Outcomes and Measures The primary outcome was patients' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix. Results In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement. Conclusions and Relevance In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.
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Affiliation(s)
- Nina A. Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis
| | - Adam Kaplan
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis
| | - David B. Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis
| | - Shannon Wiltsey Stirman
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division at the Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Craig S. Rosen
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division at the Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Nindra U, Shivasabesan G, Mellor R, Chua W, Ng W, Karikios D, Richards B, Liu J. Evaluating Systemic Burnout in Medical Oncology Through a National Oncology Mentorship Program. JCO Oncol Pract 2024; 20:549-557. [PMID: 38290086 DOI: 10.1200/op.23.00469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/14/2023] [Accepted: 12/01/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Mentorship has a positive influence on trainee skills and well-being. A 2022 Pilot Mentorship Program in New South Wales involving 40 participants revealed high burnout rates in Medical Oncology trainees. As part of an Australia-wide inaugural National Oncology Mentorship Program in 2023 (NOMP23), a national survey was undertaken to assess the prevalence of burnout, anxiety, depression, professional fulfilment, and drivers of distress in the Australian medical oncology workforce. METHODS NOMP23 is a 1-year prospective cohort study that recruited medical oncology trainees and consultants using e-mail correspondence between February and March 2023. Each participant completed a baseline survey which included the Maslach Burnout Index (MBI), Stanford Professional Fulfilment Index, and Patient Health Questionnaire-4 for anxiety and depression. RESULTS One hundred and twelve participants (56 mentors, 56 mentees) were enrolled in NOMP23, of which 86 (77%) completed the baseline survey. MBI results at baseline demonstrated that 77% of consultants and 82% of trainees experienced burnout in the past 12 months. Professional fulfilment was noted to be <5% in our cohort. Screening rates of anxiety and depression in trainees were 32% and 16%, respectively, compared with 7% and 2% for consultants. When assessing reasons for workplace stress, two thirds stated that heavy patient load contributed to stress, while almost three quarters attributed a heavy administrative load. Lack of supervision was a key stressor for trainees (39%), as was lack of support from the training college (58%). CONCLUSION Trainees and consultant medical oncologists demonstrate high rates of burnout and low professional fulfilment. The NOMP23 program has identified a number of key stress factors driving burnout and demonstrated concerning levels of anxiety and depression. Ongoing mentorship and other well-being initiatives are needed to address these issues.
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Affiliation(s)
- Udit Nindra
- Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Gowri Shivasabesan
- Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
| | - Rhiannon Mellor
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
- Garvan Institute of Applied Medical Research, Sydney, Australia
- School of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Wei Chua
- Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Weng Ng
- Department of Medical Oncology, Liverpool Hospital, Liverpool, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Deme Karikios
- School of Medicine, University of Sydney, Sydney, Australia
- Department of Medical Oncology, Nepean Hospital, Sydney, Australia
| | - Bethan Richards
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Jia Liu
- Garvan Institute of Applied Medical Research, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
- The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney Australia
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24
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Leung KCY, Lele K. A hospital-wide group approach to promote open dialogues of workplace issues and staff wellbeing with Schwartz Rounds. Australas Psychiatry 2024; 32:151-156. [PMID: 38288725 PMCID: PMC10913322 DOI: 10.1177/10398562241229887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVES This study aims to explore the feasibility and impact of Schwartz Rounds® led by psychiatrists/mental health professionals in an urban Australian public hospital setting and to develop strategies for optimising participants' experiences. METHODS Being a mixed-methods study collecting qualitative and quantitative data through post-Rounds evaluation surveys, this study thematically analysed responses from 105 participants attending four consecutive monthly Rounds between February and May 2023 to assess the perceived benefits and challenges of Schwartz Rounds. RESULTS Respondents highly valued the Rounds and felt cared for by the healthcare organisation. Themes related to perceived benefits included (i) Connectedness and shared experience; (ii) Understanding other professionals; (iii) Normalisation of emotional distress, validation and a safe space for vulnerability; and (iv) Fostering authenticity and humanitarian aspects of healthcare. Challenges included (i) Fear of exposure and judgment; (ii) Emotional discomfort; (iii) Unfamiliarity with reflection; and (iv) Safety concerns. CONCLUSIONS This study suggests acceptability and feasibility of implementing Schwartz Rounds within an Australian public health setting, particularly when facilitated by skilled mental health professionals. The outcomes provide preliminary support for the use of group interventions to enhance staff collegiality and culture in healthcare settings, thereby addressing critical needs for health professional wellbeing.
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Affiliation(s)
| | - Kiran Lele
- University of Sydney, Camperdown, NSW, Australia
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25
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Akoo C, McMillan K, Price S, Ingraham K, Ayoub A, Rolle Sands S, Shankland M, Bourgeault I. "I feel broken": Chronicling burnout, mental health, and the limits of individual resilience in nursing. Nurs Inq 2024; 31:e12609. [PMID: 37927120 DOI: 10.1111/nin.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future.
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Affiliation(s)
- Chaman Akoo
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Sheri Price
- School of Nursing, Dalhousie University, Nova Scotia, Ontario, Canada
| | | | - Abby Ayoub
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Mylène Shankland
- Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Ivy Bourgeault
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada
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26
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Meredith LS, Ahluwalia S, Chen PG, Dong L, Farmer CM, Bouskill KE, Dalton S, Qureshi N, Blagg T, Timmins G, Schulson LB, Huilgol SS, Han B, Williamson S, Watson P, Schnurr PP, Martineau M, Davis K, Cassells A, Tobin JN, Gidengil C. Testing an Intervention to Improve Health Care Worker Well-Being During the COVID-19 Pandemic: A Cluster Randomized Clinical Trial. JAMA Netw Open 2024; 7:e244192. [PMID: 38687482 PMCID: PMC11061774 DOI: 10.1001/jamanetworkopen.2024.4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/26/2024] [Indexed: 05/02/2024] Open
Abstract
Importance Stress First Aid is an evidence-informed peer-to-peer support intervention to mitigate the effect of the COVID-19 pandemic on the well-being of health care workers (HCWs). Objective To evaluate the effectiveness of a tailored peer-to-peer support intervention compared with usual care to support HCWs' well-being at hospitals and federally qualified health centers (FQHCs) during the COVID-19 pandemic. Design, Setting, and Participants This cluster randomized clinical trial comprised 3 cohorts of HCWs who were enrolled from March 2021 through July 2022 at 28 hospitals and FQHCs in the US. Participating sites were matched as pairs by type, size, and COVID-19 burden and then randomized to the intervention arm or usual care arm (any programs already in place to support HCW well-being). The HCWs were surveyed before and after peer-to-peer support intervention implementation. Intention-to-treat (ITT) analysis was used to evaluate the intervention's effect on outcomes, including general psychological distress and posttraumatic stress disorder (PTSD). Intervention The peer-to-peer support intervention was delivered to HCWs by site champions who received training and subsequently trained the HCWs at their site. Recipients of the intervention were taught to respond to their own and their peers' stress reactions. Main Outcomes and Measures Primary outcomes were general psychological distress and PTSD. General psychological distress was measured with the Kessler 6 instrument, and PTSD was measured with the PTSD Checklist. Results A total of 28 hospitals and FQHCs with 2077 HCWs participated. Both preintervention and postintervention surveys were completed by 2077 HCWs, for an overall response rate of 28% (41% at FQHCs and 26% at hospitals). A total of 862 individuals (696 females [80.7%]) were from sites that were randomly assigned to the intervention arm; the baseline mean (SD) psychological distress score was 5.86 (5.70) and the baseline mean (SD) PTSD score was 16.11 (16.07). A total of 1215 individuals (947 females [78.2%]) were from sites assigned to the usual care arm; the baseline mean (SD) psychological distress score was 5.98 (5.62) and the baseline mean (SD) PTSD score was 16.40 (16.43). Adherence to the intervention was 70% for FQHCs and 32% for hospitals. The ITT analyses revealed no overall treatment effect for psychological distress score (0.238 [95% CI, -0.310 to 0.785] points) or PTSD symptom score (0.189 [95% CI, -1.068 to 1.446] points). Post hoc analyses examined the heterogeneity of treatment effect by age group with consistent age effects observed across primary outcomes (psychological distress and PTSD). Among HCWs in FQHCs, there were significant and clinically meaningful treatment effects for HCWs 30 years or younger: a more than 4-point reduction for psychological distress (-4.552 [95% CI, -8.067 to -1.037]) and a nearly 7-point reduction for PTSD symptom scores (-6.771 [95% CI, -13.224 to -0.318]). Conclusions and Relevance This trial found that this peer-to-peer support intervention did not improve well-being outcomes for HCWs overall but had a protective effect against general psychological distress and PTSD in HCWs aged 30 years or younger in FQHCs, which had higher intervention adherence. Incorporating this peer-to-peer support intervention into medical training, with ongoing support over time, may yield beneficial results in both standard care and during public health crises. Trial Registration ClinicalTrials.gov Identifier: NCT04723576.
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Affiliation(s)
| | | | | | - Lu Dong
- RAND Corporation, Santa Monica, California
| | | | | | | | | | - Tara Blagg
- RAND Corporation, Santa Monica, California
| | | | - Lucy B. Schulson
- Section of General Internal Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
- RAND Corporation, Boston, Massachusetts
| | | | - Bing Han
- Department of Research & Evaluation, Southern California Kaiser Permanente, Pasadena
| | | | | | - Paula P. Schnurr
- National Center for PTSD, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | | | | | - Jonathan N. Tobin
- Clinical Directors Network, New York, New York
- The Rockefeller University Center for Clinical and Translational Science, New York, New York
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27
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Burt-Miller JF, Rismani M, Hopkins A, Cunningham T, Farquharson D, Balcázar AG, Chosed RJ, McPhail B, Green L, Gordon MC, Kennedy AB. "I realized I was not alone": A mixed-methods investigation of the implementation of Ubuntu groups to reduce burnout and social isolation in an allopathic medical School in the Southeastern United States. MEDICAL TEACHER 2024:1-11. [PMID: 38500338 DOI: 10.1080/0142159x.2024.2326123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE/BACKGROUND Healthcare providers experience higher rates of workplace burnout, a reality highlighted by the COVID-19 pandemic. In response, small groups, inspired by South African philosophy, Ubuntu, were introduced to decrease burnout and social isolation and build community and belonging. This study examines how participation in these groups can impact these measures. METHODS In this mixed-methods study, trained facilitators led small groups that utilized story-sharing to foster connections within the group and broader community. Quantitative and qualitative data were analyzed separately and merged to identify convergence. RESULTS Three main qualitative themes emerged: 1) seeking and building connections and community, 2) curiosity, learning, and growing, and 3) open-hearted and thriving. These themes were linked to quantitative outcomes, showing a statistically significant decrease in social isolation among staff/faculty and students. Furthermore, faculty/staff exhibited reduced burnout compared to students, while students reported increased feelings of belonging. CONCLUSION Participation in Ubuntu groups positively influenced students' sense of belonging, reduced faculty/staff burnout, and alleviated social isolation for all participants. Future research should explore the potential of this intervention to further promote wellness on medical campuses. Programs emphasizing the well-being of individuals, including faculty, staff, and students, are crucial for supporting the overall health of medical communities and the wider society.
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Affiliation(s)
- Joel F Burt-Miller
- Harvard T.H. Chan School of Public Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Mina Rismani
- Department of Internal Medicine, Medical College of Georgia, Augusta, Georgia, USA
| | - Alexis Hopkins
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Taylor Cunningham
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Daniel Farquharson
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Ana Gabriela Balcázar
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Renee J Chosed
- Department of Biomedical Sciences, the University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Brooks McPhail
- Department of Physiology & Pharmacology at Wake Forest, University School of Medicine Charlotte, Charlotte, North Carolina, USA
| | - Lisa Green
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina, USA
| | | | - Ann Blair Kennedy
- Biomedical Sciences Department at the University of South Carolina School of Medicine Greenville and in the Family Medicine Department at Prisma Health, Director of the University of South Carolina Patient Engagement Studio, Greenville, South Carolina, USA
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28
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Ferwana I, Varshney LR. The impact of COVID-19 lockdowns on mental health patient populations in the United States. Sci Rep 2024; 14:5689. [PMID: 38454064 PMCID: PMC10920688 DOI: 10.1038/s41598-024-55879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
During the start of the COVID-19 pandemic in 2020, lockdowns and movement restrictions were thought to negatively impact population mental health, since depression and anxiety symptoms were frequently reported. This study investigates the effect of COVID-19 mitigation measures on mental health across the United States, at county and state levels using difference-in-differences analysis. It examines the effect on mental health facility usage and the prevalence of mental illnesses, drawing on large-scale medical claims data for mental health patients joined with publicly available state- and county-specific COVID-19 cases and lockdown information. For consistency, the main focus is on two types of social distancing policies, stay-at-home and school closure orders. Results show that lockdown has significantly and causally increased the usage of mental health facilities in regions with lockdowns in comparison to regions without such lockdowns. Particularly, resource usage increased by 18% in regions with a lockdown compared to 1% decline in regions without a lockdown. Also, female populations have been exposed to a larger lockdown effect on their mental health. Diagnosis of panic disorders and reaction to severe stress significantly increased by the lockdown. Mental health was more sensitive to lockdowns than to the presence of the pandemic itself. The effects of the lockdown increased over an extended time to the end of December 2020.
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Affiliation(s)
- Ibtihal Ferwana
- Coordinated Science Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
| | - Lav R Varshney
- Coordinated Science Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
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29
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Gould KA. A Call for Manuscripts on Wellness and Healthier Work Environments. Dimens Crit Care Nurs 2024; 43:51-52. [PMID: 38271307 DOI: 10.1097/dcc.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Kathleen Ahern Gould
- Kathleen Ahern Gould, PhD, RN, is editor in chief of Dimensions of Critical Care Nursing, Duxbury, Massachusetts
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30
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MacGregor W, Horn M, Raphael D. Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht. THE JOURNAL OF MEDICAL HUMANITIES 2024; 45:53-77. [PMID: 37341851 DOI: 10.1007/s10912-023-09801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 06/22/2023]
Abstract
Bertolt Brecht's poem "A Worker's Speech to a Doctor" is frequently cited as a means to raise awareness among health workers of the health effects of living and working conditions. Less cited is his Call to Arms trilogy of poems, which calls for class-based action to transform the capitalist economic system that sickens and kills so many. In this article, we show how "A Worker's Speech to a Doctor," with its plea for empathy for the ill, contrasts with the more activist and often militant tone of the Call to Arms trilogy: "Call to a Sick Communist," "The Sick Communist's Answer to the Comrades," and "Call to the Doctors and Nurses." We also show that, while "A Worker's Speech to a Doctor" has been applied in the training of health workers, its accusatorial tone towards health workers' complicity in the system the poem is critiquing risks alienating such workers. In contrast, the Call to Arms trilogy seeks common ground, inviting these same workers into the broader political and social fight against injustice. While we contend that the description of the sick worker as a "Communist" risks estranging these health workers, our analysis of the Call to Arms poems nevertheless indicates that their use can contribute to moving health workers' educational discourse beyond a laudable but fleeting elicitation of empathy for the ill towards a structural critique and deeper systemic understanding in order to prompt action by health workers to reform or even replace the capitalist economic system that sickens and kills so many.
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Affiliation(s)
- William MacGregor
- Graduate Program in Health Policy and Equity, York University, Toronto, ON, Canada
| | | | - Dennis Raphael
- School of Health Policy and Management, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
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31
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Lown BA, Collier J, Manning C, Gareis K. The Healing Healthcare Initiative: Guiding leaders to heal a traumatized workforce. Healthc Manage Forum 2024; 37:74-79. [PMID: 37831518 DOI: 10.1177/08404704231204874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The COVID-19 pandemic amplified burnout and moral distress among healthcare professionals and accentuated the systemic gaps and limitations of current approaches to workforce well-being. The Schwartz Center for Compassionate Healthcare launched the Healing Healthcare Initiative (HHI) in response to these compounded challenges. Aligned with national recommendations, the HHI framework comprises six key principles and eight implementation domains that foster compassionate and trauma-informed organizational cultures. C-suite level executive teams from six diverse healthcare organizations were selected to participate in the year-long pilot. Organizational and executive team surveys identified siloed well-being efforts and gaps in knowledge and awareness that undermine meaningful progress. The HHI pilot offers executive teams a space for reflection and open conversations, fostering trust within the team, and reinforcing the commitment to employee well-being. The program supports leadership teams in creating a strategy to implement the HHI framework that engages frontline workers in co-designing organizational solutions for a thriving workforce.
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Affiliation(s)
- Beth A Lown
- The Schwartz Center for Compassionate Healthcare, Somerville, Massachusetts, United States
| | - Julie Collier
- The Schwartz Center for Compassionate Healthcare, Somerville, Massachusetts, United States
| | - Colleen Manning
- Goodman Research Group, Inc., Cambridge, Massachusetts, United States
| | - Karen Gareis
- Goodman Research Group, Inc., Cambridge, Massachusetts, United States
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32
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Bowser DM, Maurico K, Ruscitti BA, Crown WH. American clusters: using machine learning to understand health and health care disparities in the United States. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae017. [PMID: 38756919 PMCID: PMC10986293 DOI: 10.1093/haschl/qxae017] [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: 10/03/2023] [Revised: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 05/18/2024]
Abstract
Health and health care access in the United States are plagued by high inequality. While machine learning (ML) is increasingly used in clinical settings to inform health care delivery decisions and predict health care utilization, using ML as a research tool to understand health care disparities in the United States and how these are connected to health outcomes, access to health care, and health system organization is less common. We utilized over 650 variables from 24 different databases aggregated by the Agency for Healthcare Research and Quality in their Social Determinants of Health (SDOH) database. We used k-means-a non-hierarchical ML clustering method-to cluster county-level data. Principal factor analysis created county-level index values for each SDOH domain and 2 health care domains: health care infrastructure and health care access. Logistic regression classification was used to identify the primary drivers of cluster classification. The most efficient cluster classification consists of 3 distinct clusters in the United States; the cluster having the highest life expectancy comprised only 10% of counties. The most efficient ML clusters do not identify the clusters with the widest health care disparities. ML clustering, using county-level data, shows that health care infrastructure and access are the primary drivers of cluster composition.
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Affiliation(s)
- Diana M Bowser
- Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Kaili Maurico
- Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Brielle A Ruscitti
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, United States
| | - William H Crown
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, United States
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Ramers CB, Scott JD, Struminger BB. Burnout, Compassion Fatigue, and the Long Haul of Caring for Long COVID. Open Forum Infect Dis 2024; 11:ofae080. [PMID: 38449917 PMCID: PMC10917153 DOI: 10.1093/ofid/ofae080] [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: 12/06/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
The current landscape of clinician burnout is prompting the need for our health care system to revise its approach toward complex conditions such as long coronavirus disease (COVID), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other postinfectious fatiguing illnesses (PIFIs). We discuss our efforts here at Family Health Center of San Diego (FHCSD) to help share insight and glean perspective from clinicians who have participated in our Centers for Disease Control and Prevention (CDC)-funded 3-year continuing professional development initiative. The Long COVID and Fatiguing Illness Recovery Program uses multidisciplinary team-based case consultation and peer-to-peer sharing of emerging best and promising practices (ie, teleECHO [Extension for Community Healthcare Outcomes]) to support the management of complex cases associated with long COVID, ME/CFS, and other PIFIs. We believe that this perspective captures a key moment in the trajectory of postpandemic clinician burnout and prompts further reflection and action from the health care system to improve clinician- and patient-level outcomes related to the care of patients with postinfectious fatiguing illnesses.
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Affiliation(s)
- Christian B Ramers
- Family Health Centers of San Diego, Laura Rodriguez Research Institute, San Diego, California, USA
- School of Medicine, UC San Diego, San Diego, California, USA
- School of Public Health, San Diego State University, San Diego, California, USA
- Global Hepatitis & COVID-19 Treatment Access Program, Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - John D Scott
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Rehabilitation Clinic, Harborview Medical Center, Seattle, Washington, USA
| | - Bruce B Struminger
- Project ECHO, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Mema B, Helmers A, Proulx C, Min KSK, Navne LE. Through the looking glass: qualitative study of critical care clinicians engaging in humanities. Intensive Care Med 2024; 50:427-436. [PMID: 38451286 DOI: 10.1007/s00134-024-07331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/20/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Critical care medicine is facing an epidemic of burnout and consequent attrition. Interventions are needed to re-establish the medical field as a place of professional growth, resilience, and personal well-being. Humanities facilitate creation, reflection, and meaning-making, holding the promise of personal and community transformation. This study aimed to explore how clinicians engage with a humanities program, and what role and impact do the humanities play in their individual and collective journey. METHODS This is a qualitative study employing a phenomenological approach. Participants were faculty and trainees who participated in the program. Data consisted of (a) 60-h observations of humanities evenings, (b) more than 200 humanities artifacts brought by participants, and (c) 15 in-depth participant interviews. Data were analyzed inductively and reflectively by a team of researchers. RESULTS Participants were motivated to engage with the humanities curriculum because of past experiences with art, identifying a desire to re-explore their creativity to make meaning from their clinical experiences and a wish to socialize with and understand their colleagues through a different lens. The evenings facilitated self-expression, and inspired and empowered participants to create art pieces and re-engage with art in their daily lives. More importantly, they found a community where they could be vulnerable and supported, where shared experiences were discussed, emotions were validated, and relationships were deepened between colleagues. CONCLUSIONS Humanities may impact resilience and personal and community well-being by facilitating reflection and meaning-making of challenging clinical work and building bonds between colleagues.
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Affiliation(s)
- Briseida Mema
- Department of Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Andrew Helmers
- Department of Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Catherine Proulx
- Department of Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- University of Toronto, Toronto, Canada
| | - Kyung-Seo Kay Min
- Rare Book School (RBS), University of Virginia, Charlottesville, USA
| | - Laura E Navne
- The Danish Center for Social Science Research, VIVE, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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McCloskey RJ, Santucci R, Hammond GC. Ohio pharmacy personnel's burnout and wellbeing: The impact of the COVID-19 pandemic. J Am Pharm Assoc (2003) 2024:102033. [PMID: 38360111 DOI: 10.1016/j.japh.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND While burnout is a well-known phenomenon among physicians and nurses, burnout among pharmacists and pharmacy personnel is understudied and less recognized. OBJECTIVES The primary objectives of this study were to describe and compare Ohio pharmacy personnel's self-reports of burnout and wellbeing prior to and during the COVID-19 pandemic. METHODS A one-time online survey was completed by over 13,000 health care professionals in Ohio in July and August 2021. This brief report describes a subanalysis of the 1452 participating pharmacy professionals licensed by the State of Ohio Board of Pharmacy. RESULTS Most survey respondents identified as White (90.84%) and female (70.04%), including pharmacists (59.16%) and pharmacy technicians (38.15%). Findings demonstrated a 360.55% increase in feeling emotionally drained "every day" during the pandemic. Participants felt emotionally drained more frequently; cared less about what happened to patients; felt less accomplished; felt down, depressed, or hopeless more frequently; had more thoughts of suicide; and were more concerned about their substance use during the pandemic than prior to it. CONCLUSION Pharmacy personnel are experiencing some dimensions of burnout and poor wellbeing more frequently. These issues were present prior to the COVID-19 pandemic and now require even swifter attention as outcomes have worsened. Increased awareness of burnout among pharmacy personnel is required. Additionally, policy and organizational interventions are recommended to improve pharmacy personnel wellbeing.
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Gomes Souza L, Bouba DA, Corôa RDC, Dofara SG, Robitaille V, Blanchette V, Kastner K, Bergeron F, Guay-Bélanger S, Izumi SS, Totten AM, Archambault P, Légaré F. The Impact of Advance Care Planning on Healthcare Professionals' Well-being: A Systematic Review. J Pain Symptom Manage 2024; 67:173-187. [PMID: 37827454 DOI: 10.1016/j.jpainsymman.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
CONTEXT Advance care planning (ACP) improves care for patients with chronic illnesses and reduces family stress. However, the impact of ACP interventions on healthcare professionals' well-being remains unknown. OBJECTIVE To systematically review the literature evaluating the impact of ACP interventions on healthcare professionals' well-being. METHODS We followed the Joanna Briggs Institute methodology for systematic reviews and registered the protocol in PROSPERO (CRD42022346354). We included primary studies in all languages that assessed the well-being of healthcare professionals in ACP interventions. We excluded any studies on ACP in psychiatric care and in palliative care that did not address goals of care. Searches were conducted on April 4, 2022, and March 6, 2023 in Embase, CINAHL, Web of Science, and PubMed. We used the Mixed Methods Appraisal Tool for quality analysis. We present results as a narrative synthesis because of their heterogeneity. RESULTS We included 21 articles published in English between 1997 and 2021 with 17 published after 2019. All were conducted in high-income countries, and they involved a total of 1278 participants. Three reported an interprofessional intervention and two included patient partners. Studies had significant methodological flaws but most reported that ACP had a possible positive impact on healthcare professionals' well-being. CONCLUSION This review is the first to explore the impact of ACP interventions on healthcare professionals' well-being. ACP interventions appear to have a positive impact, but high-quality studies are scarce. Further research is needed, particularly using more rigorous and systematic methods to implement interventions and report results.
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Affiliation(s)
- Lucas Gomes Souza
- Department of Social and Preventive Medicine (L.G.S., D.A.B.), Faculty of Medicine, Université Laval, Québec, Canada, and VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Dalil Asmaou Bouba
- Department of Social and Preventive Medicine (L.G.S., D.A.B.), Faculty of Medicine, Université Laval, Québec, Canada, and VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Roberta de Carvalho Corôa
- Department of Family Medicine and Emergency Medicine (R.C.C.), VITAM, Centre de recherche en santé durable, Unité de soutien au système de santé apprenant, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Suélène Georgina Dofara
- VITAM, Centre de recherche en santé durable (S.G.B., S.G.D.), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Vincent Robitaille
- Faculty of Medicine, Université Laval (V.R.), VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine (V.B.), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | | - Sabrina Guay-Bélanger
- VITAM, Centre de recherche en santé durable (S.G.B., S.G.D.), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | | | - Annette M Totten
- Department of Medical Informatics and Clinical Epidemiology (A.M.T.), School of Medicine, Oregon Health & Science University, Portland, OR
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine (P.A.), Faculty of Medicine, Université Laval, VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Québec, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine (F.L.), Faculty of Medicine, Université Laval, VITAM, Centre de recherche en santé durable, Researcher, Centre de recherche du CHU de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada.
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Naim R, Ziadé N, Haouichat C, Baron F, Al-Mayouf SM, Abdulateef N, Masri B, El Rakawi M, El Kibbi L, Al Mashaleh M, Abutiban F, Hmamouchi I. Burnout syndrome among rheumatologists and rheumatology fellows in Arab countries: an ArLAR multinational study. Clin Rheumatol 2024; 43:765-774. [PMID: 38012468 DOI: 10.1007/s10067-023-06827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Burnout is frequent among physicians and seems to be underestimated among rheumatologists. OBJECTIVE To estimate the frequency of burnout in a sample of rheumatologists practising in the Arab countries and determine its associated factors. METHODS This was a descriptive cross-sectional study conducted by the Arab League of Associations for Rheumatology (ArLAR research group) using an anonymous electronic questionnaire set up on the Google Forms platform. All Arab rheumatologists and rheumatology fellows were invited to participate in the spring of 2022 via ArLAR social media accounts, societies' WhatsApp groups, and mass emails. Burnout was defined by at least one positive domain of the Maslach Burnout Inventory (MBI) (Emotional exhaustion, Depersonalization, and Personal accomplishment). The final score was correlated to socio-demographic factors using a multivariable binary logistic regression. RESULTS The study included 445 rheumatologists and rheumatology fellows with an average age of 45.2 years (SD 11.5); 61.8% were men. The frequency of burnout among rheumatologists was 61.3% and was driven by low personal accomplishment scores (58.1%). Younger age (OR 1.92 (95%CI 1.20-3.08)), dissatisfaction with the specialty (OR 2.036 (95% CI 1.20-3.46)), and low income (OR 2.26 (95% CI 1.01-5.10)) were associated with burnout. CONCLUSION The frequency of burnout in a sample of rheumatologists in Arab countries is very high, driven by low personal accomplishment scores and associated with a low income, dissatisfaction with the specialty and younger age. Some associated factors might be modifiable, thus reducing the burden of burnout on rheumatologists and on the healthcare system. Key Points • The frequency of burnout in a sample of Arab rheumatologists was 61.3% according to the MBI. • The score was mainly driven by low personal accomplishment scores (58.1%). • Younger age, dissatisfaction with the specialty, and low income were associated with burnout. • Acting upon modifiable risk factors would help reducing the burden of burnout on rheumatologists and on the healthcare system.
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Affiliation(s)
- Rita Naim
- Internal Medicine Department, Saint-Joseph University, Beirut, Lebanon.
- Hotel-Dieu de France Hospital, Alfred Naccache Blvd. Achrafieh, Beirut, Lebanon.
| | - Nelly Ziadé
- Hotel-Dieu de France Hospital, Alfred Naccache Blvd. Achrafieh, Beirut, Lebanon
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
| | - Chafika Haouichat
- Rheumatology Department, Djillali Bounaama University Hospital, Douera, Algiers, Algeria
- Faculty of Medicine El Mahdi Si Ahmed, Blida, Algeria
| | - Fatemah Baron
- Unit of Rheumatology, Internal Medicine Department, Al-Jahra Hospital, Ministry of Health, State of Kuwait, Kuwait City, Kuwait
| | - Sulaiman M Al-Mayouf
- Division of Rheumatology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Nizar Abdulateef
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Basel Masri
- Department of Internal Medicine, Rheumatology Division, Jordan Hospital & Medical Center, Amman, Jordan
| | - Manal El Rakawi
- Rheumatology Department, Djillali Bounaama University Hospital, Douera, Algiers, Algeria
- Faculty of Medicine El Mahdi Si Ahmed, Blida, Algeria
| | - Lina El Kibbi
- Division of Rheumatology, Department of Internal Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Manal Al Mashaleh
- Rheumatology Division of Internal Medicine, King Hussein Medical Center, Royal Medical Services, Jordan Armed Forces, Amman, Jordan
| | - Fatemah Abutiban
- Unit of Rheumatology, Department of Internal Medicine, Jaber Alahmed Hospital, Ministry of Health, State of Kuwait, Kuwait City, Kuwait
| | - Ihsane Hmamouchi
- Faculty of Medicine , Health Sciences Research Center (CReSS), International University of Rabat (UIR), Rabat, Morocco
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Meese KA, Boitet LM, Sweeney KL, Gorman CA, Nassetta LB, Patel N, Rogers DA. Don't Go: Examining the Relationships Between Meaning, Work Environment and Turnover Intention Across the Entire Healthcare Team. J Multidiscip Healthc 2024; 17:353-366. [PMID: 38284119 PMCID: PMC10821655 DOI: 10.2147/jmdh.s437816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Healthcare workers tend to have a strong sense of altruism in their work, which may be protective against turnover despite poor working conditions. Due to the increased distress noted during the pandemic, the challenges of working in healthcare and changing attitudes about work may have surpassed the protective effect of meaning and purpose in work. This study empirically examines perceived meaning in work, and specific work-related factors that contribute to employees' intent to stay and to recommend working at the organization to others as COVID-19 transitions from a pandemic to endemic phase. Methods Data from a survey of 4451 clinical and non-clinical healthcare workers were analyzed using regression and dominance analyses to identify specific predictors of turnover intention and net promoter score. Results The variables that explained the greatest contribution to variance in turnover intention from highest to lowest were burnout, trust and confidence in senior leadership, perceived organizational support, sense of belonging, and sense of recognition. The variables that explained the greatest overall contribution to variance for net promoter score from highest to lowest were perceived organizational support, trust and confidence in senior leadership, resource availability, sense of recognition, and sense of belonging. While meaning in work was associated with turnover intent, organizational and team level factors such as trust and belonging were more predictive of the outcomes. Discussion While meaning and purpose are important job resources, they are not sufficient to retain employees in the absence of trust, organizational support, belonging, recognition and access to necessary resources. Leaders must seek to foster environments that support trust, belonging and recognition in their retention efforts.
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Affiliation(s)
- Katherine A Meese
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Medicine Office of Wellness, UAB, Birmingham, AL, USA
| | - Laurence M Boitet
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Medicine Office of Wellness, UAB, Birmingham, AL, USA
| | - Katherine L Sweeney
- UAB Medicine Office of Wellness, UAB, Birmingham, AL, USA
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C Allen Gorman
- Department of Management, Information Systems, & Quantitative Methods, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Lauren B Nassetta
- UAB Medicine Office of Wellness, UAB, Birmingham, AL, USA
- Department of Pediatrics, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Nisha Patel
- UAB Medicine Office of Wellness, UAB, Birmingham, AL, USA
| | - David A Rogers
- UAB Medicine Office of Wellness, UAB, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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Buerhaus P, Hayes R. Leveraging nursing strengths, listening to nursing needs: A keynote paper from the 2022 Emory University Business Case for Nursing Summit. Nurs Outlook 2024; 72:101993. [PMID: 37365080 DOI: 10.1016/j.outlook.2023.101993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023]
Abstract
This keynote paper is the first installment in the six-part Nursing Outlook special edition based on the 2022 Emory University Business Case for Nursing Summit. The summit, which took place in March 2022, was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises. Each of the summit's panels authored a paper in this special edition on their respective topic(s). Those topics included the growth, distribution, resilience, and value of the nursing workforce. As on the day of the event, the keynote frames the panelists' discussions by sharing nursing workforce trends, expert workforce insights, and data-informed questions to help promote dialogue in this series and beyond.
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Affiliation(s)
- Peter Buerhaus
- Montana State University College of Nursing, Bozeman, MT
| | - Rose Hayes
- Emory University School of Nursing, Atlanta, GA.
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Kissler K, Thumm EB, Smith DC, Anderson JL, Wood RE, Johnson R, Roberts M, Carmitchel-Fifer A, Patterson N, Amura CR, Barton AJ, Jones J. Perinatal Telehealth: Meeting Patients Where They Are. J Midwifery Womens Health 2024; 69:9-16. [PMID: 37641584 PMCID: PMC10873126 DOI: 10.1111/jmwh.13560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Prior to the coronavirus disease 2019 (COVID-19) pandemic, studies of innovative telehealth perinatal care models showed similar clinical outcomes and perceived quality of care between groups receiving a combination of virtual video and in-person visits. However, these studies included primarily White, English-speaking participants, excluding those who were economically disenfranchised or did not speak English. The purpose of this qualitative study was to describe perinatal patients' and providers' experiences with telehealth during and after the acute phase of the COVID-19 pandemic to inform future utilization of telehealth to drive the delivery of high-quality, accessible, and equitable perinatal care to diverse communities. METHODS This descriptive qualitative study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse-midwifery practice or the nurse-family partnership care model between March 2020 and April 2022. Maximum variation sampling offered a diverse population based on race, ethnicity, and rurality. Researchers conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context. RESULTS Six themes were identified through inductive analysis: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers' fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients appreciated the increased ease and reduced cost of accessing visits, which led to fewer missed appointments. Health care providers saw great opportunity in telehealth but expressed concerns about accessibility for patients with language barriers or limited resources. DISCUSSION This study provides insight into priorities for continued telehealth utilization focused on providing equitable access to perinatal care. Rather than returning to practices from before the COVID-19 pandemic formed from longstanding routines and perceived limitations, providers are encouraged to capitalize on the rapid innovations in telehealth to build a more effective, equitable, and patient-centered approach to perinatal care.
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Affiliation(s)
- Katherine Kissler
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - E Brie Thumm
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Denise C Smith
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica L Anderson
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rachel E Wood
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia
| | - Rachel Johnson
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mia Roberts
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Nicole Patterson
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Claudia R Amura
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amy J Barton
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Cunningham T, Caza B, Hayes R, Leake S, Cipriano P. Design health care systems to protect resilience in nursing. Nurs Outlook 2024; 72:101999. [PMID: 37481349 DOI: 10.1016/j.outlook.2023.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/30/2023] [Accepted: 06/11/2023] [Indexed: 07/24/2023]
Abstract
This panel paper is the fourth installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic(s) of discussion, and this panel paper is focused on resilience in nursing. It addresses the importance of organizational culture in nursing retention, the role of leadership in reducing nurse turnover, and strategies for how to build resilience systems that counteract or eliminate sources of moral distress. Cost rationales are discussed as part of 'the busienss case' for investing in resilience systems.
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Affiliation(s)
| | - Brianna Caza
- University of North Carolina Greensboro, Greensboro, NC.
| | - Rose Hayes
- Emory University School of Nursing, Atlanta, GA.
| | - Sandy Leake
- The University of Tennessee Medical Center, Knoxville, TN.
| | - Pamela Cipriano
- University of Virginia School of Nursing, Charlottesville, VA.
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Mulligan EP, Hegedus EJ, Foucrier J, Dickson T. Influences of Financial and Workplace Factors on Physical Therapist Job Satisfaction. Phys Ther 2023; 103:pzad093. [PMID: 37440453 DOI: 10.1093/ptj/pzad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/11/2023] [Accepted: 05/12/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE The physical therapist labor market has recently noted higher rates of turnover and job vacancies. An understudied factor contributing to these trends in the profession is job satisfaction. The profession continues to experience relatively low wages compared with other health professions, and graduates of Doctor of Physical Therapy programs face increasingly high student debt. This study used the labor-search model as a conceptual framework to understand associations between job satisfaction, income, and educational debt. The purpose of this study is to observe the financial and workplace factors that are associated with higher levels of physical therapist job satisfaction. METHODS Data from 4764 physical therapists in 1 state were captured retrospectively through the state's licensure renewal process from 2014 to 2020. A random effects panel analysis, with job satisfaction as the dependent variable, was used to evaluate the relationships between job satisfaction and income, educational debt, and a variety of work-related factors. RESULTS Job satisfaction was negatively correlated with educational debt, number of hours worked per week, and some practice settings. Conversely, job satisfaction was positively correlated with the expected age of retirement. The percentage of time spent in research and administration was also positively correlated with job satisfaction, though additional research in this area is needed to draw meaningful conclusions on this association. CONCLUSION The results support the conceptual framework, which suggests that early career physical therapists, motivated by high amounts of educational debt, may choose more financially advantageous practice settings and increased working hours to the detriment of job satisfaction. IMPACT High levels of job satisfaction among physical therapists are correlated with low levels of educational debt, working 45 hours or less per week, a longer time horizon until retirement, and practice settings other than home health and skilled nursing facilities.
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Affiliation(s)
- Edward P Mulligan
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Phoenix, Arizona, USA
| | - Eric J Hegedus
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Phoenix, Arizona, USA
| | - Jeffrey Foucrier
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Phoenix, Arizona, USA
| | - Tara Dickson
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Phoenix, Arizona, USA
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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Acosta N, Dai X, Bautista MA, Waddell BJ, Lee J, Du K, McCalder J, Pradhan P, Papparis C, Lu X, Chekouo T, Krusina A, Southern D, Williamson T, Clark RG, Patterson RA, Westlund P, Meddings J, Ruecker N, Lammiman C, Duerr C, Achari G, Hrudey SE, Lee BE, Pang X, Frankowski K, Hubert CRJ, Parkins MD. Wastewater-based surveillance can be used to model COVID-19-associated workforce absenteeism. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 900:165172. [PMID: 37379934 PMCID: PMC10292917 DOI: 10.1016/j.scitotenv.2023.165172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023]
Abstract
Wastewater-based surveillance (WBS) of infectious diseases is a powerful tool for understanding community COVID-19 disease burden and informing public health policy. The potential of WBS for understanding COVID-19's impact in non-healthcare settings has not been explored to the same degree. Here we examined how SARS-CoV-2 measured from municipal wastewater treatment plants (WWTPs) correlates with workforce absenteeism. SARS-CoV-2 RNA N1 and N2 were quantified three times per week by RT-qPCR in samples collected at three WWTPs servicing Calgary and surrounding areas, Canada (1.4 million residents) between June 2020 and March 2022. Wastewater trends were compared to workforce absenteeism using data from the largest employer in the city (>15,000 staff). Absences were classified as being COVID-19-related, COVID-19-confirmed, and unrelated to COVID-19. Poisson regression was performed to generate a prediction model for COVID-19 absenteeism based on wastewater data. SARS-CoV-2 RNA was detected in 95.5 % (85/89) of weeks assessed. During this period 6592 COVID-19-related absences (1896 confirmed) and 4524 unrelated absences COVID-19 cases were recorded. A generalized linear regression using a Poisson distribution was performed to predict COVID-19-confirmed absences out of the total number of absent employees using wastewater data as a leading indicator (P < 0.0001). The Poisson regression with wastewater as a one-week leading signal has an Akaike information criterion (AIC) of 858, compared to a null model (excluding wastewater predictor) with an AIC of 1895. The likelihood-ratio test comparing the model with wastewater signal with the null model shows statistical significance (P < 0.0001). We also assessed the variation of predictions when the regression model was applied to new data, with the predicted values and corresponding confidence intervals closely tracking actual absenteeism data. Wastewater-based surveillance has the potential to be used by employers to anticipate workforce requirements and optimize human resource allocation in response to trackable respiratory illnesses like COVID-19.
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Affiliation(s)
- Nicole Acosta
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Xiaotian Dai
- Department of Mathematics and Statistics, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Maria A Bautista
- Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Barbara J Waddell
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Jangwoo Lee
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Kristine Du
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Janine McCalder
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Puja Pradhan
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Chloe Papparis
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Xuewen Lu
- Department of Mathematics and Statistics, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Thierry Chekouo
- Department of Mathematics and Statistics, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada; Division of Biostatistics, School of Public Health, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN 55455, USA
| | - Alexander Krusina
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Danielle Southern
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada
| | - Rhonda G Clark
- Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Raymond A Patterson
- Haskayne School of Business, University of Calgary, SH 250, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | | | - Jon Meddings
- Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Norma Ruecker
- Water Services, City of Calgary, 625 25 Ave SE, Calgary, Alberta T2G 4k8, Canada
| | - Christopher Lammiman
- Calgary Emergency Management Agency (CEMA), City of Calgary, 673 1 St NE, Calgary, Alberta T2E 6R2, Canada
| | - Coby Duerr
- Calgary Emergency Management Agency (CEMA), City of Calgary, 673 1 St NE, Calgary, Alberta T2E 6R2, Canada
| | - Gopal Achari
- Department of Civil Engineering, University of Calgary, 622 Collegiate Pl NW, T2N 4V8, Canada
| | - Steve E Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Analytical and Environmental Toxicology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Women & Children's Health Research Institute, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Li Ka Shing Institute of Virology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Li Ka Shing Institute of Virology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Alberta Precision Laboratories, Public Health Laboratory, Alberta Health Services, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada
| | - Kevin Frankowski
- Advancing Canadian Water Assets, University of Calgary, 3131 210 Ave SE, Calgary, Alberta T0L 0X0, Canada
| | - Casey R J Hubert
- Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Michael D Parkins
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
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Griebenow R, Herrmann H, Smith M, Bassiouny M, Gual A, Li PKT, Elsayed E, Schaefer RD, Al Sinani S, McMahon GT. Continuing Education as a Contributor to Mitigating Physician Burnout. JOURNAL OF CME 2023; 12:2272461. [PMID: 37929072 PMCID: PMC10623890 DOI: 10.1080/28338073.2023.2272461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Affiliation(s)
| | - Henrik Herrmann
- European Cardiology Section Foundation, Cologne, Germany
- Marburger Bund Germany, Berlin, Germany
| | - Michel Smith
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | | | - Arcadi Gual
- Spanish Medical Professional Accreditation Council for CPD/CME (SEAFORMEC), Madrid, Spain
| | | | | | - Robert D Schaefer
- European Board for Accreditation of Continuing Education for Health Professionals, Cologne, Germany
| | | | - Graham T McMahon
- Accreditation Council for Continuing Medical Education, Chicago, USA
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Boitet LM, Meese KA, Hays MM, Gorman CA, Sweeney KL, Rogers DA. Burnout, Moral Distress, and Compassion Fatigue as Correlates of Posttraumatic Stress Symptoms in Clinical and Nonclinical Healthcare Workers. J Healthc Manag 2023; 68:427-451. [PMID: 37944174 DOI: 10.1097/jhm-d-23-00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
GOAL Research has highlighted psychological distress resulting from the COVID-19 pandemic on healthcare workers (HCWs), including the development of posttraumatic stress symptoms (PTSS). However, the degree to which these conditions have endured beyond the pandemic and the extent to which they affect the entire healthcare team, including both clinical and nonclinical workers, remain unknown. This study aims to identify correlates of PTSS in the entire healthcare workforce with the goal of providing evidence to support the development of trauma-informed leadership strategies. METHODS Data were collected from June to July 2022 using a cross-sectional anonymous survey in a large academic medical center setting. A total of 6,466 clinical and nonclinical employees completed the survey (27.3% response rate). Cases with at least one missing variable were omitted, for a total sample size of 4,806, the evaluation of which enabled us to understand individual, organizational, and work-related and nonwork-related stressors associated with PTSS. Data were analyzed using ordinal logistic regression and dominance analyses to identify predictors of PTSS specific to clinical and nonclinical workers. PRINCIPAL FINDINGS While previous studies have shown that HCWs in different job roles experience unique stressors, our data indicate that the top correlates of PTSS among both clinical and nonclinical HCWs are the same: burnout, moral distress, and compassion fatigue. These three factors alone explained 45% and 44.4% of the variance in PTSS in clinical and nonclinical workers, respectively. PTSS was also associated with a lower sense of recognition and feeling mistreated by other employees at work in the clinical workforce. Concerningly, women and sexual minorities in the clinical sample exhibited a higher incidence of PTSS. In nonclinical workers, social isolation or loneliness and lower trust and confidence in senior leadership were associated with PTSS. Nonwork-related factors, such as exhaustion from caregiving responsibilities and financial strain, were also significantly associated with PTSS. Even after controlling for discrimination at and outside of work in both samples, we found that non-White populations were more likely to experience PTSS, highlighting a deeply concerning issue in the healthcare workforce. PRACTICAL APPLICATIONS The primary objective of this article is to help healthcare leaders understand the correlates of PTSS across the entire healthcare team as organizations recover from the COVID-19 pandemic. Understanding which factors are associated with PTSS will help healthcare leaders develop best practices that aim to reduce HCW distress and strategies to circumvent trauma derived from future crises. Our data indicate that leaders must address the correlates of PTSS in the workforce, focusing attention on both those who work on the frontlines and those who work behind the scenes. We urge leaders to adopt a trauma-informed leadership approach to ensure that the entire healthcare workforce is recognized, supported, and cared for as each HCW plays a unique role in the care of patients.
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Affiliation(s)
| | - Katherine A Meese
- Department of Health Services Administration, University of Alabama at Birmingham (UAB) and UAB Medicine Office of Wellness, Birmingham, Alabama
| | | | - C Allen Gorman
- Department of Management, Information Systems & Quantitative Methods, UAB
| | | | - David A Rogers
- UAB Medicine Office of Wellness and Department of Surgery, UAB
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Doyle K, Murray T, Fong IC, Chavez A, Rounds G, Linenberger M, Wieck M. Building a Culture of Support at a Pediatric Surgery Center Through Multidisciplinary Peer Support. J Surg Res 2023; 291:90-96. [PMID: 37354705 DOI: 10.1016/j.jss.2023.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Surgeons and perioperative staff experience high rates of burnout manifesting as exhaustion, depersonalization, and lack of achievement. Consequences include increases in errors and adverse patient events. Little data exist regarding the effectiveness of multidisciplinary peer support systems in combatting burnout. We sought to improve staff morale through establishment of a formally trained, multidisciplinary peer support team. METHODS Selfselected surgeons, anesthesiologists, and nurses were formally trained as Peer Responders as part of an institutional peer support program. All perioperative staff at our pediatric surgery center (n = 120) were surveyed before initiation of the program and then 1-mo and 12-mo after initiation. Primary outcomes were unit morale, unit support, and peer approachability. Kruskal-Wallis tests and Chi-squared tests were used for comparison of primary outcomes among surveys and by position with an alpha value of 0.05 set for significance. Institutional review board approval was waived. RESULTS The survey response rates were 57.5%, 32.5%, and 37.5% chronologically. After 1 year, there were statistically significant increases in unit support (P < 0.01) and peer approachability (P < 0.001), and a nonstatistically significant increase in unit morale (P = 0.22). On subgroup analysis by staff role, surgeons were least likely to utilize peer support. CONCLUSIONS A multidisciplinary peer support team is an effective and easily reproducible means of building a culture of support and improving morale among perioperative staff. Surgeons were least likely to seek interprofessional peer support. Consequently, surgeon-specific strategies may be necessary. Further investigations are ongoing regarding secondary effects on staff burnout rates, patient safety, and quality of care.
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Affiliation(s)
| | - Trudee Murray
- Children's Surgery Program Patient Care Services, UC Davis, Sacramento, California
| | - Ian C Fong
- Children's Surgery Center Perioperative Service, UC Davis, Sacramento, California
| | - Angela Chavez
- Children's Surgery Center Perioperative Service, UC Davis, Sacramento, California
| | - Ginger Rounds
- Child Life and Creative Arts Therapy, UC Davis, Sacramento, California
| | | | - Minna Wieck
- Department of Surgery, UC Davis, Sacramento, California; Division of Pediatric Surgery, UC Davis, Sacramento, California.
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Wiig S, Lyng HB, Greenfield D, Braithwaite J. Care in the future-reconciling health system and individual resilience. Int J Qual Health Care 2023; 35:mzad082. [PMID: 37795897 DOI: 10.1093/intqhc/mzad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Siri Wiig
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger 4036, Norway
| | - Hilda Bø Lyng
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger 4036, Norway
| | - David Greenfield
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Macquarie Park, NSW 2109, Australia
- International Society for Quality in Health Care (ISQua), Suite 113, 1st Floor, South Point, Herbert House, Harmony Row, Dublin 2 D02 H270, Ireland
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Jain N, Kourampi I, Umar TP, Almansoor ZR, Anand A, Ur Rehman ME, Jain S, Reinis A. Global population surpasses eight billion: Are we ready for the next billion? AIMS Public Health 2023; 10:849-866. [PMID: 38187896 PMCID: PMC10764969 DOI: 10.3934/publichealth.2023056] [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] [Received: 07/06/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 01/09/2024] Open
Abstract
In November 2022, the global population had officially crossed eight billion. It has long been recognized that socioeconomic or health-related problems in the community always accompany an uncontrolled population expansion. International calls have been made regarding lack of universal health coverage, an insufficient supply of healthcare providers, the burden of noncommunicable disease, population aging and the difficulty in obtaining safe drinking water and food. The present health policy paper discusses how to conquer these crowded world issues, including (1) promoting government and international organization participation in providing appropriate infrastructure, funding and distribution to assist people's health and well-being; (2) shifting health program towards a more preventive approach and (3) reducing inequalities, particularly for the marginalized, isolated and underrepresented population. These fundamental principles of health policy delivery as a response to an increasingly crowded world and its challenges are crucial for reducing the burden associated with excessive healthcare costs, decreased productivity and deteriorating environmental quality.
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Affiliation(s)
- Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, 16 Dzirciema street, Riga, Latvia, LV-1007
| | - Islam Kourampi
- Department of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece, 11527
| | - Tungki Pratama Umar
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia 30128
| | - Zahra Rose Almansoor
- Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Ayush Anand
- BP Koirala Institute of Health Sciences, Buddha Road, Dharan 56700, Nepal
| | | | - Shivani Jain
- Department of Oral and Maxillofacial Surgery, Genesis Institute of Dental Sciences & Research, Ferozepur-Moga Road, Ferozepur, Punjab, India 152002
| | - Aigars Reinis
- Department of Biology and Microbiology, Riga Stradinš University, 16 Dzirciema street, Riga, Latvia, LV-1007
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Mann A, Shah AN, Thibodeau PS, Dyrbye L, Syed A, Woodward MA, Thurmon K, Jones CD, Dunbar KS, Fainstad T. Online Well-Being Group Coaching Program for Women Physician Trainees: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2335541. [PMID: 37792378 PMCID: PMC10551770 DOI: 10.1001/jamanetworkopen.2023.35541] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
Importance Physician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking. Objective To assess the generalizability of a coaching program (Better Together Physician Coaching) in a national sample of women physician trainees. Design, Setting, and Participants A randomized clinical trial involving trainees in 26 graduate medical education institutions in 19 states was conducted between September 1, 2022, and December 31, 2022. Eligible participants included physician trainees at included sites who self-identified as a woman (ie, self-reported their gender identity as woman, including those who reported woman if multiple genders were reported). Intervention A 4-month, web-based, group coaching program. Main Outcomes and Measures The primary outcomes were change in burnout (measured using subscales for emotional exhaustion, depersonalization, and personal achievement from the Maslach Burnout Inventory). Secondary outcomes included changes in impostor syndrome, moral injury, self-compassion, and flourishing, which were assessed using standardized measures. A linear mixed model analysis was performed on an intent-to-treat basis. A sensitivity analysis was performed to account for the missing outcomes. Results Among the 1017 women trainees in the study (mean [SD] age, 30.8 [4.0] years; 540 White participants [53.1%]; 186 surgical trainees [18.6%]), 502 were randomized to the intervention group and 515 were randomized to the control group. Emotional exhaustion decreased by an estimated mean (SE) -3.81 (0.73) points in the intervention group compared with a mean (SE) increase of 0.32 (0.57) points in the control group (absolute difference [SE], -4.13 [0.92] points; 95% CI, -5.94 to -2.32 points; P < .001). Depersonalization decreased by a mean (SE) of -1.66 (0.42) points in the intervention group compared with a mean (SE) increase of 0.20 (0.32) points in the control group (absolute difference [SE], -1.87 [0.53] points; 95%CI, -2.91 to -0.82 points; P < .001). Impostor syndrome decreased by a mean (SE) of -1.43 (0.14) points in the intervention group compared with -0.15 (0.11) points in the control group (absolute difference [SE], -1.28 (0.18) points; 95% CI -1.63 to -0.93 points; P < .001). Moral injury decreased by a mean (SE) of -5.60 (0.92) points in the intervention group compared with -0.92 (0.71) points in the control group (absolute difference [SE], -4.68 [1.16] points; 95% CI, -6.95 to -2.41 points; P < .001). Self-compassion increased by a mean (SE) of 5.27 (0.47) points in the intervention group and by 1.36 (0.36) points in the control group (absolute difference [SE], 3.91 [0.60] points; 95% CI, 2.73 to 5.08 points; P < .001). Flourishing improved by a mean (SE) of 0.48 (0.09) points in the intervention group vs 0.09 (0.07) points in the control group (absolute difference [SE], 0.38 [0.11] points; 95% CI, 0.17 to 0.60 points; P < .001). The sensitivity analysis found similar findings. Conclusions and Relevance The findings of this randomized clinical trial suggest that web-based professional group-coaching can improve outcomes of well-being and mitigate symptoms of burnout for women physician trainees. Trial Registration ClinicalTrials.gov Identifier: NCT05222685.
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Affiliation(s)
- Adrienne Mann
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Veterans’ Health Administration, Eastern Colorado Health Care System, Aurora
| | - Ami N. Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Pari Shah Thibodeau
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Liselotte Dyrbye
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Adnan Syed
- University of Colorado School of Medicine, Aurora
- Veterans’ Health Administration, Eastern CO Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado
| | | | - Kerri Thurmon
- Division of Urology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Christine D. Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Veterans’ Health Administration, Eastern Colorado Health Care System, Aurora
- Division of Geriatrics, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Kimiko S. Dunbar
- Children’s Hospital of Colorado, Section of Hospital Medicine, University of Colorado, School of Medicine, Aurora
| | - Tyra Fainstad
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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