Psycho‐cognitive predictors of burnout in healthcare professionals working in emergency departments

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper

AIM

Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame.

DESIGN

Discursive paper.

METHOD

This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections.

CONCLUSION

Nursing recognizes the patient-nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections.

IMPACT ON NURSING PRACTICE

A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or writing of this discursive article.

The Partial Mediator Role of Satisficing Decision-Making Style Between Trait Emotional Intelligence and Compassion Fatigue in Healthcare Professionals

Background: Compassion fatigue (CF) represents a relevant issue for healthcare professionals. Currently, it is still unclear which psychological mechanism might lead to CF and which might protect workers from that. Decision-making styles, as well as emotional intelligence, might partially account for the presence of CF. Specifically, we hypothesized that a satisficing decision-making style would mediate the relationship between emotional intelligence and CF.Methods: A cross-sectional online survey was conducted on physicians and nurses from Italian Medical Departments. Three self-reported questionnaires were administered to collect data in accordance with our aims. A mediation model with Structural Equation Modeling on the relationship between trait emotional intelligence (TEI) and CF through the maximizing decision-making style was performed.Results: We found a significant relationship between TEI and CF (β = -0.28, SE = 0.04, p < .001). The maximizing style partially mediated this relationship (β = -0.04, SE = 0.01, p < .001). Moreover, negative relationships were found between sex (male), working hours, sleep quality, and CF. Conversely, a positive relationship between age and CF was demonstrated.Conclusions: Being emotionally intelligent resulted as a protective factor for developing CF, while the decision-making styles shaped the risk of developing CF.

Frontline Health Care Workers' Mental Health and Well-Being During the First Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data

BACKGROUND

The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being.

OBJECTIVE

This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels).

METHODS

We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs' mental health during the first year of the COVID-19 pandemic.

RESULTS

The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW's coping strategies; negative mental health effects; organizational support; social network and support; and public and government support.

CONCLUSIONS

These findings demonstrate the need for open conversations, where staff's well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW's well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers.

Factors related to the appearance and development of burnout in nursing students: a systematic review and meta-analysis

Introduction

Burnout may be suffered not only by experienced nurses, but also by those in training. The university environment can be highly stressful for student nurses, who are exposed to various stress-producing situations.

Aim

The aim of this study is to identify and analyse the main risk factors for burnout among nursing students.

Methods

A systematic review with meta-analysis was performed. The search equation used was "Burnout AND Nursing students". Quantitative primary studies on burnout in nursing students, and related risk factors published in English or Spanish and with no restriction by year of publication were included.

Results

A sample of n = 33 studies were included. Three variables are identified can influence burnout in nursing students: academic, interpersonal, environmental and/or social factors. The meta-analyses, with the higher sample of n = 418 nursing students, show that some personality factors, empathy, and resilience are correlated with emotional exhaustion, depersonalization and personal accomplishment.

Conclusion

The personality factors that can influence the development of burnout in nursing students, such as resilience and empathy, among others, must be taken into account when preventing the appearance and treating burnout. Professors should teach nursing students to prevent and recognize the most frequent symptoms of burnout syndrome.

Investigating burn-out contributors and mitigators among intensive care unit nurses during COVID-19: a focus group interview study

OBJECTIVE

Past literature establishes high prevalence of burn-out among intensive care unit (ICU) nurses, and the influence of the COVID-19 pandemic in intensifying burn-out. However, the specific pandemic-related contributors and practical approaches to address burn-out have not been thoroughly explored. To address this gap, this work focuses on investigating the effect of the COVID-19 pandemic on the burn-out experiences of ICU nurses and identifying practical approaches for burn-out mitigation.

DESIGN

Semistructured focus group interviews were conducted via convenience sampling and qualitatively analysed to identify burn-out contributors and mitigators. Maslach Burnout Inventory for Medical Personnel (MBI-MP) and Post-traumatic Stress Disorder Checklist (PCL-5) were employed to quantify the prevalence of burn-out of the participants at the time of study.

SETTING

Two ICUs designated as COVID-19 ICUs in a large metropolitan tertiary care hospital in the Greater Houston area (Texas, USA).

PARTICIPANTS

Twenty registered ICU nurses (10 from each unit).

RESULTS

Participants experienced high emotional exhaustion (MBI-MP mean score 32.35, SD 10.66), moderate depersonalisation (M 9.75, SD 7.10) and moderate personal achievement (M 32.05, SD 7.59) during the pandemic. Ten out of the 20 participants exhibited post-traumatic stress disorder symptoms (PCL-5 score >33). Regarding contributors to burn-out in nurses during the pandemic, five thematic levels emerged-personal, patient related, coworker related, organisational and societal-with each factor comprising several subthemes (eg, emotional detachment from patients, constant need to justify motives to patients' family, lack of staffing and resources, and politicisation of COVID-19 and vaccination). Participants revealed several practical interventions to help overcome burn-out, ranging from mental health coverage to educating public on the severity of the pandemic and importance of vaccination.

CONCLUSIONS

By identifying the contributors to burn-out in ICU nurses at a systems level, the study findings inform the design and implementation of effective interventions to prevent or mitigate pandemic-related burn-out among nurses.

Mindfulness-Based Intervention for the Reduction of Compassion Fatigue and Burnout in Nurse Caregivers of Institutionalized Older Persons with Dementia: A Randomized Controlled Trial

The recent COVID-19 pandemic has severely impacted the mental health of nurses caring for institutionalized older people. Caring in this environment can be complex, with higher levels of burnout and compassion fatigue in staff. It is therefore important to find interventions to increase the well-being of staff. Mindfulness training is known to be effective in treating a variety of physical and mental health conditions. This study sought to conduct a direct evaluation of the effectiveness of a combined online training in two types of mindfulness-based therapies for the reduction of compassion fatigue and burnout in geriatric nurses caring for institutionalized elderly people with dementia. In a randomized controlled trial (n = 39 experimental group, n = 35 control group), we explored whether individuals with high levels of burnout and compassion fatigue would benefit more from an online mindfulness training program. The outcome variable was the ProQoL professional quality of life scale, which was collected at baseline, at six weeks, and at three months after completion of the intervention. Significant differences were found between both groups for the subscales Compassion Fatigue and Burnout (p < 0.05), with a significant improvement in the experimental group (significant effect size). These findings were maintained at three months after the end of the intervention for both compassion fatigue (F1,28 = 18.14, p = 0.003) and burnout (F1,28 = 7.25, p = 0.040). However, there were no differences between groups for the satisfaction subscale. The effect of time and the effects of comparing the two groups after controlling for time were statistically significant for all three subscales of the questionnaire (all p values < 0.001), with effect sizes ranging from small to large (R² change 0.10-0.47). These data indicate that the experimental condition was more effective, explaining between 10 and 18% more of the variance. A short, online intervention based on mindfulness training appears to be effective for reducing compassion fatigue and burnout in geriatric nurses, with sustained effects over time.

“Usability testing of a new digital integrated health ecosystem PainRELife for the clinical man-agement of chronic pain in early breast cancer patients: Protocol for a Pilot Study” (Preprint)

BACKGROUND

Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps.

OBJECTIVE

The primary end point of this pilot study is to evaluate patients' usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources-based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app).

METHODS

This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named "PainRELife," which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care data. The study received approval from the Ethical Committee of the European Cancer Institute in December 2021 (number R1597/21-IEO 1701).

RESULTS

The recruitment process started in May 2022 and ended in October 2022.

CONCLUSIONS

The new integrated technological ecosystems might be considered an encouraging affordance to enhance a patient-centered approach to managing patients with cancer. This pilot study will inform about which features the health technological ecosystems should have to be used by cancer patients to manage CP.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41216.

Job burnout among Israeli healthcare workers during the first months of COVID-19 pandemic: The role of emotion regulation strategies and psychological distress

The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13–28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.

Helping others not always helps ourselves: the relationship between victim incivility and emergency workers' burnout through work-to-family conflict

Purpose

This study aims to analyse whether and when victim incivility may be related to work-to-family conflict and then burnout among emergency workers.

Design/methodology/approach

A total of 304 Italian emergency workers from five firehouses and six emergency rooms completed questionnaires, examining: victim incivility, work-to-family conflict, social support seeking and burnout symptoms. Descriptive analyses, confirmatory factor analyses and structural equation models were conducted.

Findings

Victim incivility was positively associated with burnout symptoms, both directly and indirectly, as mediated by work-to-family conflict. Additionally, social support seeking exacerbated (rather than mitigated) the impact of work-to-family conflict on burnout symptoms.

Practical implications

Organisations can greatly benefit from implementing family-friendly practices and providing their workers with training programmes on how to deal with difficult victims.

Originality/value

This study contributes to the existing literature on workplace incivility and work–life interface by supporting for the first time the notion that victim incivility can spill over into emergency workers' family domain and by clarifying how and when victim incivility is related to burnout symptoms.

Influence of Resilience on Burnout Syndrome of Faculty Professors

This research aims to describe the relationship between resilience and burnout facing COVID-19 pandemics. The sample was n = 831 lecturers and professors of a Mexican public university. This study is a quantitative, non-experimental, cross-sectional, explanatory, and ex post facto research using Structural Equations Modeling with latent variables under the partial least square's method technique. We used the CD-RISC-25 and SBI questionnaires to measure resilience and burnout, respectively. Structural Equations Modeling (SEM-PLS) allowed the visualization of the exogenous variable (resilience) in endogenous variables (dimensions of SBI burnout: E9 guilt, E7 emotional exhaustion, E8 indolence, and E6 work illusion). To this day, there are very few previous studies that jointly analyze in Mexico the characteristics of resilience and burnout in the face of the COVID-19 pandemic. Findings show that resources availability has the strongest correlation with accomplishment in teaching, followed by cynicism and emotional exhaustion. These results have important professional implications.

Mindfulness-Based Program for Anxiety and Depression Treatment in Healthcare Professionals: A Pilot Randomized Controlled Trial

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; η² = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; η² = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; η² = 0.071-F (2.79) = 2.874; p = 0.049; η² = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs.

Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain

Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F_(2,91) = 5.165; p = 0.008; η² = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.

Quality of life and psycho-emotional wellbeing in bladder cancer patients and their caregivers: a comparative analysis between urostomy versus ileal orthotopic neobladder

Background

The impact of neobladder and urostomy on bladder cancer patient’s health-related quality of life (HR-QoL) is controversial and many issues currently remain under-investigated. Initial studies pointed out that the emotional responses of caregivers might be ‘contagious’, influencing emotional reactions in bladder cancer patients undergoing radical cystectomy.

Methods

Three hundred and eighty-two bladder cancer patients (aged M = 67.29 years; SD = 9.23) (16.9% (65) were female and 82.9% (319) were male) and their caregivers were enrolled. Data were collected prospectively: at T0 (1 month before the surgery), at T1 (2 weeks after the surgery, at patient discharge from the hospital) and at T2 (6-month follow-up). At each time point (T0, T1 and T2), a set of questionnaires (EORT QLQ-C30 and emotion thermometer) were given to patients and their caregivers.

Results

All patients reported a general improvement in the HR-QoL and global health status/QoL from T0 to T2 (p < 0.001). No significant differences were observed between neobladder and urostomy. At T0, the emotional thermometer total scoring in caregivers was positive in relation to HR-QoL (p < 0.001) and negative in relation to the patient’s perception of QoL (p < 0.001) and global health (p < 0.001). Similar trends were observed at T1 and T2.

Conclusions

These results suggest that patients and their caregiver’s emotional reactions to cancer are deep-rooted and strongly interconnected, and they provide innovative insights for the clinical management of bladder cancer patients.

Predictors of burnout of health professionals in the departments of maternity and gynaecology, and its association with personality factors: A multicentre study

AIMS AND OBJECTIVES

To analyse the prevalence, levels and phases of burnout syndrome in midwives and obstetrics and gynaecology nurses, and to evaluate the relationship between burnout and sociodemographic, occupational and psychological factors.

BACKGROUND

Burnout syndrome is a major problem in occupational health, characterised by feelings of exhaustion, depersonalisation and a low sense of personal achievement that appears after long-term occupational stress. Recent research has found that burnout harms the physical and mental well-being of workers, and jeopardises the quality of care provided. The association between burnout and a risk profile in maternity wards has not previously been investigated but it deserves special attention since it is a highly stressful area to work in.

DESIGN

A cross-sectional survey design was selected.

METHODS

A total of 150 nurses and midwives at 18 hospitals participated in this study. The data were collected using the Maslach Burnout Inventory, NEO Personality Inventory and the Educational-Clinical Questionnaire: Anxiety and Depression. This study adhered to the STROBE guideline.

RESULTS

17% of participants presented high levels of emotional exhaustion, 16.6% high depersonalisation and 55.1% a sense of low personal accomplishment. The sociodemographic and occupational variables related to burnout were gender, marital status and work shift. The three dimensions of the syndrome, emotional exhaustion, depersonalisation and personal accomplishment were predicted by depression, neuroticism, agreeableness and openness.

CONCLUSIONS

One third of the sample presented high levels of burnout, which was most strongly experienced as feelings of low personal accomplishment. Furthermore, personality factors play an important role in the development of burnout syndrome.

RELEVANCE TO CLINICAL PRACTICE

Managers and policy makers should promote strategies to reduce burnout. To prevent the syndrome, personality factors should be taken into account, for the early identification of a profile of professionals most at risk of developing burnout.

Short Bouts of Physical Activity Are Associated with Reduced Smoking Withdrawal Symptoms, but Perceptions of Intensity May Be the Key

The primary aim of this study was to assess the effectiveness of a short bout (10 min) of moderate-intensity exercise to reduce withdrawal symptomatology, craving and negative affect; while the secondary aim was to assess how the effectiveness of a short bout of moderate exercise can be modulated by the perception of intensity in physically active and low-activity smokers. Fifty low-activity and physically active smokers were recruited (24 male and 26 female) and randomized in three different conditions. Prescribed (objective) moderate intensity (OBJ) and perceived moderate intensity (PER), and passive waiting (PW). After the intervention (T3), smokers reported less desire to smoke in the PER (p < 0.001) and OBJ (p < 0.001) conditions, relative to the PW condition. At T3 smokers in the PER condition reported less negative affect than smokers in the PW condition relative to the baseline (T1) (p < 0.007). Further, smokers in the PER condition reported less negative affect than smokers in the PW condition (p < 0.048). Physically active (PA) smokers perceived less exertion than low-activity (LA) smokers, and the effects were stronger in the PER condition relative to OBJ. Generally, our results suggest that a short bout of moderate exercise helps both LA and PA smokers. These findings provided a novel insight into the psychological mechanisms that affect the efficacy of the exercise in smoking cessation and suggest that exercise should be tailored according to individual perception of intensity.

2020s Heroes Are Not Fearless: The Impact of the COVID-19 Pandemic on Wellbeing and Emotions of Italian Health Care Workers During Italy Phase 1

Objective

The study aimed to investigate the mental health and emotional reaction of physicians working during phase 1 of the COVID-19 pandemic in Italy.

Methods

A total of 458 Italian Health Care Workers (HCWs) working during phases 1 of the COVID-19 outbreak were voluntarily enlisted in the study and recruited with the snowball technique through an online survey. We examined our variables with the General Health Questionnaire – 12 and with Visual Analog Scales.

Results

The sample has a high level of psychological distress 21.26 (SD = 4.46), the emotional reaction was characterized by high level of fear for family members and cohabitants (M = 77.67, SD = 27.16) and patients (M = 67.16, SD = 27.71). Perceived control, fear for patients, and for family members and cohabitants, feeling alone and anger all contribute to a decreased mental health in Italian physicians (R² = 0.285, p < 0.001).

Conclusion

Italian HCWs’ mental health and emotional reaction have to be considered to prevent high risk of burnout and post-traumatic stress disorder (PTSD). It becomes pivotal in the next months to implement a tailored psychological intervention to take care of HCWs and to prevent costly consequences for them, patients, and the healthcare system.

Self-compassion mediates the association between conflict about ability to practice end-of-life care and burnout in emergency nurses

INTRODUCTION

End-of-life care (EOLC) is necessary for patients who are not expected to live long. Nurses have positive attitudes toward EOLC, but they encounter difficulties in practice. That situation creates conflict, which can affect burnout. It is essential to manage nurses' conflict about their ability to practice EOLC by enhancing their individual strengths. Focusing on the role of self-compassion may help to prevent burnout related to the conflict about ability to practice EOLC.

OBJECTIVE

The study aim was to assess the mediating effect of self-compassion on the association between conflict about ability to practice EOLC and burnout.

METHODS

A correlational study was conducted with emergency department nurses who practiced EOLC. Self-report measures of conflict about ability to practice EOLC, burnout, and self-compassion were obtained.

RESULTS

Negative aspects of self-compassion mediated the relationship among conflict, emotional exhaustion, and depersonalization (burnout). Self-compassion did not mediate the association between conflict and reduced personal accomplishment (burnout).

CONCLUSIONS

Negative aspects of self-compassion mediated the relationship between conflict and burnout (excluding reduced personal accomplishment). To prevent burnout, it is necessary to screen for nurses with low self-compassion and to provide opportunities to change their cognitive recognition and disclose their conflicts.

Burnout Syndrome in Paediatric Oncology Nurses: A Systematic Review and Meta-Analysis

Purpose: To determine levels of burnout among paediatric oncology nurses, and the risk factors that may influence its development. Method: A literature review with meta-analysis was conducted, via a search in the PubMed, CINHAL, Scopus, ProQuest (Health and Medical Complete), Scielo and PsycINFO databases, using the search equation: "Nurs* AND burnout AND oncology AND pediatric". Results: The final sample of selected studies was of eight articles. All were quantitative studies of paediatric oncology nurses, using the Maslach Burnout Inventory, written in English or Spanish. No search restrictions were established on the year of publication. The eight studies reported moderate-high levels of burnout in each of its three dimensions. These dimensions were all related to the characteristics of the profession, in terms of complexity, shifts and workload, and to sociodemographic variables such as marital status, work experience, age and gender. The prevalence meta-analytical estimation for a sample of n = 361 nurses were 37% for high emotional exhaustion, 16% for high depersonalisation and 27% for low personal fulfilment. Conclusions: Most paediatric oncology nurses present moderate-high levels of burnout. Therefore, strategies and interventions should be identified and implemented to protect these workers from the syndrome.

Professional quality of life and burnout among medical physicists working in radiation oncology: The role of alexithymia and empathy

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Burnout is critical for oncology professionals, affecting quality of life and performance at work.

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Alexithymia and empathy are personality traits influencing the capacity to cope with stress.

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Alexithymia increases burnout among medical physicists with a negative impact at work.

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Higher level of empathy are correlated to a better professional quality of life.

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This data may help identifying subjects at risk to implement preventive strategies.

Background and purpose

The professional quality of life of radiation oncology professionals can be influenced by different contributing factors, including personality traits. Alexithymia involves deficits in emotion processing and awareness. Empathy is the ability to understand another’s ‘state of mind/emotion’. We investigated professional quality of life, including burnout, in radiation oncology, exploring the role of alexithymia and empathy and targeting the population of medical physicists (MPs), since this professional category is usually underrepresented in surveys exploring professional well-being in radiation oncology and MPs may experience professional distress given the increasing complexity of multimodal cancer care.

Material and methods

An online survey was addressed to ESTRO members. Participants filled out three questionnaires to evaluate alexithymia, empathy and professional quality of life: a) Toronto Alexithymia Scale (TAS-20); b) Interpersonal Reactivity Index (IRI); c) Professional Quality of Life Scale (ProQoL). Professional quality of life as per ProQoL was considered as dependent variable. The three domains of the ProQoL, namely compassion satisfaction (CS), secondary traumatic stress (STS) and burnout were correlated with alexithymia (as per TAS-20) and empathy (as per IRI with three subcategories: empathic concern, perspective taking and personal distress) and demographic/professional characteristics as independent variables. Generalized linear modeling was used. Significant covariates on univariate linear regression analysis were included in the multivariate linear regression model.

Results

A total of 308 medical physicists completed all questionnaires. Alexithymia as per TAS-20 was correlated to decreased CS (β = −0.25, p < 0 0.001), increased likelihood for STS (β = 0.26, p < 0 0.001) and burnout (β = 0.47, p < 0 0.001). With respect to empathy, the ‘Empatic Concern’ subscale of the IRI was found to be a significant predictor for increased CS (β = 0.19, p = 0 0.001) and increased STS (β = 0.19, p < 0 0.001), without significant correlation with burnout. The individual’s perception of being valued by own’s supervisor was correlated to increased CS (β = 0.23, p < 0.001), and decreased burnout (β = −0.29, p < 0.001).

Conclusions

Alexithymic personality trait increased the likelihood to develop burnout, with less professional satisfaction amongst MPs working in radiation oncology. Empathy results in higher professional fulfilment. These results may be used to benchmark preventing strategies, including peer support, debriefing sessions, leadership initiatives and work-load limitation strategies.

Prevalence and Predictors of Depression, Anxiety and Stress Symptoms in Paramedics at Saudi Red Crescent Authority

Background:

Emergency medical professionals often encounter situations when dealing with patients that can affect their mental health. In Saudi Arabia, there is paucity of data regarding the mental health of paramedics involved in prehospital care.

Objectives:

To determine the prevalence and predictors of stress, anxiety and depression symptoms among paramedics working at Saudi Red Crescent Authority (SRCA) stations in Riyadh, Saudi Arabia.

Methods:

This cross-sectional, questionnaire study included all paramedics working in the prehospital medical services of 21 SRCA stations in Riyadh (N = 300) between March and June 2017. Sociodemographic data were collected using a self-reporting questionnaire, and the Arabic version of the Depression Anxiety and Stress Scale-21 was used to identify the states of stress, anxiety and depression. Bivariate analysis using chi-square test and multivariate logistic regression analysis were performed to determine the association between sociodemographic factors and mental health.

Results:

In total, 240 emergency medical professionals responded (response rate = 80%). Of these, 30.5% had stress, 40% had anxiety and 26.7% had depression. All cases of stress were of mild-to-moderate level, while 5.1% of the respondents had severe-to-extremely severe anxiety and 1.3% had severe depression; there were no cases of extremely severe depression. Number of mission calls was identified as a predictor for stress and anxiety; intake of medications for noncommunicable diseases as a predictor for stress and depression; hours of sleep/day for anxiety and depression and use of stimulant beverages other than tea, coffee and energy drinks as predictors for anxiety.

Conclusion:

This study demonstrates that stress, anxiety and depressive symptoms are relatively common in paramedics working at SRCA stations in Riyadh. The authors suggest that the above-mentioned predictors should be monitored in paramedics and interventions should be made when necessary.

Stress of nursing professionals working in pre-hospital care

ABSTRACT Objectives: To analyze the factors related to the occupational stress of a Mobile Emergency Care Service (Samu) nursing team. Methods: This is a descriptive study, with a quantitative approach, performed with nursing professionals from Samu service of a city of Pernambuco. A sociodemographic questionnaire and the Lipp’s Stress Symptom Inventory were used. Results: The participants presenting stress (24.6%) were classified in the phases: resistance (19.7%), exhaustion (4.4%) and near exhaustion (0.5%). It was also observed an association of stress level with the following factors: gender, sleep quality, professional autonomy restriction, emotional exhaustion with work performed and work in inadequate or unhealthy physical facilities. Conclusions: Although showing low occurrence of stress, this study pointed out the profile that presents the highest risk of developing occupational stress, through the factors significantly associated with stress in the studied population.

Protecting emergency room nurses from burnout: The role of dispositional mindfulness, emotion regulation and empathy

AIM

To verify the role of dispositional mindfulness, difficulties in emotion regulation and empathy in explaining burnout levels of emergency room (ER) nurses.

BACKGROUND

Many studies have examined the variables that can affect burnout amongst ER nurses, but little is known about factors that can protect ER nurses against work-related stress.

METHOD

A multi-centre cross-sectional design was used. Burnout level intensity, dispositional mindfulness facets, difficulties in emotion regulation and empathy dimensions were assessed using valid and reliable self-report questionnaires in a sample of ER nurses (N = 97) from three different hospitals.

RESULTS

Higher dispositional mindfulness and cognitive empathy levels and lower difficulties in emotion regulation, were negatively associated with emotional exhaustion levels.

CONCLUSION

ER nurses with more mindful, emotion regulation and empathy skills are more able to manage work-related distress.

IMPLICATIONS FOR NURSING MANAGEMENT

Experiential interventions to promote mindfulness skills, emotion regulation variability and flexibility in a clinical context and the cognitive side of empathy are recommended for ER nurses to reduce professional distress, and to enhance personal and work satisfaction. Future research should assess the effectiveness of new multi-factorial interventions which combine the development of mindfulness, emotion regulation and empathy skills in ER nurses.