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Musker M, Othman S. Effective interventions to reduce burnout in nurses: A meta-analysis. Complement Ther Clin Pract 2024; 54:101827. [PMID: 38181650 DOI: 10.1016/j.ctcp.2023.101827] [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: 08/24/2023] [Revised: 11/29/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND To examine the effectiveness of interventions to ameliorate burnout, secondary traumatic stress, and emotional exhaustion in nurses and midwives. The systematic review was completed with all available studies that reported data on the effect of interventions that targeted burnout using the outcome measures of the Professional Quality of Life scale (ProQOL), or the Maslach Burnout Inventory (MBI). METHODS We used a systematic review methodology, which included a meta-analysis. A total of 2103 articles resulted from the systematic search; 688 were removed as duplicates, and 1415 articles were reviewed by the title and abstract, of which 255 were eligible for full-text screening. Only 66 met the inclusion criteria and were included in the analysis. The final meta-analysis consisted of 33 reports divided into 12 studies for ProQOL and 21 studies for the MBI. RESULTS The results provide an overall effect in studies using the ProQOL measurement was Z = 2.07 (P = 0.04) and a positive improvement mean difference of 9.32. The overall effect in studies using MBI was Z = 3.13 (P = 0.002) and a positive improvement mean difference of 6.58. CONCLUSIONS Whilst most studies indicated a positive difference, the most effective interventions included clinical supervision or activities that addressed the personal physical and mental well-being of nurses. Less effective interventions were managerial interventions or ones that used a strictly educational approach.
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Affiliation(s)
- Mike Musker
- UniSA, Clinical & Health Sciences, Mental Health and Suicide Prevention Research and Education Group, University of South Australia, Adelaide, SA, 5000, Australia.
| | - Shwikar Othman
- Wardliparingga Aboriginal Health Equity, Population Health, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA, 5000, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
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Rushforth A, Durk M, Rothwell-Blake GAA, Kirkman A, Ng F, Kotera Y. Self-Compassion Interventions to Target Secondary Traumatic Stress in Healthcare Workers: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6109. [PMID: 37372696 DOI: 10.3390/ijerph20126109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Healthcare professionals' wellbeing can be adversely affected by the intense demands of, and the secondary traumatic stress associated with, their job. Self-compassion is associated with positive wellbeing outcomes across a variety of workforce populations and is potentially an important skill for healthcare workers, as it offers a way of meeting one's own distress with kindness and understanding. This systematic review aimed to synthesise and evaluate the utility of self-compassion interventions in reducing secondary traumatic stress in a healthcare worker population. Eligible articles were identified from research databases, including ProQuest, PsycINFO, ScienceDirect, Google Scholar, and EBSCO. The quality of non-randomised and randomised trials was assessed using the Newcastle-Ottawa Scale. The literature search yielded 234 titles, from which 6 studies met the inclusion criteria. Four studies reported promising effects of self-compassion training for secondary traumatic stress in a healthcare population, although these did not use controls. The methodological quality of these studies was medium. This highlights a research gap in this area. Three of these four studies recruited workers from Western countries and one recruited from a non-Western country. The Professional Quality of Life Scale was used to evaluate secondary traumatic stress in all studies. The findings show preliminary evidence that self-compassion training may improve secondary traumatic stress in healthcare professional populations; however, there is a need for greater methodological quality in this field and controlled trials. The findings also show that the majority of research was conducted in Western countries. Future research should focus on a broader range of geographical locations to include non-Western countries.
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Affiliation(s)
- Annabel Rushforth
- College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
| | - Mia Durk
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London WC2R 2LS, UK
| | | | - Ann Kirkman
- College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
| | - Fiona Ng
- School of Health Sciences, University of Nottingham, Nottingham NG7 2TU, UK
| | - Yasuhiro Kotera
- School of Health Sciences, University of Nottingham, Nottingham NG7 2TU, UK
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Matos M, McEwan K, Kanovský M, Halamová J, Steindl SR, Ferreira N, Linharelhos M, Rijo D, Asano K, Vilas SP, Márquez MG, Gregório S, Brito-Pons G, Lucena-Santos P, da Silva Oliveira M, de Souza EL, Llobenes L, Gumiy N, Costa MI, Habib N, Hakem R, Khrad H, Alzahrani A, Cheli S, Petrocchi N, Tholouli E, Issari P, Simos G, Lunding-Gregersen V, Elklit A, Kolts R, Kelly AC, Bortolon C, Delamillieure P, Paucsik M, Wahl JE, Zieba M, Zatorski M, Komendziński T, Zhang S, Basran J, Kagialis A, Kirby J, Gilbert P. Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1845. [PMID: 36767212 PMCID: PMC9915071 DOI: 10.3390/ijerph20031845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.
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Affiliation(s)
- Marcela Matos
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), 3004-531 Coimbra, Portugal
| | - Kirsten McEwan
- Centre for Compassion Research and Training, College of Health, Psychology and Social Care, University of Derby, Derby DE22 1G, UK
| | - Martin Kanovský
- Institute of Social Anthropology, Faculty of Social and Economic Sciences, Comenius University, 814 99 Bratislava, Slovakia
| | - Júlia Halamová
- Institute of Applied Psychology, Faculty of Social and Economic Sciences, Comenius University, 814 99 Bratislava, Slovakia
| | - Stanley R. Steindl
- Compassionate Mind Research Group, School of Psychology, University of Queensland, Brisbane 4072, Australia
| | - Nuno Ferreira
- Department of Social Sciences, University of Nicosia, Nicosia 2417, Cyprus
| | - Mariana Linharelhos
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), 3004-531 Coimbra, Portugal
| | - Daniel Rijo
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), 3004-531 Coimbra, Portugal
| | - Kenichi Asano
- Department of Psychological Counseling, Faculty of Psychology, Mejiro University, Tokyo 161-0032, Japan
| | - Sara P. Vilas
- Behavior, Emotions, and Health Research Group, Department of Psychology, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Margarita G. Márquez
- Behavior, Emotions, and Health Research Group, Department of Psychology, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Sónia Gregório
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), 3004-531 Coimbra, Portugal
- Behavior, Emotions, and Health Research Group, Department of Psychology, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Gonzalo Brito-Pons
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Paola Lucena-Santos
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), 3004-531 Coimbra, Portugal
| | - Margareth da Silva Oliveira
- Evaluation and Treatment in Cognitive and Behavioral Psychotherapies—Research Group (GAAPCC), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre 90619-900, Brazil
| | | | | | - Natali Gumiy
- Motivación Compasiva, Buenos Aires C1001, Argentina
| | | | - Noor Habib
- Neuroscience Department, Section of Psychiatry and Psychology, King Faisal Specialist Hospital and Research Centre (KFSH&RC), Jeddah 11564, Saudi Arabia
| | - Reham Hakem
- Neuroscience Department, Section of Psychiatry and Psychology, King Faisal Specialist Hospital and Research Centre (KFSH&RC), Jeddah 11564, Saudi Arabia
| | - Hussain Khrad
- Neuroscience Department, Section of Psychiatry and Psychology, King Faisal Specialist Hospital and Research Centre (KFSH&RC), Jeddah 11564, Saudi Arabia
| | - Ahmad Alzahrani
- Neuroscience Department, Section of Psychiatry and Psychology, King Faisal Specialist Hospital and Research Centre (KFSH&RC), Jeddah 11564, Saudi Arabia
| | - Simone Cheli
- School of Human Health Sciences, University of Florence, 50121 Florence, Italy
| | - Nicola Petrocchi
- Department of Economics and Social Sciences, John Cabot University, 00165 Rome, Italy
| | - Elli Tholouli
- Center for Qualitative Research in Psychology and Psychosocial Well-Being, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Philia Issari
- Center for Qualitative Research in Psychology and Psychosocial Well-Being, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 546 36 Thessaloniki, Greece
| | | | - Ask Elklit
- Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark
| | - Russell Kolts
- Department of Psychology, Eastern Washington University, Cheney, WA 99004, USA
| | - Allison C. Kelly
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Catherine Bortolon
- Laboratoire Inter-Universitaire de Psychologie: Personnalité, Cognition et Changement Social, Grenoble Alpes University, 38400 Grenoble, France
- Centre Hospitalier Alpes Isère, C3R—Réhabilitation Psychosociale et Remédiation Cognitive, 38100 Grenoble, France
| | - Pascal Delamillieure
- CHU de Caen, Service de Psychiatrie Adulte, 14000 Caen, France
- UNICAEN, ISTS, GIP Cyceron, University of Normandy, 76000 Caen, France
| | - Marine Paucsik
- Laboratoire Inter-Universitaire de Psychologie: Personnalité, Cognition et Changement Social, Grenoble Alpes University, 38400 Grenoble, France
| | - Julia E. Wahl
- The Mind Institute Poland, 33-332 Warsaw, Poland
- Institute of Psychology, Department of General Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland
| | - Mariusz Zieba
- Institute of Psychology, Department of General Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland
| | - Mateusz Zatorski
- Institute of Psychology, Department of General Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland
| | - Tomasz Komendziński
- Department of Cognitive Science, Nicolaus Copernicus University, 87-100 Torún, Poland
- Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, 87-100 Torún, Poland
| | - Shuge Zhang
- School of Human Sciences, University of Derby, Derby DE22 1G, UK
| | - Jaskaran Basran
- Centre for Compassion Research and Training, College of Health, Psychology and Social Care, University of Derby, Derby DE22 1G, UK
| | - Antonios Kagialis
- Department of Social Sciences, University of Nicosia, Nicosia 2417, Cyprus
| | - James Kirby
- Compassionate Mind Research Group, School of Psychology, University of Queensland, Brisbane 4072, Australia
| | - Paul Gilbert
- Centre for Compassion Research and Training, College of Health, Psychology and Social Care, University of Derby, Derby DE22 1G, UK
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Johansson M, Marcusson-Clavertz D, Gunnarsson C, Olsson I, Kaldo V, Bratt A. Feasibility and preliminary evaluation of internet-based compassion and cognitive-behavioral stress-management courses for health care professionals: A randomized controlled pilot trial. Internet Interv 2022; 30:100574. [PMID: 36185345 PMCID: PMC9520015 DOI: 10.1016/j.invent.2022.100574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
Health care professionals (HCPs) are exposed to excessive demands in their work environment. In Sweden, work-related stress is one of the most common reasons for sick leaves. Finding cost-effective and easily accessible interventions for HCPs is crucial to counteract stress-related problems and reduce the number of sick leaves. The study aimed to evaluate the feasibility of two internet-based stress management courses and their preliminary effectiveness to reduce HCPs' stress of conscience and work-related stress, and act as a pilot for a larger randomized controlled trial (RCT). Thirty-two HCPs registered for the courses and were randomized to either an internet-based compassion course, ICOP (n = 18), or an internet-based cognitive-behavioral course, ICB (n = 14). Participants completed measures pre- (i.e., baseline, n = 32), post-intervention (at five weeks, n = 21), and at follow-up at 10 weeks (n = 17), 15 weeks (n = 13), and six months (n = 12). The study used the following scales: Stress of Conscience Questionnaires, Copenhagen Psychosocial Questionnaire, Self-Compassion Scale, and Professional Quality of Life Scale. Adherence of HCPs (n = 21) was measured using the number of logins, messages between course leaders and HCPs, and completed modules. Twelve interviews were conducted to explore participants' perceptions of the accessibility of the courses. Participants reported overall satisfaction with both the ICOP and ICB courses, stating that the courses contributed to new knowledge, individual insight, and behavior change. Both courses showed similar patterns of adherence. Quantitative analyses on pre-and post-intervention data (n = 21) showed that stress of conscience and secondary traumatic stress decreased, and self-compassion increased following ICOP. Following ICB, HCPs reported decreased burnout symptoms (according to one of two questionnaires) and increased compassion satisfaction. Both courses seemed feasible, showed promising results, and could be further evaluated in a larger study with a similar design.
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Affiliation(s)
- Maude Johansson
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Corresponding author at: Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden.
| | - David Marcusson-Clavertz
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Ida Olsson
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Anna Bratt
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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Bratt AS, Johansson M, Holmberg M, Fagerström C, Elmqvist C, Rusner M, Kaldo V. An internet-based compassion course for healthcare professionals: Rationale and protocol for a randomised controlled trial. Internet Interv 2021; 28:100463. [PMID: 35646603 PMCID: PMC9136314 DOI: 10.1016/j.invent.2021.100463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Severe stress is one of the most common causes of sick leave in Sweden. Previous research has shown that compassion interventions for healthcare professionals can decrease work-related stress through the introduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations. Internet-based stress management interventions have hitherto shown promising results in reducing stress. However, further research is needed to examine the effectiveness of internet-based compassion interventions for healthcare professionals. OBJECTIVE In the present study protocol, a randomised controlled trial is described, aiming to examine the effects of an internet-based compassion course for healthcare professionals on work-related stress and stress of conscience. METHOD Healthcare professionals will be offered an internet-based stress management course of five modules across a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled in one of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n = 120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stress management course (n = 36). We hypothesise that the internet-based compassion course would reduce the participants' stress of conscience to a greater degree compared to the other two groups. The secondary hypothesis is that the compassion course would increase the participants' professional quality of life (i.e., higher job satisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion course is expected to reduce the participants' work-related stress and sick leave rates to the same degree (non-inferiority) as the cognitive behavioural stress management course and to a higher degree when compared to the waitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondary outcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related Stress Copenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will be performed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10 weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimating equation for repeated measurements to examine whether changes over time differ between the groups and whether the improvements persist over time. DISCUSSION The clinical trial is expected to provide novel data on the effects of compassion interventions and add to the existing knowledge of internet-based interventions for stress management in healthcare professionals.
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Affiliation(s)
- Anna Sofia Bratt
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,Corresponding author at: Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden.
| | - Maude Johansson
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Mats Holmberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden,School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Cecilia Fagerström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Carina Elmqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Marie Rusner
- Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden
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