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Weber KD, Mower W, Krishnadasan A, Mohr NM, Montoy JC, Rodriguez RM, Giordano PA, Eyck PT, Harland KK, Wallace K, McDonald LC, Kutty PK, Hesse EM, Talan DA. Coronavirus Disease 2019 Infections Among Emergency Health Care Personnel: Impact on Delivery of United States Emergency Medical Care, 2020. Ann Emerg Med 2024; 84:40-48. [PMID: 38493375 PMCID: PMC11193658 DOI: 10.1016/j.annemergmed.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 03/18/2024]
Abstract
STUDY OBJECTIVE In the early months of the coronavirus disease 2019 (COVID-19) pandemic and before vaccine availability, there were concerns that infected emergency department (ED) health care personnel could present a threat to the delivery of emergency medical care. We examined how the pandemic affected staffing levels and whether COVID-19 positive staff were potentially infectious at work in a cohort of US ED health care personnel in 2020. METHODS The COVID-19 Evaluation of Risks in Emergency Departments (Project COVERED) project was a multicenter prospective cohort study of US ED health care personnel conducted from May to December 2020. During surveillance, health care personnel completed weekly electronic surveys and underwent periodic serology and nasal reverse transcription polymerase chain reaction testing for SARS-CoV-2, and investigators captured weekly data on health care facility COVID-19 prevalence and health care personnel staffing. Surveys asked about symptoms, potential exposures, work attendance, personal protective equipment use, and behaviors. RESULTS We enrolled 1,673 health care personnel who completed 29,825 person weeks of surveillance. Eighty-nine (5.3%) health care personnel documented 90 (0.3%; 95% confidence interval [CI] 0.2% to 0.4%) person weeks of missed work related to documented or concerns for COVID-19 infection. Health care personnel experienced symptoms of COVID-19 during 1,256 (4.2%) person weeks and worked at least one shift whereas symptomatic during 1,042 (83.0%) of these periods. Seventy-five (4.5%) participants tested positive for SARS-CoV-2 during the surveillance period, including 43 (57.3%) who indicated they never experienced symptoms; 74 (98.7%; 95% CI 90.7% to 99.9%) infected health care personnel worked at least one shift during the initial period of infection, and 71 (94.7%) continued working until laboratory confirmation of their infection. Physician staffing was not associated with the facility or community COVID-19 levels within any time frame studied (Kendall tau's 0.02, 0.056, and 0.081 for no shift, one-week time shift, and 2-week time shift, respectively). CONCLUSIONS During the first wave of the pandemic, COVID-19 infections in ED health care personnel were infrequent, and the time lost from the workforce was minimal. Health care personnel frequently reported for work while infected with SARS-CoV-2 before laboratory confirmation. The ED staffing levels were poorly correlated with facility and community COVID-19 burden.
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Affiliation(s)
- Kurt D Weber
- Department of Emergency Medicine, Orlando Health, Orlando, FL.
| | - William Mower
- Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, the David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, IA
| | - Juan Carlos Montoy
- Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA
| | | | - Patrick Ten Eyck
- Department of Emergency Medicine, University of Iowa, Iowa City, IA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa, Iowa City, IA
| | - Kelli Wallace
- Department of Emergency Medicine, University of Iowa, Iowa City, IA
| | | | - Preeta K Kutty
- Division of Healthcare Quality Promotion Centers for Disease Control and Prevention, Atlanta, GA; Division of Preparedness and Emerging Infections Centers for Disease Control and Prevention, Atlanta, GA
| | - Elisabeth M Hesse
- Division of Preparedness and Emerging Infections Centers for Disease Control and Prevention, Atlanta, GA
| | - David A Talan
- Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, the David Geffen School of Medicine at UCLA, Los Angeles, CA; Olive View-UCLA Education and Research Institute, Los Angeles, CA
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Hor SY, Wyer M, Barratt R, Turnbull M, Rogers K, Murphy M, Urwin R, Jorm C, Gilbert GL. Risk assessment and the use of personal protective equipment in an emergency department: Differing perspectives of emergency and infection control clinicians. A video-vignette survey. Am J Infect Control 2024:S0196-6553(24)00557-1. [PMID: 38925501 DOI: 10.1016/j.ajic.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. METHODS An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test. RESULTS Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED. DISCUSSION Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints. CONCLUSIONS To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.
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Affiliation(s)
- Su-Yin Hor
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
| | - Mary Wyer
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia; NSW Biocontainment Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ruth Barratt
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Margo Turnbull
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kris Rogers
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Margaret Murphy
- Emergency Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Christine Jorm
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
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Kilova K, Stoyanova R, Harizanova S, Baltov M. Burnout and Satisfaction with Work-Life Balance among General Practitioners in Bulgaria during the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:987. [PMID: 38786398 PMCID: PMC11121710 DOI: 10.3390/healthcare12100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
The objective of the present study is to analyze the link between the degree of professional burnout among general practitioners in Bulgaria during a pandemic and their satisfaction with the balance between their personal lives and professional lives. A cross-sectional study was conducted during the fourth wave of the COVID-19 pandemic from December 2021 to January 2022 among 377 general practitioners. We identified the presence and level of burnout syndrome among GPs using V. Boyko's method for diagnostics of the severity of symptoms and the phases of formation and completion of the 'occupational burnout' process. Descriptive statistics and parametric and non-parametric tests were used for the analysis. For the significance level of the null hypothesis, we assumed that p < 0.05 at a 95% confidence interval. A total of 96.3% of the GPs had a high level of burnout during the COVID-19 pandemic. They worked more than 8 h a day (74.8%) and more than 5 days a week (69.0%). A total of 86.3% of them were not satisfied with the spare time they had and stated that they could not balance their work and personal lives (67.1%) since the pandemic was announced. A link was found between the level of professional burnout and long working hours (p = 0.022), dissatisfaction with free time (p = 0.028), and the inability to balance work and personal life (p = 0.000), as well as concerns related to safety during the pandemic (p = 0.048). Unrealistically high levels of burnout during the COVID-19 pandemic due to a disturbed work-life balance is a reason to re-evaluate health policies and involve more hospital care doctors at the frontlines to fight against severe infectious diseases. The results of this study could be used to inform policy makers, healthcare managers, and other stakeholders about the factors that have had profound impacts on GPs' stress levels during the COVID-19 pandemic.
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Affiliation(s)
- Kristina Kilova
- Department of Medical Informatics, Biostatistics and E-Learning, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Rumyana Stoyanova
- Department of Health Management and Health Economics, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | | | - Marin Baltov
- Department of Forensic Medicine and Deontology, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
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Akhavan AR, Zhan T, Lall MD, Barton MA, Reisdorff EJ, Hu Y, Bilimoria KY, Lu DW. Suicidal ideation, perception of personal safety, and career regret among emergency medicine residents during the COVID-19 pandemic. AEM EDUCATION AND TRAINING 2024; 8:e10955. [PMID: 38516253 PMCID: PMC10951625 DOI: 10.1002/aet2.10955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/23/2024]
Abstract
Objectives The COVID-19 pandemic was disruptive for trainees and may have affected career decisions for some learners. This study examined the impact of the pandemic on emergency medicine (EM) resident perceptions of their mental health, perceptions of personal safety, and career choice regret. Methods This was a cross-sectional survey study administered following the 2021 American Board of Emergency Medicine In-Training Examination (ITE). Survey measures included suicidal ideation (SI), COVID concerns in terms of infection prevention and control (IPC) training, COVID risk to self and/or COVID risk to family, and COVID-related career regret. COVID concerns were compared by gender and race/ethnicity using Pearson's chi-square tests. Multivariable logistic regression models were used to test the association between SI and COVID concerns, resident characteristics, and program characteristics. Results A total of 6980 out of 8491 EM residents (82.2%) from 244 programs completed the survey. Only 1.1% of participants reported insufficient training in COVID IPC practices. Participants were concerned about COVID risk to themselves (40.3%) and to their families (63.3%) due to their job roles. These concerns were more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); senior residents (vs. PGY-1, PGY-2 residents); and residents who were married or in relationships (vs. single or divorced). A total of 6.1% of participants reported that COVID made them reconsider choosing EM as their career. Career regret in this cohort was higher than that in the proportion (3.2%) expressing career regret in the 2020 ITE (p < 0.001). Career regret was more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); and senior residents (vs. PGY-1, PGY-2 residents). The overall SI rate was 2.6%, which did not differ from that of the 2020 sample of EM residents (2.5%, p = 0.88). Conclusions Many EM residents reported concerns about COVID risks to themselves and their families. Although the rate of SI remained unchanged, more EM residents reported career regret during the COVID pandemic.
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Affiliation(s)
- Arvin R. Akhavan
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Tiannan Zhan
- Department of SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | | | | | - Yue‐Yung Hu
- Department of SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Karl Y. Bilimoria
- Department of SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Dave W. Lu
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
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Chatham AA, Petruzzi LJ, Patel S, Brode WM, Cook R, Garza B, Garay R, Mercer T, Valdez CR. Structural Factors Contributing to Compassion Fatigue, Burnout, and Secondary Traumatic Stress Among Hospital-Based Healthcare Professionals During the COVID-19 Pandemic. QUALITATIVE HEALTH RESEARCH 2024; 34:362-373. [PMID: 38011747 PMCID: PMC10905984 DOI: 10.1177/10497323231213825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
High levels of burnout among healthcare providers (HCPs) have been a widely documented phenomenon, which have been exacerbated during the COVID-19 pandemic. In the United States, qualitative studies that are inclusive of HCPs in diverse professional roles have been limited. Therefore, we utilized a qualitative-quantitative design to examine professional quality of life in terms of compassion fatigue, burnout, and secondary traumatic stress among hospital-based HCPs, including social workers, hospitalists, residents, and palliative care team members during COVID-19. HCPs (n = 26) participated in virtual semi-structured focus groups or individual interviews and online surveys (n = 30) including the Professional Quality of Life (ProQOL) Scale. While ProQOL scores indicated low levels of compassion fatigue, burnout, and secondary traumatic stress, thematic analysis of our qualitative data included rich descriptions of compassion fatigue, burnout, and secondary traumatic stress. Safety concerns and value misalignment characterized structural stressors perceived to contribute to HCP compassion fatigue, burnout, and secondary traumatic stress. The discrepancy between our qualitative and quantitative findings may be indication that modifications to current screenings are warranted. These findings also suggest a need to identify and implement structural and policy changes that increase HCPs' physical and emotional safety and promote better alignment of institutional interests with HCP values.
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Affiliation(s)
- Ana A. Chatham
- Steve Hicks School of Social Work at The University of Texas at Austin, Austin, TX, USA
| | - Liana J. Petruzzi
- Population Health Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Snehal Patel
- Population Health Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
- Internal Medicine Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - W. Michael Brode
- Population Health Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
- Internal Medicine Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Rebecca Cook
- Population Health Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
- Internal Medicine Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Brenda Garza
- Population Health Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Ricardo Garay
- Population Health Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Tim Mercer
- Population Health Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
- Internal Medicine Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Carmen R. Valdez
- Steve Hicks School of Social Work at The University of Texas at Austin, Austin, TX, USA
- Population Health Department, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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6
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Oskvarek JJ, Blutinger EJ, Pilgrim R, Joshi AU, Lin MP, Mazer-Amirshahi M, Miller G, Smiley A, Becker CW, Pines JM. Beyond the Four Walls: The American College of Emergency Physicians 2022 New Practice Models Task Force Report. Ann Emerg Med 2024; 83:250-271. [PMID: 37777937 DOI: 10.1016/j.annemergmed.2023.08.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/02/2023]
Abstract
Emergency physicians are highly trained to deliver acute unscheduled care. The emergency physician core skillset gained during emergency medicine residency can be applied to many other roles that benefit patients and extend and diversify emergency physician careers. In 2022, the American College of Emergency Physicians (ACEP) convened the New Practice Models Task Force to describe new care models and emergency physician opportunities outside the 4 walls of the emergency department. The Task Force consisted of 21 emergency physicians with broad experience and 2 ACEP staff. Fifty-nine emergency physician roles were identified (21 established clinical roles, 16 emerging clinical roles, 9 established nonclinical roles, and 13 emerging nonclinical roles). A strength-weakness-opportunity-threat (SWOT) analysis was performed for each role. Using the analysis, the Task Force made recommendations for guiding ACEP internal actions, advocacy, education, and research opportunities. Emphasis was placed on urgent care, rural medicine, telehealth/virtual care, mobile integrated health care, home-based services, emergency psychiatry, pain medicine, addiction medicine, and palliative care as roles with high or rising demand that draw on the emergency physician skillset. Advocacy recommendations focused on removing state and federal regulatory and legislative barriers to the expansion of new and emerging roles. Educational recommendations focused on aggregating available resources, developing a centralized resource for career guidance, and new educational content for emerging roles. The Task Force also recommended promoting research on potential advantages (eg, improved outcomes, lower cost) of emergency physicians in certain roles and new care models (eg, emergency physician remote supervision in rural settings).
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Affiliation(s)
- Jonathan J Oskvarek
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Summa Health System, Akron, OH.
| | - Erik J Blutinger
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Michelle P Lin
- Department of Emergency Medicine, Stanford University, Palo Alto, CA
| | | | | | - Abbey Smiley
- Department of Emergency Medicine, The Ohio State University, Columbus
| | | | - Jesse M Pines
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
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7
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Ferber MF, Chen T, McHowat J, Charney RL, Bitter CC. Perceived and Received Support by Academic Medicine Faculty During the COVID-19 Pandemic: A Single Institution Study. Disaster Med Public Health Prep 2024; 18:e3. [PMID: 38214070 DOI: 10.1017/dmp.2023.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The COVID-19 pandemic negatively impacted healthcare worker well-being, leading to increased burnout and decreased workplace engagement. To combat expected stressors from the pandemic, our mid-sized academic health center implemented numerous institutional support, such as town halls, and virtual support groups. This study aimed to evaluate faculty utilization of institutional support, its association with perceived organizational support, received organizational support, and burnout. METHODS A retrospective, cross-sectional survey was distributed to 630 faculty employed at our institution in September 2020, assessing participant demographics, institutional support utilized, perceived organizational support, and burnout, through a combination of self-report measures and qualitative responses. RESULTS A total of 79 (12.5%) faculty provided complete responses and were included in the analysis. Qualitative analysis identified 4 primary themes: (1) flexibility and adjusted expectations, (2) direct communication, (3) sense of community, and (4) no support felt, with additional subthemes within each larger theme. Increased utilization of institutional support was associated with decreased odds of experiencing burnout. CONCLUSION Flexibility, communication, and sense of community emerged as important strategies for maintaining faculty well-being and engagement during the early stages of the COVID-19 pandemic. This study suggests that utilization of workplace support is protective against burnout. Perceived support was not beneficial.
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Affiliation(s)
- Megan Ferriby Ferber
- Medical Family Therapy Program, Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Tina Chen
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Jane McHowat
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO
| | - Rachel L Charney
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO
| | - Cindy C Bitter
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
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8
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Duffton JD, Heystek MJ, Engelbrecht A, Rajan S, Du Toit RA. The psychological impact of COVID-19 on frontline doctors in Tshwane public hospitals. S Afr Fam Pract (2004) 2023; 65:e1-e10. [PMID: 38197689 PMCID: PMC10784208 DOI: 10.4102/safp.v65i1.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic placed immense pressure on frontline doctors. Burnout is a psychological syndrome that develops in response to chronic work stress. It consists of emotional exhaustion (EE), depersonalisation (DP) and reduced personal accomplishment (PA). Burnout is associated with personal dysfunction and compromises the work profession and patient safety. International studies suggest burnout is exacerbated during a pandemic. METHODS We conducted a descriptive cross-sectional observational study. Respondents included frontline doctors working in emergency medicine, family medicine and internal medicine during COVID-19 in Tshwane public hospitals. The survey included two validated questionnaires, the Maslach Burnout Inventory and the Depression, Anxiety, Stress Scale-21. The aim was to determine the prevalence and severity of burnout, psychological and somatic symptoms in frontline doctors. RESULTS Of the 163 participants, we found clinical burnout to be present in 58.9% (n = 96) and extreme burnout in 19.6% (n = 32). Moderate to extremely severe levels of stress, anxiety and depression were present in 55.1% (n = 90), 43.6% (n = 71) and 22.1% (n = 36) of participants, respectively. We found significant correlations between burnout and psychological symptoms. Increased levels of burnout, anxiety, depression and stress were found to be meaningfully associated with adverse somatic symptoms. CONCLUSION Our study demonstrated an insufferably high prevalence of burnout and psychosomatic symptoms in frontline doctors during COVID-19. In the event of future pandemics, more measures should be taken to support frontline doctors.Contribution: Pandemic-associated burnout and its psychophysical consequences have not been studied in frontline doctors in South Africa.
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Affiliation(s)
- Juliet D Duffton
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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9
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Pankratz L, Gill G, Pirzada S, Papineau K, Reynolds K, Riviere CL, Bolton JM, Hensel JM, Olafson K, Kredentser MS, El-Gabalawy R, Hiebert T, Chochinov HM. "It took so much of the humanness away": Health care professional experiences providing care to dying patients during COVID-19. DEATH STUDIES 2023; 48:706-718. [PMID: 37938174 DOI: 10.1080/07481187.2023.2266639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
COVID-19 has affected healthcare in profound and unprecedented ways, distorting the experiences of patients and healthcare professionals (HCPs) alike. One area that has received little attention is how COVID-19 affected HCPs caring for dying patients. The goal of this study was to examine the experiences of HCPs working with dying patients during the COVID-19 pandemic. Between July 2020-July 2021, we recruited HCPs (N = 25) across Canada. We conducted semi-structured interviews, using a qualitative study design rooted in constructivist grounded theory methodology. The core themes identified were the impact of the pandemic on care utilization, the impact of infection control measures on provision of care, moral distress in the workplace, impact on psychological wellbeing, and adaptive strategies to help HCPs manage emotions and navigate pandemic imposed changes. This is the first Canadian study to qualitatively examine the experiences of HCPs providing care to dying patients during the COVID-19 pandemic. Implications include informing supportive strategies and shaping policies for HCPs providing palliative care.
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Affiliation(s)
- Lily Pankratz
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gagan Gill
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salina Pirzada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelsey Papineau
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christian La Riviere
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kendiss Olafson
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maia S Kredentser
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Anesthesiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tim Hiebert
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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10
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Martin SR, Heyming T, Morphew T, Sayrs L, Fortier MA, Sanger T, Kain ZN. Impact of COVID-19 pandemic on pediatric healthcare burnout in acute care: a longitudinal study. Pediatr Res 2023; 94:1771-1778. [PMID: 37301924 PMCID: PMC10257162 DOI: 10.1038/s41390-023-02674-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND COVID-19 pandemic introduced significant challenges that may have exacerbated healthcare worker (HCW) burnout. To date, assessments of burnout during COVID-19 pandemic have been cross-sectional, limiting our understanding of changes in burnout. This longitudinal study assessed change across time in pediatric HCW burnout during the COVID-19 pandemic and whether demographic and psychological factors were associated with changes in burnout. METHODS This longitudinal study included 162 physicians, physician assistants, nurses, and medical technicians within the emergency department (ED), intensive care, perioperative, and inter-hospital transport services in a children's hospital. HCW demographics, anxiety and personality traits were reported via validated measures. HCWs completed the Maslach Burnout Inventory in April 2020 and March 2021. Data were analyzed using generalized estimating equations. RESULTS The percentage of HCWs reporting high emotional exhaustion and/or depersonalization burnout increased significantly across time (18.5% to 28.4%, P = 0.010). Factors associated with increased emotional exhaustion included working in the ED (P = 0.011) or perioperative department (P < 0.001), being a nurse or medical technician (P's < 0.001), not having children (P < 0.001), and low conscientiousness (P < 0.001). CONCLUSIONS Pediatric HCW burnout significantly increased over 11-months of the COVID-19 pandemic. Results suggest that certain demographic and psychological factors may represent potential area to target for intervention for future pandemics. IMPACT This longitudinal study revealed that the COVID-19 pandemic has had a significant impact on pediatric healthcare worker burnout. The percentage of healthcare workers reporting high levels of emotional exhaustion and depersonalization burnout increased significantly over 11-months of the COVID-19 pandemic. Results suggest that certain demographic and psychological factors may represent potential targets for future interventions.
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Affiliation(s)
- Sarah R Martin
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA
- Center on Stress & Health, University of California, Irvine, Irvine, CA, USA
- Children's Hospital of Orange County, Orange, CA, USA
| | - Theodore Heyming
- Children's Hospital of Orange County, Orange, CA, USA
- Emergency Medicine, University of California, Irvine, Irvine, CA, USA
| | - Tricia Morphew
- Morphew Consulting, LLC, Bothell, WA, USA
- Research Institute, Children's Hospital of Orange County, Orange, CA, USA
| | - Lois Sayrs
- Children's Hospital of Orange County, Orange, CA, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Michelle A Fortier
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA
- Center on Stress & Health, University of California, Irvine, Irvine, CA, USA
- Children's Hospital of Orange County, Orange, CA, USA
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, USA
| | | | - Zeev N Kain
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA.
- Center on Stress & Health, University of California, Irvine, Irvine, CA, USA.
- Children's Hospital of Orange County, Orange, CA, USA.
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11
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Hayirli TC, Stark N, Hardy J, Peabody CR, Kerrissey MJ. Centralization and democratization: Managing crisis communication in health care delivery. Health Care Manage Rev 2023; 48:292-300. [PMID: 37615939 PMCID: PMC10534021 DOI: 10.1097/hmr.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Communication is an essential organizational process for responding to adversity. Managers are often advised to communicate frequently and redundantly during crises. Nonetheless, systematic investigation of how information receivers perceive organizational communication amid crises has remained lacking. PURPOSE The aim of this study was to characterize features of effective internal crisis communication by examining how information-sharing processes unfolded during the initial stage of the COVID-19 pandemic. METHODOLOGY Between June and August 2020, we conducted 55 semistructured interviews with emergency department workers practicing in a variety of roles. We analyzed interview transcripts following constructivist constant comparative methods. RESULTS Our findings revealed that at the onset of COVID-19 pandemic response, emergency department workers struggled with immense fear and anxiety amid high uncertainty and equivocality. Frequent and redundant communication, however, resulted in information delivery and uptake problems, worsening anxiety, and interpersonal tension. These problems were ameliorated by the emergence of contextual experts who centralized and democratized communication. Centralization standardized information received across roles, work schedules, and settings while decoupling internal communication from turbulence in the environment. Democratization made information accessible in a way that all could understand. It also ensured information senders' receptiveness to feedback from information receivers. Centralization and democratization together worked to reduce sensed uncertainty and equivocality, which reduced anxiety and interpersonal tension. CONCLUSION Establishing frequent and redundant communication strategies does not necessarily address the anxiety and interpersonal tension produced by uncertainty and equivocality in crises. PRACTICE IMPLICATIONS Centralization and democratization of crisis communication can reduce anxiety, improve coordination, and promote a safer workplace and patient care environment.
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Affiliation(s)
- Tuna C. Hayirli
- Harvard Medical School, Boston MA
- Harvard Business School, Boston MA
| | - Nicholas Stark
- Department of Emergency Medicine, University of California, San Francisco CA
| | - James Hardy
- Department of Emergency Medicine, University of California, San Francisco CA
| | - Christopher R. Peabody
- Department of Emergency Medicine, University of California, San Francisco CA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, CA
| | - Michaela J. Kerrissey
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, MA
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12
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Song HI, Yun JA, Ahn YS, Choi KS. Validating a Korean Version of the Single-Item Burnout Measure for Evaluating Burnout Among Doctors. Psychiatry Investig 2023; 20:681-688. [PMID: 37525618 PMCID: PMC10397769 DOI: 10.30773/pi.2022.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/23/2023] [Accepted: 05/24/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE It is essential to measure the effect of burnout on doctors because burnout can affect doctors' mental health as well as the functioning of medical practice. This study aims to validate a Korean version of the single-item burnout measure (SIBM), which was developed to quickly measure the level of burnout among doctors. METHODS Through an online survey, a self-report questionnaire was administered to 324 public health doctors in Korea. The Korean version of the SIBM was validated against the Maslach Burnout Inventory-General Survey (MBI-GS), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) screening tool, the Perceived Stress Scale (PSS), and the Vaccination Attitudes Examination (VAX) scale. Pearson correlation coefficients and analysis of variance (ANOVA) were used to determine the association between the SIBM and other scales. ANOVA was additionally used to determine the associations between the subscales of the MBI-GS and those of the SIBM. RESULTS The correlation coefficient between the SIBM and the MBI-GS, PHQ-9, GAD-7, and PSS was positive (p<0.01), and the correlation coefficient between the SIBM and the VAX scale was not significant. Therefore, convergent and discriminant validity was verified. Exhaustion and cynicism, which were correlated with the SIBM, with r2=0.43 (p<0.01) and 0.48 (p<0.01), yielded R2 scores of 0.27 (p<0.01) and 0.20 (p<0.01) in ANOVA. CONCLUSION The Korean version of the SIBM is an appropriate screening tool for burnout. It can be evaluated in a short time, thereby enhancing continuous follow-up observations and response rates to burnout.
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Affiliation(s)
- Hye-in Song
- Department of Neuropsychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji-Ae Yun
- Department of Neuropsychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea
- Department of Neuropsychiatry, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
| | - Yeon-Soon Ahn
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kyeong-Sook Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea
- Department of Neuropsychiatry, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
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13
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Rahiman HU, Panakaje N, Kulal A, Harinakshi, Parvin SMR. Perceived academic stress during a pandemic: Mediating role of coping strategies. Heliyon 2023; 9:e16594. [PMID: 37287604 PMCID: PMC10232934 DOI: 10.1016/j.heliyon.2023.e16594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2024] Open
Abstract
COVID-19 rampant has impacted almost all sections of society, and the repercussions were mostly negative experiences for people and have resulted by way of disruption in their daily routines. Academics is one such vital section that has suffered directly because of the inaccessibility of a comfortable educational procedure. Due to a shift in the form of education, most of the student community failed to obtain routine and regular education as the government entirely shuttered educational facilities to limit the spread of disease. In this light, this research attempted to examine the amount of academic stress experienced by students during the COVID-19 Pandemic and the strategies they have adopted to cope with this unheard type of uncertain situation. The findings of the study indicated substantial variations in Academic Stress, Exam Anxiety, and Coping Strategies across various demographic characteristics of the respondents. Another significant finding is that students from poor socio-economic backgrounds and those seeking post-graduate courses are more stressed. As an inference, it is also opined that to mitigate the impact of the COVID-19 crisis on student performance and psychological well-being, special focus, or techniques for accommodating exam environments by the student should be implemented. To minimize stress, the study also proposed efficient coping techniques to lower the amount of stress in various academic tasks.
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Affiliation(s)
| | - Niyaz Panakaje
- The Yenepoya Institute of Arts, Science, Commerce & Management, Yenepoya (Deemed to be University), Deralakatte, 575018, Mangalore, Karnataka, India
| | - Abhinandan Kulal
- Guest Faculty, Department of Commerce, University Evening College, Mangaluru, India
| | - Harinakshi
- Research Scholar, Institute of Management and Commerce, Srinivas University, Mangalore, India
| | - S M Riha Parvin
- Institute of Management and Commerce, Srinivas University, Mangalore, India
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14
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Tsang M, Banerjee R, Quiroga D, Idossa D, Schoenbeck KL. Where the Sidewalk Ends: Parenting as a trainee during COVID-19. Cancer Invest 2023:1-14. [PMID: 37243573 DOI: 10.1080/07357907.2023.2219747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/20/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
Physicians who are also parents have faced significant difficulties during the COVID-19 pandemic. However, most studies of the physician-parent workforce have focused on the experiences of attending physicians. In this commentary, we highlight the ways that trainee parents have uniquely experienced three major stressors during the pandemic: (1) childcare challenges, (2) scheduling difficulties, and (3) career uncertainties. We discuss potential solutions to mitigate these challenges for the future hematology/oncology workforce. As the pandemic continues, we hope that these steps can improve the ability of trainee parents to care both for their patients and their families.
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Affiliation(s)
- Mazie Tsang
- Division of Hematology and Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - Rahul Banerjee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Dionisia Quiroga
- Division of Hematology/Oncology, Department of Medicine, Ohio State University
| | - Dame Idossa
- Division of Hematology, Oncology, and Transplantation Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Kelly L Schoenbeck
- Division of Hematology/Oncology, Department of Medicine, San Francisco Veteran Affairs Medical Center, San Francisco, CA
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
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15
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DiMaggio C, Susser E, Frangos S, Abramson D, Andrews H, Hoven C, Ryan M, Li G. The New York State COVID-19 Healthcare Personnel Study: One-Year Follow-up of Physicians, Nurse Practitioners, and Physician Assistants, 2020-2021. Public Health Rep 2023:333549231155473. [PMID: 36905312 PMCID: PMC10009497 DOI: 10.1177/00333549231155473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES The COVID-19 Healthcare Personnel Study is a longitudinal survey to assess the changing impact of the COVID-19 pandemic on the New York State health care workforce. We analyzed results from a follow-up survey of physicians, nurse practitioners, and physician assistants on the availability of equipment and personnel, work conditions, physical and mental health of participants, and impact of the pandemic on commitment to their profession. METHODS We conducted an online survey of all licensed New York State physicians, nurse practitioners, and physician assistants in April 2020 (N = 2105) and a follow-up survey in February 2021 (N = 978). We analyzed changes in item responses from baseline to follow-up. We calculated survey-adjusted paired t tests and odds ratios (ORs) using survey-adjusted generalized linear models controlling for age, sex, region of practice, and hospital versus non-hospital-based practice. RESULTS Twenty percent of respondents expressed continuing concern about personnel shortages at both baseline and follow-up. Respondents reported working approximately 5 more hours on average during a 2-week period at follow-up compared with baseline (78.1 vs 72.6 hours; P = .008). For 20.4% (95% CI, 17.2%-23.5%) of respondents, mental health issues had become persistent. More than one-third (35.6%; 95% CI, 31.9%-39.4%) of respondents reported that they thought about leaving their profession more often than once per month. The association between persistent mental and behavioral health issues and contemplating leaving one's profession was significant (OR = 2.7; 95% CI, 1.8-4.1; P < .001). CONCLUSIONS Interventions such as decreasing the number of hours worked, ensuring health care professionals do not work directly with patients while ill, and addressing shortages of personal protective equipment can help address concerns of the health care workforce.
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Affiliation(s)
- Charles DiMaggio
- Department of Surgery, Grossman School of Medicine, New York University, New York, NY, USA
| | - Ezra Susser
- Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Spiros Frangos
- Department of Surgery, Grossman School of Medicine, New York University, New York, NY, USA
| | - David Abramson
- School of Global Public Health, New York University, New York, NY, USA
| | - Howard Andrews
- Data Coordinating Center (DCC), Irving Medical Center, Columbia University, New York, NY, USA
| | - Christina Hoven
- Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Megan Ryan
- Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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16
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Dunn S, Milman BD, Bavolek RA, Bralow L, Jones D, Kane BG, Miller S, Moffett S, Stoneking L, Wilbanks MD, Platt MA. Impacts of the COVID-19 Pandemic on United States Emergency Medicine Education: A Council of Residency Directors in Emergency Medicine (CORD) Task Force Survey-Based Analysis. Cureus 2023; 15:e35994. [PMID: 37050989 PMCID: PMC10085248 DOI: 10.7759/cureus.35994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction The COVID-19 pandemic presented unpredicted challenges to Emergency Medicine (EM) education. The rapid onset of the pandemic created clinical, operational, administrative, and home-life challenges for virtually every member of the medical education community, demanding an educational and professional response at all levels including undergraduate medical education (UME), graduate medical education (GME), and faculty. The Council of Residency Directors in Emergency Medicine (CORD) COVID-19 Educational Impact Task Force was established in 2021 to examine these effects and the response of the EM educational community. Methods The Task Force utilized consensus methodology to develop the survey instruments, which were revised using a modified Delphi process. Both open- and closed-answer questions were included in the survey, which was initially distributed electronically to attendees of the 2021 Virtual Academic Assembly. Results were analyzed quantitatively and qualitatively. Results Sixty-three individuals responded to the first part of the survey (which addressed issues related to UME and GME) and 41 individuals responded to the second part of the survey (which addressed faculty and wellness). The pandemic's influence on EM education was viewed in both a positive and negative light. The transition to virtual platforms had various impacts, including innovation and engagement via technology. Remote technology improved participation in didactics and allowed individuals to more easily participate in departmental meetings. However, this also led to a decreased sense of connection with peers and colleagues resulting in a mixed picture for overall engagement and effectiveness. The Task Force has developed a list of recommendations for best practices for EM programs and for EM organizations. Conclusion The survey results articulated the educational benefits and challenges faced by EM educators during the COVID-19 pandemic. Through the challenging times of the pandemic, many institutional and program-based innovations were developed and implemented to address the new educational environment. These approaches will provide invaluable educational tools for future training. This will also prepare the EM academic community to respond to future educational disruptions.
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17
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Stodolska A, Wójcik G, Barańska I, Kijowska V, Szczerbińska K. Prevalence of burnout among healthcare professionals during the COVID-19 pandemic and associated factors - a scoping review. Int J Occup Med Environ Health 2023; 36:21-58. [PMID: 36727492 PMCID: PMC10464746 DOI: 10.13075/ijomeh.1896.02007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/12/2022] [Indexed: 02/03/2023] Open
Abstract
The outbreak of the COVID-19 pandemic exerted significant mental burden on healthcare workers (HCWs) operating in the frontline of the COVID-19 care as they experienced high levels of stress and burnout. The aim of this scoping review was to identify prevalence and factors associated with burnout among HCWs during the first year of the COVID-19 pandemic. A literature search was performed in PubMed, Web of Science, and CINAHL. Studies were selected based on the following inclusion criteria: cross-sectional, longitudinal, case-control, or qualitative analyses, published in peer-reviewed journals, between January 1, 2020 and February 28, 2021. Studies carried out on other occupations than healthcare workers or related to other pandemics than COVID-19 were excluded. Following the abstract screen, from 141 original papers identified, 69 articles were eventually selected. A large variation in the reported burnout prevalence among HCWs (4.3-90.4%) was observed. The main factors associated with increase/ decrease of burnout included: demographic characteristics (age, gender, education level, financial situation, family status, occupation), psychological condition (psychiatric diseases, stress, anxiety, depression, coping style), social factors (stigmatisation, family life), work organization (workload, working conditions, availability of staff and materials, support at work), and factors related with COVID-19 (fear of COVID-19, traumatic events, contact with patients with COVID-19, having been infected with COVID-19, infection of a colleague or a relative with COVID-19, higher number of deaths observed by nurses during the COVID-19 pandemic). The findings should be useful for policy makers and healthcare managers in developing programs preventing burnout during the current and future pandemics. Int J Occup Med Environ Health. Int J Occup Med Environ Health. 2023;36(1):21-58.
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Affiliation(s)
- Agata Stodolska
- Jagiellonian University Medical College, Kraków, Poland (Medical Faculty, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair)
| | - Grzegorz Wójcik
- Jagiellonian University Medical College, Kraków, Poland (Medical Faculty, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair)
- Jagiellonian University, Kraków, Poland (Faculty of Management and Social Communication, Institute of Applied Psychology)
| | - Ilona Barańska
- Jagiellonian University Medical College, Kraków, Poland (Medical Faculty, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair)
| | - Violetta Kijowska
- Jagiellonian University Medical College, Kraków, Poland (Medical Faculty, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair)
| | - Katarzyna Szczerbińska
- Jagiellonian University Medical College, Kraków, Poland (Medical Faculty, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair)
- University Hospital in Krakow, Kraków, Poland
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18
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McLean CP, Betsworth D, Bihday C, Daman MC, Davis CA, Kaysen D, Rosen CS, Saxby D, Smith AE, Spinelli S, Watson P. Helping the Helpers: Adaptation and Evaluation of Stress First Aid for Healthcare Workers in the Veterans Health Administration During the COVID-19 Pandemic. Workplace Health Saf 2023; 71:162-171. [PMID: 36726298 PMCID: PMC9899680 DOI: 10.1177/21650799221148650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Early interventions are needed to support the behavioral health of healthcare staff in the context of the COVID-19 pandemic. Stress First Aid (SFA) is a self-care and peer support model for reducing burnout and stress that is designed for use in high-stress occupations. METHODS We conducted a mixed-methods evaluation of an SFA program in the Veterans Health Administration (VHA). This brief, multi-session, didactic program was adapted for hospital workgroups. Program attendees completed a survey assessing implementation outcomes, burnout, stress, mood, and SFA skills at the beginning (N = 246) and end (n = 94) of the SFA program and a subgroup (n = 11) completed qualitative feedback interviews. FINDINGS Program acceptability, appropriateness, and feasibility were rated highly. From pre- to post-SFA, the impact of the pandemic on stress and anxiety, as well as proficiency in supporting peers increased. Qualitative findings suggest the program provided a shared language to discuss stress, normalized stress reactions, met a need for stress management tools, and helped staff feel valued, empowered, connected with each other. Staff reported being more aware of their stress, but SFA was insufficient to address many of the systemic sources of burnout and stress. CONCLUSIONS AND APPLICATIONS TO PRACTICE While the SFA program was well received, the impact of brief programs is likely to be modest when implemented in the middle of an ongoing pandemic and when burnout arises from chiefly from systemic sources. Lessons learned during the program implementation that may guide future efforts are discussed.
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Affiliation(s)
- Carmen P. McLean
- Dissemination and Training Division, VA
Palo Alto Healthcare System, National Center for PTSD,Department of Psychiatry and Behavioral
Sciences, Stanford University,Carmen P. McLean, PhD, National Center for
PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795
Willow Rd, Menlo Park, CA 94025, USA;
| | | | | | | | - C. Adrian Davis
- Dissemination and Training Division, VA
Palo Alto Healthcare System, National Center for PTSD
| | - Debra Kaysen
- Dissemination and Training Division, VA
Palo Alto Healthcare System, National Center for PTSD,Department of Psychiatry and Behavioral
Sciences, Stanford University
| | - Craig S. Rosen
- Dissemination and Training Division, VA
Palo Alto Healthcare System, National Center for PTSD,Department of Psychiatry and Behavioral
Sciences, Stanford University
| | | | | | | | - Patricia Watson
- Executive Division, VA Medical Center
(116D), National Center for PTSD,Department of Psychiatry, Geisel School
of Medicine, Dartmouth University
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19
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Tran A, Wallner C, de Wit K, Gérin-Lajoie C, Ritchie K, Mercuri M, Clayton N, Boulos M, Archambault P, Schwartz L, Gray S, Chan TMY. Humans not heroes: Canadian emergency physician experiences during the early COVID-19 pandemic. J Accid Emerg Med 2023; 40:86-91. [PMID: 36253075 DOI: 10.1136/emermed-2022-212466] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The pandemic has upended much clinical care, irrevocably changing our health systems and thrusting emergency physicians into a time of great uncertainty and change. This study is a follow-up to a survey that examined the early pandemic experience among Canadian emergency physicians and aimed to qualitatively describe the experiences of these physicians during the global pandemic. The study was conducted at a time when Canadian COVID-19 case numbers were low. METHODS The investigators engaged in an interview-based study that used an interpretive description analytic technique, sensitised by the principles of phenomenology. One-to-one interviews were conducted, transcribed and then analysed to establish a codebook, which was subsequently grouped into key themes. Results underwent source triangulation (with survey data from a similar period) and investigator-driven audit trail analysis. RESULTS A total of 16 interviews (11 female, 5 male) were conducted between May and September 2020. The isolated themes on emergency physicians' experiences during the early pandemic included: (1) disruption and loss of emergency department shift work; (2) stress of COVID-19 uncertainty and information bombardment; (3) increased team bonding; (4) greater personal life stress; (5) concern for patients' isolation, miscommunication and disconnection from care; (6) emotional distress. CONCLUSIONS Canadian emergency physicians experienced emotional and psychological distress during the early COVID-19 pandemic, at a time when COVID-19 prevalence was low. This study's findings could guide future interventions to protect emergency physicians against pandemic-related distress.
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Affiliation(s)
- Anna Tran
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Clare Wallner
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Emergency Department, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kerstin de Wit
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada .,Health research methodology, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Kerri Ritchie
- Department of Obstetrics and Gynecology, Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mathew Mercuri
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Natasha Clayton
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Emergency Department, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Mary Boulos
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Archambault
- Department of Anesthesiology and Critical Care Medicine, Universite Laval Faculte de medecine, Quebec, Quebec, Canada.,Centre integre de sante et de services sociaux de Chaudiere-Appalaches, Lévis, Quebec, Canada
| | - Lisa Schwartz
- Health research methodology, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Sara Gray
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Teresa Man-Yee Chan
- Emergency Department, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Health research methodology, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,Division of Education & Innovation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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20
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Norful AA, Brewer KC, Adler M, Dierkes A. Initial psychometric properties of the provider-co-management index-RN to scale registered nurse-physician co-management: Implications for burnout, job satisfaction, and intention to leave current position. J Interprof Care 2023:1-10. [PMID: 36688514 DOI: 10.1080/13561820.2022.2164563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Team-based care has become a cornerstone of care delivery to meet the demands of high-quality patient care. Yet, there is a lack of valid and reliable instruments to measure the effectiveness of co-management between clinician dyads, particularly physicians and registered nurses (RNs). The purpose of this study was to adapt an existing instrument, Provider Co-Management Index (PCMI), previously used among primary care providers into a new version to scale RN-physician co-management (called PCMI-RN). We also aimed to explore preliminary associations between RN-physician co-management and burnout, job satisfaction, and intention to leave current job. Face, cognitive, and content validity testing, using mixed methods approaches, were preceded by initial pilot testing (n = 122 physicians and nurses) in an acute care facility. The internal consistency reliability (α=.83) was high. One-quarter of participants reported burnout, 27% were dissatisfied with their job, and 20% reported intention to leave their job. There was a weak significant correlation between co-management and burnout (p = .010), and co-management and job satisfaction (p = .009), but not intention to leave current position. Construct validity testing is recommended. Future research using PCMI-RN may help to isolate factors that support or inhibit effective physician-nurse co-management.
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Affiliation(s)
- Allison A Norful
- School of Nursing, Columbia University School of Nursing, New York, NY, USA
| | | | - Margaret Adler
- Department of Nursing Quality, NewYork-Presbyterian Hudson Valley Hospital, Cortlandt, NY, USA
| | - Andrew Dierkes
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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21
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Dominguez-Espinosa ADC, Fontaine JRJ. It Is Not the Virus Exposure: Differentiating Job Demands and Resources That Account for Distress during the COVID-19 Pandemic among Health Sector Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1212. [PMID: 36673966 PMCID: PMC9859370 DOI: 10.3390/ijerph20021212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
A cross-sectional study of 3860 health-sector workers across two data collections was conducted to identify the predictive power of different job demands and job resources during the COVID-19 pandemic based on four indicators of distress (COVID-19 traumatic stress, burnout, generalised anxiety, and depression) among health-sector workers. Exploratory and confirmatory factor analyses, measurement invariance checks, and structural equation models were used to evaluate the dimensionality and the effect of the job demands and resources on distress indictors. The identified job demands were workload, confinement, loss, and virus exposure, while the identified job resources were self-efficacy, momentary recuperation, and meaning making. Loss and workload predicted the distress indicators best, while confinement and virus exposure mainly predicted COVID-19 traumatic stress and were less important for the other distress outcomes. Self-efficacy and meaning making negatively predicted distress, while momentary recuperation, controlled for the other demands and resources, was positively related to the distress indicators. Of the typical pandemic-related demands and resources, the experience of loss due to COVID-19 infection was the most important predictor of distress outcomes. Confinement, and especially the awareness of virus exposure, were far less important predictors.
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Affiliation(s)
| | - Johnny R. J. Fontaine
- Department of Work, Organization and Society, Faculty of Psychology and Educational Sciences, Ghent University, 9000 Ghent, Belgium
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22
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Comparison of Fear of COVID-19 in Medical and Nonmedical Personnel in a Public Hospital in Mexico: a Brief Report. Int J Ment Health Addict 2023; 21:383-394. [PMID: 34366729 PMCID: PMC8324181 DOI: 10.1007/s11469-021-00600-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 02/07/2023] Open
Abstract
The world is social distancing, and compulsory confinement has caused stress, psychological instability, stigmatization, fear, and discrimination in the general population. In this cross-sectional survey study, we administered the Fear of COVID-19 Scale (FCV-19S) to hospital medical and nonmedical personnel. A total of 1216 participants were surveyed from May 25 to May 29 of 2020. We asked all the staff for their participation in the study, and physical copies of the survey were distributed to the staff willing to participate. All surveys were answered anonymously. We found that the global FCV-19S mean score was 16.4 ± 6.1, with a significant difference between women and men's scores. Medical students presented higher scores than experienced medical personnel. Additionally, the medical and nursing personnel presented a higher level of fear than hospital staff who did not work directly with COVID-19 patients. Our findings suggest that greater knowledge of medicine or infectious diseases could decrease the overall psychological impact of the pandemic disease.
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23
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Pala AN, Chuang JC, Chien A, Krauth DM, Leitner SA, Okoye NM, Costello SC, Rodriguez RM, Sheira LA, Solomon G, Weiser SD. Depression, anxiety, and burnout among hospital workers during the COVID-19 pandemic: A cross-sectional study. PLoS One 2022; 17:e0276861. [PMID: 36490248 PMCID: PMC9733879 DOI: 10.1371/journal.pone.0276861] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 10/16/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Healthcare personnel have faced unprecedented mental health challenges during the COVID-19 pandemic. The study objective is to assess differences in depression, anxiety, and burnout among healthcare personnel with various occupational roles and whether financial and job strain were associated with these mental health outcomes. METHODS We employed an anonymous survey between July and August 2020 at an urban county hospital in California, USA. We assessed depression, anxiety, and burnout using validated scales, and asked questions on financial strain and job strain. We performed logistic and linear regression analyses. RESULTS Nurses (aOR 1.93, 95% CIs 1.12, 3.46), social workers (aOR 2.61, 95% CIs 1.35, 5.17), service workers (aOR 2.55, 95% CIs 1.20, 5.48), and administrative workers (aOR 2.93, 95% CIs 1.57, 5.61) were more likely than physicians to screen positive for depression. The odds of screening positive for anxiety were significantly lower for ancillary workers (aOR 0.32, 95% CIs 0.13-0.72) compared with physicians. Ancillary (aB = -1.77, 95% CIs -1.88, -0.47) and laboratory and pharmacy workers (aB -0.70, 95% CI -1.34, -0.06) reported lower levels of burnout compared with physicians. Financial strain partially accounted for differences in mental health outcomes across job categories. Lack of time to complete tasks and lack of supervisory support were associated with higher odds of screening positive for depression. Less job autonomy was associated with higher odds of screening positive for anxiety and higher burnout levels. CONCLUSIONS We found significant disparities in mental health outcomes across occupational roles. Policies to mitigate the adverse impact of COVID-19 on health workers' mental health should include non-clinical staff and address financial support and job characteristics for all occupational roles.
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Affiliation(s)
- Andrea Norcini Pala
- Columbia School of Social Work (CSSW), New York, NY, United States of America
| | - Jessica C. Chuang
- San Francisco (UCSF) Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, United States of America
| | - Ai Chien
- San Francisco (UCSF) Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, United States of America
| | - David M. Krauth
- San Francisco (UCSF) Division of HIV, University of California, Infectious Disease and Global Medicine, San Francisco, CA, United States of America
| | - Stefano A. Leitner
- San Francisco (UCSF) Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, United States of America
| | - Nnenna M. Okoye
- San Francisco (UCSF) Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, United States of America
| | - Sadie C. Costello
- Division of Environmental Health Sciences, University of California, Berkeley, School of Public Health, CA, United States of America
| | - Robert M. Rodriguez
- San Francisco (UCSF) Department of Emergency Medicine, University of California, San Francisco, CA, United States of America
| | - Lila A. Sheira
- San Francisco (UCSF) Division of HIV, University of California, Infectious Disease and Global Medicine, San Francisco, CA, United States of America
| | - Gina Solomon
- San Francisco (UCSF) Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, United States of America
| | - Sheri D. Weiser
- San Francisco (UCSF) Division of HIV, University of California, Infectious Disease and Global Medicine, San Francisco, CA, United States of America
- * E-mail:
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24
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Work-life balance in physicians working in two emergency departments of a university hospital: Results of a qualitative focus group study. PLoS One 2022; 17:e0277523. [DOI: 10.1371/journal.pone.0277523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 10/29/2022] [Indexed: 11/16/2022] Open
Abstract
By applying an explorative approach, we aimed to identify a wide set of challenges and opportunities for the compatibility of the work and life domains in emergency department (ED) physicians as well as their suggestions for practical approaches to improve work-life balance. Four focus groups with 14 physicians of differing hierarchical position and family status were carried out at two EDs of one major university hospital. Data analysis was based on qualitative content analysis. Discussed themes within main categories included ED work conditions, aspects of residency training, physician’s mentality and behaviors as well as context factors of university medicine. Working in an ED is associated with a comparatively high work-life-interference, mostly due to the unpredictable nature of ED work. Based on our context-specific findings, further research might address factors influencing work-life balance in ED physicians with a mixed-methods approach for identification of relevant associations and intervention approaches in this field.
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25
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Weng SS. Social workers' experiences in integrated health care during the COVID-19 pandemic. JOURNAL OF SOCIAL WORK (LONDON, ENGLAND) 2022; 22:1431-1446. [PMID: 38603282 PMCID: PMC9130868 DOI: 10.1177/14680173221101256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Summary The massive spread of the novel COVID-19 virus across the globe has been disruptive to all providers within integrated healthcare systems, including social workers. The literature on how the pandemic has impacted medical workers are emerging. The present article explored the experiences of social workers. A purposive sample of 40 social workers in integrated healthcare settings was interviewed from September to November 2020 prior to vaccine availability to learn about how they managed the earlier months of the pandemic. A constant comparison approach was used to analyze the data. Findings Themes identified included: (1) how social workers felt about safety in their work environments; (2) what it was like for social workers to transition to remote work; (3) how the pandemic affected social workers' workload and mental health; and (4) what were the preparedness issues and lessons learned. Applications This study adds to the existing literature on provider experiences of the pandemic in integrated health care with social workers' voices. This additional perspective may contribute to better preparedness of behavioral health services and taking care of social workers in future crises.
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Affiliation(s)
- Suzie S Weng
- School of Social Work, California State
University, Long Beach, CA, USA
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26
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Lin C, Siao S, Lin Y, Hsin P, Shelley M, Lee Y. Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID-19: A scoping review. J Nurs Scholarsh 2022; 55:79-96. [PMID: 36138561 PMCID: PMC9538970 DOI: 10.1111/jnu.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic. METHODS This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings. FINDINGS Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively. CONCLUSION The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics. CLINICAL RELEVANCE EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.
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Affiliation(s)
- Chia‐Hung Lin
- School of Nursing, College of MedicineNational Taiwan UniversityTaipeiTaiwan,Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
| | - Shu‐Fen Siao
- School of Nursing, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - You‐Jie Lin
- Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
| | - Pin‐Hsien Hsin
- Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
| | - Mack Shelley
- Department of Political Science, Department of StatisticsIowa State UniversityAmesIowaUSA
| | - Yen‐Han Lee
- Department of Health Sciences, College of Health Professions and SciencesUniversity of Central FloridaOrlandoFloridaUSA
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27
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Chandler AB, Wank AA, Vanuk JR, O'Connor MF, Dreifuss BA, Dreifuss HM, Ellingson KD, Khan SM, Friedman SE, Athey A. Implementing Psychological First Aid for Healthcare Workers During the COVID-19 Pandemic: A Feasibility Study of the ICARE Model. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09900-w. [PMID: 36076146 PMCID: PMC9455940 DOI: 10.1007/s10880-022-09900-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
Maintaining the resilience of healthcare workers (HCWs) during the protracted COVID-19 pandemic is critical as chronic stress is associated with burnout, inability to provide high-quality care, and decreased attentiveness to infection prevention protocols. Between May and July 2020, we implemented the ICARE model of psychological first aid (PFA) in a novel online (i.e., telehealth) format to address the psychological support needs of HCWs during the COVID-19 pandemic. We found that HCWs needed psychological support related to obtaining clear information about pandemic policies and guidelines, navigating new rules and responsibilities, and processing overwhelming and conflicting emotions. The HCWs in our program repeatedly expressed appreciation for the support we provided. Future directions include establishing online discussion forums, increasing opportunities for individual support, and training HCWs to provide peer support using PFA. This program has far-reaching potential benefit to HCWs and to society at large in the context of a pandemic.
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Affiliation(s)
- Alexa B Chandler
- Department of Psychology, The University of Arizona, 1503 E University Blvd., Tucson, AZ, 85721, USA.
| | - Aubrey A Wank
- Department of Psychology, The University of Arizona, 1503 E University Blvd., Tucson, AZ, 85721, USA
| | - John R Vanuk
- Department of Psychology, The University of Arizona, 1503 E University Blvd., Tucson, AZ, 85721, USA
| | - Mary-Frances O'Connor
- Department of Psychology, The University of Arizona, 1503 E University Blvd., Tucson, AZ, 85721, USA
| | - Bradley A Dreifuss
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA.,Department of Health Promotion Sciences, The University of Arizona, Tucson, AZ, USA.,HCW HOSTED, Inc., Tucson, AZ, USA
| | | | - Katherine D Ellingson
- HCW HOSTED, Inc., Tucson, AZ, USA.,Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, AZ, USA
| | - Sana M Khan
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, AZ, USA
| | - Sydney E Friedman
- Department of Psychology, The University of Arizona, 1503 E University Blvd., Tucson, AZ, 85721, USA
| | - Amy Athey
- Health and Wellness Initiatives, The University of Arizona, Tucson, AZ, USA.,Human Performance, KBR, Virginia Beach, VA, USA
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28
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Mercado M, Wachter K, Schuster RC, Mathis CM, Johnson E, Davis OI, Johnson-Agbakwu CE. A cross-sectional analysis of factors associated with stress, burnout and turnover intention among healthcare workers during the COVID-19 pandemic in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2690-e2701. [PMID: 35037346 DOI: 10.1111/hsc.13712] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/11/2021] [Accepted: 12/23/2021] [Indexed: 05/07/2023]
Abstract
In 2020, healthcare workers faced the COVID-19 pandemic amidst other salient sociopolitical stressors. This study, therefore, set out to examine associations between personal, work-related and contextual factors and three outcomes - stress, burnout and turnover intention - at a critical juncture in the pandemic. In December 2020, we recruited a broad array of healthcare workers (n = 985) in a public safety net healthcare system serving socially and economically marginalised communities in the Southwest region of the United States using a cross-sectional online survey. The results indicated that more health problems were associated with higher stress and burnout symptoms. While seeking emotional support and using drugs or alcohol to cope were associated with higher stress, a positive social outlook was associated with lower stress. Lower quality of work-life was associated with higher burnout symptoms and turnover intention. Negative effects of the pandemic on wellbeing and higher number of COVID-19-related concerns were associated with higher stress and burnout symptoms. Contrary to the original hypotheses, self-care was not associated with any of the three outcomes, and effects of the political climate and issues of racism on wellbeing were not associated with stress, burnout or turnover intention. However, identifying as a Person of Colour was associated with higher stress, as well as lower burnout. The findings on worker health, social outlook, quality of work-life and race/ethnicity, in particular, suggest a critical need for healthcare systems to address the wellbeing of workers through equitable organisational policy and practice.
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Affiliation(s)
- Micaela Mercado
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
- Watts College, School of Social Work, Arizona State University, Phoenix, Arizona, USA
| | - Karin Wachter
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
- Watts College, School of Social Work, Arizona State University, Phoenix, Arizona, USA
| | - Roseanne C Schuster
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
- School of Human Evolution & Social Change, Arizona State University, Tempe, Arizona, USA
| | - Cherra M Mathis
- Watts College, School of Social Work, Arizona State University, Phoenix, Arizona, USA
| | - Emma Johnson
- School of Human Evolution & Social Change, Arizona State University, Tempe, Arizona, USA
- Barretts Honors College, Arizona State University, Tempe, Arizona, USA
| | - Olga Idriss Davis
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
- Barretts Honors College, Arizona State University, Tempe, Arizona, USA
- Hugh Downs School of Human Communication, Arizona State University, Tempe, Arizona, USA
| | - Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
- Department of Obstetrics & Gynecology and Women's Health, Refugee Women's Health Clinic, Valleywise Health, Phoenix, Arizona, USA
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29
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Kimpe V, Sabe M, Sentissi O. No increase in burnout in health care workers during the initial COVID-19 outbreak: Systematic review and meta-analysis. World J Meta-Anal 2022; 10:206-219. [DOI: 10.13105/wjma.v10.i4.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/21/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND For decades and before the coronavirus disease 2019 (COVID-19) pandemic, for health care workers (HCWs) burnout can be experienced as an upsetting confrontation with their self and the result of a complex a multifactorial process interacting with environmental and personal features.
AIM To literature review and meta-analysis was to obtain a comprehensive understanding of burnout and work-related stress in health care workers around the world during the first outbreak of the COVID-19 pandemic.
METHODS We performed a database search of Embase, Google Scholar and PubMed from June to October 2020. We analysed burnout risk factors and protective factors in included studies published in peer-reviewed journals as of January 2020, studying a HCW population during the first COVID-19 wave without any geographic restrictions. Furthermore, we performed a meta-analysis to determine overall burnout levels. We studied the main risk factors and protective factors related to burnout and stress at the individual, institutional and regional levels.
RESULTS Forty-one studies were included in our final review sample. Most were cross-sectional, observational studies with data collection windows during the first wave of the COVID-19 surge. Of those forty-one, twelve studies were included in the meta-analysis. Of the 27907 health care professionals who participated in the reviewed studies, 70.4% were women, and two-thirds were either married or living together. The most represented age category was 31-45 years, at 41.5%. Approximately half of the sample comprised nurses (47.6%), and 44.4% were working in COVID-19 wards (intensive care unit, emergency room and dedicated internal medicine wards). Indeed, exposure to the virus was not a leading factor for burnout. Our meta-analytic estimate of burnout prevalence in the HCW population for a sample of 6784 individuals was 30.05%.
CONCLUSION There was a significant prevalence of burnout in HCWs during the COVID-19 pandemic, and some of the associated risk factors could be targeted for intervention, both at the individual and organizational levels. Nevertheless, COVID-19 exposure was not a leading factor for burnout, as burnout levels were not notably higher than pre-COVID-19 levels.
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Affiliation(s)
- Vincent Kimpe
- Faculty of Medicine, Geneva University, Geneva 1208, Geneva, Switzerland
| | - Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva 1205, Geneva, Switzerland
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva 1205, Geneva, Switzerland
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30
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Recurrent SARS-CoV-2 Serology Testing and Pandemic Anxiety: A Study of Pediatric Healthcare Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159562. [PMID: 35954913 PMCID: PMC9368345 DOI: 10.3390/ijerph19159562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
Abstract
Background: Limited access to SARS-CoV-2 testing has been identified as a potential source of anxiety among healthcare workers (HCWs), but the impact of repeated testing on pandemic-related anxiety in pediatric HCWs has not been examined. We sought to understand the impact of repeated SARS-CoV-2 antibody testing on pediatric HCWs’ COVID-19 anxiety. Methods: This longitudinal cohort study was conducted between April and July 2020. Participants, 362 pediatric HCWs, underwent rapid SARS-CoV-2 antibody testing either every 96 h or weekly and were asked to rate their COVID-19 anxiety on a visual analog scale. Changes in self-reported anxiety from the study baseline were calculated for each testing day response. Bivariate analyses, repeated measures, and logistic regression analyses were performed to examine demographics associated with changes in anxiety. Results: Baseline COVID-19 anxiety was significantly higher in HCWs with less than 10 years of experience (Z = −2.63, p = 0.009), in females compared to males (Z = −3.66 p < 0.001), and in nurses compared to other HCWs (F (3,302) = 6.04, p = 0.003). After excluding participants who received a positive test result, repeated measures analyses indicated that anxiety decreased over time (F (5,835) = 3.14, p = 0.008). Of the HCWs who reported decreased anxiety, 57 (29.8%) had a clinically meaningful decrease (≥30%) and Emergency Department (ED) HCWs were 1.97 times more likely to report a clinically meaningful decrease in anxiety (X2 (1) = 5.05, p = 0.025). Conclusions: The results suggest that repeated SARS-CoV-2 antibody serology testing is associated with decreased COVID-19 anxiety in HCWs. Routine screening for the disease may be a helpful strategy in attenuating pandemic-related anxiety in pediatric HCWs.
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31
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Bhanja A, Hayirli T, Stark N, Hardy J, Peabody CR, Kerrissey M. Team and leadership factors and their relationship to burnout in emergency medicine during COVID-19: A 3-wave cross-sectional study. J Am Coll Emerg Physicians Open 2022; 3:e12761. [PMID: 35782348 PMCID: PMC9245504 DOI: 10.1002/emp2.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objective We examined the relationship of team and leadership attributes with clinician feelings of burnout over time during the corona virus disease 2019 (COVID-19) pandemic. Methods We surveyed emergency medicine personnel at 2 California hospitals at 3 time points: July 2020, December 2020, and November 2021. We assessed 3 team and leadership attributes using previously validated psychological scales (joint problem-solving, process clarity, and leader inclusiveness) and burnout using a validated scale. Using logistic regression models we determined the associations between team and leadership attributes and burnout, controlling for covariates. Results We obtained responses from 328, 356, and 260 respondents in waves 1, 2, and 3, respectively (mean response rate = 49.52%). The median response for feelings of burnout increased over time (2.0, interquartile range [IQR] = 2.0-3.0 in wave 1 to 3.0, IQR = 2.0-3.0 in wave 3). At all time points, greater process clarity was associated with lower odds of feeling burnout (odds ratio [OR] [95% confidence interval (CI) = 0.36 [0.19, 0.66] in wave 1 to 0.24 [0.10, 0.61] in wave 3). In waves 2 and 3, greater joint problem-solving was associated with lower odds of feeling burnout (OR [95% CI] = 0.61 [0.42, 0.89], 0.54 [0.33, 0.88]). Leader inclusiveness was also associated with lower odds of feeling burnout (OR [95% CI] = 0.45 [0.27, 0.74] in wave 1 to 0.41 [0.24, 0.69] in wave 3). Conclusions Process clarity, joint problem-solving, and leader inclusiveness are associated with less clinician burnout during the COVID-19 pandemic, pointing to potential benefits of focusing on team and leadership factors during crisis. Leader inclusiveness may wane over time, requiring effort to sustain.
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Affiliation(s)
- Aditi Bhanja
- Harvard TH Chan School of Public Health Boston Massachusetts USA
| | | | - Nicholas Stark
- Department of Emergency Medicine University of California San Francisco California USA
| | - James Hardy
- Department of Emergency Medicine University of California San Francisco California USA
| | - Christopher R Peabody
- Department of Emergency Medicine University of California San Francisco California USA
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32
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Banfield WH, Elghawy O, Dewanjee A, Brady WJ. Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review. Am J Emerg Med 2022; 57:91-97. [PMID: 35526406 PMCID: PMC9057561 DOI: 10.1016/j.ajem.2022.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/20/2022] [Accepted: 04/11/2022] [Indexed: 10/28/2022] Open
Abstract
The novel coronavirus of 2019 (COVID-19) has resulted in a global pandemic; COVID-19 has resulted in significant challenges in the delivery of healthcare, including emergency management of multiple diagnoses, such as stroke and ST-segment myocardial infarction (STEMI). The aim of this study was to identify the impacts of the COVID-19 pandemic on emergency department care of stroke and STEMI patients. In this study a review of the available literature was performed using pre-defined search terms, inclusion criteria, and exclusion criteria. Our analysis, using a narrative review format, indicates that there was not a significant change in time required for key interventions for stroke and STEMI emergent management, including imaging (door-to-CT), tPA administration (door-to-needle), angiographic reperfusion (door-to-puncture), and percutaneous coronary intervention (door-to-balloon). Potential future areas of investigation include how emergency department (ED) stroke and STEMI care has adapted in response to different COVID-19 variants and stages of the pandemic, as well as identifying strategies used by EDs that were successful in providing effective emergency care in the face of the pandemic.
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Affiliation(s)
- W H Banfield
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - O Elghawy
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - A Dewanjee
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - W J Brady
- Department of Emergency Medicine University of Virginia Health Systems, Charlottesville, VA, United States.
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33
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Nyberg A, Rajaleid K, Demmelmaier I. The Work Environment during Coronavirus Epidemics and Pandemics: A Systematic Review of Studies Using Quantitative, Qualitative, and Mixed-Methods Designs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116783. [PMID: 35682365 PMCID: PMC9180570 DOI: 10.3390/ijerph19116783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/05/2023]
Abstract
We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.
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Affiliation(s)
- Anna Nyberg
- Department of Public Health and Caring Sciences, Uppsala University, P.O. Box 564, SE-751 22 Uppsala, Sweden;
- Correspondence: ; Tel.: +46-8-708-234318
| | - Kristiina Rajaleid
- Stress Research Institute, Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden;
| | - Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, P.O. Box 564, SE-751 22 Uppsala, Sweden;
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34
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Peck JA, Porter TH. Pandemics and the Impact on Physician Mental Health: A Systematic Review. Med Care Res Rev 2022; 79:772-788. [PMID: 35549938 DOI: 10.1177/10775587221091772] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physician mental health is a major area of concern with physician burnout on the rise, while at the same time pandemics are becoming more frequent and serious in nature. This combination of physician burnout and pandemics has the potential for serious negative implications for physicians, patients, and health care organizations. Thus, we conduct a systematic review that examines the effect of pandemics on physician mental health using the burnout cascade as a framework. We identified 30 quantitative studies for inclusion. We find that Stages 4 and 5 of the burnout cascade are particularly troublesome with physicians experiencing high levels of anxiety and depression. Furthermore, we find in the degradation phase that physicians experience stigma which may intensify other negative effects. Physicians who are women, younger, and have less training are more susceptible to the negative effects of pandemics. We discuss overall implications and recommendations for future research.
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Lavoie B, Bourque CJ, Côté AJ, Rajagopal M, Clerc P, Bourdeau V, Ali S, Doyon-Trottier E, Castonguay V, Fontaine-Pagé É, Burstein B, Desaulniers P, Goldman RD, Thompson G, Berthelot S, Lagacé M, Gaucher N. The responsibility to care: lessons learned from emergency department workers' perspectives during the first wave of the COVID-19 pandemic in Canada. CAN J EMERG MED 2022; 24:482-492. [PMID: 35543924 PMCID: PMC9091548 DOI: 10.1007/s43678-022-00306-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
Background This study’s objective was to examine emergency department (ED) workers’ perspectives during the Canadian COVID-19 first wave. Methods This qualitative study included workers from nine Canadian EDs who participated in 3 monthly video focus groups between April and July 2020 to explore (1) personal/professional experiences, (2) patient care and ED work, (3) relationships with teams, institutions and governing bodies. Framework analysis informed data collection and analysis. Results Thirty-six focus groups and 15 interviews were conducted with 53 participants (including 24 physicians, 16 nurses). Median age was 37.5 years, 51% were female, 79% had more than 5 years’ experience. Three main themes emerged. (1) Early in this pandemic, participants felt a responsibility to provide care to patients and solidarity toward their ED colleagues and team, while balancing many risks with their personal protection. (2) ED teams wanted to be engaged in decision-making, based on the best available scientific knowledge. Institutional decisions and clinical guidelines needed to be adapted to the specificity of each ED environment. (3) Working during the pandemic created new sources of moral distress and fatigue, including difficult clinical practices, distance with patients and families, frequent changes in information and added sources of fatigue. Although participants quickly adapted to a “new normal”, they were concerned about long-term burnout. Participants who experienced high numbers of patient deaths felt especially unprepared. Interpretation ED workers believe they have a responsibility to provide care through a pandemic. Trust in leadership is supported by managers who are present and responsive, transparent in their communication, and involve ED staff in the development and practice of policies and procedures. Such practices will help protect from burnout and ensure the workforce’s long-term sustainability. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00306-z.
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Affiliation(s)
- Bertrand Lavoie
- Faculty of Law, Université Sherbrooke, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Centre and Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Anne-Josée Côté
- Department of Pediatric Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Manasi Rajagopal
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Paul Clerc
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valérie Bourdeau
- Centre d'excellence en Éthique Et Partenariat, CHU Sainte-Justine, Montreal, QC, Canada
| | - Samina Ali
- Departments of Pediatrics and Emergency Medicine, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Evelyne Doyon-Trottier
- Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Véronique Castonguay
- Department of Family and Emergency Medicine, Sacré Coeur Hospital, Université de Montréal, Montreal, QC, Canada
| | - Érika Fontaine-Pagé
- Verdun Hospital, CIUSSS Centre-Sud-de-L'Île-de-Montréal, Montreal, QC, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Pierre Desaulniers
- Department of Family and Emergency Medicine, Centre Hospitalier de L'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Ran D Goldman
- The Pediatric Research in Emergency Therapeutics Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Graham Thompson
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval, Département de Médecine Familiale Et de Médecine d'urgence, Université Laval, Quebec City, QC, Canada
| | - Maryse Lagacé
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Nathalie Gaucher
- CHU Sainte-Justine Research Centre and Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
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Blanchard J, Li Y, Bentley SK, Lall MD, Messman AM, Liu YT, Diercks DB, Merritt‐Recchia R, Sorge R, Warchol JM, Greene C, Griffith J, Manfredi RA, McCarthy M. The perceived work environment and well-being: A survey of emergency health care workers during the COVID-19 pandemic. Acad Emerg Med 2022; 29:851-861. [PMID: 35531649 PMCID: PMC9347760 DOI: 10.1111/acem.14519] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 12/21/2022]
Abstract
Background During the COVID‐19 pandemic, health care provider well‐being was affected by various challenges in the work environment. The purpose of this study was to evaluate the relationship between the perceived work environment and mental well‐being of a sample of emergency physicians (EPs), emergency medicine (EM) nurses, and emergency medical services (EMS) providers during the pandemic. Methods We surveyed attending EPs, resident EPs, EM nurses, and EMS providers from 10 academic sites across the United States. We used latent class analysis (LCA) to estimate the effect of the perceived work environment on screening positive for depression/anxiety and burnout controlling for respondent characteristics. We tested possible predictors in the multivariate regression models and included the predictors that were significant in the final model. Results Our final sample included 701 emergency health care workers. Almost 23% of respondents screened positive for depression/anxiety and 39.7% for burnout. Nurses were significantly more likely to screen positive for depression/anxiety (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11–3.86) and burnout (aOR 2.05, 95% CI 1.22–3.49) compared to attendings. The LCA analysis identified four subgroups of our respondents that differed in their responses to the work environment questions. These groups were identified as Work Environment Risk Group 1, an overall good work environment; Risk Group 2, inadequate resources; Risk Group 3, lack of perceived organizational support; and Risk Group 4, an overall poor work environment. Participants in the two groups who perceived their work conditions as most adverse were significantly more likely to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05–3.42; and aOR 2.04, 95% CI 1.14–3.66) compared to participants working in environments perceived as less adverse. Conclusions We found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate. Targeted strategies to promote better perceptions of the workplace are needed.
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Affiliation(s)
- Janice Blanchard
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Yixuan Li
- Department of Health Policy, Milken Institute School of Public Health George Washington University Washington District of Columbia USA
| | - Suzanne K. Bentley
- Departments of Emergency Medicine & Medical Education Icahn School of Medicine at Mount Sinai, New York City Health+Hospitals/Elmhurst New York New York USA
| | - Michelle D. Lall
- Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
| | - Anne M. Messman
- Department of Emergency Medicine Wayne State University School of Medicine, University Health Center–6G Detroit Michigan USA
| | - Yiju Teresa Liu
- Department of Emergency Medicine David Geffen School of Medicine at UCLA, Harbor–UCLA Medical Center Torrance California USA
| | | | - Rory Merritt‐Recchia
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Randy Sorge
- Department of Emergency Medicine Louisiana State University Spirit of Charity Emergency Medicine Residency Program New Orleans Louisiana USA
| | - Jordan M. Warchol
- Department of Emergency Medicine University of Nebraska Medical Center Omaha Nebraska USA
| | - Christopher Greene
- Department of Emergency Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - James Griffith
- Department of Psychiatry George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Rita A. Manfredi
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Melissa McCarthy
- Departments of Health Policy and Emergency Medicine, Milken Institute School of Public Health George Washington University Washington District of Columbia USA
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Stark N, Hayirli T, Bhanja A, Kerrissey M, Hardy J, Peabody CR. Unprecedented Training: Experience of Residents During the COVID-19 Pandemic. Ann Emerg Med 2022; 79:488-494. [PMID: 35277294 PMCID: PMC8784436 DOI: 10.1016/j.annemergmed.2022.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Nicholas Stark
- Department of Emergency Medicine, University of California, San Francisco, CA.
| | | | | | | | - James Hardy
- Department of Emergency Medicine, University of California, San Francisco, CA
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Kim C, Park KH, Eo EK, Kim YM, Eo SK, Han J. Burnout and Resilience among Emergency Physicians at Korean University Hospitals during the COVID-19 Pandemic: A Cross-Sectional Analysis. Yonsei Med J 2022; 63:372-379. [PMID: 35352889 PMCID: PMC8965432 DOI: 10.3349/ymj.2022.63.4.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to investigate burnout and resilience among emergency physicians (EPs) at university teaching hospitals during the coronavirus disease (COVID-19) pandemic. MATERIALS AND METHODS In April to May 2021, a survey was administered to 331 and 309 emergency medicine specialists and residents, respectively, from 31 university teaching hospitals in Korea. Data on the respondents' age, sex, designation, working area, experience with treating COVID-19 patients, and personal experience with COVID-19 were collected. Based on the participants' characteristics, quality of life (compassion satisfaction, burnout, and secondary traumatic stress), resilience, emotional content, and self-image were analyzed. RESULTS A total of 247 responses were analyzed. Compared to specialists, compassion satisfaction and resilience in residents were not good, burnout was severe, and emotional content and self-image were less positive. Experiences with treating COVID-19 patients did not cause any difference in quality of life, resilience, emotional content, and self-image among participant subgroups. Personal COVID-19 experiences were associated with poor compassion satisfaction, resilience, less positive emotional content and self-image, and severe burnout. Compassion satisfaction, secondary traumatic stress, and resilience can definitively affect burnout. CONCLUSION The quality of life and resilience of EPs in university teaching hospitals in Korea during the COVID-19 pandemic have been low. Supportive measures to improve resilience can prevent burnout among emergency staff, particularly residents and EPs, with personal experiences related to COVID-19.
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Affiliation(s)
- Chanwoong Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Hye Park
- Department of Medical Education, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Emergency Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
| | - Eun Kyung Eo
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young-Min Kim
- Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Kyung Eo
- Graduate School of Art Therapy at CHA University, Pocheon, Korea
| | - JaeHun Han
- Department of Biostatistics, Graduate School of Yonsei University, Wonju, Korea
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O'Connor AB, Catalanotti JS, Desai SV, Zetkulic M, Kisielewski M, Willett LL, Zaas AK. Internal Medicine Residency Program Director Support and Burnout During the COVID-19 Pandemic: Results of a National Survey. J Grad Med Educ 2022; 14:218-223. [PMID: 35463178 PMCID: PMC9017266 DOI: 10.4300/jgme-d-21-00804.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/02/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Burnout is common among physicians and physician leaders, including residency program directors (PDs). The effects of the COVID-19 pandemic and other stressors in 2020 on PDs is unknown. OBJECTIVE To measure the prevalence of burnout among internal medicine (IM) residency PDs 6 months into the COVID-19 pandemic. METHODS A total of 429 IM PDs, representing 83% of accredited residency programs, were surveyed from August to December 2020. Burnout, using a 2-item screening tool, and self-reported consideration of resigning in 2020, were compared to their annual prevalence since 2012 and tested for possible associations with pandemic stressors and program characteristics. RESULTS The survey response rate was 61.5% (264 of 429). One-third (33.6%, 87 of 259) of PD respondents met burnout criteria, and 45.1% (110 of 244) reported considering resigning in the past year, which were within the range of preceding years. PDs who reported feeling highly supported by institutional leadership were less likely to meet burnout criteria and to have considered resigning. There were no associations between burnout or consideration of resigning and the amount of clinical time PDs spent in their roles, duration of maximum stress on programs, budget cuts to programs, or geographic region. CONCLUSIONS The prevalence of burnout among PDs in fall 2020 was similar to the prevalence of burnout in pre-pandemic years despite uniquely extreme stressors. PDs' perception of being highly supported by institutional leadership was associated with lower prevalence of burnout and consideration of resigning. Perceived leadership support may be a protective factor against burnout during periods of high stress.
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Affiliation(s)
- Alec B. O'Connor
- Alec B. O'Connor, MD, MPH, is Internal Medicine Residency Director and Professor of Medicine, University of Rochester School of Medicine and Dentistry
| | - Jillian S. Catalanotti
- Jillian S. Catalanotti, MD, MPH, is Vice Chair of Academic Affairs, General Internal Medicine Division Director, and Associate Professor of Medicine, The George Washington University School of Medicine and Health Sciences
| | - Sanjay V. Desai
- Sanjay V. Desai, MD, is Vice Chair for Education and Professor of Medicine, Johns Hopkins University School of Medicine
| | - MaryGrace Zetkulic
- MaryGrace Zetkulic, MD, is Internal Medicine Residency Director and Assistant Professor of Medicine, Hackensack-Meridian School of Medicine
| | - Michael Kisielewski
- Michael Kisielewski, MA, is Assistant Director of Surveys and Research, Alliance for Academic Internal Medicine
| | - Lisa L. Willett
- Lisa L. Willett, MD, MACM, is Internal Medicine Residency Director and Professor of Medicine, University of Alabama at Birmingham
| | - Aimee K. Zaas
- Aimee K. Zaas, MD, MHS, is Internal Medicine Residency Director and Professor of Medicine, Duke University School of Medicine
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Healthcare Worker Mental Health After the Initial Peak of the COVID-19 Pandemic: a US Medical Center Cross-Sectional Survey. J Gen Intern Med 2022; 37:1169-1176. [PMID: 34993856 PMCID: PMC8734540 DOI: 10.1007/s11606-021-07251-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is a paucity of data on the mental health impact of the Coronavirus disease 2019 (COVID-19) pandemic on United States (US) healthcare workers (HCWs) after the first surge in the spring of 2020. OBJECTIVE To determine the impact of the pandemic on HCWs, and the relationship between HCW mental health and demographics, occupational factors, and COVID-19 concerns. DESIGN Cross-sectional survey in an urban medical center (September-November 2020) in Baltimore, MD, in the United States. PARTICIPANTS A total of 605 HCWs (physicians, nurse practitioners, nurses, physician assistants, patient care technicians, respiratory therapists, social workers, mental health therapists, and case managers). MAIN MEASURES Measures of mental health (Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, PROMIS Sleep Disturbance 4a, Impact of Event Scale-Revised, Maslach Burnout Inventory-2 item, Connor-Davidson Resilience Scale-2 item), demographics, occupational factors, and COVID-19 related concerns. KEY RESULTS Fifty-two percent of 1198 HCWs responded to the survey and 14.2% reported depression, 43.1% mild or higher anxiety, 31.6% sleep disturbance, 22.3% posttraumatic stress symptoms, 21.6% depersonalization, 46.0% emotional exhaustion, and 23.1% lower resilience. Relative to HCWs providing in-person care to COVID-19 infected patients none of their working days, those doing so all or most days were more likely to experience worse depression (adjusted odds ratio, 3.9; 95% CI, 1.3-11.7), anxiety (aOR, 3.0; 95% CI, 1.4-6.3), possible PTSD symptoms (aOR, 2.6; 95% CI, 1.1-5.8), and higher burnout (aOR, 2.6; 95% CI, 1.1-6.0). Worse mental health in several domains was associated with higher health fear (aORs ranged from 2.2 to 5.0), job stressors (aORs ranged from 1.9 to 4.0), perceived social stigma/avoidance (aORs ranged from 1.8 to 2.9), and workplace safety concerns (aORs ranged from 1.8 to 2.8). CONCLUSIONS US HCWs experienced significant mental health symptoms eight months into the pandemic. More time spent providing in-person care to COVID-19-infected patients and greater COVID-19-related concerns were consistently associated with worse mental health.
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Blanchard J, Messman AM, Bentley SK, Lall MD, Liu YT, Merritt R, Sorge R, Warchol JM, Greene C, Diercks DB, Griffith J, Manfredi RA, McCarthy M, McCarthy M. In their own words: Experiences of emergency health care workers during the COVID-19 pandemic. Acad Emerg Med 2022; 29:974-986. [PMID: 35332615 PMCID: PMC9111302 DOI: 10.1111/acem.14490] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/03/2022] [Accepted: 03/19/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, a substantial number of emergency health care workers (HCWs) have screened positive for anxiety, depression, risk of posttraumatic stress disorder, and burnout. The purpose of this qualitative study was to describe the impact of COVID-19 on emergency care providers' health and well-being using personal perspectives. We conducted in-depth interviews with emergency physicians, emergency medicine nurses, and emergency medical services providers at 10 collaborating sites across the United States between September 21, 2020, and October 26, 2020. METHODS We developed a conceptual framework that described the relationship between the work environment and employee health. We used qualitative content analysis to evaluate our interview transcripts classified the domains, themes, and subthemes that emerged from the transcribed interviews. RESULTS We interviewed 32 emergency HCWs. They described difficult working conditions, such as constrained physical space, inadequate personnel protective equipment, and care protocols that kept changing. Organizational leadership was largely viewed as unprepared, distant, and unsupportive of employees. Providers expressed high moral distress caused by ethically challenging situations, such as the perception of not being able to provide the normal standard of care and emotional support to patients and their families at all times, being responsible for too many sick patients, relying on inexperienced staff to treat infected patients, and caring for patients that put their own health and the health of their families at risk. Moral distress was commonly experienced by emergency HCWs, exacerbated by an unsupportive organizational environment. CONCLUSIONS Future preparedness efforts should include mechanisms to support frontline HCWs when faced with ethical challenges in addition to an adverse working environment caused by a pandemic such as COVID-19.
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Affiliation(s)
- Janice Blanchard
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Anne M. Messman
- Wayne State University School of Medicine Detroit Michigan USA
| | - Suzanne K. Bentley
- Icahn SOM at Mount Sinai, New York City Health + Hospitals/Elmhurst New York New York USA
| | | | - Yiju Teresa Liu
- David Geffen School of Medicine at UCLA, Harbor‐UCLA Medical Center Torrance California USA
| | - Rory Merritt
- Alpert Medical School of Brown University Providence Rhode Island USA
| | - Randy Sorge
- Louisiana State University Spirit of Charity Emergency Medicine Residency Program New Orleans Louisiana USA
| | | | | | | | - James Griffith
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Rita A. Manfredi
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Melissa McCarthy
- George Washington University, Milken Institute of Public Health Washington District of Columbia USA
| | - Melissa McCarthy
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Health Policy, George Washington University, Milken Institute of Public Health, 950 New Hampshire Ave, NW, Washington, DC, USA
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Branjerdporn G, Bowman C, Kenworthy S, Stapelberg NJC. Interventional Response of Hospital and Health Services to the Mental Health Effects of Viral Outbreaks on Health Professionals. Front Psychiatry 2022; 13:812365. [PMID: 35273530 PMCID: PMC8902291 DOI: 10.3389/fpsyt.2022.812365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/27/2022] [Indexed: 12/17/2022] Open
Abstract
The aim of this integrative review was to examine the impact of past viral epidemics on staff mental health interventional responses, with a specific focus on healthcare provider response in the context of the COVID-19 pandemic. Following PRISMA methodology, databases were searched for relevant articles. A total of 55 articles with a range of methodologies (e.g., commentary papers, cohort studies, qualitative studies) were included to ensure broad coverage of this rapidly emerging research area. The literature showed that many healthcare providers implemented a variety of wellbeing initiatives to support their staff during a viral outbreak. Most of these interventions, however, were not formally evaluated. Interventions included leadership/team support; online psychoeducational resources and updated information on the pandemic; respite spaces; peer support outreach; staff resilience training; telephone hotline support; staff support groups; and individual counseling. Staff were generally supportive of the initiatives offered by hospital and health services, with certain interventions being more appreciated (e.g., staff respite areas). Rapid, locally, and culturally appropriate workplace-based responses may counter the negative mental health impact on staff; but a stepped response is required for a smaller number of staff at risk of mental illness, or those with pre-existing mental illness. Systematic Review Registration: Unique Identifier: CRD42020222761.
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Affiliation(s)
| | - Candice Bowman
- Gold Coast University Hospital, Southport, QLD, Australia
| | - Sean Kenworthy
- Gold Coast University Hospital, Southport, QLD, Australia
| | - Nicolas J. C. Stapelberg
- Gold Coast University Hospital, Southport, QLD, Australia
- Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
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The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic. Healthcare (Basel) 2022; 10:healthcare10020364. [PMID: 35206978 PMCID: PMC8872521 DOI: 10.3390/healthcare10020364] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
This literature review aimed to determine the level of burnout, compassion fatigue, and compassion satisfaction, as well as their associated risks and protective factors, in healthcare professionals during the first year of the COVID-19 pandemic. We reviewed 2858 records obtained from the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, and Web of Science databases, and finally included 76 in this review. The main results we found showed an increase in the rate of burnout, dimensions of emotional exhaustion, depersonalization, and compassion fatigue; a reduction in personal accomplishment; and levels of compassion satisfaction similar to those before the pandemic. The main risk factors associated with burnout were anxiety, depression, and insomnia, along with some sociodemographic variables such as being a woman or a nurse or working directly with COVID-19 patients. Comparable results were found for compassion fatigue, but information regarding compassion satisfaction was lacking. The main protective factors were resilience and social support.
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Levine M, Singh M, Restivo A, Petti A, Kulkarni M. Recommendations for Optimizing Virtual Simulation: A Trial and Error Process From the COVID-19 Pandemic. J Grad Med Educ 2022; 14:18-21. [PMID: 35222814 PMCID: PMC8848875 DOI: 10.4300/jgme-d-21-00515.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Michael Levine
- Michael Levine, MD, is Emergency Medicine Resident, Albert Einstein College of Medicine
| | - Maninder Singh
- Maninder Singh, MD, is Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine, and Director of Healthcare Simulation, Jacobi Medical Center
| | - Andrew Restivo
- Andrew Restivo, MD, is Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine
| | - Alexander Petti
- Alexander Petti, MD, is Critical Care Fellow, Albert Einstein College of Medicine
| | - Miriam Kulkarni
- Miriam Kulkarni, MD, is Associate Professor of Emergency Medicine, Lake Erie College of Osteopathic Medicine
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Emergency Medicine Nurse Practitioner and Physician Assistant Burnout, Perceived Stress, and Utilization of Wellness Resources During 2020 in a Large Urban Medical Center. Adv Emerg Nurs J 2022; 44:63-73. [PMID: 35089284 DOI: 10.1097/tme.0000000000000392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objectives of this study were to measure perceived stress, burnout, and utilization and perceived benefit of wellness practices among emergency medicine (EM) nurse practitioners (NPs) and physician assistants (PAs). An additional aim was to evaluate attributions of stress to racism and the COVID-19 pandemic. A 28-item electronic survey of ED NPs/PAs at 3 hospitals was used to measure respondents' perceived stress (Perceived Stress Scale), stress attributed to COVID-19 and systemic racism, burnout (2-item measure), and utilization and helpfulness of wellness practices. The sample consisted of 53 ED NPs/PAs respondents (response rate 42.4%). More than one half (58.5%) reported burnout from their job, and a majority (58.5%) reported moderate to high stress. Burnout was reported by 70% of female respondents compared with 30.8% of male respondent (p = 0.002). A large majority (70%) of Black respondents reported concerns about experiencing racism at work, and 58.8% reported higher levels of stress attributed to racism. Respondents reported meals during shifts, community donated personal protective equipment, flexible work hours, and societal offerings of financial support (e.g., Internal Revenue Service stimulus check) as helpful. The COVID-19 pandemic and the impact of systemic racism are significant contributors to the stress and burnout of NPs/PAs. Female ED NPs/PAs disproportionally share the burden of burnout. Strategies to reduce burnout should be prioritized by institutional leadership. In addition, a majority of Black ED NPs/PAs are concerned about experiencing racism at work and report moderate to high stress associated with racism in general. There is an urgent need to address racism in the workplace with training on implicit bias, systemic racism, and allyship behavior.
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Promoting and Risk Factors of Nurses' Hardiness Levels during the COVID-19 Pandemic: Results from an Italian Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031523. [PMID: 35162544 PMCID: PMC8835395 DOI: 10.3390/ijerph19031523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 12/14/2022]
Abstract
Aim: Few studies in the literature specifically address the hardiness of nurses during the COVID-19 pandemic. Thus, the primary aim of this study was to assess the impact of COVID-19 on the hardiness levels in an Italian cohort of nurses. The secondary aims were to assess the level of hardiness in nurses directly caring for patients with COVID-19 and to verify the presence of related risk and promoting factors. Methods: A descriptive and explorative study was performed through an online survey from March to July 2020. The survey was composed of a multiple answer questionnaire with open, closed, and semi-closed-ended questions. Hardiness and anxiety were assessed using two psychometric instruments: the Dispositional Resilience Scale (DRS-15) and State-Trait Anxiety Inventory (STAI-Y). Results: A total of 1250 nurses completed the questionnaire entirely (92.3% of respondents). The average length of service was 17.8 ± 11.5 years. A decrease in the hardiness was recorded after the first wave of COVID-19 if compared to the baseline (mean Δ DRS-15 total = 1.3 ± 5.0), whereas in the subsample of nurses caring for COVID-19 patients, the total hardiness level decreased more consistently (mean Δ DRS Total = 1.9 + 5.3). Multivariate analysis showed that high levels of anxiety were risk factors for reducing hardiness. In contrast, anxiety, when associated with a greater length of service, was a promoting factor for the increase in hardiness. Conclusions: The correlation between anxiety and years of length of service appears to be pivotal. Future research should focus on the role of anxiety to establish its actual role as a predictor of hardiness.
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Kase SM, Gribben JL, Guttmann KF, Waldman ED, Weintraub AS. Compassion fatigue, burnout, and compassion satisfaction in pediatric subspecialists during the SARS-CoV-2 pandemic. Pediatr Res 2022; 91:143-148. [PMID: 34211128 PMCID: PMC8245661 DOI: 10.1038/s41390-021-01635-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to explore factors contributing to compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) during the severe acute respiratory syndrome coronavirus-2 pandemic in pediatric subspecialists. METHODS The Compassion Fatigue and Satisfaction Self-Test (CFST) and a questionnaire of personal/professional characteristics were distributed electronically to pediatric subspecialists. RESULTS There were no significant differences in pre- and early-pandemic CF, BO, and CS scores. Nearly 40% of respondents felt their contributions to the pandemic were not valued by their institutions. Higher CF scores were significantly associated with: higher BO score; "I have put myself at increased risk through my work"; working in one's specialty >50% of time; distress about mental health and/or future uncertainty. Higher BO scores were significantly associated with: higher CF score; "Self-care is not a priority"; emotional depletion. Higher CS scores were significantly associated with: "My institution values my contribution to the COVID-19 crisis"; workplace debriefs; pet therapy. CONCLUSIONS The pandemic has only increased the need for physicians to receive social/emotional support from their institution and to feel their workplace contributions are valued. Successful pre-pandemic workplace interventions may not adequately support physicians during the pandemic. Further study is needed to identify supports that best counter the pandemic's unprecedented challenges. IMPACT The sentiment "My institution has valued my contribution to the Covid-19 crisis" was the only significant factor associated with lower BO scores and was also associated with higher CS scores in pediatric subspecialists. This study is the first comparison of pre- and early-pandemic CF, BO, and CS scores in a national cohort of pediatric subspecialists. When considering interventions to promote CS and mitigate CF and BO for pediatric subspecialists during and after the pandemic, institutional leadership must offer wellness programming focused on social/emotional supports and prioritize a culture that explicitly recognizes and values every physician's contributions.
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Affiliation(s)
- Samuel M. Kase
- grid.59734.3c0000 0001 0670 2351Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Jeanie L. Gribben
- grid.413734.60000 0000 8499 1112Weill Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY USA
| | - Katherine F. Guttmann
- grid.59734.3c0000 0001 0670 2351Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Elisha D. Waldman
- grid.413808.60000 0004 0388 2248Division of Palliative Care, Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Andrea S. Weintraub
- grid.59734.3c0000 0001 0670 2351Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Garcia R, Henderson C, Randell K, Villaveces A, Katz A, Abioye F, DeGue S, Premo K, Miller-Wallfish S, Chang JC, Miller E, Ragavan MI. The Impact of the COVID-19 Pandemic on Intimate Partner Violence Advocates and Agencies. JOURNAL OF FAMILY VIOLENCE 2022; 37:893-906. [PMID: 34720393 PMCID: PMC8547898 DOI: 10.1007/s10896-021-00337-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 05/07/2023]
Abstract
Relatively few studies have considered the impact of the COVID-19 pandemic on intimate partner violence (IPV) advocates or the agencies where they work. In this study, based on United States IPV advocates' experiences working with survivors during the COVID-19 pandemic, we conducted interviews to explore: 1) personal challenges and resilience working as IPV advocates during the COVID-19 pandemic; 2) how agencies adapted to the pandemic to support IPV survivors and advocates; and 3) specific needs and challenges of culturally-specific agencies. We conducted semi-structured interviews with 53 IPV advocates from June to November 2020. Participants were included if they worked directly with survivors, identified as an IPV advocate, worked at a US-based agency, and spoke and understood English. We created a sampling matrix to ensure adequate representation from IPV advocates serving survivors from communities which have been marginalized. Interviews were conducted through a virtual platform by a trained member of the research team. We used an inductive thematic analysis approach, with weekly coding meetings to resolve discrepancies in coding. Five themes emerged from the data: 1) IPV advocates described how working as an IPV advocate during the COVID-19 pandemic impacted them personally; 2) agencies developed new methods of addressing IPV advocates' needs; 3) agencies developed new solutions to address pandemic-related client needs; 4) transitioning advocacy work to virtual formats created challenges but also opportunities and; 5) pandemic limitations and impacts compounded pre-pandemic challenges for culturally specific agencies. IPV advocates are frontline workers who have played essential roles in adjusting services to meet survivor needs during the COVID-19 pandemic while simultaneously coping with pandemic impacts on themselves and their agencies. Developing inter-agency collaborations and promoting advocates' safety and wellbeing during future public health crises will help support IPV survivors.
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Affiliation(s)
- Rebecca Garcia
- Women’s Center & Shelter of Greater Pittsburgh, PO Box 9024, Pittsburgh, PA 15224 USA
| | - Cynterria Henderson
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213 USA
| | - Kimberly Randell
- Division of Pediatric Emergency Medicine, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64110 USA
- University of Kansas City-Missouri School of Medicine, Kansas City, MO USA
- University of Kansas School of Medicine, Kansas City, KS USA
| | - Andrés Villaveces
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway., S106-10, Atlanta, GA 30341 USA
| | - Abbey Katz
- Futures Without Violence, 101 Montgomery Street, San Francisco, CA 94129 USA
| | - Fatimah Abioye
- Child Welfare, Trauma, and Resilience Initiatives, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL 60413 USA
| | - Sarah DeGue
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway., S106-10, Atlanta, GA 30341 USA
| | - Kelley Premo
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213 USA
| | - Summer Miller-Wallfish
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213 USA
| | - Judy C. Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213 USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213 USA
| | - Maya I. Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, 3420 Fifth Avenue, Pittsburgh, PA 15213 USA
- University of Pittsburgh, 3415 Fifth Avenue, Pittsburgh, PA 15213 USA
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Sinsky CA, Brown RL, Stillman MJ, Linzer M. COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1165-1173. [PMID: 34901752 PMCID: PMC8651505 DOI: 10.1016/j.mayocpiqo.2021.08.007] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE To evaluate relationships between coronavirus disease 2019 (COVID-19)-related stress and work intentions in a sample of US health care workers. PATIENTS AND METHODS Between July 1 and December 31, 2020, health care workers were surveyed for fear of viral exposure or transmission, COVID-19-related anxiety or depression, work overload, burnout, and intentions to reduce hours or leave their jobs. RESULTS Among 20,665 respondents at 124 institutions (median organizational response rate, 34%), intention to reduce hours was highest among nurses (33.7%; n=776), physicians (31.4%; n=2914), and advanced practice providers (APPs; 28.9%; n=608) while lowest among clerical staff (13.6%; n=242) and administrators (6.8%; n=50; all P<.001). Burnout (odds ratio [OR], 2.15; 95% CI, 1.93 to 2.38), fear of exposure, COVID-19-related anxiety/depression, and workload were independently related to intent to reduce work hours within 12 months (all P<.01). Intention to leave one's practice within 2 years was highest among nurses (40.0%; n=921), APPs (33.0%; n=694), other clinical staff (29.4%; n=718), and physicians (23.8%; n=2204) while lowest among administrators (12.6%; n=93; all P<.001). Burnout (OR, 2.57; 95% CI, 2.29 to 2.88), fear of exposure, COVID-19-related anxiety/depression, and workload were predictors of intent to leave. Feeling valued by one's organization was protective of reducing hours (OR, 0.65; 95% CI, 0.59 to 0.72) and intending to leave (OR, 0.40; 95% CI, 0.36 to 0.45; all P<.01). CONCLUSION Approximately 1 in 3 physicians, APPs, and nurses surveyed intend to reduce work hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether. Reducing burnout and improving a sense of feeling valued may allow health care organizations to better maintain their workforces postpandemic.
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Affiliation(s)
| | | | - Martin J. Stillman
- Department of Medicine, Hennepin Health System and University of Minnesota, Minneapolis
| | - Mark Linzer
- Department of Medicine, Hennepin Health System and University of Minnesota, Minneapolis
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Yeo IH, Kim YJ, Kim JK, Lee DE, Choe JY, Kim CH, Park JB, Seo KS, Park SY, Lee SH, Cho JK, Lee SH. Impact of the COVID-19 Pandemic on Emergency Department Workload and Emergency Care Workers’ Psychosocial Stress in the Outbreak Area. Medicina (B Aires) 2021; 57:medicina57111274. [PMID: 34833491 PMCID: PMC8618446 DOI: 10.3390/medicina57111274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives: Due to the unexpected spread of coronavirus disease 2019 (COVID-19), there was a serious crisis of emergency medical system collapse. Healthcare workers working in the emergency department were faced with psychosocial stress and workload changes. Materials and Methods: This was a cross-sectional survey of healthcare workers in the emergency department in Daegu and Gyeongbuk, Korea, from November 16 to 25, 2020. In the survey, we assessed the general characteristics of the respondents; changes in the working conditions before and after the COVID-19 pandemic; and resulting post-traumatic stress disorder, depression and anxiety statuses using 49 questions. Results: A total of 529 responses were collected, and 520 responses were included for the final analyses. Changes in working conditions and other factors due to COVID-19 varied by emergency department level, region and disease group. Working hours, intensity, role changes, depression and anxiety scores were higher in the higher level emergency department. Isolation ward insufficiency and the risk of infection felt by healthcare workers tended to increase in the lower level emergency department. Treatment and transfer delay were higher in the fever and respiratory disease groups (M = 3.58, SD = 1.18; M = 4.08, SD = 0.95), respectively. In all the disease groups, both treatment and transfer were delayed more in Gyeongbuk than in Daegu. Conclusions: Different goals should be pursued by the levels and region of the emergency department to overcome the effects of the COVID-19 pandemic and promote optimal care.
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Affiliation(s)
- In-Hwan Yeo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Yun-Jeong Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Jong-Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
- Correspondence: ; Tel.: +82-53-200-6400
| | - Dong-Eun Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Jae-Young Choe
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Chang-Ho Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Jung-Bae Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Kang-Suk Seo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Sin-Yul Park
- Department of Emergency Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Suk-Hee Lee
- Department of Emergency Medicine, Daegu Catholic University, Daegu 42472, Korea;
| | - Jae-Kyung Cho
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu 41199, Korea;
| | - Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Korea;
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