An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Healthcare Professionals: A Call for Action

A Mindfulness-Based Intervention for Acute Care Nursing Staff: A Pilot Study

Purpose:The purpose of this study was to determine if a mindfulness-based smartphone application, used for 5 minutes a day for 30 days, could address burnout among acute care nursing staff. Methods: A pretest-posttest design with a midpoint evaluation was utilized. The sample included 31 nursing staff from cardiovascular acute care units. The Copenhagen Burnout Inventory, Cognitive and Affective Mindfulness Scale-Revised, Perceived Stress Scale, and Brief Resilience Scale were used to measure the impact of the intervention on participants. Findings: In a repeated measures analysis, there were no statistically significant changes in scores on the Brief Resilience Scale across the three timeframes (F = 0.64, df = 1.42, p = .49). There were significant reductions over time for perceived stress (F = 10.56, df = 1.74, p = .002) and personal burnout (F = 11.8, df = 1.10, p = .007), and increased scores on mindfulness (F = 4.76, df = 1.57, p = .039). Conclusions: The utilization of a mindfulness-based smartphone application may promote the health and well-being of cardiovascular nurses in acute care units. Mindfulness-based smartphone apps should be considered as a method of self-care, along with other holistic approaches to improve well-being.

A Survey of Burnout Among Neurocritical Care Practitioners

BACKGROUND

Burnout is a growing problem among medical professionals, reaching a crisis proportion. It is defined by emotional exhaustion, cynicism, and career dissatisfaction and is triggered by a mismatch between the values of the person and the demands of the workplace. Burnout has not previously been examined thoroughly in the Neurocritical Care Society (NCS). The purpose of this study is to assess the prevalence, contributing factors, and potential interventions to reduce burnout within the NCS.

METHODS

A cross-sectional study of burnout was conducted using a survey distributed to members of the NCS. The electronic survey included personal and professional characteristic questions and the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). This validated measure assesses for emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). These subscales are scored as high, moderate, or low. Burnout (MBI) was defined as a high score in either EE or DP or a low score in PA. A Likert scale (0-6) was added to the MBI (which contained 22 questions) to provide summary data for the frequencies of each particular feeling. Categorical variables were compared using χ2 tests, and continuous variables were compared using t-tests.

RESULTS

A total of 82% (204 of 248) of participants completed the entire questionnaire; 61% (124 of 204) were burned out by MBI criteria. A high score in EE was present in 46% (94 of 204), a high score in DP was present in 42% (85 of 204), and a low score in PA was present in 29% (60 of 204). The variables feeling burned out now, feeling burned out in the past, not having an effective/responsive supervisor, thinking about leaving one's job due to burnout, and leaving one's job due to burnout were significantly associated with burnout (MBI) (p < 0.05). Burnout (MBI) was also higher among respondents early in practice (currently training/post training 0-5 years) than among respondents post training 21 or more years. In addition, insufficient support staff contributed to burnout, whereas improved workplace autonomy was the most protective factor.

CONCLUSIONS

Our study is the first to characterize burnout among a cross-section of physicians, pharmacists, nurses, and other practitioners in the NCS. A call to action and a genuine commitment by the hospital, organizational, local, and federal governmental leaders and society as a whole is essential to advocate for interventions to ameliorate burnout and care for our health care professionals.

Providing Trauma-Informed Care During a Pandemic: How Health Care Workers at Ryan White-Funded Clinics in the Southeastern United States Responded to COVID-19 and Its Effects on Their Well-Being

As HIV/AIDS health care workers (HCWs) deliver services during COVID-19 under difficult conditions, practicing trauma-informed care (TIC) may mitigate negative effects on mental health and well-being. This secondary qualitative analysis of a larger mixed methods study sought to understand the pandemic's impact on HCWs at Ryan White-funded clinics (RWCs) across the southeastern US and assess changes in prioritization of TIC. RWC administrators, providers, and staff were asked about impacts on clinic operations/culture, HCW well-being, institutional support for well-being, and prioritization of TIC. HCWs described strenuous work environments and decreased well-being (eg, increased stress, burnout, fear, and social isolation) due to COVID-19. RWCs initiated novel responses to disruptions of clinic operations and culture to encourage continuity in care and promote HCW well-being. Despite increased awareness of the need for TIC, prioritization remained variable. Implementing and institutionalizing trauma-informed practices could strengthen continuity in care and safeguard HCW well-being during public health emergencies.

The impact of COVID-19 on mental health and well-being in critical care nurses - a longitudinal, qualitative study

BACKGROUND

The COVID-19 pandemic has had both a psychological and physiological effect on the human race. For those working in health care, particularly in critical care, the pandemic has put unprecedented strain on staff. Witnessing suffering during crisis in an organizational setting can be a traumatic experience and critical care nurses often risked, not only their own lives, but their psychological well-being, so that those infected with the virus might have a better chance at survival.

AIM

The aim of this study was to explore the challenges to mental health and psychological well-being experienced by Critical Care Nurses during the COVID-19 pandemic.

STUDY DESIGN

A longitudinal, qualitative study involving semi-structured interviews with 54 critical care nurses across 38 hospitals in the United Kingdom and Ireland. Interviews were transcribed verbatim and analysed using thematic analysis.

RESULTS

Four key themes were identified which represent the challenges faces by critical care nurses during the COVID-19 pandemic: Lack of control, Psychological trauma, Unexpected leadership, Public-political betrayal.

CONCLUSIONS

While public-political praise may lead to a short-term lift in morale for front line workers; where it is not accompanied by practical support in terms of appropriate equipment, leadership, emotional support and renumeration it is likely to be damaging in the longer term.

RELEVANCE TO CLINICAL PRACTICE

This study has provided a greater understanding of the factors which affected the well-being and mental health of critical care nurses during a global pandemic.

Decreasing Nurses' Anxiety About Pediatric End-of-Life Care With Simulation

BACKGROUND

Caring for pediatric patients at the end of life (EOL) can lead to anxiety and burnout for critical care nurses. New graduate nurses (NGNs) often report receiving inadequate education related to EOL care and then enter the workforce with limited clinical experience in caring for patients at EOL. A quality improvement project at a pediatric academic hospital sought to determine whether a simulation-based educational program for NGNs working in critical care could reduce anxiety about EOL care.

METHOD

Eight NGNs participated in a case study and simulation-based educational program that encompassed topics such as communication, symptom management, postmortem care, and support for the family at EOL. Anxiety was measured pre- and postprogram with the Spielberger State-Trait Anxiety Inventory (STAI©).

RESULTS

Anxiety levels after participation in the EOL educational program decreased by 24.1% from preprogram levels.

CONCLUSION

Providing NGNs in critical care with a case- and simulation-based EOL educational program can reduce anxiety levels and potentially decrease caregiver burnout. [J Contin Educ Nurs. 2023;54(12):574-580.].

Burnout syndrome among medical nurse-technicians in intensive care units in cardiovascular surgery

Background

Healthcare workers in intensive care units work under specifically hard conditions compared to healthcare workers who work under regular clinical conditions. In this sense, the research aims at assessing the level of burnout symptomatology among nurse technicians working in intensive care units for cardiovascular surgery and to compare those burnout levels with those recorded for medical technicians working under regular clinical conditions.

Method

The research was designed as a cross-sectional study. The sample consisted of nurse technicians working in intensive care units specializing in cardiovascular surgery (70 participants) and nurse technicians working under regular clinical conditions (70 participants) at the Institute for Cardiovascular Diseases "Dedinje," Belgrade, Serbia. To evaluate the manifestation of burnout syndrome at work, the analysis uses the Serbian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).

Results

To examine the variances in the average sub-scores for burnout within two groups of medical technicians, the study used Two Independent Samples T-test. The statistically noteworthy differentiation was ascertained for emotional exhaustion and personal accomplishment, but this does not hold true for depersonalization. However, the mean score values across the different burnout levels (low, moderate, high) are similar in two cohorts of respondents (p > 0.05).

Conclusion

This study will serve as an impetus for a policy reform focused on ameliorating working conditions and improving healthcare workers' satisfaction and overall healthcare quality.

The Role of Data Science in Closing the Implementation Gap

Data science has the potential to greatly enhance efforts to translate evidence into practice in critical care. The intensive care unit is a data-rich environment enabling insight into both patient-level care patterns and clinician-level treatment patterns. By applying artificial intelligence to these novel data sources, implementation strategies can be tailored to individual patients, individual clinicians, and individual situations, revealing when evidence-based practices are missed and facilitating context-sensitive clinical decision support. To achieve these goals, technology developers should work closely with clinicians to create unbiased applications that are integrated into the clinical workflow.

Work-related stress, job satisfaction, and quality of work life among cardiovascular nurses in Italy: Structural equation modeling

AIM

To investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life.

BACKGROUND

Prior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion.

METHODS

A multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed.

RESULTS

Nurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction.

CONCLUSION

Cardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved.

Quality of Life in Healthcare Workers during COVID-19-A Longitudinal Study

The COVID-19 pandemic occurred in 2020, and affected people's daily life worldwide at work and at home. Healthcare workers are a professional group with heavy workloads, and during the COVID-19 pandemic, their burden increased. The literature from earlier outbreaks describes risks for affected mental health in frontline workers, and the main aim of this study is to examine healthcare workers' quality of life during the COVID-19 pandemic. In addition, we sought to assess if there was any difference in working at a pandemic ward compared to anon-pandemic ward. In this longitudinal and descriptive study, a total of 147 healthcare workers assessed their perceived health every third month over one year using the RAND-36 health survey. RAND-36 is a general instrument that consists of 36 questions and is widely used for assessing quality of life. The healthcare workers in this study showed reductions in perceived quality of life during the first six months of the COVID-19 pandemic. Healthcare workers on a pandemic ward reported a lower score in RAND-36 compared to healthcare workers on a non-pandemic ward. Registered nurses and licensed practical nurses seemed more negatively affected in their quality of life than physicians. Compared to data from the general Swedish population, healthcare workers in this study had less energy during this period.

Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned

BACKGROUND

The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support.

METHODS

A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement.

RESULTS

All 178 respondents (response rate: 25-32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to 'team cooperation', 'team solidarity' and 'work ethic'. Lessons learned were mostly related to 'quality of care' and 'professional qualities'.

CONCLUSIONS

Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals' dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience.

TRIAL REGISTRATION

The trial was registered on The Netherlands Trial Register, number NL9177.

Debriefing After Critical Events Is Feasible and Associated With Increased Compassion Satisfaction in the Pediatric Intensive Care Unit

BACKGROUND

Repeated exposure to death and dying increases health care professionals' risk for burnout and secondary traumatic stress. Pediatric critical care providers are at particularly high risk because the death and dying of children are associated with even greater psychological impact.

LOCAL PROBLEM

A charge nurse in the pediatric intensive care unit identified a need for additional staff support after critical patient events.

METHODS

The aim of this quality improvement project was to design and implement a debriefing process, the Rapid Review of Resuscitation, in a 40-bed, high-acuity pediatric intensive care unit at an urban children's hospital in the midwestern United States. A preintervention-postintervention survey used the Professional Quality of Life Scale, version 5, to evaluate staff members' compassion satisfaction, burnout, and secondary traumatic stress before and 1 year after implementation. The debriefing process was designed and implemented on the basis of interview data and literature review.

RESULTS

Preimplementation (104 of 222 staff members [47%]) and postimplementation (72 of 184 staff members [39%]) survey responses were compared. Compassion satisfaction scores (mean [SD] T scores: preimplementation, 54.10 [7.52]; postimplementation, 56.71 [6.62]) were significantly higher (P = .02) 1 year after implementation. Burnout (P = .69) and secondary traumatic stress (P = .06) scores were not significantly different. After implementation, 74% of respondents reported that the debriefing process was "very helpful" or "somewhat helpful" after critical patient events.

CONCLUSIONS

Compassion satisfaction improved and burnout and secondary traumatic stress did not change with implementation of the debriefing process after critical patient events.

Influence of spirituality on moral distress and resilience in critical care staff: A scoping review

OBJECTIVE

The Covid 19 pandemic has created a situation in which critical care staff experience moral distress. For reducing moral distress, resources such as spirituality can be used. The aim of this scoping review is to explore whether spirituality mitigates the moral distress of critical care staff and strengthens their resilience. The spiritual resources will be identified and the ability of the staff to use spiritual resources will be explored.

METHODOLOGY

A scoping review of studies reporting on the association between spirituality, moral distress, and resilience. Qualitative and quantitative studies from 2020 that examined critical care staff are included. This scoping review used the five-step framework proposed by Arksey and O'Malley and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in 12 databases.

RESULTS

13 studies met inclusion criteria. Critical care staff declaring themselves as spiritual have a higher risk of moral distress and are often not able to use spiritual resources on their own. For effective use of spiritual resources to reduce moral distress, staff need to be skilled in the practice of spirituality with the aim to find inner peace, focus on the positive, and regain a sense of purpose in the work.

CONCLUSION

Spirituality does not automatically help the critical care staff to cope with moral distress and strengthen resilience. Institutions need to create conditions in which the critical care staff are supported to use their spiritual resources.

IMPLICATION FOR CLINICAL PRACTICE

Institutions need to involve staff more in the design, implementation, and delivery of spiritual interventions to minimise moral distress. Further research is necessary to examine the impact of critical care staff's demographic characteristics on their spirituality, moral distress, and resilience.

Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography

BACKGROUND

Patient safety for people experiencing dementia in acute hospitals is a global priority. Despite national strategies as well as safety and quality guidelines, how safety practices are enacted within the complexities of everyday work are poorly understood and articulated.

METHODS

Using video reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people experiencing dementia and/or delirium in Australia. Patients, family members, and staff members participated by: allowing researchers to document fieldwork notes and video-record their practices and/or accounts thereof; and/or interpreting video-recordings with researchers to co-analyse and make sense of the data.

RESULTS

Safe care for people experiencing advanced dementia involved: negotiating risk via leadership, teamwork, and transparency; practice-based learning through situated adaptation; managing personhood versus protocols by doing the 'right' thing; joyful and meaningful work; as well as incorporating patient and family voices to do safety together.

CONCLUSION

Patient safety for people experiencing dementia requires continuous responsiveness and prioritising in the context of multiple risks by a staff collective with a shared purpose. Ongoing research to better understand how the nuances of patient safety unfold in everyday complex clinical realities in diverse contexts and with key stakeholders is required.

Mindfulness-Based Interventions for Professionals Working in End-of-Life Care: A Systematic Review of the Literature

Objectives: The potential usefulness of mindfulness-based interventions (MBIs) is being investigated for healthcare staff burnout and associated problems, but empirical research on MBI's for end-of-life (EOL) professionals is still in its infancy. The aim of this review is to describe and evaluate the body of evidence-based research on the use of MBIs to support the psychological wellbeing of professional staff in EOL care settings. Methods: A systematic review of the literature was conducted. Database records were extracted from ERIC, PsycInfo, EBSCO, PubMed Central (PMC) and Web of Science, using search terms to locate peer-reviewed studies on professional (not volunteer) staff in dedicated end-of-life settings, administering MBIs not embedded in more general therapeutic modalities (such as ACT or DBT). After removing duplicates, 8701 potential studies were identified: eliminating those that did not fit the eligibility criteria reduced the number of eligible studies to six. Results: A total of six empirical studies were identified and further evaluated. Interventions primarily focussed on reducing burnout symptoms, increasing self-care and self-compassion, and fostering mindfulness. Studies demonstrated very little overlap in treatment, methodology and measures. Only one study was a randomised control trial, which on application of the 3-item Jadad quality scoring, (evidence of randomisation, blinding of researcher to participants' identity and accounts provided of all participants), achieved 1 out of 5 possible points. Furthermore, other concerns were identified as to the study's methodology. Conclusions: Results of this review point to significant gaps in the research on the potential of MBIs to improve the wellbeing of EOL professionals.

High-level burnout in physicians and nurses working in adult ICUs: a systematic review and meta-analysis

PURPOSE

The prevalence of burnout in intensive care unit (ICU) professionals is difficult to establish due to the variety of survey instruments used, the heterogeneity of the targeted population, the design of the studies, and the differences among countries regarding ICU organization.

METHODS

We performed a systematic review and meta-analysis examining the prevalence of high-level burnout in physicians and nurses working in adult ICUs, including only studies that use the Maslach Burnout Inventory (MBI) as a tool to evaluate burnout and involving at least 3 different ICUs.

RESULTS

Twenty-five studies with a combined population of 20,723 healthcare workers from adult ICUs satisfied the inclusion criteria. Combining 18 studies including 8187 ICU physicians, 3660 of them reported a high level of burnout (prevalence 0.41, range 0.15-0.71, 95% CI [0.33; 0.5], I2 97.6%, 95% CI [96.9%; 98.1%]). The heterogeneity can be at least in part explained by the definition of burnout used and the response rate as confirmed by the multivariable metaregression done. In contrast, there was no significant difference regarding other factors such as the study period (before or during the coronavirus disease 2019 (COVID-19) pandemic), the income of the countries, or the Healthcare Access and Quality (HAQ) index. Combining 20 studies including 12,536 ICU nurses, 6232 of nurses were reporting burnout (prevalence 0.44, range 0.14-0.74, [95% CI 0.34; 0.55], I2 98.6% 95% CI [98.4%; 98.9%]). The prevalence of high-level burnout in ICU nurses for studies performed during the COVID-19 pandemic was higher than that reported for studies performed before the COVID-19 pandemic (0.61 [95% CI, 0.46; 0.75] and 0.37 [95% CI, 0.26; 0.49] respectively, p = 0.003). As for physicians, the heterogeneity is at least in part explained by the definition used for burnout using the MBI but not by the number of participants. When compared, the prevalence of high-level burnout was not different between ICU physicians and ICU nurses. However, the proportion of ICU nurses with a high level of emotional exhaustion was higher than for ICU physicians (0.42 [95% CI, 0.37; 0.48] and 0.28 [0.2; 0.39], respectively, p = 0.022).

CONCLUSION

According to this meta-analysis, the prevalence of high-level burnout is higher than 40% in all ICU professionals. However, there is a great heterogeneity in the results. To evaluate and to compare preventive and therapeutic strategies, there is the need to use a consensual definition of burnout when using the MBI instrument.

The Association Between Korean American Nurse and Primary Care Provider Burnout, Areas of Worklife, and Perceptions of Pandemic Experience: Cross-sectional Study

BACKGROUND

Korean immigrants are among the fastest-growing ethnic minority groups and make up the fifth-largest Asian group in the United States. A better understanding of the work environment factors and its impact on Korean American nurse and primary care provider (PCP) burnout may guide the development of targeted strategies to help mitigate burnout and workplace stressors, which is critical for the retention of Korean American nurses and PCPs to promote better alignment of national demographic trends and meet patients' preference for cultural congruence with their health care providers (HCPs). Although there is a growing number of studies on HCP burnout, a limited number of studies specifically focus on the experience of ethnic minority HCPs, particularly during the COVID-19 pandemic.

OBJECTIVE

In light of these gaps in literature, the aim of this study was to assess burnout among Korean American HCPs and to identify work conditions during a pandemic that may be associated with Korean American nurse and PCP burnout.

METHODS

A total of 184 Korean American HCPs (registered nurses [RNs]: n=97; PCPs: n=87) practicing in Southern California responded to a web-based survey between February and April 2021. The Maslach Burnout Inventory, Areas of Worklife Survey, and Pandemic Experience & Perceptions Survey were used to measure burnout and work environment factors during the pandemic. A multivariate linear regression analysis was used to assess work environment factors associated with the 3 subcategories of burnout.

RESULTS

No significant differences were found in the level of burnout experienced by Korean American nurses and PCPs. For RNs, greater workload (P<.001), lower resource availability (P=.04), and higher risk perception (P=.02) were associated with higher emotional exhaustion. Greater workload was also associated with higher depersonalization (P=.003), whereas a greater (professional) community (P=.03) and higher risk perception (P=.006) were associated with higher personal accomplishment. For PCPs, greater workload and poor work-life balance were associated with higher emotional exhaustion (workload: P<.001; worklife: P=.005) and depersonalization (workload: P=.01; worklife: P<.001), whereas only reward was associated with personal accomplishment (P=.006).

CONCLUSIONS

Findings from this study underscore the importance of strategies to promote a healthy work environment across multiple levels that recognize demographic variation among Korean American RNs and PCPs, potentially influencing their burnout mitigation needs. A growing recognition of identity-informed burnout experiences across frontline Korean American RNs and PCPs argues for future explorations that capture nuance both across and within this and other ethnic minority nurse and PCP groups. By recognizing and capturing these variations, we may better support the creation of targeted, burnout-mitigating strategies for all.

Satisfaction, Stress, and Turnover: Comparing U.S. Intensivist Physicians Before and During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic

To evaluate changes in work satisfaction, work-life balance (WLB) satisfaction, stress, and turnover intention among U.S. critical care physicians during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic of 2021-2022 compared with prepandemic levels in 2016.

DESIGN

A cross-sectional electronic survey.

SETTING

Critical care practices in the United States.

SUBJECTS

U.S. physician members of the Society for Critical Care Medicine.

MEASUREMENTS AND MAIN RESULTS

A total of 1,148 intensivists completed online surveys administered in two waves: in 2016 (693 respondents) and in the late 2021 to early 2022 (455 respondents). They reported demographic and practice characteristics, self-perceived levels of satisfaction, stress, health, and intention to leave their current job. U.S.-based critical care physicians in 2022 report significantly lower levels of job satisfaction compared with 2016. Frequency of work stress and turnover intention also increased, whereas WLB satisfaction has remained the same. Nearly two-thirds of intensivists wish they could work fewer hours, and this discontentment is correlated with decreased satisfaction, increased stress, and increased turnover, particularly in pandemic respondents. More than 25% of physicians rated their mental health as poor or fair, and 20% rated their physical health as poor or fair; these self-ratings correlated with decreased satisfaction and increased stress and turnover intention.

CONCLUSIONS

The SARS-CoV-2 pandemic has further burdened an already-strained critical care workforce. During the pandemic, job satisfaction fell, work stress became more frequent, and turnover intention increased for critical care physicians. They also have consistently low rates of WLB satisfaction. Work hours matter the most for physician satisfaction, stress, and turnover intention, and the desire to work fewer hours is negatively related to all outcomes. Many critical care physicians reported poor mental and physical health during the pandemic, which is strongly and negatively related to all outcomes. These results emphasize the importance of prioritizing the working preferences and the self-care of intensivist physicians.

Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the Longevity of a Critical Specialty

A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical care physicians are especially affected. This article reviews the history of burnout in health care workers, presents the signs and symptoms, discusses the specific impact of the COVID-19 pandemic on intensive care unit caregivers, and attempts to identify potential strategies to combat the Great Resignation disproportionately affecting health care workers. The article also focuses on how the specialty can amplify the voices and highlight the leadership potential of underrepresented minorities, physicians with disabilities, and the aging physician population.

The nature and sources of the emotional distress felt by intensivists and the burdens that are carried: A qualitative study

BACKGROUND

Work in intensive care units is often traumatic and emotionally distressing, sometimes leading to growth but at other times to negative outcomes such as worker burnout and mental illness. The type and origin of distresses to intensivists has been poorly characterised in the literature. This evidence gap makes it difficult to develop tailored educational process or cultural interventions for all who work within the specialty.

OBJECTIVES

The aim of this study was to elicit the nature and sources of workplace emotional distress in an international sample of intensivists.

METHOD

Interviews were undertaken with experienced intensivists in Australia and Israel related to the basis of workplace distress. These were transcribed and qualitatively thematically analysed.

RESULTS

In 2018, 19 intensivists participated in the study. Several key themes emerged from data analysis, some relating to clinical work, such as catastrophic patient outcomes, and some relating to interpersonal and systems-level challenges. Navigating complex interpersonal dynamics with carers and staff, both within and outside the intensive care unit team, caused substantial emotional burden.

CONCLUSIONS

Many factors contribute to workplace stress for doctors in the intensive care setting. In elucidating common reactions to these stressors, we have attempted to normalise responses. We further note that the skill sets relevant to the many challenges identified are generally missing in medical training curricula. It may be prudent to consider their inclusion in the future.

Impact of work-family support on job burnout among primary health workers and the mediating role of career identity: A cross-sectional study

Objective

In China, medical workers in the primary sector shoulder the task of providing people with the basic medical and public health services, and are the "gatekeepers" of the public health. This study aims to analyze the current situation of job burnout among primary health workers of China, and shed light on the effect of work-family support and career identity on job burnout among them and their relationships. This may provide a new perspective for primary health care institutions and health administrative departments so as to formulate policies to "attract, retain and stabilize" primary health workers.

Methods

A multi-stage sampling method was adopted to select 8,135 primary health workers from 320 primary health care institutions in a province of central China. A descriptive statistical analysis, univariate analysis, Pearson correlation analysis, and mediation effect analysis were applied to analyze the effects of work-family support and career identity on job burnout among primary health workers as well as the mediating role of career identity.

Results

Among 8,135 primary health workers, 4,911 (60.4%) participants had mild to moderate levels of job burnout, 181 (2.2%) participants had severe job burnout, and the burnout detection rate is 62.6%. Work-family support was negatively correlated with job burnout (r = -0.46, p < 0.01) and positively correlated with career identity (r = 0.42, p < 0.01). Work-family support (β = -0.346, p < 0.01) and career identity (β = -0.574, p < 0.01) were negative predictors of job burnout respectively. In addition, career identity had a mediating effect between work-family support and job burnout, with the mediating effect contributing 33.7% to the overall effect.

Conclusions

The findings of this study demonstrate that work-family support is a protective factor against job burnout in primary health workers and reveal that career identity is a critical mediating mechanism linking work-family support to burnout. We propose to reduce job burnout by strengthening work-family support (especially work support), enhancing career identity, increasing the number of primary health workers and reducing the workload of existing incumbents, which can provide important practical implications for the future prevention and intervention programs.

Patient safety as a global health priority

Patient safety is a discipline that has arisen in response to the increasing complexity of health care delivery and the associated increase in patient harm. Adverse health care events are a serious problem, causing significant harm to the patient and increasing health care costs. The World Health Organization has identified patient safety as one of the key priorities for world health. The current review presents the historical background that led to the formation of the discipline of patient safety, the determinants of adverse events in medical practice, and the main tools for dealing with them.

Legal Regulations and the Anticipation of Moral Distress of Prospective Nurses: A Comparison of Selected Undergraduate Nursing Education Programmes

Moral distress is commonly experienced by nurses in all settings. This bears the risk of a reduced quality of care, burnout and withdrawal from the profession. One approach to the prevention and management of moral distress is ethical competence development in undergraduate nursing education. Profession-specific legal regulations function as a foundation for the decision on the educational content within these programmes. This theoretical article presents the extent to which legal regulations may open framework conditions that allow for the comprehensive preparation of prospective nurses to manage moral distress. The legal frameworks and the immediate responsibilities regarding their realisation in the context of undergraduate nursing education vary slightly for the three chosen examples of Switzerland, Austria and Germany. While an increased awareness of ethics’ education is represented within the nursing laws, no definite presumption can be made regarding whether undergraduate nursing students will be taught the ethical competencies required to manage moral distress. It remains up to the curriculum design, the schools of nursing and instructors to create an environment that allows for the realisation of corresponding learning content. For the future, the establishment of professional nursing associations may help to emphasise acutely relevant topics, including moral distress, in undergraduate nursing education.

Prevalence, features and workplace factors associated with burnout among intensivists in Australia and New Zealand

Objectives: To investigate the prevalence and features of self-reported burnout among intensivists working in Australia and New Zealand, and evaluate potentially modifiable workplace stressors associated with increased risk of self-reported burnout. Methods: We performed an electronic survey among registered intensivists in Australia and New Zealand. Burnout and professional quality of life were measured using the Professional Quality of Life Scale version 5 (ProQOL-5). Socio-organisational factors were defined a priori and assessed using a five-point Likert scale. Thematic analysis was conducted on an open-ended question on workplace stressors. Results: 261 of 921 estimated intensivists responded (response rate, 28.3%). Overall, few participants (0.8%) demonstrated high scores (> 75th centile) for burnout, and 70.9% of participants scored in the average range for burnout. Of note, 98.1% of participants scored in the average to high range for compassion satisfaction. No association was found between sex, age, or years of practice with the level of burnout or compassion satisfaction. Seven themes emerged regarding intensivists' most stressful aspects of work: interpersonal interactions and workplace relationships (25.5%), workload and its impact (24.9%), resources and capacity (22.6%), health systems leadership and bureaucracy (16.1%), end-of-life issues and moral distress (8.4%), clinical management (4.9%), and job security and future uncertainty (1.3%). Conclusion: Fewer Australian and New Zealand intensivists experienced burnout than previously reported. Many self-reported work stressors do not relate to clinical work and are due to interpersonal interactions with other colleges and hospital administrators. Such factors are potentially modifiable and could be the focus of future interventions.

Burnout from Gender Inequity in a Pandemic

Women represent approximately one-third of all anesthesiologists in the United States. Before the COVID-19 pandemic, research regarding gender bias in anesthesiology defined the scope of the problem. Unfortunately, the pandemic exposed and expanded the imbalances associated with gender, placing women anesthesiologists as both primary caregivers in the home and on the frontlines of health care. These systemic inequities exacerbated burnout in women anesthesiologists. Several initiatives that can improve well-being and the work culture for all anesthesiologists, including women, will also be discussed.

Time Is the Fire in Which We Burn (Out): How Time Perspectives Affect Burnout Tendencies in Health Care Professionals Via Perceived Stress and Self-Efficacy

Aim and Background: The purpose of the current study is to examine the influence of time perspectives (TP) on the burnout-tendency of health care professionals. The concept of TP delivers a construct on how individuals frame their thinking and behavior on the emotional, cognitive and motivational level towards the past, the present and the future. Consequently, we assume that the TP configuration of health care professionals, determines how vulnerable or reluctant they will be to burnout. TP is assumed to influence the stress perception and the degree of self-efficacy which are in turn well-known factors of influence on burnout. Methods: The sample consisted of 398 health care professionals in Germany. We have measured TPs by the Zimbardo Time Perspective Inventory (ZTPI) and the burnout tendencies by the German version of the Maslach Burnout-Inventory (MBI-GS-D). Results: The Past-Negative and Past-Positive perspectives were identified as factors that were significantly associated with the burnout dimensions of emotional exhaustion, cynicism and personal accomplishment. The Present-Fatalistic orientation was only associated with cynicism and the Future dimension with cynicism and personal accomplishment. Furthermore, we observed that high deviations from a Negative Time Perspective (DNTP) caused a decrease on all three burnout dimensions. In addition, the influence of the DNTP on emotional exhaustion, cynicism and personal accomplishment was fully mediated by perceived stress and self-efficacy. Conclusion: We identified time perspective as a substantial factor of influence on burnout for health care professions and observed an underlying mechanism of the influence of DNTP on burnout. Both factors are important for practical therapeutic conclusions, as well as for a better understanding of the role of TP for burnout.

Moral distress interventions: An integrative literature review

Moral distress has been well reviewed in the literature with established deleterious side effects for all healthcare professionals, including nurses, physicians, and others. Yet, little is known about the quality and effectiveness of interventions directed to address moral distress. The aim of this integrative review is to analyze published intervention studies to determine their efficacy and applicability across hospital settings. Of the initial 1373 articles discovered in October 2020, 18 were appraised as relevant, with 1 study added by hand search and 2 after a repeated search was completed in January and then in May of 2021, for a total of 22 reviewed articles. This review revealed data mostly from nurses, with some studies making efforts to include other healthcare professions who have experienced moral distress. Education-based interventions showed the most success, though many reported limited power and few revealed statistically lowered moral distress post intervention. This may point to the difficulty in adequately addressing moral distress in real time without adequate support systems. Ultimately, these studies suggest potential frameworks which, when bolstered by organization-wide support, may aid in moral distress interventions making a measurable impact.

Compromised Integrity, Burnout, and Intent to Leave the Job in Critical Care Nurses and Physicians

OBJECTIVES:

To describe relationships between compromised integrity (CI), burnout, and intent-to-leave (ITL) practice in critical care (CC) and noncritical care (non-CC) nurses and physicians.

DESIGN:

CC nurses (RNs) and physicians (MDs) from the American Medical Association Coping with COVID survey were matched by gender, race, years in practice, and role with non-CC clinicians to determine likelihood of ITL in relation to burnout and CI.

SETTING:

U.S. Healthcare organizations; July—December 2020.

SUBJECTS:

One hundred sixty-five CC RNs and 148 CC MDs (n = 313) matched with 165 non-CC RNs and 148 non-CC MDs from 83 healthcare organizations.

MEASUREMENTS AND MAIN RESULTS:

Burnout was measured with a single, validated question that mainly reflects emotional exhaustion (EE), and CI was determined by asking if respondents worried about doing things that compromised their integrity moderately or to a great extent. ITL included those moderately, likely, or definitely, intending to leave. Burnout correlated strongly with CI (tetrachoric r = 0.704 [0.606–0.803]; P < 0.001). Of 626 subjects, 59% experienced burnout, 24% CI, and 33% ITL. CC RNs experienced burnout more often (76%) than non-CC RNs (62%; P < 0.01) and CC MDs (51%; P < 0.001). CI was more frequent in CC RNs (44%) than non-CC RNs (23%) and CC MDs (16%; P < 0.001). In multivariate regressions, CC clinicians experiencing burnout had 50% greater odds of ITL than non-CC clinicians experiencing burnout; odds of ITL were substantially higher (odds ratio, 2.8–3.2) in those with CI regardless of location or burnout. In the ICU, those feeling valued by their organization had one-third the odds of ITL.

CONCLUSIONS:

Burnout (EE) is high (>50%) among CC RNs and MDs, which may result in losses of CC clinicians while demand rises. Preventing CI independent of burnout may reduce turnover in all settings and especially in ICUs. Feeling valued may promote staff retention.

New approach to assessing and addressing moral distress in intensive care unit personnel: a case study

PURPOSE

To test a new approach to address moral distress in intensive care unit (ICU) personnel.

METHODS

Using principles of participatory action research, we developed an eight-step moral conflict assessment (MCA) that guides participants in describing the behaviour that they have to implement, the effects this has on them, their current coping strategies, their values in conflict, any other concerns related to the situation, what helps and hinders the situation, new coping strategies, and the effect of the preceding steps on participants. This assessment was tested with eight ICU providers in an 11-bed community ICU.

RESULTS

During three one-hour sessions, participants described their moral distress that was caused by the use of ongoing life-support for a patient who the team believed did not prefer this course of care, but whose family was requesting it. Participants experienced frustration and discouragement and coping strategies included speaking to colleagues and exercising. They felt that they were unable to take meaningful action to resolve this conflict. Values that were in conflict in the situation included beneficence and patient autonomy. Based on ranking of helping and hindering factors, the team proposed new strategies including improving consistency of care plans and educating patients' family members and ICU personnel about advance care planning and end-of-life care. After completing this assessment, participants reported less stress and a greater ability to take meaningful action, including some of the proposed new strategies.

CONCLUSIONS

We found this new approach to address moral distress in ICU personnel to be feasible and a useful tool for facilitating plans for reducing moral distress.

A Research Agenda for Diagnostic Excellence in Critical Care Medicine

Diagnosing critically ill patients in the intensive care unit is difficult. As a result, diagnostic errors in the intensive care unit are common and have been shown to cause harm. Research to improve diagnosis in critical care medicine has accelerated in past years. However, much work remains to fully elucidate the diagnostic process in critical care. To achieve diagnostic excellence, interdisciplinary research is needed, adopting a balanced strategy of continued biomedical discovery while addressing the complex care delivery systems underpinning the diagnosis of critical illness.

Effect of compassion rounds on nurses' professional quality of life on a COVID-19 unit

INTRODUCTION

Evidence suggests that support groups enhance nurses' professional quality of life (QOL), and positive professional QOL is associated with better patient and nurse outcomes. This study examined the effect of a unit-level support group on the professional QOL of nurses working on a progressive care unit-turned-dedicated-COVID-19 unit.

AIM

We hypothesized that a professionally facilitated Compassion Rounds (CR) support group would improve compassion satisfaction (CS) and reduce compassion fatigue (CF) among COVID-19 unit nurses.

METHODS

For this pre/post, within-group trial we recruited an inclusive, convenience sample of 84 nurses on a COVID-19 unit within a 377-bed, Magnet®-designated hospital. The 10-week, CR consisted of biweekly meetings, and the ProQOL version 5 measured pre/post CS and CF.

RESULTS

Paired t-testing showed that CS scores fell after CR (n = 10; p = .005), while scores rose for CF burnout (p = .05) and secondary traumatic stress (p = .008). Results were similar for unpaired analysis (N = 38; p < .05).

IMPLICATIONS/CONCLUSION

Although pandemic-related challenges likely overwhelmed CR's potential to improve professional QOL, CR may have prevented worse deterioration of work-life quality. CR may also create clinically meaningful improvements for groups or individual nurses, and thus enhance nurse and patient outcomes.

Moral distress, emotional impact and coping in intensive care units staff during the outbreack of COVID-19

Background

From the beginning, the COVID-19 pandemic increased ICU workloads and created exceptionally difficult ethical dilemmas. ICU staff around the world have been subject to high levels of moral stress, potentially leading to mental health problems. There is only limited evidence on moral distress levels and coping styles among Spanish ICU staff, and how they influenced health professionals’ mental health during the pandemic.

Objectives

To assess moral distress, related mental health problems (anxiety and depression), and coping styles among ICU staff during the first wave of the COVID-19 pandemic in Spain.

Design

Cross-sectional.

Settings and participants

The study setting consisted of intensive care unit and areas converted into intensive care units in public and private hospitals. A total of 434 permanent and temporary intensive care staff (reassigned due to the pandemic from other departments to units) answered an online questionnaire between March and June 2020.

Methods

Sociodemographic and job variables, moral distress, anxiety, depression, and coping mechanisms were anonymously evaluated through a self-reported questionnaire. Descriptive and correlation analyses were conducted and multivariate linear regression models were developed to explore the predictive ability of moral distress and coping on anxiety and depression.

Results

Moral distress during the pandemic is determined by situations related to the patient and family, the intensive care unit, and resource management of the organisations themselves. intensive care unit staff already reached moderate levels of moral distress, anxiety, and depression during the first wave of the pandemic. Temporary staff (redeployed from other units) obtained higher scores in these variables (p = 0.04, p = 0.038, and p = 0.009, respectively) than permanent staff, as well as in greater intention to leave their current position (p = 0.03). This intention was also stronger in health staff working in areas converted into intensive care units (45.2%) than in normal intensive care units (40.2%) (p = 0.02). Moral distress, coupled with primarily avoidance-oriented coping styles, explains 37% (AdR²) of the variance in anxiety and 38% (AdR²) of the variance in depression.

Conclusions

Our study reveals that the emotional well-being of intensive care unit staff was already at risk during the first wave of the pandemic. The moral distress they experienced was related to anxiety and depression issues, as well as the desire to leave the profession, and should be addressed, not only in permanent staff, but also in temporary staff, redeployed to these units as reinforcement workers.

Prevalence, Risk Factors and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis

Nursing is considered to be an at-risk profession of burnout due to daily exposure to difficult situations such as death and pain care. In addition, some units such as the intensive care unit (ICU), can be stressful due to high levels of morbidity and mortality and ethical dilemmas. Burnout causes a deterioration in quality of care, increasing the risk of mortality in patients due to poor performance and errors in the healthcare environment. The aim of this study was to analyse the levels, prevalence and related factors of burnout in ICU nurses. A systematic review and meta-analysis were carried out in the Medline, Scopus and CINAHL databases. Fifteen articles were found for the systematic review and four for the meta-analysis. With a sample of n = 1986 nurses, the meta-analytic estimate prevalence for high emotional exhaustion was 31% (95% CI, 8-59%), for high depersonalization was 18% (95% CI, 8-30%), and for low personal accomplishment was 46% (95% CI, 20-74%). Within the dimensions of burnout, emotional exhaustion had a significant relationship with depression and personality factors. Both sociodemographic factors (being younger, single marital status, and having less professional experience in ICU) and working conditions (workload and working longer hours) influence the risk of burnout syndrome.

Moral Distress Among Interdisciplinary Critical Care Team Members at a Comprehensive Cancer Center

BACKGROUND

Moral distress (MD) has been linked to health care professional burnout, intent to leave, and decreased quality of care.

OBJECTIVES

The aim of this study was to describe the perceptions of MD among critical care interdisciplinary team members and assess the association of MD with team member characteristics.

METHODS

A descriptive cross-sectional design was used with interdisciplinary team members in an intensive care unit setting at an NCI-designated Comprehensive Cancer Center in the southeastern United States. The Measure of Moral Distress for Healthcare Professionals was provided to registered nurses, oncology technicians, providers, respiratory therapists, and ancillary team members (social workers, pharmacists, dietitians).

RESULTS

A total of 67 team members completed the survey. Mean responses for 3 items were higher than 8 (halfway point of scale): "Follow family's insistence to continue aggressive treatment even though I believe it is not in the best interest of patient" (mean [SD], 11.4 [4.8]); "Continue to provide aggressive treatment for a patient most likely to die regardless of this treatment when no one will make a decision to withdraw it" (mean [SD], 10.5 [5.3]); and "Witness providers giving 'false hope' to patient/family" (mean [SD], 9.0 [5.3]). Higher responses on the "Continuing to provide aggressive treatment" item was associated with having "considered leaving due to MD" (P = .027) and "considering leaving now due to MD" (P = .016). Higher total scores were related to having left or considered leaving a job (P = .04). When examining education level, registered nurses with a master's degree (n = 5) exhibited the most MD (P = .04).

CONCLUSION

This study suggests that the Measure of Moral Distress for Healthcare Professionals is useful in identifying areas for focused efforts at reducing MD for interdisciplinary teams.

Tricky transitions: Conversations on resiliency for new practitioners

In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Healthcare workers' structured daily reflection on patient safety, workload and work environment in intensive care. A descriptive retrospective study

OBJECTIVES

To describe the results of use of structured daily reflection assessments among healthcare workers at an intensive care unit over the course of one year.

METHODS

In this descriptive retrospective study, data were analysed both quantitatively and qualitatively. The data encompassed 1095 work shifts, evaluated by healthcare workers at an intensive care unit using a structured daily reflection instrument. The areas evaluated were patient safety, workload and work environment, and free-text comments were possible.

FINDINGS

The results showed that 36% (n = 395) of work shifts, most of them daytime shifts (44%; n = 161), were affected. Workload was the area that affected most work shifts (29%; n = 309). Missed nursing care, complex care and inaccurate communication impacted patient safety, while patient care, multitasking and working conditions affected workload. Work environment was impacted by organisational factors, environment, lack of control and moral stress.

CONCLUSION

Using daily reflection among healthcare workers in the intensive care unit illuminated areas that affect patient safety, workload, and work environment. The importance of communication and collaboration and how they can impact patient safety, workload, and the work environment were highlighted by the team.

Moral Distress and Other Wellness Measures in Canadian Critical Care Physicians

Rationale: Understanding the magnitude of moral distress and its associations may point to solutions. Objectives: To understand the magnitude of moral distress and other measures of wellness in Canadian critical care physicians, to determine any associations among these measures, and to identify potentially modifiable factors. Methods: This was an online survey of Canadian critical care physicians whose e-mail addresses were registered with either the Canadian Critical Care Society or the Canadian Critical Care Trials Group. We used validated measures of moral distress, burnout, compassion fatigue, compassion satisfaction, and resilience. We also measured selected individual, practice, and workload characteristics. Results: Of the 499 physicians surveyed, 239 (48%) responded and there were 225 usable surveys. Respondents reported moderate scores of moral distress (107 ± 59; mean ± standard deviation, maximum 432), one-third of respondents had considered leaving or had previously left a position because of moral distress, about one-third met criteria for burnout syndrome, and a similar proportion reported medium-high scores of compassion fatigue. In contrast, about one-half of respondents reported a high score of compassion satisfaction, and overall, respondents reported a moderate score of resilience. Each of the "negative" wellness measures (moral distress, burnout, and compassion fatigue) were associated directly with each of the other "negative" wellness measures, and inversely with each of the "positive" wellness measures (compassion satisfaction and resilience), but moral distress was not associated with resilience. Moral distress was lower in respondents who were married or partnered compared with those who were not, and the prevalence of burnout was lower in respondents who had been in practice for longer. There were no differences in any of the wellness measures between adult and pediatric critical care physicians. Conclusions: Canadian critical care physicians report moderate scores of moral distress, burnout, and compassionate fatigue, and moderate-high scores of compassion satisfaction and resilience. We found no modifiable factors associated with any wellness measures. Further quantitative and qualitative studies are needed to identify interventions to reduce moral distress, burnout, and compassion fatigue.

Practice Recommendations for End-of-Life Care in the Intensive Care Unit

TOPIC

A substantial number of patients die in the intensive care unit, so high-quality end-of-life care is an important part of intensive care unit work. However, end-of-life care varies because of lack of knowledge of best practices.

CLINICAL RELEVANCE

Research shows that high-quality end-of-life care is possible in an intensive care unit. This article encourages nurses to be imaginative and take an individual approach to provide the best possible end-of-life care for patients and their family members.

PURPOSE OF PAPER

To provide recommendations for high-quality end-of-life care for patients and family members.

CONTENT COVERED

This article touches on the following domains: end-of-life decision-making, place to die, patient comfort, family presence in the intensive care unit, visiting children, family needs, preparing the family, staff presence, when the patient dies, after-death care of the family, and caring for staff.

Critical care work during COVID-19: a qualitative study of staff experiences in the UK

OBJECTIVE

To understand National Health Service (NHS) staff experiences of working in critical care during the first wave of the COVID-19 pandemic in the UK.

DESIGN

Qualitative study using semistructured telephone interviews and rapid analysis, interpreted using Baehr's sociological lens of 'communities of fate'.

PARTICIPANTS

Forty NHS staff working in critical care, including 21 nurses, 10 doctors and advanced critical care practitioners, 4 allied health professionals, 3 operating department practitioners and 2 ward clerks. Participants were interviewed between August and October 2020; we purposefully sought the experiences of trained and experienced critical care staff and those who were redeployed.

SETTING

Four hospitals in the UK.

RESULTS

COVID-19 presented staff with a situation of extreme stress, duress and social emergency, leading to a shared set of experiences which we have characterised as a community of fate. This involved not only fear and dread of working in critical care, but also a collective sense of duty and vocation. Caring for patients and families involved changes to usual ways of working, revolving around: reorganisation of space and personnel, personal protective equipment, lack of evidence for treating COVID-19, inability for families to be physically present, and the trauma of witnessing extreme patient acuity and death on a large scale. The stress and isolation of working in critical care during COVID-19 was mitigated by strong teamwork, camaraderie, pride and fulfilment.

CONCLUSION

COVID-19 has changed working practices in critical care and profoundly affected staff physically, mentally and emotionally. Attention needs to be paid to the social and organisational conditions in which individuals work, addressing both practical resourcing and the interpersonal dynamics of critical care provision.

Systems to Address Burnout and Support Well-being: Implications for Intensive Care Unit Nurses

Burnout, a syndrome resulting from chronic job-related stress in the workplace, is an extensive problem among clinicians working in health care organizations. The 3 dimensions of burnout include emotional exhaustion, depersonalization, and loss of a sense of professional efficacy. Approximately 35% of all nurses experience symptoms of burnout. Critical care nurses are at risk for chronic job stress because of the complexity and pace of the critical care environment. Addressing the individual and systems-related factors that stem from the work environment is essential in order to achieve well-being among all clinicians. Strategies aimed at fostering individual resilience and well-being must be coupled with systemic solutions that create a work environment that removes impediments to ethically grounded practice, restores fulfillment achieved in clinical practice, and fosters resilience and well-being.

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

BACKGROUND

.

OBJECTIVE

Electronic health records (EHRs) are linked with documentation burden resulting in clinician burnout. While clear classifications and validated measures of burnout exist, documentation burden remains ill-defined and inconsistently measured. We aim to conduct a scoping review focused on identifying approaches to documentation burden measurement and their characteristics.

MATERIALS AND METHODS

Based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews (ScR) guidelines, we conducted a scoping review assessing MEDLINE, Embase, Web of Science, and CINAHL from inception to April 2020 for studies investigating documentation burden among physicians and nurses in ambulatory or inpatient settings. Two reviewers evaluated each potentially relevant study for inclusion/exclusion criteria.

RESULTS

Of the 3482 articles retrieved, 35 studies met inclusion criteria. We identified 15 measurement characteristics, including 7 effort constructs: EHR usage and workload, clinical documentation/review, EHR work after hours and remotely, administrative tasks, cognitively cumbersome work, fragmentation of workflow, and patient interaction. We uncovered 4 time constructs: average time, proportion of time, timeliness of completion, activity rate, and 11 units of analysis. Only 45.0% of studies assessed the impact of EHRs on clinicians and/or patients and 40.0% mentioned clinician burnout.

DISCUSSION

Standard and validated measures of documentation burden are lacking. While time and effort were the core concepts measured, there appears to be no consensus on the best approach nor degree of rigor to study documentation burden.

CONCLUSION

Further research is needed to reliably operationalize the concept of documentation burden, explore best practices for measurement, and standardize its use.

Evaluating Wellness Interventions for Resident Physicians: A Systematic Review

BACKGROUND

Wellness initiatives implemented by graduate medical education programs can help mitigate burnout in resident physicians.

OBJECTIVE

This systematic review seeks to identify factors that impact the effectiveness of resident wellness interventions and to provide a conceptual framework to guide future interventions.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 6 electronic databases were searched in November 2019 using variations of the keywords "resident physicians," "wellness," and "intervention." Peer-reviewed full-text English-language articles on controlled studies were considered for inclusion. The quality of the studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines.

RESULTS

The initial search disclosed 1196 articles, of which 18 studies enrolling 666 resident physicians met inclusion criteria for qualitative review. Interventions using peer support and individual meditation enhanced well-being. Effective wellness interventions also used educational theory to guide program development, surveyed participants to guide intervention design, incorporated programming into existing didactic curricula, and recruited voluntary participants. The quality of most of the included studies was poor (13 of 18, 72%) and could be improved by using standardized wellness assessments supported by validity evidence.

CONCLUSIONS

This systematic review suggests that future resident wellness initiatives should focus on grounding interventions in educational theory, forging consensus on wellness instruments with validity evidence, and examining the impact of initiatives on patient outcomes. A logic model can provide a framework for designing and implementing effective wellness interventions.

Prevalence of and Factors Associated With Nurse Burnout in the US

IMPORTANCE

Clinician burnout is a major risk to the health of the US. Nurses make up most of the health care workforce, and estimating nursing burnout and associated factors is vital for addressing the causes of burnout.

OBJECTIVE

To measure rates of nurse burnout and examine factors associated with leaving or considering leaving employment owing to burnout.

DESIGN, SETTING, AND PARTICIPANTS

This secondary analysis used cross-sectional survey data collected from April 30 to October 12, 2018, in the National Sample Survey of Registered Nurses in the US. All nurses who responded were included (N = 50 273). Data were analyzed from June 5 to October 1, 2020.

EXPOSURES

Age, sex, race and ethnicity categorized by self-reported survey question, household income, and geographic region. Data were stratified by workplace setting, hours worked, and dominant function (direct patient care, other function, no dominant function) at work.

MAIN OUTCOMES AND MEASURES

The primary outcomes were the likelihood of leaving employment in the last year owing to burnout or considering leaving employment owing to burnout.

RESULTS

The weighted sample of 50 273 respondents (representing 3 957 661 nurses nationally) was predominantly female (90.4%) and White (80.7%); the mean (SD) age was 48.7 (0.04) years. Among nurses who reported leaving their job in 2017 (n = 418 769), 31.5% reported burnout as a reason, with lower proportions of nurses reporting burnout in the West (16.6%) and higher proportions in the Southeast (30.0%). Compared with working less than 20 h/wk, nurses who worked more than 40 h/wk had a higher likelihood identifying burnout as a reason they left their job (odds ratio, 3.28; 95% CI, 1.61-6.67). Respondents who reported leaving or considering leaving their job owing to burnout reported a stressful work environment (68.6% and 59.5%, respectively) and inadequate staffing (63.0% and 60.9%, respectively).

CONCLUSIONS AND RELEVANCE

These findings suggest that burnout is a significant problem among US nurses who leave their job or consider leaving their job. Health systems should focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift.

Psychological Impact of the COVID-19 Pandemic on Frontline Health Care Workers During the Pandemic Surge in New York City

Background

This study sought to assess the magnitude of and factors associated with mental health outcomes among frontline health care workers (FHCWs) providing care during the Spring 2020 COVID-19 pandemic surge in New York City.

Methods

A cross-sectional, survey-based study over 4 weeks during the Spring 2020 pandemic surge was used to assess symptoms of COVID-19-related posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in 2,579 FHCWs at the Mount Sinai Hospital. Participants were additionally asked about their occupational and personal exposures to COVID-19. Multivariable logistic regression and relative importance analyses were conducted to identify factors associated with these outcomes.

Results

A total of 3,360 of 6,026 individuals completed the survey (55.8% participation), with 2,579 (76.8%) analyzed based on endorsing frontline responsibilities and providing information related to the three outcomes. 1,005 (39.0%) met criteria for symptoms of COVID-19-related PTSD, MDD, or GAD. 599 (23.3%) screened positively for PTSD symptoms, 683 (26.6%) for MDD symptoms, and 642 (25.0%) for GAD symptoms. Multivariable analyses revealed that past-year burnout was associated with the highest risk of developing symptoms for COVID-19-related PTSD (odds ratio [OR] = 2.10), MDD (OR = 2.83), and GAD (OR = 2.68). Higher perceived support from hospital leadership was associated with a lowest risk of all outcomes [PTSD (OR = 0.75), MDD (OR = 0.72), and GAD (OR = 0.76).

Conclusion

In this large sample of FHCWs providing care during the 2020 NYC pandemic surge, 39% experienced symptoms of COVID-19-related PTSD, MDD, and/or GAD and pre-pandemic burnout as well as leadership support were identified as the most highly associated factors. These findings suggest that interventions aimed at reducing burnout and augmenting support from hospital leadership may be appropriate targets to mitigate the risk for developing further psychopathology in this population and others working in the midst of crisis.