Nurse Burnout Predicts Self-Reported Medication Administration Errors in Acute Care Hospitals

Factors influencing healthcare workers' performance before and after the coronavirus disease 2019 pandemic: A bibliometric analysis with supplementary comparative analysis

BACKGROUND

The performance of healthcare workers directly impacts patient safety and treatment outcomes. This was particularly evident during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE

This study aimed to analyze research trends on factors influencing work performance among healthcare workers through bibliometric analysis and conduct a comparative analysis from macro and micro perspectives before and after the COVID-19 pandemic to complement the existing research.

METHODS

This study involved a bibliometric analysis of 1408 articles related to work performance in the healthcare field published between 2010 and 2023, using the Web of Science, Scopus, and PubMed databases, and 37 articles were selected to determine the factors influencing work performance.

RESULTS

By conducting a bibliometric analysis of the articles based on country, institution, journal, co-cited references, and keywords, this study identified a significant growth trend regarding the factors influencing work performance in the healthcare field, and research hotspots shifted from organizational factors like standard towards psychological factors such as burnout, anxiety, and depression following the outbreak of the COVID-19 pandemic. Subsequently, this study extracted 10 micro-level and 9 macro-level influencing factors from the selected articles for supplementary analysis. Furthermore, this study conducted a comparative analysis of the impact of these factors on work performance before and after the COVID-19 pandemic.

CONCLUSIONS

This study addressed the limitations of previous studies regarding incomplete extraction of factors influencing work performance and unclear comparisons of parameters before and after the COVID-19 pandemic. The findings provide insights and guidance for improving the performance of healthcare workers.

Comparison of Alabama Nurse Experiences Between Practice Areas During the Early COVID-19 Pandemic

BACKGROUND

According to the Total Worker Health® framework, safety culture including a reasonable workload among healthcare workers is essential to the security and well-being of patients, staff, and healthcare organizations. Evaluating the impact of the pandemic on the nursing workforce in different practice areas is critical for addressing workforce health and sustainability. The purpose of this study was to compare work and selfcare experiences among Alabama nurses between practice areas and the early pandemic years (2020 vs. 2021).

METHODS

A secondary analysis of cross-sectional Alabama State Nurses Association (ASNA) survey data was conducted. Kruskal-Wallis analysis of variance, Wilcoxon rank, and false discovery rates were examined.

RESULTS

There were 1,369 and 2,458 nurse survey responses in 2020 and 2021, respectively. By 2021, nurses reported worsening staff shortages, a greater need for retired and new graduate nurses to help with the workload burden, and perceptions of heavier emergency department workloads. Lower proportions of nurses reported the ability to engage in self-care activities and satisfaction with state and federal crisis management. Intensive care nurses were more likely to report staffing shortages while also reporting the lowest ability to engage in self-care.

CONCLUSIONS

Overall, the Alabama nursing workforce perceived worsening work conditions in 2021 compared to when the pandemic began. Practice areas varied greatly in their responses, with acute and intensive care areas perceiving more difficult work conditions. Total Worker Health® programs should be designed to promote and support nurses' well-being based on their experience and the needs of specific practice areas.

Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19

BACKGROUND

Traumatic stress and moral injury may contribute to burnout, but their relationship to institutional betrayal and moral resilience is poorly understood, leaving risk and protective factors understudied.

OBJECTIVES

To examine traumatic stress symptoms, moral injury symptoms, moral resilience, and institutional betrayal experienced by critical care nurses and examine how moral injury and traumatic stress symptoms relate to moral resilience, institutional betrayal, and patient-related burnout.

METHODS

This cross-sectional study included 121 critical care nurses and used an online survey. Validated instruments were used to measure key variables. Descriptive statistics, regression analyses, and group t tests were used to examine relationships among variables.

RESULTS

Of participating nurses, 71.5% reported significant moral injury symptoms and/or traumatic stress. Both moral injury symptoms and traumatic stress were associated with burnout. Regression models showed that institutional betrayal was associated with increased likelihood of traumatic stress and moral injury. Increases in scores on Response to Moral Adversity subscale of moral resilience were associated with a lower likelihood of traumatic stress and moral injury symptoms.

CONCLUSIONS

Moral resilience, especially response to difficult circumstances, may be protective in critical care environments, but system factors (eg, institutional betrayal) must also be addressed systemically rather than relying on individual-level interventions to address nurses' needs.

Feasibility of a Mindfulness Education Module for Nurses: An Evidence-Based Practice Project

Nurse burnout is a well-defined problem that has been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic and negatively affects nurses' mental health, nursing shortages, patient safety, and quality of care. Evidence shows that mindfulness is an effective strategy for managing stress and decreasing burnout among nurses. This article describes an evidence-based practice project that translated this evidence into practice via a vetted mindfulness educational intervention for nurses on a pulmonary medicine unit and a medical intensive care unit. The goal of this project was to assess the feasibility of this educational intervention, processes, and outcomes with the goal to extend the project hospital-wide. Preintervention levels of nurse burnout were assessed using the validated Copenhagen Burnout Inventory. For both units, personal and work-related burnout were in the moderate range and patient-related burnout was in the mild range. Postintervention surveys completed by participant nurses and the nurse managers of both units supported the feasibility of this education module. Future implementation of annual mindfulness education was supported through both participant and administrative feedback. [J Contin Educ Nurs. 2023;54(11):516-523.].

Interventions to reduce burnout among clinical nurses: systematic review and meta-analysis

Sporadic evidence exists for burnout interventions in terms of types, dosage, duration, and assessment of burnout among clinical nurses. This study aimed to evaluate burnout interventions for clinical nurses. Seven English databases and two Korean databases were searched to retrieve intervention studies on burnout and its dimensions between 2011 and 2020.check Thirty articles were included in the systematic review, 24 of them for meta-analysis. Face-to-face mindfulness group intervention was the most common intervention approach. When burnout was measured as a single concept, interventions were found to alleviate burnout when measured by the ProQoL (n = 8, standardized mean difference [SMD] = - 0.654, confidence interval [CI] =  - 1.584, 0.277, p < 0.01, I2 = 94.8%) and the MBI (n = 5, SMD = - 0.707, CI = - 1.829, 0.414, p < 0.01, I2 = 87.5%). The meta-analysis of 11 articles that viewed burnout as three dimensions revealed that interventions could reduce emotional exhaustion (SMD = - 0.752, CI = - 1.044, - 0.460, p < 0.01, I2 = 68.3%) and depersonalization (SMD = - 0.822, CI = - 1.088, - 0.557, p < 0.01, I2 = 60.0%) but could not improve low personal accomplishment. Clinical nurses' burnout can be alleviated through interventions. Evidence supported reducing emotional exhaustion and depersonalization but did not support low personal accomplishment.

Understanding complexity in a safety critical setting: A systems approach to medication administration

'Medication errors' are a significant concern and are associated with a higher incidence of adverse events and unintentional patient harm than any other aspect of healthcare. While much research has focused on adverse medication errors, limited studies have specifically examined 'normal' medication delivery performance and the interactions between tasks, agents, and information within the medication administration system. This article describes a study that applied the Event Analysis of Systemic Teamwork (EAST) model to study the hospital medication administration system to identify opportunities to optimise performance and patient safety. Key findings of this study demonstrate that this is a highly complex system, comprising many social agents and a relatively closely linked series of tasks and information. However, most of the workload relies on a small proportion of healthcare professionals. Significantly, the patient has a minimal role in the medication administration system during their hospital stay. The research has shown that this approach enables mapping networks and their interdependencies to optimise the system as a whole rather than its parts in isolation.

The associations of psychological burnout and time factors on medication errors in rotating shift nurses in Korea: A cross sectional descriptive study

AIM

To describe the associations of psychological burnout and time factors on hospital nurses' medication errors.

DESIGN

A cross-sectional survey design was used.

METHODS

A structured questionnaire pertaining to psychological burnout, time factors and medication error was administered to 200 bedside nurses working at two tertiary university hospitals in Korea. The associations between the psychological burnout, time factor and medication error were analysed with the zero-inflated negative binomial regression for over-dispersed and over-abundant zeros count data.

RESULTS

Higher psychological burnout, shorter meal time during duty and longer weekly overtime were associated with an increased likelihood of medication error of nurses working in tertiary university hospitals. For medication safety, nurse managers should provide appropriate administrative support to nurses to cope with psychological burnout of nurses. Work time management should also be considered as human factors to satisfy the needs of nurses, such as securing meal times and maintaining a low level of weekly overtime.

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.

Work environment, resilience, burnout, intent to leave during COVID pandemic among nurse leaders: A cross-sectional study

AIMS

The aims of this work are to (1) investigate the work environment, resilience, burnout, and turnover intention and (2) examine how work environment and personal resilience impact burnout and turnover intention among nurse leaders in the midst of the COVID-19 crisis.

BACKGROUND

The COVID-19 pandemic introduced tremendous stressors to nurse leaders, for example, managing the complex staffing situation while balancing patients' and family's needs.

METHODS

During May to September 2021, an electronic survey was sent out to nurse leaders in Birmingham, Alabama, USA, and surrounding areas.

RESULTS

Fifty-six respondents were included in the study. The composite score of the work environment measure was moderately to highly related to resilience [ρ (rho) = .59] and burnout [ρ = -.63 to -.68] but had small association to intent to leave [ρ = -.30]. The resilience was highly correlated to burnout [ρ = -.53 to -.59] and moderately associated to intent to leave [ρ = -.32].

CONCLUSIONS

A better work environment for nurse leaders is related to higher resilience, lower burnout, and lower turnover intention. Resilience impacts burnout and turnover intention among nurse leaders.

IMPLICATIONS FOR NURSING MANAGEMENT

Health care organizations and stakeholders should implement effective strategies to improve the work environment, which could lead to enhanced resilience, reduced burnout, and lower turnover intention of their nurse leaders especially during and following this pandemic.

Influence of Evidence-Based Design Strategies on Nurse Wellness

OBJECTIVES

The purpose of this study was to understand how specific evidence-based design strategies are related to aspects of nurse wellness.

BACKGROUND

Addressing burnout among the healthcare workforce is a system-level imperative. Nurses face continuous and dynamic physical and emotional demands in their role. Greater insight into the role of the physical environment can support efforts to promote nurse wellness.

METHODS

This exploratory qualitative study was conducted at new Parkland Hospital in Dallas, TX. We conducted five focus groups with nursing staff in July 2018. These sessions covered five topics related to nursing work in the facility which had been redesigned nearly 3 years earlier: (1) professional and social communication, (2) workflow and efficiency, (3) nurses' tasks and documentation, (4) ability to care for patients, and (5) nurses' overall health. We conducted a thematic analysis and first identified different aspects of wellness discussed by participants. Then, we examined how nurses related different design elements to different aspects of their wellness.

RESULTS

Participants included 63 nurses and nurse managers. They related environmental factors including facility size, break rooms, and decentralized workstations to social, emotional/spiritual, physical, intellectual, and occupational aspects of wellness.

CONCLUSIONS

It is critical to inform and integrate nurses at all levels into planning, design, and activation of new healthcare environments in order to ensure the well-being of nurses and, therefore, their ability to effectively support patients.

Comparing the Nurse Work Environment, Job Satisfaction, and Intent to Leave Among Military, Magnet®, Magnet-Aspiring, and Non-Magnet Civilian Hospitals

OBJECTIVE

This study aimed to compare the nurse work environment, job satisfaction, and intent to leave (ITL) among military, Magnet®, Magnet-aspiring, and non-Magnet civilian hospitals.

BACKGROUND

The professional nurse work environment is an important, modifiable, organizational trait associated with positive nurse and patient outcomes; creating and maintaining a favorable work environment should be imperative for nursing leaders.

METHODS

Secondary data from the Army Nurse Corps and the National Database of Nursing Quality Indicators included the Practice Environment Scale of the Nursing Work Index (PES-NWI) and single-item measures of job satisfaction and ITL.

RESULTS

Magnet and military hospitals had identical PES-NWI composite scores; however, statistically significant differences existed among the subscales. Military nurses were the most satisfied among all groups, although this difference was not statistically significant, yet their ITL was highest.

CONCLUSIONS

Favorable work environments may exist in other organizational forms besides Magnet; however, the specific components must be considered.

Effective Holistic Approaches to Reducing Nurse Stress and Burnout During COVID-19

BACKGROUND

Prolonged exposure to work-related stress can lead to nurse burnout, potentiating clinical and medication errors and low-quality patient care. Holistic approaches (such as mindfulness training, "zen rooms," and massage chairs, among others) have been shown to reduce nurses' anxiety, stress, and burnout.

PURPOSE

To evaluate the use of "serenity lounges" (dedicated rooms where nurses can take workday breaks for the purposes of relaxation and rejuvenation) and massage chairs on nurses' anxiety, stress, and burnout.

METHODS

This quality improvement project analyzed 67 paired responses to surveys filled out by nurses before and after their use of serenity lounges at a medical center in Los Angeles between November 2020 and May 2021. Following successful implementation of a serenity lounge on a pilot unit, this project was expanded to a total of 10 units, including COVID-19 cohort units. As part of this expansion, massage chairs were added to 10 serenity lounges, along with items such as wipes, gloves, and shoe covers to enable nurses to adhere to infection control protocols.

RESULTS

Analysis of the 67 paired responses to pre- and post-lounge-use surveys revealed a significant reduction in feelings of emotional exhaustion, burnout, frustration, being worn out, stress, and anxiety after use of the serenity lounge. Improvements in feelings of emotional exhaustion, being worn out, and being anxious were also noted after using the massage chair for at least 10 to 20 minutes.

CONCLUSIONS

These results highlight the importance of providing a holistic approach, including a serene space, massage equipment, and other amenities, to help nurses reduce feelings of anxiety, stress, and burnout, particularly during challenging times such as the COVID-19 pandemic.

Workplace Protections and Burnout Among Brazilian Frontline Health Care Professionals During the COVID-19 Pandemic

Health care workers from low- and middle-income countries have been playing a critical role in overcoming the challenges related to the COVID-19 pandemic; yet little is known about the relationship between workplace protections and wellbeing of Brazilian health care workers during the pandemic. This study aimed to evaluate whether Brazilian health care workers were satisfied with their workplace measures to protect their physical and mental health during the pandemic, and to assess the associations of such levels of satisfaction with indicators of burnout. Licensed Brazilian health care professionals were recruited via popular media between 5/19/2020 and 8/23/2020 to complete an online survey including questions about their demographic/professional characteristics, satisfaction with their workplace protective measures during the pandemic, and validated questionnaires assessing neuroticism, resilient coping, and symptoms of burnout. Most participants reported being dissatisfied with their workplace measures to protect their physical (516, 56.3%) and mental health (756, 82.5%). In multivariable analysis adjusted for personal and environmental factors, dissatisfaction with workplace physical health protections was significantly associated with higher levels of emotional exhaustion (B = 1.08, 95% CI = 0.47–1.69) and depersonalization (B = 0.61, 95% CI = 0.10–1.12), and dissatisfaction with workplace mental health protections significantly associated with higher levels emotional exhaustion (B = 1.17, 95% CI = 0.40–1.95). Efforts to improve both physical and mental health protective measures are critical to guarantee that health care workers continue to provide care at their maximum capacity.

Development and Testing of the Quality Improvement Self-efficacy Inventory

Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses' ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses' knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies.

Determining levels of nurse burnout during the COVID-19 pandemic and Lebanon's political and financial collapse

Background

The COVID-19 pandemic compounded political and financial pressures on the nursing workforce in Lebanon. The government resigned in October 2019 in response to the popular uprising that called for an end to corruption and economic mismanagement 5 months before the first COVID-19 case appeared in the country. The continuing crises and the added stress of COVID-19 has increased the risk of occupational burnout and turnover in the nursing workforce. Therefore, valid and reliable measurement is imperative to determine burnout levels, prioritize intervention, and inform evidence-based workforce policy and practice. The primary aim of the study was to delineate burnout levels and cut-points in a national sample of nurses to inform workforce policies and prioritize interventions.

Methods

Multidimensional and unidimensional Rasch analyses of burnout data collected from a national convenience sample of 457 hospital nurses 9–12 months after Lebanon’s political and economic collapse began. The data were collected in July–October 2020.

Results

Multidimensional Rasch analysis confirmed that the Copenhagen Burnout Inventory has three highly correlated unidimensional scales that measure personal burnout, work-related burnout, and client-related burnout. Except for a ceiling effect of ~ 2%, the three scales have excellent measurement properties. For each scale, Rasch rating scale analysis confirmed five statistically different nurse burnout levels. The mean personal burnout scores and work-related burnout scores (50.24, 51.11 respectively) were not higher than those reported in the international literature. However, the mean client-related burnout score of 50.3 was higher than reported for other countries. Compared with a baseline study conducted at the beginning of Lebanon’s political and economic crises, only client-related burnout scores were higher p. <.01.

Conclusions

The CBI scales are reliable and valid measures for monitoring nurse burnout in crises torn countries. Stakeholders can use the CBI scales to monitor nurse burnout and prioritize burnout interventions. Urgent action is needed to reduce levels of client-related burnout in Lebanon’s nursing workforce.

Nurse Burnout Syndrome and Work Environment Impact Patient Safety Grade

BACKGROUND

Burnout impacts nurses' health as well as brain structures and functions including cognitive function, which could lead to work performance and patient safety issues. Yet, few organization-level factors related to patient safety have been identified.

PURPOSE

This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment.

METHODS

A cross-sectional electronic survey was conducted among nurses (N = 928) in acute care Alabama hospitals.

RESULTS

In multilevel ordinal mixed-effects models with nurses nested within hospitals, all burnout dimensions of the Copenhagen Burnout Inventory (OR for +1 SD ranging 0.63-0.78; P < .05) and work environment (OR for +1 SD ranging 4.35-4.89; P < .001) were related to the outcome of patient safety grade after controlling for nurse characteristics.

CONCLUSIONS

Results indicate that health care organizations may reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level.

COVID-related work changes, burnout, and turnover intentions in mental health providers: A moderated mediation analysis

Objective: The novel coronavirus disease (COVID-19) has drastically impacted the provision of mental health services. Changes required of providers were substantial and could lead to increased burnout and, subsequently, increased turnover intentions. This study examined burnout experienced by mental health services providers in the context of COVID-19 and through the lens of the job demands-resources (JD-R) model. We examined the effects of work changes on burnout and subsequent turnover intentions, and how job and personal resources may have buffered the extent to which work changes due to COVID-19 impacted burnout. Methods: Service providers (n = 93) from six community mental health centers (CMHCs) in one Midwestern state in the United States completed surveys as part of service contracts to implement evidence-based practices. Path analysis tested the unconditional indirect relations between work changes and turnover intentions through burnout. Moderated mediation determined whether the indirect effect of work changes on turnover intentions via burnout varied in strength by job and personal resources. Results: Work changes had a significant indirect effect on turnover intentions through burnout ( β ^ = .140, 95% CI = .072, .217). This indirect effect varied as a function of two job resources, organizational trust and perceived organizational support. Conclusions and Implications for Practice: Burnout was relatively low only when work changes were low and job resources levels high. When work changes were high, burnout was similarly high across levels of job resources. To minimize burnout, organizations should limit task, setting, and team-related work changes to the extent possible. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Medication administration errors: A concept analysis

AIM

To provide an analysis of the concept of medication errors that occur during the nursing task of medication administration.

BACKGROUND

Medication errors occurring during medication administration have an increased risk for an adverse patient outcome. Many terms are associated with medication errors, with limited clarification for a medication administration error at the point of care delivery.

DATA SOURCES

Twenty-seven sources were chosen from database searches of PubMed, CINAHL, EMBASE, and Scopus. Key search terms used to narrow the search consist of the following terminology: ("bedside" OR "point-of-care" OR "nursing care*") AND "medication administration errors" AND ("acute care").

REVIEW METHODS

Rodger's evolutionary method of concept analysis was used to clarify the concept of medication administration error.

RESULTS

The concept analysis identified three attributes of a medication administration error: nurse-provided care, administration, and point of care. Antecedents identified in the analysis are organizational factors and nurse factors. Consequences identified in the analysis are patient, nurse and organizational themes.

CONCLUSION

The continued occurrence of medication administration errors warrants the need for an investigation into existing safety measures. Using this concept analysis may help guide the study of the healthcare environment and determine empirical measures to assess the impact that a medication administration error has.

The mediating role of COVID-19-related burden in the association between adverse childhood experiences and emotional exhaustion: results of the egePan - VOICE study

BACKGROUND

Adverse childhood experiences (ACEs) increase the risk for mental health problems. However, there is a lack of data targeting the role of ACEs for one of the most prevalent mental health problems in health-care professionals: burnout.

OBJECTIVE

We aimed to assess the relationship between ACEs and the core burnout dimension 'emotional exhaustion' (EE). As health-care professionals have been facing particular challenges during the COVID-19 pandemic, we furthermore aimed to assess the role of COVID-19 associated burden in the interplay between ACEs and EE.

METHODS

During the first lockdown in Germany, a total of 2500 medical healthcare professionals were questioned in a cross-sectional online survey. Questions targeted, among others, sociodemographics, ACEs, COVID-19-associated problems (e.g. increase of workload, worries about relatives and patients) and emotional exhaustion, measured by the respective dimension of the Maslach Burnout Inventory (MBI).

RESULTS

In German health-care professionals, ACEs were associated with a higher EE score. The number of experienced ACEs was associated with the majority of assessed COVID-19-associated problems. An increasing number of ACEs predicted higher EE scores, controlling for gender. The association between ACEs and EE was mediated significantly by COVID-19-associated problems. These included maladaptive coping strategies such as increased smoking, drinking and use of antidepressants/tranquilizers, feeling less protected by measures of the employee or the state, a greater feeling of being burdened by COVID-19-associated problems and greater exhaustion and sleep problems.

CONCLUSION

Our findings suggest ACEs as significant risk factor for EE in German health-care professionals. The current pandemic means a significant burden that further pronounces this risk.