Prevalence of burnout in health professionals working in palliative care: a systematic review

Associations between effort-reward imbalance and risk of burnout among Swedish physicians

BACKGROUND

The high prevalence of burnout among Swedish physicians may have several possible effects on individuals and society. However, further investigations of work-related factors associated with the risk of burnout among Swedish physicians are needed.

AIMS

We aimed to study the associations between psychosocial work factors, based on the effort-reward imbalance (ERI) model, and the risk of burnout among Swedish physicians.

METHODS

A representative sample of 7200 Swedish physicians was invited in 2021. Data were gathered through questionnaires, with a response rate of 41%. Logistic regression models were used to study the associations between exposure to ERI and the risk of burnout.

RESULTS

Approximately 62% of Swedish physicians were exposed to a high ERI. Exposure to a high ERI was associated with 11 times increased risk (95% confidence interval 6.5-20.0) of burnout in adjusted models. Large variations in the prevalence of ERI and risk of burnout across sociodemographic and occupational factors were identified, particularly across different clinical specialties.

CONCLUSIONS

A majority of Swedish physicians were exposed to high levels of work-related stress, strongly associated with an increased risk of burnout. This population-based cross-sectional study underlines the need to further study variations of work-related stress across clinical specialties and to monitor occupational health among physicians longitudinally.

Factors influencing fatigue, mental workload and burnout among Chinese health care workers during public emergencies: an online cross-sectional study

OBJECTIVES

The purpose of this study was to investigate fatigue, mental workload, and burnout among health care workers (HCWs) and explore the possible underlying factors.

MATERIALS AND METHODS

An online cross-sectional survey design was used to collect data from HCWs in Chongqing, China. The online survey included the Fatigue Severity Scale, NASA Task Load Index, and Chinese version of the Maslach Burnout Inventory-General Survey to assess fatigue, mental workload, and burnout, respectively, and was conducted from February 1 to March 1, 2023.

RESULTS

In this study, the incidence of fatigue and burnout among HCWs was 76.40% and 89.14%, respectively, and the incidence of moderate to intolerable mental workloads was 90.26%. Work-family conflict, current symptoms, number of days of COVID-19 positivity, mental workload, burnout and reduced personal accomplishment were significantly associated with fatigue. Mental workload was affected by fatigue and reduced personal accomplishment. Furthermore, burnout was influenced by marital status and fatigue. Moreover, there was a correlation among mental workload, fatigue, and burnout.

CONCLUSIONS

Fatigue, mental workload and burnout had a high incidence and were influenced by multiple factors during COVID-19 public emergencies in China.

Mediating role of loneliness and emotional disturbance in the association between childhood trauma and occupational burnout among nurses: a cross-sectional study

Background

The occupational burnout status of nurses in China warrants attention. Childhood trauma, loneliness, and emotional disturbance are significant predictors of this burnout, yet few studies have delved into the underlying mechanisms. This study seeks to explore the mediating pathway from childhood trauma to loneliness, emotional disturbance, and ultimately occupational burnout among nurses through a cross-sectional analysis.

Method

Data for the study were collected from Yunnan province, China, from 11 July to 26 July 2022. Key variables were measured using standardized scales: the Childhood Trauma Questionnaire Short Form for childhood trauma, the three-item loneliness scale for loneliness, the Patient Health Questionnaire and the Generalized Anxiety Disorder questionnaire for emotional disturbance, and the Maslach Burnout Inventory-Human Service Survey for occupational burnout. Mediation modeling analysis was employed for data analysis to test the effect of loneliness and emotional disturbance on the association between childhood trauma and occupational burnout. Data analysis was conducted using AMOS and SPSS software.

Results

Loneliness and emotional disturbance fully mediated the association between childhood trauma and emotional exhaustion [indirect effect (95% CI) = 0.228 (0.196, 0.270)]. Loneliness and emotional disturbance partially mediated the association between childhood trauma [indirect effect (95% CI) = -0.020 (-0.039, 0.002)] and personal accomplishment or depersonalization [indirect effect (95% CI) = 0.221 (0.186, 0.255)].

Conclusion

Childhood trauma could affect occupational burnout through loneliness and emotional disturbance among nurses. Preventive strategies could include protective interventions like treatment of loneliness and emotional disturbance, especially in nurses who experienced childhood trauma.

Impact of confrontation to patient suffering and death on wellbeing and burnout in professionals: a cross-sectional study

BACKGROUND

Palliative care and oncology generate a risk of burnout and psychological distress in professionals. The purpose of this study is to identify both psychopathological and positive factors related to mental health at work. It aims (i) to explore the extent to which these professionals are confronted with suffering, illness, and death; and to explore the prevalence of psychological distress and/or burnout, (ii) to identify potential determinants of burnout and psychological wellbeing at work, (iii) to develop an integrative model of mental health; and to identify frequency and impact of confrontations with death, and (iv) to identify profiles of professionals are at risk of developing a mental health disorder or, conversely, characterized by wellbeing.

METHODS

A cross-sectional questionnaire study was conducted in palliative care and oncology evaluating confrontations with death, coping, burnout, psychological distress, personality, self-esteem, well-being and meaning at work. Regressions, clustering, and structural equation modeling analyses were performed.

RESULTS

109 professionals participated (58% from oncology and 42% from palliative care), of which 79% were female, and 65% were between 30 and 49 years old. Aim i: 30% witnessed an intolerable suffering at least 9 times a month, 45% reported moderate to high levels of burnout, 39% suffered from anxiety and 11% from depression. Aim ii: the determinants of burnout were the personality traits conscientiousness and neuroticism, low meaning of work, and low wellbeing (R2 = 0.44). The determinants of wellbeing were work meaning, depersonalization, self-esteem, fulfillment and low emotional exhaustion (R2 = 0.71). Aim iii: the integrative model included both well-being (self-esteem, conscientiousness) and psychopathology (neuroticism, anxiety) parameters, and strongly satisfied the standard SEM goodness of fit indices (e.g., CFI, IFI, and TLI ≥ 0.95). Aim iv: three profiles were identified: (a) a "distressed profile" with a majority of professionals at the patient's bedside, (b) a "disengaged profile" with professionals working as second-line consultants, (c) a "wellbeing profile" contains profiles of caregivers insensitive to psychological distress and with a high level of positive Impact of confrontation on different areas of their lives.

CONCLUSIONS

An integrative approach is essential to understand the full range of mental health issues for professionals. Meaning of work is a key factor in professional interventions that should primarily affect front-line professionals with limited experience.

Close but Not Close Enough: How Distance Caregiving is Associated with Hospice Family Caregiver Hospice Communication Experiences

Half of hospice family caregivers report having unmet information needs, which can contribute to poor pain and symptom management, emergency department use, and hospice disenrollment for care-recipients and to caregiver strain and stress. Effective communication between hospice teams and family caregivers is critical yet communication inadequacies persist. Despite the growing prevalence of distance caregiving, including in hospice care, and the relationship between caregiver proximity and communication effectiveness, little is known about how caregiver proximity is associated with caregiver perceptions of hospice communication. In this secondary analysis of quantitative data from two multisite randomized clinical trials (NCT03712410 and NCT02929108) for hospice family caregivers (N = 525), multivariate linear models with demographic and contextual controls were used to analyze caregivers' perceptions of caregiver-centered communication with hospice providers based on caregiver proximity to the hospice care-recipient. In multivariate models, "local" hospice family caregivers who lived within 1 hour of the hospice care-recipient reported less effective communication with the hospice team than co-residing caregivers; and older caregivers rated communication more favorably than younger caregivers. To improve communication and collaboration between hospice teams and caregivers, regardless of proximity, distance communication training for hospice teams and interventions such as telehealth communication and virtual tools that enable triadic collaboration are recommended. Research is needed to understand why local caregivers, specifically, perceive communication quality less favorably and how hospice teams can better meet local and distance caregiver communication needs.

Improving safety and preventing falls using an evidence-based, front-line staff huddling practice: protocol for a pragmatic trial to increase quality of care in State Veterans Homes

INTRODUCTION

Falls in nursing homes are a major cause for decreases in residents' quality of life and overall health. This study aims to reduce resident falls by implementing the LOCK Falls Programme, an evidence-based quality improvement intervention. The LOCK Falls Programme involves the entire front-line care team in (1) focusing on evidence of positive change, (2) collecting data through systematic observation and (3) facilitating communication and coordination of care through the practice of front-line staff huddles.

METHODS AND ANALYSIS

The study protocol describes a mixed-methods, 4-year hybrid (type 2) effectiveness-implementation study in State Veterans Homes in the USA. The study uses a pragmatic stepped-wedge randomised trial design and employs relational coordination theory and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework to guide implementation and evaluation. A total of eight State Veterans Homes will participate and data will be collected over an 18-month period. Administrative data inclusive of all clinical assessments and Minimum Data Set assessments for Veterans with a State Veterans Home admission or stay during the study period will be collected (8480 residents total). The primary outcome is a resident having any fall. The primary analysis will be a partial intention-to-treat analysis using the rate of participants experiencing any fall. A staff survey (n=1200) and qualitative interviews with residents (n=80) and staff (n=400) will also be conducted. This research seeks to systematically address known barriers to nursing home quality improvement efforts associated with reducing falls.

ETHICS AND DISSEMINATION

This study is approved by the Central Institutional Review Board (#167059-11). All participants will be recruited voluntarily and will sign informed consent as required. Collection, assessment and managing of solicited and spontaneously reported adverse events, including required protocol alterations, will be communicated and approved directly with the Central Institutional Review Board, the data safety monitoring board and the Office of Research and Development. Study results will be disseminated through peer-reviewed publications and conference presentations at the Academy Health Annual Research Meeting, the Gerontological Society of America Annual Scientific Meeting and the American Geriatrics Society Annual Meeting. Key stakeholders will also help disseminate lessons learnt.

TRIAL REGISTRATION NUMBER

NCT05906095.

Burnout and attachment in oncology and palliative care healthcare professionals

OBJECTIVES

Examine the prevalence of burn-out in health professionals working in a hospital dedicated to patients with cancer. Explore the relationship between attachment style and burn-out in healthcare professionals working in Oncology and Palliative Care.

METHODS

Cross-sectional descriptive and correlational study with a sample of 337 health professionals working in a tertiary hospital dedicated to oncology care. The evaluation protocol included a sociodemographic questionnaire, two burn-out (Copenhagen Burnout Inventory (CBI) and Maslach Burnout Inventory) and attachment (Adult Attachment Scale) scales. Statistical analysis was performed by IBM SPSS Statistics V.25. The tests were performed at a significance level of 5%.

RESULTS

In the sample, there is a predominance of professionals working in oncology services (76,8%). Comparing professionals who work in oncology services and palliative care, it appears that just over half have high levels of personal burn-out, however the groups do not differ significantly (53.5% vs 56.8%, p=0.619); the same is observed in work-related (p=0.626) and patient-related burn-out (p=0.672). The number of hours per week in which one has the perception that is exposed to suffering is positively correlated with personal, work-related burn-out and exhaustion (p<0.05). Correlating the two burn-out scales in the sample, it is observed that higher levels of personal, work-related and patient-related burn-out are associated with higher levels of emotional exhaustion and depersonalisation, as well as lower levels of personal accomplishment (p<0.001). Considering the correlation between the burn-out dimensions and attachment scale, it appears that high levels of exhaustion, depersonalisation, personal, work-related and patient-related burn-out were associated with higher levels of anxiety (p<0.001). Similar results were found in the palliative care professionals sample.

CONCLUSIONS

The constant exposure to the suffering of others places high emotional demands on oncology and palliative care professionals, making them vulnerable to burn-out. Burn-out is a multifactorial process, that involves individual characteristics with environmental effects. There are no significant differences between Oncology and Palliative Care professionals. Higher levels of personal, work-related and patient-related burn-out are associated with higher levels of anxiety. These results suggest that an anxious attachment style increases the risk of burn-out . In the sample, the most important predictor of burn-out was the number of hours per week exposed to suffering. In order to prevent burn-out, there is a growing evidence that suggests mindfulness, exercise, high-quality sleep and pursuit of happiness can improve burn-out in healthcare professionals. This work brings the advantage of using two burn-out assessment scales (particularly CBI scale), in addition to trying to correlate the level of burn-out and attachment in professionals exposed to suffering.

Clinical Simulation in Palliative Care for Undergraduate Nursing Students: A Randomized Clinical Trial and Complementary Qualitative Study

BACKGROUND

a lack of adequate training in palliative care leads to a greater emotional burden on nurses.

PURPOSE

to assess the effect of a simulation using standardized patients on self-efficacy in palliative care, ability to cope with death, and emotional intelligence among nursing students.

METHODS

a randomized clinical trial and qualitative study. A total of 264 nursing students in a palliative care module completed the Bugen, trait meta-mood, and self-efficacy in palliative care scales after active participation in the simulation (n = 51), watching the simulation (n = 113), and the control group (n = 100). An ANOVA with a multi-comparative analysis and McNemar's tests for paired samples were calculated. Active participants were interviewed, and a thematic analysis was conducted.

RESULTS

there was an improvement after the assessment in all three groups assessed for coping with death (p < 0.01), emotional intelligence (p < 0.01), and self-efficacy (p < 0.01). In addition, the active group improved more than the observer group and the control group in coping with death, attention, and repair. The students in the interviews identified sadness and an emotional lack of control.

CONCLUSIONS

the simulation improved nursing students' self-efficacy in palliative care. This effect was partially stronger in the active group.

Psychological well-being of hospice staff: systematic review

BACKGROUND

Poor psychological well-being among healthcare staff has implications for staff sickness and absence rates, and impacts on the quality, cost and safety of patient care. Although numerous studies have explored the well-being of hospice staff, study findings vary and the evidence has not yet been reviewed and synthesised. Using job demands-resources (JD-R) theory, this review aimed to investigate what factors are associated with the well-being of hospice staff.

METHODS

We searched MEDLINE, CINAHL and PsycINFO for peer-reviewed quantitative, qualitative or mixed-methods studies focused on understanding what contributes to the well-being of hospice staff who provide care to patients (adults and children). The date of the last search was 11 March 2022. Studies were published from 2000 onwards in the English language and conducted in Organisation for Economic Co-operation and Development countries. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was conducted using a result-based convergent design, which involved an iterative, thematic approach of collating data into distinct factors and mapping these to the JD-R theory.

RESULTS

A total of 4016 unique records were screened by title and abstract, 115 full-text articles were retrieved and reviewed and 27 articles describing 23 studies were included in the review. The majority of the evidence came from studies of staff working with adult patients. Twenty-seven individual factors were identified in the included studies. There is a strong and moderate evidence that 21 of the 27 identified factors can influence hospice staff well-being. These 21 factors can be grouped into three categories: (1) those that are specific to the hospice environment and role, such as the complexity and diversity of the hospice role; (2) those that have been found to be associated with well-being in other similar settings, such as relationships with patients and their families; and (3) those that affect workers regardless of their role and work environment, that is, that are not unique to working in a healthcare role, such as workload and working relationships. There was strong evidence that neither staff demographic characteristics nor education level can influence well-being.

DISCUSSION

The factors identified in this review highlight the importance of assessing both positive and negative domains of experience to determine coping interventions. Hospice organisations should aim to offer a wide range of interventions to ensure their staff have access to something that works for them. These should involve continuing or commencing initiatives to protect the factors that make hospices good environments in which to work, as well as recognising that hospice staff are also subject to many of the same factors that affect psychological well-being in all work environments. Only two studies included in the review were set in children's hospices, suggesting that more research is needed in these settings.

PROSPERO REGISTRATION NUMBER

CRD42019136721 (Deviations from the protocol are noted in Table 8, Supplementary material).

Staff well-being in UK children's hospices: a national survey

OBJECTIVES

Poor psychological well-being among healthcare workers can have numerous negative impacts, but evidence about levels of burnout in children's hospice care staff is limited. This study aimed to determine the prevalence of burnout and to explore the association between staff characteristics and support mechanisms with burnout among children's hospice care staff in the UK.

METHODS

Two national online surveys collecting data on hospice care staff psychological well-being and hospice organisational characteristics. All children's hospices in the UK were invited.Thirty-one hospices (out of 52) responded to the hospice survey and 583 staff responded to the staff survey. Data collection took place between May and December 2020 and measures included the Copenhagen Burnout Inventory, Work Engagement and the Health and Safety Executive Management Standards Indicator Tool.

RESULTS

Burnout prevalence was 11% and mean burnout score was 32.5 (SD: 13.1). Burnout levels were independent of working arrangements (eg, working from home or at the hospice) during the COVID-19 pandemic. Hospices performed well in most management standards, but poorly on the 'Control' domain. The average Work Engagement score for staff was 7.5 (SD: 1.5).

CONCLUSIONS

Burnout levels for staff in children's hospices in the UK were lower than in other healthcare settings, with this comparing to 17.3% among palliative care staff generally. Overall, hospices performed well in management standards and there was no indication of urgent action needed. Work Engagement in our sample was higher compared with other National Health Service workers during the COVID-19 pandemic.

Biophilic Design and Its Effectiveness in Creating Emotional Well-Being, Green Satisfaction, and Workplace Attachment Among Healthcare Professionals: The Hospice Context

OBJECTIVE

The present study aimed to explore the biophilic design attributes within a hospice care center from the healthcare professionals' perspective by utilizing a qualitative research and investigated the effect of hospice professionals' attitudes toward the uncovered green features on the prediction of their workplace attachment through a quantitative research.

BACKGROUND

In hospice establishments, studies showed that applying biophilic design principles significantly reduces stress and improves emotional well-being. Yet, despite its importance, attitude toward biophilic design, and its significant influence on well-being, satisfaction and attachment to the workplace of hospice healthcare professionals have not yet been researched.

METHODS

The qualitative research used semi-structured in-depth interviews among hospice professionals to reveal biophilic design features that exert an influence on their activity, while the quantitative research employed a confirmatory factor analysis and the structural equation modeling to analyze the data.

RESULTS AND CONCLUSIONS

The qualitative research generated five biophilic design features, such as open spaces with natural light, natural decorative elements, landscape provided by nature through windows, wooden furniture, and colors that create a warm atmosphere within the hospice care center. The quantitative approach indicated that attitude toward the uncovered biophilic design features in the context of the COVID-19 pandemic significantly improved the healthcare providers' emotional well-being. This dimension, in turn, contributed to their satisfaction with green features/natural decor and attachment to the workplace. Results of this study provide practitioners and researchers valuable strategies to incorporate biophilic design features in the working environments of hospice settings.

Work-related resources and demands predicting the psychological well-being of staff in children's hospices

OBJECTIVES

This study assessed the work-related resources and demands experienced by children's hospice staff to help identify staff support systems and organizational practices that offer the most potential to prevent staff burnout and enhance well-being at work.

METHODS

The relationships between individual and organizational characteristics, work-related resources and demands, and burnout and work engagement outcomes experienced by children's hospice staff were explored using two surveys: the Children's Hospice Staff survey, completed by UK children's hospice staff, and the Children's Hospice Organisation and Management survey, completed by the Heads of Care. We used structural equation modeling to assess the relationships between the variables derived from the survey measures and to test a model underpinned by the Job Demands-Resource (JD-R) theory.

RESULTS

There were 583 staff responses from 32 hospices, and 414 participants provided valid data for burnout and work engagement outcome measures. Most participants were females (95.4%), aged 51-65 years old (31.3%), and had more than 15 years of experience in life-limiting conditions (29.7%). The average score for burnout was 32.5 (SD: 13.1), and the average score for work engagement was 7.5 (SD: 1.5). The structural model validity showed good fit. Demands significantly predicted burnout (b = 4.65, p ≤ 0.001), and resources predicted work engagement (b = 3.09, p ≤ 0.001). The interaction between resources and demands only predicted work engagement (b = -0.31, p = 0.115). Burnout did not predict work engagement (b = -0.09, p = 0.194).

SIGNIFICANCE OF RESULTS

The results partly supported the JD-R model, with a clear association between resources and work engagement, even when the demands were considered. Demands were only directly associated with burnout. The findings also identified a set of the most relevant aspects related to resources and demands, which can be used to assess and improve staff psychological well-being in children's hospices in the UK.

Talking about dying and death: Essentials of communicating about approaching death from the perspective of major stakeholders

OBJECTIVES

Although caring for dying patients and their family caregivers (FC) is integral to patient care, training in communication about approaching death is almost inexistent in medical and nursing curricula. Consequently, many health professionals have insufficient knowledge about conducting these conversations. In order to gain a broader insight into essential aspects of this communication from different perspectives, we conducted focus groups with key stakeholders.

METHODS

Medical specialists, nurses, medical students, bereaved FC and patient representatives participated in five focus groups (n = 30). Following a focus group schedule, we elicited relevant aspects of communication about approaching death, associated emotions, and appropriate communication frameworks. We analyzed data thematically.

RESULTS

Four main themes were central to conversations about approaching death: (1) embracing care within medical expertise, (2) preparing the conversation while remaining open to the unexpected, (3) recognizing and reflecting on own emotions and reactions, and (4) establishing a meaningful connection with others.

SIGNIFICANCE OF RESULTS

Communicating about approaching death with dying patients and their FC can be complex and challenging at a professional and personal level. With the recognition of the dying phase, a process is initiated for which health professionals need solid clinical knowledge about but also effective communication skills, constant self-reflection and self-care strategies. Comprehensive training and supervision while dealing with the challenges of communicating approaching death to dying patients and their FC are key, particularly for trainees, less experienced physicians and nurses. The essential components identified in this study can help health professionals to master these conversations.

Too Close for Comfort? Attitudes of Gynecologic Oncologists Toward Caring for Dying Patients

PURPOSE

To assess gynecologic oncologists' attitudes relating to palliative care referrals among advanced cancer patients.

METHODS

Gynecologic oncologists were surveyed using validated measures to assess stigmatizing attitudes toward palliative care, anticipated stigma of palliative care, acceptance of palliative care, and willingness to refer to palliative care. Descriptive statistics were calculated. Analysis was performed using linear regression.

RESULTS

1200 physicians received the survey and 108 (9%) completed it. Most were female (69.4%) and white (82.4%). Most practiced in academics (64.8%) in urban environments (71.3%). Respondents did not have anticipated stigma surrounding palliative care referral (mean score 1.89, range 1-7, higher score indicating more stigma), were accepting of palliative care (mean score 1.45, range 1-7, higher score indicating less acceptance), and were willing to refer patients to palliative care (mean score 5.75, range 1-7, higher score indicating more willingness to refer). Linear regression demonstrated females had less anticipated stigma surrounding palliative care (B = -.213, P = .04) and higher acceptance of palliative care (B = -.244, P = .01). Most surveyed derived satisfaction from work with advanced cancer patients (83%). Nineteen percent were depressed by managing advanced cancer patients. One fourth felt emotionally burned out by dealing with too many deaths.

CONCLUSIONS

Most gynecologic oncologists did not exhibit stigma surrounding palliative care and derive satisfaction from their work. Some gynecologic oncologists experience depression and burnout related to their profession. This close connection with patients as they transition to the end of life may take a toll on providers.

Euro-Burn I: Assessment of burnout syndrome in health workers in a mediterranean country during the SARS-CoV-2 pandemic

BACKGROUND

Burnout syndrome (BS) has a negative impact among health professionals.

AIMS

Our research objective is to quantify the level of burnout in health workers of the Spanish National Health System during the COVID-19 pandemic using and comparing two independent measurement instruments.

METHODS

Cross-sectional, descriptive and multicenter study conducted through an anonymous online survey among health workers of the National Health System, measuring the level of burnout using the Maslach Burnout Inventory (MBI) and the Copenhagen Burnout Inventory (CBI).

RESULTS

A total of 448 questionnaires were analyzed, the mean age of the participants was 43.53 years (range: 20-64), 365 (81.5%) women. 161 (35.9%) participants presented BS measured with the MBI and 304 (67.9%) measured with the CBI. Regarding work contract, those who had greater job stability presented a higher degree of cynicism with respect to the eventual ones (p = .010), the eventual ones presenting higher mean scores in professional efficacy (p = .034). Urban workers had higher scores of exhaustion (p < .001) and cynicism (p < .001) than those living in rural areas. When comparing both tests, a high predictive value for exhaustion and cynicism was found to measure BS through the CBI (AUC = 0.92 and 0.84, respectively) and a low AUC with respect to the predictive value for efficacy (AUC = 0, 59).

CONCLUSIONS

The results obtained show a high level of BS among the health workers who participated in our study. Both tests have an excellent correlation in the degree of exhaustion and cynicism, but not in efficacy. The BS measurement must be performed with at least two validated instruments to increase its reliability.

Physicians' Knowledge, Attitudes, and Perception Toward Pediatric Palliative Care in Saudi Arabia: A National Exploratory Survey

Background

Pediatric palliative care (PPC) helps maintain the quality of life for both children and their families. It has been identified as an important goal within the global health agenda. In Saudi Arabia, the discipline remains in its infancy, as illustrated by the absence of PPC programs in academic and health care institutions.

Aim

The aim was to conduct a pilot study assessing physicians' knowledge, attitudes, and perceptions toward PPC.

Method

Data were gathered through a self-administered questionnaire sent to physicians working in Saudi Arabia.

Results

One hundred twelve completed the survey (male 54.2%, n = 50). A total of 40.8% (n = 42) had 20 years or more of experience, 42.9% (n = 48) were from the hematology-oncology specialty, and 68.5% (n = 74) received no training in PPC. Half suggested that children should be informed of their condition but mostly when reaching 12 or 15 years of age. Various physicians reported that the most appropriate time to discuss a transition to palliative care goals is when diagnosing an incurable condition or when despite all efforts, a condition continues to progress and death is expected.

Conclusion

Multiple gaps were identified. PPC basic concepts should be included in the formal medical curriculum (e.g., pain management, communication, and ethical considerations at the end of life). There is also a significant need to develop further both primary and specialized palliative care.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

Palliative care nurses' experiences of stress, anxiety, and burnout: A thematic synthesis

OBJECTIVES

This systematic literature review aimed to critically appraise empirical evidence investigating palliative care (PC) nurses' experiences of stress, anxiety, and burnout.

METHODS

Six databases (PsycINFO, MEDLINE, Scopus, CINAHL, PubMed, and Web of Science) covering literature within psychology, medicine and healthcare, and social sciences were searched from inception until December 2020. Studies were eligible if they included qualitative literature reporting on experiences of nurses working in a PC setting of stress, anxiety, or burnout, and were published in English. Eighteen studies satisfied the review's inclusion criteria and were considered relevant to the review aims. Critical appraisal was undertaken using the Critical Appraisal Skills Programme Qualitative Checklist.

RESULTS

Thematic synthesis identified three main themes: When work becomes personal, The burden on mind and body, and Finding meaning and connection. The findings suggested that stress, anxiety, and burnout are deeply personal feelings experienced by nurses both on an emotional and physical level. Additionally, PC nurses' experiences can differ in meaning and strength depending on their relationships with patients, patients' families, and colleagues.

SIGNIFICANCE OF THE RESULTS

The synthesis highlighted that PC nurses' experiences are complex, encompassing clinical and organizational challenges, and the personal impact their work has on them. Having a greater understanding of the factors that contribute to PC nurses' experiences may help in PC nurses' core training and continuing professional education, as well as the provision of effective supervision and staff support.

[Burnout syndrome due to workload in the care for cancer patients]

Background

The burnout syndrome (BS) is defined as a response to chronic work stress. It appears as a subjective phenomenon and its main symptoms are the loss of enthusiasm towards work, a feeling of professional failure, feelings of guilt, emotional exhaustion and indifference to patients' problems.

Objective

To evaluate the prevalence of BS in health personnel who care for cancer patients in a tertiary hospital.

Material and methods

Descriptive cross-sectional study. The sample consisted of 41 health professionals dedicated to providing direct care to cancer patients, which were selected through an intentional non-probabilistic sampling. The Questionnaire for the Evaluation of the Burnout Syndrome was applied.

Results

In the sample studied, BS presented a prevalence of 51.21% at the medium level, 9.75% at the high level and 2.43% at the critical level. Significant differences were found between groups by service and work seniority.

Conclusions

A high prevalence of symptoms of BS was found in the study participants, derived mainly from the excessive workload, the type of care provided, as well as experiences related to contact with people living with cancer, the hospital environment, and the type of interpersonal relationships that emerge there. The personnel most affected was that one belonging to Medical Oncology, Psychology, and Social Work.

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

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

Over a third of palliative medicine physicians meet burnout criteria: Results from a survey study during the COVID-19 pandemic

BACKGROUND

Palliative medicine physicians may be at higher risk of burnout due to increased stressors and compromised resilience during the COVID-19 pandemic. Burnout prevalence and factors influencing this among UK and Irish palliative medicine physicians is unknown.

AIM

To determine the prevalence of burnout and the degree of resilience among UK and Irish palliative medicine physicians during the COVID-19 pandemic, and associated factors.

DESIGN

Online survey using validated assessment scales assessed burnout and resilience: The Maslach Burnout Inventory Human Services Survey for Medical Personnel [MBI-HSS (MP)] and the Connor-Davidson Resilience Scale (CD-RISC). Additional tools assessed depressive symptoms, alcohol use, and quality of life.

SETTING/PARTICIPANTS

Association of Palliative Medicine of UK and Ireland members actively practising in hospital, hospice or community settings.

RESULTS

There were 544 respondents from the 815 eligible participants (66.8%), 462 provided complete MBI-HSS (MP) data and were analysed. Of those 181/462 (39.2%) met burnout criteria, based on high emotional exhaustion or depersonalisation subscales of the MBI-HSS (MP). A reduced odds of burnout was observed among physicians who worked ⩽20 h/week (vs 31-40 h/week, adjusted odds ratio (aOR) 0.03, 95% confidence interval (CI) 0.002-0.56) and who had a greater perceived level of clinical support (aOR 0.70, 95% CI 0.62-0.80). Physicians with higher levels of depressive symptoms had higher odds of burnout (aOR 18.32, 95% CI 6.75-49.73). Resilience, mean (SD) CD-RISC score, was lower in physicians who met burnout criteria compared to those who did not (62.6 (11.1) vs 70.0 (11.3); p < 0.001).

CONCLUSIONS

Over one-third of palliative medicine physicians meet burnout criteria. The provision of enhanced organisational and colleague support is paramount in both the current and future pandemics.

Burnout and occupational stress among Hungarian radiographers working in emergency and non-emergency departments during COVID-19 pandemic

INTRODUCTION

The increased workload caused by the coronavirus pandemic may have had a significant impact on the mental health of radiographers. The aim of our study was to investigate burnout and occupational stress in radiographers working in emergency departments (ED) and non-emergency departments (NED).

METHODS

Quantitative, cross-sectional, descriptive research was carried out among radiographers working in the public health sector in Hungary. Due to the cross-sectional nature of our survey, there was no overlap between the ED and NED groups. For data collection, we used simultaneously the Maslach Burnout Inventory (MBI), the Effort-Reward Imbalance questionnaire (ERI), and our self-designed questionnaire.

RESULTS

We excluded incomplete questionnaires from our survey; finally, 439 responses were evaluated. Significantly higher scores for depersonalisation (DP; 8.43 (SD = 6.69) vs. 5.63 (SD = 4.21) and emotional exhaustion (EE; 25.07 (SD = 11.41) vs. 19.72 (SD = 11.72)) were observed in radiographers working in ED (p = 0.001; p = 0.001) when compared to NED. Male radiographers working in ED aged 20-29 and 30-39 years with experience of 1-9 years were more affected by DP (p ≤ 0.05). Worrying about one's own health had a negative effect on DP and EE (p ≤ 0.05). Having close friend with a COVID-19 infection had a negative effect on EE (p ≤ 0.05); not being infected with coronavirus, not being quarantined and relocating within the workplace had a positive effect on personal accomplishment (PA); radiographers who were 50 years or older with 20-29 years of experience were more affected by depersonalisation (DP); and those who worried about their health had significantly higher stress scores (p ≤ 0.05) in both ED and NED settings.

CONCLUSION

Male radiographers at the beginning of their careers were more affected by burnout. Employment in EDs had a negative impact on DP and EE.

IMPLICATIONS FOR PRACTICE

Our results support the implementation of interventions to counter the effects of occupational stress and burnout among radiographers working in ED.

Resourcefulness and stress among hospice and palliative nurses: the role of positive thinking

Background: Among healthcare professionals, hospice and palliative nurses have a high risk of experiencing work stress. However, little attention has been paid to protective factors that could mitigate the impact of daily stressors on hospice and palliative nurses. Aim: This study aimed to determine whether resourcefulness and positive thinking have a negative association with perceived stress among hospice and palliative nurses, and whether positive thinking moderates or mediates the link between resourcefulness and stress among hospice and palliative nurses. Method: A cross-sectional, correlational design was used to address these two aims. Results: A convenience sample of 86 hospice and palliative nurses (95% female) in the US completed an online survey. The results demonstrated that positive thinking and resourcefulness are useful predictors of stress reduction and help mitigate the effects of stress. Positive thinking did not mediate the relationship between resourcefulness and stress. Conclusion: Moderation analysis suggests that social resourcefulness may be especially helpful in reducing stress among hospice and palliative nurses with a low level of positive thinking.

The burden in palliative care assistance: A comparison of psychosocial risks and burnout between inpatient hospice and home care services workers

OBJECTIVE

Literature suggests that home care professionals could be at higher risk of burnout than their colleagues in hospital settings, but research on home-based palliative care is still limited. Our study investigates psychosocial risk factors and burnout among workers involved in palliative care, comparing inpatient hospice, and home care settings.

METHOD

A cross-sectional study was carried out in a single palliative care organization providing inpatient hospice-based and home care-based assistance in a large urban area of Northern Italy. Participants completed a self-administered questionnaire collecting socio-demographic and occupational data, psychosocial risk factors, and burnout scales (Psychosocial Safety Climate 4; Conflict and Offensive Behavior - COPSOQ II; Work Life Boundaries; Work-home Interaction; Peer Support - HSE; Copenhagen Burnout Inventory).

RESULTS

The study sample included 106 subjects (95% of the overall eligible working population) who were predominantly female (68%) and nurses (57%), with a mean age of 41 years. Compared to inpatient hospice staff, home care workers reported more frequent communications with colleagues (p = 0.03) and patients/caregivers (p = 0.01), while there were no differences in the perception of work intrusiveness. Inpatient hospice workers showed lower peer support (p = 0.08) and lower psychosocial safety climate (p = 0.001) than home care colleagues. The experience of aggressive behaviors was rare, and it was relatively more frequent among inpatient hospice workers, female workers, and health assistants. Average scores of burnout scales were similar for both groups except for caregiver-related burnout, which was higher among inpatient hospice workers compared to home care colleagues (p = 0.008). The number of subjects at risk for work-related burnout was similar for both groups.

SIGNIFICANCE OF RESULTS

Our study confirms the presence of psychological and physical fatigue in both home-based and inpatient hospice palliative care. Results suggest that home care assistance may not be characterized by higher psychological burden compared to inpatient hospice setting. Given the general tendency to increase home-based care in our aging population, it is essential to broaden the knowledge of psychosocial risks in this specific context to properly protect workers' health.

Exploring the Brazilian pediatric palliative care network: a quantitative analysis of a survey data

OBJECTIVE

The aim of this study was to identify the characteristics of services in Brazil that compound the Brazilian Pediatric Palliative Care (PPC) Network.

METHODS

An online survey was conducted among representatives from PPC services. A total of 90 services from Brazil completed the online survey and answered a questionnaire about the service's characterization, health professionals working in PPC, access to opioid prescription and education, and research in PPC.

RESULTS

In total, 80 services (88.9%) were created after 2010, 52 (57.9%) were in the southeast region, 56 (62.2%) were in public hospitals, 63 (70%) had up to 100 beds, and 57 (63.3%) were at the tertiary level. Notably, 88 (97.8%) had a physician in the team and 68 (75.5%) dedicated part-time to PPC. Also, 33 (36.7%) revealed concern with the care of health professionals and 36 (40%) reported difficulty or no access to opioid prescription. Research studies were reported to be conducted in 29 (32.2%) services.

CONCLUSIONS

This mapping points out to a concentration of PPC services in the southeast region, with part-time professional dedication, and the need to improve professionals' care. Difficulty in opioid access was reported. It is necessary to extend PPC participation to other Brazilian regions, increase time dedicated to PPC, improve professionals' care and improve access to opioid prescription.

Burdens and Resources of Staff of a Specialized Ward for Neuropalliative Care: A Cross-Sectional Survey

Palliative care adds significant burdens to healthcare workers. In neuropalliative care (NPC), additional challenges include patient symptom burdens, such as impairments in mobility, cognition, and communication. After one year of operating the first NPC ward in Germany, we assessed burdens, resources, and the number of deaths perceived as stressful. NPC physicians and nursing staff were compared with the team of other neurological wards, including a stroke unit. The assessment took place between March 2022 and May 2022. All 64 team members were contacted; the responder rate was 81%. The perceived burden was high but did not differ between groups. There were no differences between the NPC- and the neurological wards in the number of deaths perceived as stressful. However, rather than the number of deaths, the circumstances of dying influence the perceived distress. The resources mentioned were similar between groups, with the team and private life being most important. Communication difficulties were frequently cited as stressful, whereas successful communication was identified as a resource.

Impact of COVID-19 pandemic on nurses' burnout and related factors: A rapid systematic review

AIM

This study aimed to investigate the effect of COVID-19 pandemic on nurses' burnout and related factors.

BACKGROUND

Nurses at the frontlines in every field of the health system and composed most of the health service industry closely experience all negative events during the pandemic.

METHODS

This study is a rapid systematic review.

RESULTS

A total of 751 studies were selected, of which 13 studies were compatible with the inclusion criteria. The sample size ranged from 107 to 12.596. The studies determined that nurses' burnout levels were generally moderate level and above during the COVID-19 pandemic. Sociodemographic, occupational, psychological, and COVID-19-related factors affected this burnout.

CONCLUSION

The results of this review may use to make implications that would ease the effect of the pandemic on nurses and develop strategies to protect nurses from burnout in similar possible situations. The protocol information is included here for blind peer review.

PROSPERO REGISTRATION NUMBER (ID)

CRD42021244849.

REGISTRATION AND PROTOCOL

Prior to undertaking the review, we registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42021244849. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244849. The changes made during the review process were registered in PROSPERO with an update.

Status and related factors of burnout among palliative nurses in China: a cross-sectional study

Background

Burnout occurs frequently in nurses and seems more common in nurses providing palliative care. However, to our knowledge, there is a lack of understanding regarding the factors influencing burnout among palliative nurses in China.

Methods

A cross-sectional design was conducted. A total of 331 palliative nurses from 25 hospitals participated in this study. Anonymous data were collected through a self-designed social-demographic questionnaire, the Nursing Burnout Scale, the Perceived Social Support Scale, the General Self-Efficacy Scale, the Connor-Davidson Resilience Scale, and the Simplified Coping Style Questionnaire. Independent sample t tests, one-way ANOVA, Pearson correlations, and multiple linear regressions were performed to identify the related factors of the three dimensions of burnout.

Results

In the results of multiple linear regression, resilience, health condition, coping style, and pessimistic personality were common related factors; in addition, end-of-life care training, social support, and income satisfaction were statistically significantly associated with burnout. These factors could explain 38.6%, 27.8%, and 34.5% of the total variance in emotional exhaustion, depersonalization, and reduced personal accomplishment, respectively.

Conclusions

The findings of this study help policy makers and nurse managers better understand burnout among palliative nurses in China. The results highlighted the importance of implementing culture-oriented training programs, providing perceived organizational support, and building a reasonable salary system to decrease burnout among palliative nurses, increase the quality of nursing and promote the development of Chinese palliative care.

Influence of Palliative Care Qualifications on the Job Stress Factors of General Practitioners in Palliative Care: A Survey Study

Due to demographic change, the number of patients in palliative care (PC) is increasing. General Practitioners (GPs) are important PC providers who often have known their patients for a long time. PC can be demanding for GPs. However, there are few studies on the job stress factors of GPs performing PC and the potential influence of their PC training. To get more insights, a postal survey was performed with GPs in North Rhine, Germany. The questionnaire was based on a literature search, qualitative pre-studies, and the Hospital Consultants' Job Stress & Satisfaction Questionnaire (HCJSSQ). Participants state that a high level of responsibility, conflicting demands, and bureaucracy are the most important stressors they experienced in PC. The influence of PC qualification level on their perceived job stress factors is low. Only advanced but not specialist qualification shows a correlation with renumeration-related stress. Gender and work experience are more dominant influences. In our study, female GPs and physicians with more work experience tend to be more stressed. In conclusion, organisational barriers, such as administration, should be reduced and renumeration should be increased to facilitate the daily work of GPs.

Challenges in Palliative Care Nursing at a University Hospital: A Qualitative Interview Study

We examined the perception of palliative care nurses regarding challenges, coping strategies, resources, and needs when working in a university hospital in Austria. A qualitative descriptive design was applied, using semistructured interviews with 8 female and 2 male nurses. All interviews were recorded as digital audio and transcribed verbatim. We used thematic analysis and MAXQDA. In our analysis, 6 themes emerged: Four themes related to challenges: ( a ) lack of a supporting structural framework, ( b ) conflict in interdisciplinary work, ( c ) conflict with caregivers, and ( d ) dealing with death in a highly specialized university environment. One theme related to ( e ) individual solutions and coping strategies, and 1 theme comprised ( f ) needs and suggestions for improvements. Taking care of the family of a dying person, handling threatening situation, and working with inexperienced physicians were among the most important challenges reported by nurses. A supportive team, professional counseling, and training related to communication skills and to culturally specific needs of families are perceived to be necessary to provide high-quality palliative care. Addressing the needs of nurses can substantially improve their working condition and has an impact not only on the nurses themselves but also on the quality of patient care.

Burnout and Nursing Care: A Concept Paper

Burnout comprises a series of undetermined physical and psychosocial symptoms caused by an excessive energy requirement at work-it is a crisis in relationships with work itself and not necessarily a concern with underlying clinical disorders related to workers. Professions involving human interactions commonly involve emotional engagement, especially when the cared-for person needs assistance and support, as is the primary concern in the nursing profession. To some extent, the acknowledgment of the phenomena of burnout and how it affects people is sometimes addressed from a biomedical perspective. This concept paper aims to describe the burnout concept and reflect on the impact on nurses. Our intention with this reflection, considering the burnout impact on nurses, is to support a paradigm change in the prevention and management of burnout in healthcare contexts, promoting and fostering the well-being of nurses.

Frequency and Prediction of Burnout Among Physicians Who Completed Palliative Care Fellowship Training - A 10 Year Survey

CONTEXT

Palliative Care (PC) physicians are vulnerable to burnout given the nature of practice. Reports suggest that burnout frequency is variable across different countries.

OBJECTIVE

The main objective of our study was to determine knowledge, attitudes and frequency of burnout among Hospice and Palliative Medicine (HPM) Fellowship graduates trained at a comprehensive cancer center.

METHODS

We conducted a survey to determine the knowledge, attitudes, and frequency of burnout in former fellows, consisting of the Maslach Burnout Inventory (MBI) and 41 custom questions. Palliative care fellows who trained at a Comprehensive Cancer Center from 2008 to 2018 were included in the survey.

RESULTS

Eighty-four percent of the 52 eligible physicians completed surveys. Median age was 38 years, with 68% females. Seventy-seven percent practiced PC more than 50% of time. Median practice duration was four years, and 84% were board certified. Most common disease types treated were cancer (89%), cardiac (43%) and pulmonary (43%). Burnout rate was high at 52% (n=20). The median scores for emotional exhaustion were 25.5, depersonalization 9, and personal accomplishment 48. Female gender (P=0.07) and having administration as a component in the job description (P=0.044) were associated with risk of burnout. Clinical care setting, work hours/week, frequency of weekend calls, and size of team were not significantly associated with burnout.

CONCLUSION

Burnout among former fellows trained in HPM between 2008 and 2018 is high. More research is needed to develop strategies to better prevent and manage burnout among HPM fellowship trained PC physicians.

The emotional impact of COVID-19 on Spanish nurses and potential strategies to reduce it

BACKGROUND

Although the emotional and psychological impact of nurses' work had been identified before the COVID-19 pandemic, the pandemic aggravated risk indicators for their mental health.

AIM

The objective of this study was to analyse the levels of anxiety, depression, post-traumatic stress and burnout of nurses in the Balearic Islands (Spain) during the pandemic to identify possible sociodemographic and related occupational factors.

DESIGN

A cross-sectional study of 892 nurses was conducted during four weeks from February to March 2021.

METHODS

Sociodemographic data related to the pandemic were collected and anxiety, depression, burnout and post-traumatic stress were measured with validated scales. A multivariate and predictive analysis was carried out with risk estimates.

FINDINGS

About 75.6% of the nurses had experience in COVID-19 units, and 49.1% had worked for more than 10 months in a COVID-19 unit. Nurses in COVID-19 units (hospital ward or ICU) were more likely to report emotional fatigue (OR 1.9, p < 0.001) and anxiety (OR 1.5, p = 0.021). In general, moderate post-traumatic stress was evident in general nurses (p = 0.027), and severe post-traumatic stress was evident in ICU nurses (p = 0.027). A 1.24-month reduction in COVID-19 patient care predicted reduced levels of emotional fatigue (5.45 points), depersonalisation (1.87 points) and post-traumatic stress (4.65 points) in nurses.

CONCLUSION

Given the occurrence of new waves of COVID-19, the need to establish preventive strategies that focus on the personal and occupational characteristics related to these indicators and to implement urgent psychological support strategies is demonstrated.

IMPACT

Given these findings, it is imperative solutions are urgently applied in order to prevent compounding risk to the health system.

Influencing factors of high PTSD among medical staff during COVID-19: evidences from both meta-analysis and subgroup analysis

Background

PTSD (Post-traumatic stress disorder, PTSD) had a great impact on health care workers during the COVID-19 (Corona Virus Disease 2019, COVID-19). Better knowledge of the prevalence of PTSD and its risk factors is a major public health problem. This study was conducted to assess the prevalence and important risk factors of PTSD among medical staff during the COVID-19.

Methods

The databases were searched for studies published during the COVID-19, and a PRISMA (preferred reporting items for systematic review and meta-analysis) compliant systematic review (PROSPERO-CRD 42021278970) was carried out to identify articles from multiple databases reporting the prevalence of PTSD outcomes among medical staff. Proportion random effect analysis, I² statistic, quality assessment, subgroup analysis, and sensitivity analysis were carried out.

Results

A total of 28 cross-sectional studies and the PTSD results of doctors and nurses were summarized from 14 and 27 studies: the prevalences were 31% (95% CI [confidence interval, CI]: 21%–40%) and 38% (95% CI: 30%–45%) in doctors and nurses, respectively. The results also showed seven risks (p < 0.05): long working hours, isolation wards, COVID-19 symptoms, nurses, women, fear of infection, and pre-existing mental illness. Two factors were of borderline significance: higher professional titles and married.

Conclusion

Health care workers have a higher prevalence of PTSD during COVID-19. Health departments should provide targeted preventive measures for medical staff away from PTSD.

Mental and Physical Well-Being and Burden in Palliative Care Nursing: A Cross-Setting Mixed-Methods Study

The working routines in palliative care nursing are associated with a variety of causes of stress with regional and setting-specific differences in Germany. This mixed-methods study aimed to investigate the mental and physical well-being among nurses in German palliative and hospice care and to gain a deeper understanding of procedural and structural aspects that may influence the mental and physical burden in palliative nursing care. The mixed-methods approach combined qualitative interviews, (n = 16) an online survey (n = 101), and subsequent data validation in a focus group (n = 6). Interview and focus group data were analysed using structured qualitative content analysis. Survey data were analysed using descriptive statistics and an explorative quantitative analysis. Moderate to very high levels of stress were reported across all settings, but were highest for nurses in specialized outpatient palliative care settings. Underlying causes of stress related to working conditions in the nursing profession across all palliative care settings were poor working hours, perceived inadequate remuneration, and high demands for documentation. To ensure sustainable high-quality palliative care, adaptations to working conditions that target causes of stress and burden in palliative care nurses are required.

Prevalence of burnout syndrome among unmatched trainees and residents in surgical and nonsurgical specialties: a cross-sectional study from different training centers in Palestine

BACKGROUND

Burnout is a psychological syndrome that involves physical, mental, and emotional exhaustion. This study was conducted to determine the prevalence of burnout among unmatched trainees and residents in surgical and nonsurgical specialties in Palestine. Additionally, this study also sought to identify the associated variables and predictors of higher burnout scores.

METHODS

This study was conducted in a cross-sectional design using a questionnaire in the period between October 2020 and March 2021. The questionnaire collected sociodemographic characteristics of the residents and trainees in 18 different training centers/hospitals. The Copenhagen Burnout Inventory was used to determine burnout among the residents and trainees. Pearson's correlations, analysis of variance, Student's t-test, and multiple linear regressions were used to analyze the data.

RESULTS

The study tool was completed by 250 residents and trainees in surgical and nonsurgical specialties (response rate = 83.3%). Of all participants, 203 (81.2%) reported a moderate-severe degree of burnout in the personal domain, 188 (75.2%) reported a moderate-severe degree of burnout in the work-related domain, and 97 (38.8%) reported moderate-severe degree of burnout in the client-related domain. There was a moderate and positive correlation between personal and work-related burnout scores (Pearson's r = 0.69, p-value < 0.001), and client-related burnout scores (Pearson's r = 0.52, p-value < 0.001). Similarly, there was a moderate and positive correlation between work-related and client-related burnout scores (Pearson's r = 0.57, p-value < 0.001). The multiple linear regression model showed that higher burnout scores were predicted by being married, not having another paid employment, inability to financially support oneself, frequent consumption of tea/coffee, dissatisfied with the training/job, thinking to change the profession, and long working hours.

CONCLUSION

The findings of this study indicated that burnout was highly prevalent among residents and trainees in surgical and nonsurgical specialties in Palestine. Decision-makers in healthcare authorities, hospital managers, professional groups, directors of residency programs, and educators/trainers should consider addressing burnout and improving the well-being of residents and trainees in surgical and nonsurgical specialties in Palestine. Future studies are still needed to determine which interventions could be effective in reducing burnout among residents and trainees in surgical and nonsurgical specialties in Palestine.

The relationships between self-efficacy, self-care ability, and burnout and compassion satisfaction among hospice staff in Taiwan

OBJECTIVES

Professional quality of life involves the negative and positive effects of proving care to terminal patients on health care professionals, including burnout and compassion satisfaction. Around 18% of hospice staff have experienced burnout, and few studies explore the role of an innate ability to cope with burnout. The aim of this study was to explore the significant predictors of burnout and compassion satisfaction as well as the coping strategies among hospice staff in Taiwan.

METHODS

A cross-sectional study was conducted, and 220 hospice staff were recruited. Standardized questionnaires were used to collect self-rated stress and growth due to hospice care, self-efficacy, self-awareness, and managing emotion.

RESULTS

Hospice staff who perceived higher stress and lower growth due to hospice care and had lower self-efficacy in providing hospice care experienced higher burnout and lower compassion satisfaction. Those who had a lower level of ability related to self-awareness and managing emotion tended to experience higher burnout. The common coping strategies included seeking social support, taking professional courses for clinical skills, and developing hobbies.

CONCLUSION

Hospice staff have to develop professional abilities in regard to hospice care as well as an ability to maintain awareness and manage emotions related to work.

A Pilot Observational Exploratory Study of Well-Being in Hospice Interdisciplinary Team Members

INTRODUCTION

Well-being and turnover intent represent key aspects to the promotion of a healthy workforce. Alarming levels of burnout and low levels of well-being have been documented in health professionals across care settings. Not only do high levels of burnout, low well-being and high turnover affect health professionals, but they are associated with poor patient care. However, limited research has investigated this topic specifically in hospice interdisciplinary team (IDT) members, nurses, chaplains, social workers. Thus, the purpose of this study was to explore hospice IDT members' well-being, and turnover intent.

METHODS

This observational, pilot study used quantitative surveys to examine the well-being, and turnover intention at baseline and at 3 months. Twenty-five hospice IDT members at one site participated.

RESULTS

Paired t-tests and percent change demonstrated significant decreases in compassion satisfaction (44.5 vs. 42.1, p = 0.04) and secondary traumatic stress score (18.5 vs. 13.3, p = 0.0001) and a significant increase in burnout score (17.6 vs. 20.5, p = 0.03) from baseline to follow up. Employee turnover slightly decreased from baseline to follow-up.

CONCLUSIONS

In this pilot study, hospice IDT members had low levels of well-being at baseline that worsened over 3-months indicating a higher potential risk for burnout. Moreover, given the COVID-19 pandemic, this may be an ominous sign of what lies ahead for hospice providers regarding turnover, leading to significant long-term staffing problems in the field. If these results hold true in a larger sample, it could necessitate developing and testing further strategies to ensure a healthy and stable workforce.

Investigating job satisfaction in palliative rehabilitation: Reflections and perspectives of health professionals working with amyotrophic lateral sclerosis

STUDY RATIONALE

Amyotrophic lateral sclerosis is a progressive neurodegenerative disease which causes impairment of the motor functions in the upper and lower limbs and bulbar muscles with a median survival time is three years from the first appearance of symptoms. There is massive psychological impact on health professionals to persons with amyotrophic lateral sclerosis, hence the work leads to multiple challenges and stressful and demanding situations with high risk of experiencing diminished personal well-being including burnout, moral distress, and compassion fatigue.

AIM

To investigate reflections and perspectives from health professionals working within palliative rehabilitation for elements of importance in relation to job satisfaction.

METHODS AND MATERIALS

The design was qualitative and based on the phenomenological-hermeneutical methodology by Paul Ricoeur's interpretation theory. Data consisted of two semi-structured focus group interviews with a total of 12 specialized health professionals: Nurses, Psychologists, Physicians, Occupational Therapists, Physiotherapists, and Social workers, working within a hospital setting of specialized palliative rehabilitation for people with amyotrophic lateral sclerosis and their families.

RESULTS

The analysis revealed insight into four themes: fundamental drive, working conditions, value of collegiality and work-life balance. Fundamental drive was deeply rooted in the professionals' sense of having a meaningful job. Working conditions such as self-management were important for job satisfaction as were good collegial relations. Finally, a good balance between working life and private life was considered important for job satisfaction.

CONCLUSION

Our study indicates that work within the field of palliative rehabilitation is experienced as enriching and beneficial under the right circumstances and in an appreciatory working environment. We found elements like autonomy, mastery, purpose, collegiality, and work-life balance to be of great importance. Our findings can help guide managements and health professionals in other palliative rehabilitation contexts to ensure satisfied employees and to optimize the quality of care.

Emotional Exhaustion of Burnout Among Medical Staff and Its Association With Mindfulness and Social Support: A Single Center Study During the COVID-19 Pandemic in Japan

BACKGROUND

Although higher rates of burnout have been reported during the COVID-19 pandemic, the contribution of the modifiable factors is lesser-known. We investigated how the risk of emotional exhaustion was associated with mindfulness skills and social support in a single medical center in Japan.

METHODS

We conducted a cross-sectional web survey on mental health for all staff of a national medical hospital from February to March 2021. We examined the association between self-rated emotional exhaustion and levels of mindfulness and social support using multivariate logistic regression.

RESULTS

Of the 830 participants, signs of emotional exhaustion were observed in 261 (31%) individuals. Among those highly exposed to the virus at work, individuals with low levels of mindfulness and social support had significantly higher odds of emotional exhaustion [OR 3.46 (95% CI; 1.48-8.09), OR; 3.08 (95% CI; 1.33-7.13), respectively] compared to those with high levels. However, among those not highly exposed to the virus, individuals with both low and moderate levels of mindfulness had significantly higher odds of emotional exhaustion. [OR 3.33 (95% CI; 2.22-5.00), OR; 2.61 (95% CI; 1.73-3.94), respectively].

CONCLUSION

We found that factors associated with emotional exhaustion differed by exposure to SARS-CoV-2. Building mindfulness skills can help reduce the high burden placed on the staff. Additionally, increasing social support may be useful especially for workers highly exposed to SARS-CoV-2.

A Japanese Nationwide Survey of Nutritional Counseling for Cancer Patients and Risk Factors of Burnout among Registered Dietitians

Purpose

Registered dietitians have played a key role in the nutritional management of cancer patients; however, no study has investigated the prevalence of burnout and associated factors among this population. The aim of this study was to investigate the following: (1) experiences, approaches, and perspectives during nutritional counseling, (2) the prevalence of burnout, and (3) burnout-associated factors among registered dietitians.

Methods

A nationwide survey with self-administered questionnaires was conducted for 1070 registered dietitians belonging to all 390 designated cancer hospitals in Japan. Nutrition counseling, the prevalence of burnout, and burnout-associated factors were analyzed.

Results

A total of 631 responses were analyzed. Half of the respondents recommended a consultation about treatment of symptoms or listened to their patients' distress and anxiety of death. Respondents with a severe level of burnout for emotional exhaustion, depersonalization, and personal accomplishment (PA) were 21.1%, 2.8%, and 71.9%, respectively. Burnout was associated with fewer years of clinical experience, more overtime hours, higher score of Patient Health Questionnaire-9, higher score of K-6, not so positive attitude about caring for dying patients, the approach of listening to the patients and family distress and anxiety about death, the uneasiness interacting with patients and families without an effective proposal, the difficulty of allocating staff without increasing medical costs, and the absence of feeling of a good contribution to patients and families.

Conclusions

The prevalence of burnout on PA was quite high. Registered dietitians who engaged in nutritional counseling for cancer patients and families might benefit from education to help protect against burnout.

Prevalence of Burnout in Portuguese Public Health Medical Residents amid the Response to the COVID-19 Pandemic

<b><i>Introduction:</i></b> Burnout is a psychological syndrome characterized by a state of emotional exhaustion, depersonalization, and a lack of personal accomplishment at the workplace. We aimed to evaluate the prevalence of burnout among Portuguese Public Health Medical Residents during the SARS-CoV-2 virus pandemic. <b><i>Methods:</i></b> Burnout was assessed with the Maslach Burnout Inventory – Human Services Survey, using a zero (never) to six (always) ordinal scale. Sociodemographic and workplace setting data were also collected. Categorical variables were presented as frequencies and percentages, and continuous variables as means and standard deviations (SDs). Chi-squared and independent sample <i>t</i> tests were used to evaluate the distributions of these variables, with a <i>p</i> value of 0.05. <b><i>Results:</i></b> Eighty-three people participated. The average age was 30.46 (±3.91), and 57.8% were female. We found that 77.11% had high levels of emotional exhaustion, 61.4% had high levels of depersonalization, and 44.6% had low levels of personal accomplishment. 32.5% of the participants were experiencing burnout, 30.5% were at high risk, 25.3% were at moderate risk, and 12% were at low risk. Burned-out participants had higher levels of emotional exhaustion (40.63 ± 7.36; mean ± SD) and depersonalization (15.63 ± 5.94; mean ± SD), and lower levels of personal achievement (29.42 ± 7.30; mean ± SD) than their peers. Regarding sociodemographic and work setting-related data, no statistically significant differences were found between professionals with and with no burnout. <b><i>Conclusion:</i></b> The present study shows high scores on all components of burnout and its prevalence among the population studied. Further studies are needed to determine whether this phenomenon was specific to this period.

Effect of soft skills and emotional intelligence of health-care professionals on burnout: a Lebanese cross-sectional study / Effekte von Soft Skills und emotionaler Intelligenz auf Burnout von Fachkräften im Gesundheitswesen: eine Querschnittsstudie aus dem Libanon

Objectives

The main objective of this study is to assess the effect of soft skills and emotional intelligence on burnout among health-care professionals in Lebanon.

Materials and methods

A cross-sectional study was conducted among health-care professionals working all over Lebanon for a period of 3 months starting from March till June 2021. In total, 324 out of 345 contacted health-care professionals responded. The survey was anonymous and administered via social networks as a link to an electronic form. The study included general sociodemographic questions and validated scales to measure emotional intelligence (Trait Meta-Mood Scale [TMMS-24]), burnout (Maslach Burnout Inventory for Health Services Survey [MBI-HSS]), and soft skills.

Results

Higher burnout was associated with lower soft skills (β = −0.137). Job satisfaction was negatively associated with burnout (β = −8.064). Nurses had higher burnout levels than dentists, radiologists, midwives, nutritionists, psychotherapists, and speech therapists (β = −4.595). Also, people working in Baalbek, Akkar, Beqaa, North and South had lower burnout levels compared to those working in Beirut (β = −9.015). As for emotional intelligence, no statistically significant association was found with burnout (P = 0.116).

Conclusion

This study showed that soft skills and emotional intelligence can affect job burnout. Additional research should be conducted in order to support our findings.

Emotional Intelligence and Perceived Health Related to Expressed Compassion Fatigue: A Study in Health Sector at Regional Level

Background: The work of health professionals often involves physical as well as psychological strain. They constantly deal with traumatic situations of pain and suffering, which destabilize the sense of well-being. Compassion fatigue is a feeling that appears in these cases and is related to other variables such as burnout or emotional drain.

Aims: The principal aim of this project was to deepen the analysis of compassion fatigue and how it could be explained through the relationship with other constructs such as emotional intelligence and perceived health.

Methods: This work followed the STROBE checklist for cross-sectional studies. In this study 1,521 nurses (M_age = 47.32; SD = 8.44) participated. The responses reported by the nurses were analyzed by classifying them as high or low compassion fatigue and the differences of both groups were analyzed for the variables of emotional intelligence, perceived health and quality of professional life.

Results: It was obtained significant differences for all factors except for emotional intelligence factor. A linear regression analysis showed both emotional intelligence and perceived health helped to explain (12%) compassion fatigue.

Conclusion: This study provides light on comprehending the conception of compassion fatigue. It highlights the importance of intervention programs that improve the quality of professional life.

Promoting evidence-based practice: training health professionals for the evidence synthesis

OBJECTIVE

To report the experience of the Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence in the training of health professionals, researchers, and professors in the Comprehensive Systematic Review Training Program, a course on Evidence Synthesis, specifically on Systematic Literature Reviews.

METHOD

This article aims to report the experience of the Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence in the implementation of the Comprehensive Systematic Review Training Program that trains health professionals, researchers, and teachers to develop Systematic Reviews, according to the JBI approach.

RESULTS

By the end of 2020, 11 editions of the course had been developed with 136 participants from different educational and health institutions, from different countries. As a result of the training of these participants, 13 systematic reviews were published in JBI Evidence Synthesis and 10 reviews were published in other journals.

CONCLUSION

The reported results and the students' satisfaction evaluation allow us to emphasize the relevance of the course for health professionals training on evidence synthesis.

Rationing of Nursing Care and Professional Burnout Among Nurses Working in Cardiovascular Settings

Introduction: Nursing needs close interpersonal contact with the patient and emotional involvement, therefore can contribute to professional burnout and rationing of nursing care.

Aim: Assessing the relationship between the rationing of nursing care and professional burnout in nursing staff.

Materials and Methods: The study included a group of 219 nurses working in cardiovascular facilities. This was a cross-sectional study designed to investigate the relationship between factors of the care rationing and professional burnout. The survey data was collected with standardised and research instruments such as the revised Basel Extent of Rationing of Nursing Care questionnaire (BERNCA-R) and the Maslach Burnout Inventory (MBI).

Results: The total mean BERNCA-R score was 1.38 (SD = 0.62), while the total MBI score amounted to 38.14 (SD = 22.93). The specific components of professional burnout yielded the values: emotional exhaustion (M = 44.8), job dissatisfaction (M = 40.66), and depersonalisation (M = 28.95). Multiple linear regression showed that independent predictors of BERNCA-R score were emotional exhaustion, depersonalisation, job dissatisfaction, and multi-jobs activity (p < 0.001).

Conclusion: The level of rationing of nursing care in cardiovascular facilities increases along with emotional exhaustion, depersonalisation and job dissatisfaction, and multi-jobs activity.

Differential Effects of Mindfulness-Based Intervention Programs at Work on Psychological Wellbeing and Work Engagement

Two different mindfulness-based interventions were deployed in a sample of white-collar workers to explore the differential effects on different facets of mindfulness, dimensions of psychological wellbeing, work engagement, performance, and stress of a participant. A total of 28 participants completed one of the different programs, and their results were compared between groups and against 27 participants randomly allocated to a waiting list control group. Results suggest both mindfulness intervention programs were successful at increasing the levels of psychological wellbeing, work engagement, and performance of the participants, as well as decreasing their levels of stress. Significant differences were found between the two programs in all outcome variables. Results suggest that brief and customized mindfulness interventions at work are as successful as lengthier programs.

Conducting proportional meta-analysis in different types of systematic reviews: a guide for synthesisers of evidence

BACKGROUND

Single group data present unique challenges for synthesises of evidence. Proportional meta-analysis is becoming an increasingly common technique employed for the synthesis of single group data. Proportional meta-analysis shares many similarities with the conduct and reporting of comparative, or pairwise, meta-analysis. While robust and comprehensive methods exist detailing how researchers can conduct a meta-analysis that compares two (or more) groups against a common intervention, there is a scarcity of methodological guidance available to assist synthesisers of evidence in the conduct, interpretation, and importance of proportional meta-analysis in systematic reviews.

MAIN BODY

This paper presents an overview targeted to synthesisers of evidence and systematic review authors that details the methods, importance, and interpretation of a proportional meta-analysis. We provide worked examples of how proportional meta-analyses have been conducted in research syntheses previously and consider the methods, statistical considerations, and presentation of this technique.

CONCLUSION

This overview is designed to serve as practical guidance for synthesisers of evidence in the conduct of proportional meta-analyses.

Prevention of work-related stress, fatigue, loss of cognitive function, attention and recovery of stamina with Robuvit® in professionals with increased oxidative stress

AIM

The aim of this open, pilot supplement registry study was to evaluate the protective, preventive effects of Robuvit® on professional-related fatigue symptoms and on aspects of cognitive functions, professional attitudes and decision-making in healthy nurses under professional stress and with increased oxidative stress.

RESULTS

In total, 40 subjects, aged 30 - 37, completed the 4-week registry study. A control group of 20 subjects used only the standard management (SM) and one group of 20 subjects took 300 mg Robuvit®. Safety and tolerability of Robuvit® were optimal. The two registry groups were comparable at inclusion. The overall scores of the real daily life & tasks questionnaire after 4 weeks were significantly higher in the Robuvit® group (p<0.05) as compared to controls. It increased from 4.3±0.4 at baseline to 6.78±0.8 after 4 weeks of Robuvit® intake and from 4.2±0.5 to 5.12±1.0 in the control group. The supplementation significantly improved the objective perception of fatigue in comparison with controls (p<0.05). A practical professional score evaluation provided an indication of professional attitude and stamina, in difficult, stressful working conditions under continuous pressure. The results showed that after 4-week supplementation all assessed parameters improved significantly and the difference with controls was statistically significant (p<0.05). Furthermore,oxidative stress as plasma free radicals decreased significant in the Robuvit® group (p<0.05) but not in the control group.

CONCLUSIONS

Robuvit® supplementation appears to improve most symptoms related to work-induced fatigue, stress and cognitive function and supports stamina. Further evaluations need to be planned according to the concept of this pilot registry in a field that requires more attention.

Healthcare Professionals' Work-Related Stress in Palliative Care: A Cross-Sectional Survey

CONTEXT

Providing palliative care can lead to work-related stress and ultimately to burnout. The need for palliative care will further increase due to population aging and people living longer with life-threatening diseases. Therefore, a healthy palliative care workforce is vital.

OBJECTIVES

This study aims to get insight into the experienced work-related stress among healthcare professionals providing palliative care in the Netherlands and their strategies and needs in relation to maintaining a healthy work-life balance.

METHODS

A cross-sectional online survey among members of the Dutch Association for Palliative Care Professionals was conducted between February and March 2020. Burnout was assessed by the validated Burnout Assessment Tool. Self-constructed questions assessed strategies and needs of healthcare professionals providing palliative care regarding work-related stress.

RESULTS

In total 179 eligible respondents responded (response rate 54%). Respondents were mostly female (79%) and older than 50 years (66%). Most respondents were nurses (47%) and physicians (39%). Two-thirds of respondents (69%) experienced a median level of burnout and 2% a (very) high level. Furthermore, 7% had been on sick leave due to burnout. Although healthcare professionals engage on average in 3.7 coping activities, a quarter (23%) felt that these activities were not sufficient to maintain balanced. Respondents feel a need for activities aimed at the team and organisation level such as feeling emotionally safe within their team.

CONCLUSION

Symptoms of burnout are quite prevalent among healthcare professionals providing palliative care in the Netherlands. Healthcare professionals have a need for team and organisation approaches to maintain a healthy work-life balance.