Burnout, psychological morbidity, job satisfaction, and stress: a survey of Canadian hospital based child protection professionals

Impacts on paediatricians testifying in cases of child maltreatment: protocol for a systematic review

INTRODUCTION

Paediatricians perform medical assessments for children in cases of suspected child maltreatment. Due to their role with statutory child protection agencies and police, paediatricians may be asked to testify in court about child protection and criminal justice matters. To the authors' knowledge, there has been no previous systematic review of the literature synthesising the evidence on the impacts on paediatricians testifying in cases of child maltreatment.

METHODS AND ANALYSIS

A search strategy comprising indexed and key terms will be applied to six electronic reference databases from inception to May 2023: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts and Cochrane Library. Two reviewers will independently screen titles and abstracts and full-text articles against predefined eligibility criteria to identify studies of interest. Conflicts will be independently adjudicated by a third reviewer.

ETHICS AND DISSEMINATION

Since the systematic review methodology aims at synthesising information from available publications, this study does not require ethical approval. An article reporting the results of the systematic review will be submitted for publication in a scientific journal, presented at relevant conferences and used in subsequent stakeholder consultations.

Examining resilience among child protection professionals during COVID-19: A global comparison across 57 countries

BACKGROUND

The COVID-19 pandemic led to numerous challenges for child protection professionals (CPPs). However, limited research has investigated the interwoven concepts of coping, resilience, and mental distress among CPPs during COVID-19 on a global scale.

OBJECTIVES

This study aimed to explore CPPs' practice, resilience, and mental distress during COVID-19, the relationship between their resilience and mental distress, the global stability of the Multi-System Model of Resilience (MSMR), and how CPPs' resilience varied according to the Human Development Index (HDI).

METHODS

Data were collected from 420 CPPs in 57 countries across five continents between July and September 2021. Participants completed an online questionnaire on demographics, resilience, mental distress, coping, and perceptions of child protection during the pandemic in their native languages. The analyses compared the countries grouped according to HDI using means comparisons, correlations, and multiple linear regressions. A two-path analysis was also performed to identify variables associated with behavioral resilience engagement and mental distress.

RESULTS

The findings indicated that CPPs' perceptions of COVID-19's impact on child maltreatment varied in correlation with their country's HDI. There were also significant HDI-based differences regarding the perceived opportunity to engage in resilient behavior and its helpfulness. Years of professional experience, internal resilience, and external resilience were shown to be significant predictors of mental distress among CPPs during the pandemic, and resilience mediated how years of experience predicted mental distress.

CONCLUSIONS

This study emphasized the importance of experience and internal resilience for CPPs' psychological well-being. It also provides empirical evidence to support the MSMR theory on a global scale. Additionally, it demonstrates how the perceived changes in child maltreatment during COVID-19 may be associated with regional HDI. Lastly, the opportunities CPPs had to engage in resilient behavior and how much this helped them was associated with regional HDI, but not in the way originally predicted. Study results also hold implications for how practice and policy may be altered to help CPPs cope better during times of crisis and generally.

The role of fellowship experience in decreasing burnout for child abuse pediatricians

BACKGROUND

Compassion fatigue and burnout are important issues within the medical field, and may be an even bigger problem for Child Abuse Pediatricians (CAPs). While the Accreditation Council for Graduate Medical Education (ACGME) mandates educational activities focused on burnout and resilience, there is currently minimal data to inform the choice and implementation of these activities.

OBJECTIVE

Our objectives were to: determine the availability and perceived usefulness of educational activities related to burnout and resilience available in CAP fellowships; and explore the relationship between fellowship activities and burnout.

PARTICIPANTS AND SETTING

Surveys were distributed in 2016 to 133 participants in CAP fellowships since 2006.

METHODS

Burnout risk was measured using the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Logistic regression models were used to assess the association of burnout as measured by the MBI-HSS with specific educational activities.

RESULTS

Of 133 eligible individuals, 85 (64 %) responded. Of these, 40 (53 %) scored in the high-risk range for at least 1 of the three subscales. Activities perceived to be most useful in addressing burnout were: multidisciplinary team interactions, time spent with the team outside of work, and faculty/trainee one-on-one mentorship. Educational activities were only weakly associated with addressing burnout as measured by the MBI-HSS.

CONCLUSIONS

Moderate or high levels of burnout are present in a large proportion of practicing CAPs and more than one-third of participants felt that the quality of burnout training in fellowship did not meet their needs. These data support the need to more effectively address burnout education within the training experience of CAP fellows.

The global impact of COVID-19 on child protection professionals: A scoping review and thematic analysis

BACKGROUND

The COVID-19 pandemic triggered new risks for child maltreatment (CM) and exacerbated existing challenges for families and children, elevating the importance of child protection professionals (CPPs) while also adding barriers to their work. During the pandemic, many CPPs experienced increased workloads, a disrupted work environment, and personal pandemic-related hardships. However, the scope of how COVID-19 impacted CPPs globally, as well as their adopted coping strategies, have not been well explored.

OBJECTIVE

This study addresses these gaps in the research by conducting an international scoping review to explore and analyze these topics.

METHOD

The scoping review was performed in six languages: English, Hebrew, Arabic, French, Spanish, and Portuguese, across 16 databases. Sixteen manuscripts were included in the final thematic analysis of this review.

RESULTS

Two main themes were identified: 1) the impact of COVID-19 on CPPs, and 2) the coping and adaptation strategies employed by CPPs during COVID-19. This review revealed and emphasized the importance of CPPs' resilience during COVID-19, underpinned by the theoretical framework of the social ecology of resilience.

CONCLUSIONS

This study highlights the responsibility of social ecologies and organizational structures to create readiness for a rapid response in times of crisis as well as valuable evidence to inform how CPPs, children, and families may be better supported in the event of a future crisis.

Decreasing Burnout and Improving Work Environment: The Impact of Firgun on a Pediatric Hematopoietic Cell Transplant Team

PURPOSE

Oncology teams are challenged by BO, which may be alleviated by meaningful recognition. In this study, firgun-altruistic acknowledgment-was implemented on a pediatric hematopoietic cell transplant unit to evaluate its impact on staff and work environment.

METHODS

In this longitudinal, mixed-methods pilot study, interdisciplinary inpatient hematopoietic cell transplant providers received web-based firgun education. Electronic administration of validated surveys occurred at baseline and 8 weeks, including Perceived Stress Scale, Professional Quality of Life Scale, Maslach Burnout Inventory, Workplace Civility Index, Areas of Work Life Survey, and WHO-5. Weekly e-mails reminded participants to practice and log firgun. Wilcoxon signed test for paired data compared pre/post results. Interviews conducted at project completion were coded using MaxQDA software.

RESULTS

Forty-two participants enrolled; 25 completed pre/post surveys; eight were interviewed. At study end, participants reported feeling less nervous and stressed (P = .008), and less difficulty coping (P = .01; Perceived Stress Scale), while noting increased acknowledgment of others' work (P = .04) and seeking constructive feedback (P = .04; Workplace Civility Index). Marked BO was not evident overall on the Maslach Burnout Inventory; however, emotional exhaustion subscale mean (SD) scores improved from pre (19.4 [8.6]) to post (16 [6.3; P = .02]) and individual items illustrated decreased fatigue (P = .008), frustration (P = .04), and feeling "at the end of my rope" (P = .001). Postintervention participants noted increased receipt of recognition (P = .02; Areas of Work Life Survey), decreased feeling "bogged down" (P = .02), decreased affective stress (P = .04), and negative pre-occupations (P = .04; Professional Quality of Life Scale). Qualitative analysis revealed themes of improved confidence at work and enhanced feelings of trust and teamwork.

CONCLUSION

Firgun is a tool that can potentially reduce BO and stress in interdisciplinary providers, facilitate teamwork, and promote positive work environments in clinical oncology and beyond.

Job Satisfaction and Burnout Levels of the Human Resources of a Public Oncology Hospital During the COVID-19 Pandemic

To investigate job satisfaction and burnout levels among the personnel of a public oncology hospital amid the COVID-19 pandemic, a cross-sectional survey was designed. The study was carried out from December 2021 to January 2022 through the application of an anonymous, structured, self-completed, closed-ended questionnaire, consisting of the Job Satisfaction Survey (JSS) and the Copenhagen Burnout Inventory (CBI) in a convenience sample comprised by 117 employees of "Agioi Anargyroi" General Oncology Hospital (response rate: 98%). It was observed that while overall job satisfaction was reduced, several of its determining dimensions like supervision, relationship with co-workers, or work nature were increased. Also, an average overall burnout of 49% was observed across all participants, with women, nurses, and those with a lower educational level experiencing it more intensely. The COVID-19 pandemic outbreak affected negatively healthcare professionals who experienced significant personal and occupational burnout, consequently reducing their job satisfaction.

Relationship between Job Burnout, Depressive Symptoms, and Career Choice Regret among Chinese Postgraduates of Stomatology

A qualified Chinese dental postgraduate requires at least eight years of training. The huge academic burden, strict clinical requirements, and high workload increases the risk of job burnout, depression symptoms, and career choice regret of dental postgraduates, which may cause one to waver in their choice of a career as a doctor. Therefore, we aimed at assessing the relationship between job burnout, depressive symptoms, and career choice regret among Chinese dental postgraduates. The Chongqing Stomatological Association conducted an online cross-sectional study among 558 dental postgraduates in China, with an average age of 22.54 ± 2.44. Demographic information, the Maslach Burnout Inventory, the 2-item Primary Care Evaluation of Mental Disorders scale, and career choice regret scale were included in the questionnaire. About 41.0% of dental postgraduates experienced job burnout, 44.1% had depressive symptoms, and 41.6% reported career choice regret. Logistic regression analysis indicated the risk factors for job burnout were time worked/studied per week, depressive symptoms, and career choice regret. Job burnout and career choice regret was significantly related to depressive symptoms (p < 0.001). Risk factors for career choice regret were gender, postgraduate entrance examination score, daily hours of sleep, job burnout, and depressive symptoms. Such results suggest that job burnout, depressive symptoms, and career choice regrets are prevalent among dental postgraduates. Accurate measures should be taken to change this situation.

How Stressful Is Examining Children with Symptoms of Child Abuse?-Measurement of Stress Appraisal (SAM) in German Physicians with Key Expertise in Pediatrics

BACKGROUND

Pediatricians frequently feel uncertain about their ability to detect early symptoms of child abuse and how to respond in suspected cases.

AIM

This study investigated the transactional stress model in German pediatricians who experienced imagination stories with a child protection scenario and another potentially stress-triggering scenario.

METHODS

A two-part survey was conducted online. Each part included a different imagination story and evaluation of the Stress Appraisal Measure (SAM), as well as questions on child protection, current problematics, and suggested remedies. In total, 96 pediatricians participated. The child abuse scenario was perceived as significantly more threatening and more stressful than a medical emergency. The pediatricians declared moderate familiarity with the Child Protection Guidelines and the Federal Child Protection Act and an average confidence in their application. The greatest perceived problems were communication difficulties with parents and youth welfare services. Suggested improvements were concrete procedural directives, more training programs, better interdisciplinary networks, and greater exchange among colleagues.

CONCLUSIONS

To optimize their potential in the child protection system, pediatricians need to be better supported in coping with the identified stressors in child abuse scenarios.

Occupational Stress among Dental Professionals

Stress at the work place was declared by the World Health Organization as a worldwide epidemic. The stress caused by work appears when the balance between one’s own possibilities and the environment demands is disturbed, which leads to a poor mental state. The fact is that the majority of dentists find they are under constant stress, which is caused by the nature of dental work. Literature describes dentistry as an extremely stressful profession. The main stressors include the tendency toward technical perfection, the causation of pain in patients, the lack of patient cooperation during dental treatment, the failure to maintain the given appointments. Adequate education and preparation, even during dental studies, non-neglect of symptoms and difficulties at the work place, adequate and timely response to the identification of the cause and its elimination or balancing, have a key role in solving this great problem in modern dentistry.

Building skills and resilience in child abuse pediatricians: A novel program to address Secondary Traumatic Stress

BACKGROUND

Secondary traumatic Stress (STS) is an increasingly recognized phenomenon experienced by clinicians working with patients who have experienced trauma firsthand. STS is experienced in a range of clinical settings; medical trainees and those working in Child Abuse Pediatrics (CAP) are at particular risk of experiencing STS. To date, there are no interventions described to address STS experienced by medical trainees in the context of CAP training.

OBJECTIVE

The aim of this project was to design and pilot an innovative program to increase resilience and address STS symptoms among fellows in a CAP training program.

PARTICIPANTS AND SETTING

The Therapeutic Group Sessions (TGS) program was developed for CAP fellows at the Hospital for Sick Children, Toronto, Canada.

METHODS

The intervention involved mandatory, monthly small group sessions facilitated by a consistent mental health professional throughout fellowship. Sessions included low intensity focusing activities, sharing impactful work-related experiences, mental health professional-led discussion of strategies and reflection on the session. Written evaluations were completed to understand the perceived impact on fellows and were analyzed for themes.

RESULTS

Fellows reported improvements in perceived STS symptoms and increased feelings of resilience. Unanticipated positive outcomes were described including, a highly bonded fellowship group and transferrable skills gained in supportive communication. Programs developed to support clinicians in other settings are reviewed and compared to the TGS program.

CONCLUSIONS

This is the first program aimed at improving resilience and addressing STS among child abuse fellows. Outcomes demonstrated numerous positive impacts that are widely applicable to the broader clinical setting.

Occupational Stress and Burnout Among Health Care Workers in Ethiopia: A Systematic Review and Meta-analysis

Objective

To estimate the pooled national burden of occupational stress, burnout, and contributing factors among health care workers in Ethiopia.

Data Sources

Both published and unpublished observational studies conducted on the burden of occupational stress and burnout among health workers in Ethiopia were included.

Study Selection

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO (CRD42020166585). The eligibility of the studies was evaluated based on predetermined inclusion and exclusion criteria.

Data Extraction

Data extraction was conducted using major databases; PubMed, Google Scholar, Cumulative Index to Nursing and Allied Health, Scopes, Cochrane Library, the Web of Science, and African Journals Online were involved in the review. Two reviewers extracted data independently using a standardized data extraction checklist on Microsoft Excel. Any discrepancy was resolved by including the third reviewer for a possible consensus.

Data Synthesis

Fourteen studies, with a total of 4066 health care workers, were included in the meta-analysis. The pooled burdens of occupational stress and burnout were 52.9% (95% confidence interval [CI], 46.2-59.7) and 39.1% (95% CI, 23.9-52.3), respectively. Major determinants of occupational stress were being female (odds ratio [OR], 1.9; 95% CI, 1.1-3.3), being younger (OR, 1.4; 95% CI, 1.03-1.9), having a lower educational level (OR, 2.7; 95% CI, 1.05-7.2), and being satisfied with a job (OR, 0.3; 95% CI, 0.2-0.5). Being married (OR, 0.7; 95% CI, 0.5-0.9), having a lower educational level (OR, 0.5; 95% CI, 0.4-0.8), and working in shifts (OR, 0.7; 95% CI, 0.5-0.9) were significant predictors of burnout.

Conclusions

More than half and more than one-third of health care workers were affected by occupational stress and burnout, respectively, in Ethiopia, and sociodemographic and occupation-related factors were significant factors. Measures that improve job satisfaction, career development, and educational opportunities should be strengthened.

Experience of Medical Disputes, Medical Disturbances, Verbal and Physical Violence, and Burnout Among Physicians in China

Background

Medical disputes, medical disturbances, verbal and physical violence against physicians, and burnout have reached epidemic levels. They may negatively impact both physicians and the healthcare system. The experience of medical disputes, medical disturbances, verbal, and physical violence, and burnout and the correlates in physicians working in public hospitals in China needed to be investigated.

Methods

A nationwide cross-sectional survey study was conducted between 18 and 31 March 2019. An anonymous online questionnaire was administered. The questionnaire included the 22-item Maslach Burnout Inventory-Human Services Survey (Chinese version). We also collected data on demographic and job-related factors, as well as physicians’ experiences of medical disputes, medical disturbances, verbal and physical violence from patients and the patients’ family members.

Findings

In total, 22,213 physicians from 144 tertiary public hospitals in all of China’s 31 provinces completed the survey. The overall burnout rate among the surveyed physicians was 31.28%. Moreover, 33.48% of physicians experienced disputes, 20.86% experienced disturbances, 48.52% experienced verbal violence, and 5.84% experienced physical violence in the past 12 months. Factors found to be significantly associated with burnout included younger age, being divorced or widowed, having a lower educational background, working in internal medicine departments, longer working hours per day, working in general hospitals, being in East China, as well as having experienced disputes, disturbances, and physical and verbal violence.

Interpretation

Close to a third of the Chinese doctors working in the tertiary hospitals reportedly experienced burnout, and the problem is related to the unsafe working environment caused by the worsening doctor-patient relationship.

Child Abuse Taking Its Toll on the Emotional Well-Being of Pediatricians

Pediatricians caring for patients with child abuse or neglect (CABN) may experience secondary traumatic stress (STS) from traumatized patients, or burnout (BO) from workplace stress. This may be buffered by compassion satisfaction (CS), positive meaning from one's work. For this study, STS, BO, and CS specific to a pediatrician's care of CABN were assessed for residents, hospitalists, intensivists, and outpatient physicians. Using the Professional Quality of Life Scale modified for CABN experiences, participants (n = 62) had a mean STS score at the 84th percentile, a mean BO score at the 66th percentile, and a mean CS score at the 17th percentile. Reporting one CABN patient as most emotionally impactful predicted STS, caring for all types of CABN predicted BO, and perceived knowledge no longer predicted CS when adjusting for the experience of mandated reporting or CABN fatality. These results highlight the need to support pediatricians involved with CABN.

Burnout, Job Dissatisfaction, and Mental Health Outcomes Among Medical Students and Health Care Professionals at a Tertiary Care Hospital in Pakistan: Protocol for a Multi-Center Cross-Sectional Study

Burnout, a state of vital exhaustion, has frequently been related to work-related stress and job dissatisfaction. Given the emotionally and physically challenging nature of their work, high rates of burnout have been reported among health care professionals. This may put them at a higher risk for of suffering from adverse mental health outcomes, including depression, anxiety and stress. In our study, we aim to assess the prevalence i of and associations among burnout and job dissatisfaction and adverse mental health outcomes in a developing country, where the challenges faced by the health care system are unique. Facilities are over-burdened and there is a sharp contrast between doctor to patient ratios in developing and developed countries. We plan to conduct a cross sectional study at the largest tertiary care hospital in Pakistan and its peripheral affiliated health centers. A proportionate sampling technique will be employed to include medical and nursing students, interns, residents and consultants. Previously validated questionnaires, including the Maslach Burnout tool, DASS 21, and Job Satisfaction Survey will be disseminated through Survey Monkey. Statistical analysis will be conducted using IBM SPSS Statistics Version 23 to study the association among burnout, job dissatisfaction, adverse health outcomes and demographic and work-related factors This study may begin laying the foundation for prioritizing the novel concept of physician mental health in the developing world. Further research building on to the results of this study will generate evidence to make recommendations about routine screening for mental illness and policy changes in the health care system.

Burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists

Objective:

To investigate the prevalence of and personal and professional characteristics associated with burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists.

Methods:

The China Neurologist Association conducted a national cross-sectional study from September 2014 to March 2015. A questionnaire including the Maslach Burnout Inventory, the 12-item General Health Questionnaire, the Consultants' Mental Health Questionnaire, and questions assessing personal and professional characteristics, career satisfaction, and current doctor-patient relationships was administered.

Results:

A total of 693 directors of neurology departments and 6,111 neurologists in 30 Chinese provinces returned surveys. Overall, 53.2% of responding neurologists experienced burnout, 37.8% had psychological morbidity, 50.7% had high levels of job stress, 25.7% had low levels of job satisfaction, 76.9% had poor doctor-patient relationships, and 58.1% regretted becoming a doctor. Factors independently associated with burnout were lower income, more hours worked per week, more nights on call per month, working in public hospitals, psychological morbidity, high levels of job stress, low levels of job satisfaction, and poor doctor-patient relationships. Factors independently associated with psychological morbidity included lower income, more nights on call per month, working in enterprise-owned hospitals, burnout, high levels of job stress, and low levels of job satisfaction.

Conclusions:

Burnout and psychological morbidity are common in Chinese neurologists. Burnout is the single greatest predictor of neurologists' psychological morbidity, high job stress, and low job satisfaction.

Extraversion, neuroticism and secondary trauma in Internet child abuse investigators

BACKGROUND

Working with victims and perpetrators of child sexual abuse has been shown to cause secondary traumatic stress (STS) in child protection professionals.

AIMS

To examine the role of gender and personality on the development of secondary trauma responses.

METHODS

A study of Internet child abuse investigators (ICAIs) from two UK police forces. Participants completed a personality test together with tests for anxiety, depression, burnout, STS and post-traumatic stress disorder to assess secondary trauma. The data were normally distributed and the results were analysed using an independent t-test, Pearson correlation and linear regression.

RESULTS

Among 126 study subjects (50 females and 75 males), there was a higher incidence of STS in investigators who were female, introverted and neurotic. However, there were lower levels of STS in the participants in this study than those found in other studies.

CONCLUSIONS

Psychological screening and surveillance of ICAI teams can help to identify risk factors for the development of STS and identify where additional support may be required.

The experience of paediatric residents participating in a child protection rotation: A qualitative study

BACKGROUND

Practitioners working in the field of child maltreatment are at risk for vicarious traumatization. For Canadian paediatric residents, exposure to child abuse during training is limited.

OBJECTIVE

To explore how paediatric residents experience a mandatory rotation within a hospital-based child protection team (CPT) from an emotional and professional development standpoint.

METHOD

Eight paediatric residents were interviewed following their CPT rotation and transcripts were analyzed using a phenomenological approach. Exemplar quotes were then highlighted.

RESULTS

FOUR MAJOR THEMES WERE IDENTIFIED: baseline experiences; individual resident factors; intrinsic CPT rotation factors; and overall rotation assessment. The themes and their subthemes were used to inform a conceptual model of residents' experiences.

CONCLUSIONS

The knowledge provided through residents' accounts can be applied to strengthen future educational opportunities in the field of child maltreatment and offer insight to help guide the development of support systems and debriefing processes that are important in this challenging field.

"Preventing the pain" when working with family and sexual violence in primary care

Primary care professionals (PCPs) are increasingly being expected to identify and respond to family and sexual violence as the chronic nature and severity of the long-term health impacts are increasingly recognized. This discussion paper reports the authors' expert opinion from their experiences running international workshops to prevent trauma among those who work and research sexual violence. It describes the burnout and secondary traumatic stress literature which provides the evidence supporting their work. Implications for practicing basic training in response to trauma and ongoing education are a key area for responding to family violence and preventing professional stress. A professional culture that supports and values caring well for those who have experienced family violence as well as "caring for the carer" is needed. Working in teams and having more support systems in place are likely to protect PCPs from secondary traumatic stress and burnout. Undergraduate and postgraduate training of PCPs to develop trauma knowledge and the skills to ask about and respond to family violence safely are essential. In addition, the healthcare system, workplace, and the individual practitioner support structures need to be in place to enable PCPs to provide safe and effective long-term care and access to other appropriate services for those who have experienced family violence.

Child abuse physicians: coping with challenges

This article explores how child abuse physicians (CAPs) experience the unique challenges of the emerging field of child abuse pediatrics. Practicing CAPs completed a written survey about known challenges in their field. Fifty-six CAPs completed the written survey and reported experiencing many negative consequences including: threats to their personal safety (52%), formal complaints to supervisors (50%) and licensing bodies (13%), negative stories in the media (23%), and malpractice suits (16%). A purposeful sample of CAPs participated in telephone interviews about these challenges. The 19 physicians who were interviewed described the challenges, while they spontaneously expressed satisfaction with their career and described some strategies for coping with the stresses of child abuse pediatrics. The findings highlight the stressors and challenges that may affect the ability to maintain an adequate CAP workforce. Better understanding of the challenges should help prepare physicians to practice this subspecialty.

Work pressure and patient flow management in the emergency department: findings from an ethnographic study

OBJECTIVES

In this hypothesis-generating study, we observe, identify, and analyze how emergency clinicians seek to manage work pressure to maximize patient flow in an environment characterized by delayed patient admissions (access block) and emergency department (ED) crowding.

METHODS

An ethnographic approach was used, which involved direct observation of on-the-ground behaviors, when and where they happened. More than 1,600 hours over a 12-month period were spent observing approximately 4,500 interactions across approximately 260 emergency physicians and nurses, emergency clinicians, and clinicians from other hospital departments. The authors content analyzed and thematically analyzed more than 800 pages of field notes to identify indicators of and responses to pressure in the day-to-day ED work environment.

RESULTS

In response to the inability to control inflow, and the reactions of inpatient departments to whom patients might be transferred, emergency clinicians: reconciled urgency and acuity of conditions; negotiated and determined patients' admission-discharge status early in their trajectories; pursued predetermined but coevolving pathways in response to micro- and macroflow problems; and exercised flexibility to reduce work pressure by managing scarce time and space in the ED.

CONCLUSIONS

To redress the linearity of most literature on patient flow, this study adopts a systems perspective and ethnographic methods to bring to light the dynamic role that individuals play, interacting with their work contexts, to maintain patient flow. The study provides an empirical foundation, uniquely discernible through qualitative research, about aspects of ED work that previously have been the subject only of discussion or commentary articles. This study provides empirical documentation of the moment-to-moment responses of emergency clinicians to work pressure brought about by factors outside much of their control, establishing the relationship between patient flow and work pressure. We conceptualize the ED as a dynamic system, combining socioprofessional influences to reduce and control work pressure in the ED. Interventions in education, practice, policy, and organizational performance evaluations will be supported by this systematic documentation of the complexity of emergency clinical work. Future research involves testing the five findings using systems dynamic modeling techniques.

Personality dimensions and their relationship with job satisfaction amongst Dutch nurse anaesthetists

AIM

This study investigates the relationship between personality dimensions and job satisfaction.

BACKGROUND

The shortage of nurses, and those voluntarily leaving their jobs, continues to be a problem affecting the delivery of healthcare all over the world, including anaesthesia. If it is found that nurse anaesthetists with certain personality types have high levels of job satisfaction, the information may be helpful for the retention of nurse anaesthetists.

METHODS

A questionnaire was distributed amongst Dutch nurse anaesthetists. Factor and multiple regression analyses were performed to reveal personality dimensions and their impact on job satisfaction.

RESULTS

Nine hundred and twenty-three questionnaires were completed and analysed (46% response rate). Two personality dimensions -'easy going' and 'orderly'- explained 3.5% of the variance in job satisfaction.

CONCLUSION

Personality dimensions as measured with the Myers-Briggs Type Indicator (MBTI) are only minimally relevant in predicting job satisfaction amongst Dutch nurse anaesthetists.

IMPLICATIONS FOR NURSING MANAGEMENT

Before using personality traits as a selection tool for retaining employees, it is important to understand the relationship of particular personalities to job satisfaction; it is also important to know which combination of personality traits is likely to create a highly cohesive work group.

[Guidelines and evidence. Recent developments in medical child protection]

Medical child protection comprises different types of involvement of physicians in order to protect children and adolescents from abuse and neglect. This review gives an overview of historical and recent developments in medical child protection. The professional foundation of medical involvement in this field requires a debate on the following questions: Is there evidence for the diagnostic criteria of child abuse and neglect? How far are the principles of evidence-based medicine applicable to the development of guidelines in child protection?

Burnout, psychosomatic symptoms and job satisfaction among Dutch nurse anaesthetists: a survey

BACKGROUND

To meet the increasing demand for healthcare providers, it is crucial to recruit and retain more nurse anaesthetists (NAs). The majority of NAs in the Netherlands are >45 years old, and retaining them in their jobs is very important. This study investigates the relationships among burnout, physical health and job satisfaction among Dutch NAs.

METHODS

Two thousand NAs working in Dutch hospitals were invited to participate in this online questionnaire. We tested the relationships among burnout, psychosomatic symptoms, sickness absence, perceived general health and job satisfaction.

RESULTS

Nine hundred and twenty-three questionnaires were completed and analysed (46% response rate). Burnout and psychosomatic symptoms were negatively associated with job satisfaction, and predicted 27% of job satisfaction. Perceived general health was positively and sickness absence was negatively related to job satisfaction. Older NAs had a higher incidence of burnout than their younger counterparts.

CONCLUSIONS

The results confirmed the importance of a healthy psychosocial work environment for promoting job satisfaction. To prevent burnout, further research is necessary to determine the factors causing stress. These findings may also apply to anaesthesiologists who share many tasks and work in close cooperation with NAs.

Combining job stress models in predicting burnout by hierarchical multiple regressions: a cross-sectional investigation in Shanghai

OBJECTIVE

To compare the predictive validity of the demand control and effort-reward imbalance model, alone and in combination with each other, for job burnout in Shanghai employees.

METHODS

A sample of 1368 Shanghai employees responded to a core job stress questionnaire and burnout scale in Chinese. Hierarchically moderated multiple regressions were used to analyze the relationship between job stress and burnout.

RESULTS

All factors from both job stress models predicted 33.5% of the variance in emotional exhaustion, and 20.9% in depersonalization and 5.5% in personal accomplishment. Factors from the effort-reward model demonstrated more power in predicting emotional exhaustion and depersonalization than that of demand control model. Personal accomplishment was significantly associated with sociodemographic factors.

OUTCOME

The combination of two models may improve our understanding of the relationship between the psychosocial work environment and job burnout.

Burnout, staff support, and coping in Pediatric Oncology

GOALS OF WORK

The goals of the study were the following: (1) to study the rate of burnout of the staff in Pediatric Oncology and compare it with that of a group of staff in other pediatric specialties, (2) to find out if job satisfaction, role clarity, staff support, and ways of coping are related to the burnout of these two groups, and (3) as a secondary aim, to identify other parameters, i.e., profession, experience, having children, etc., which might affect burnout, staff support, and ways of coping.

MATERIALS AND METHODS

The study group (n = 58) consisted of the staff of two Pediatric Oncology units and a Bone Marrow Transplantation unit, and the control group (n = 55) consisted of the staff of two Pediatric departments and one Pediatric Orthopedics department. The Maslach Burnout Inventory, the Staff Support Questionnaire, the Shortened Ways of Coping Questionnaire-Revised, and the Social Readjustment Scale were used.

MAIN RESULTS

No differences were found in burnout between Pediatric Oncology staff and that of other specialties, the existing staff support, and the ways of coping. Decreased role clarity and wishful thinking, as a way of coping, were positively correlated to emotional exhaustion, whereas a negative correlation of the lack of role clarity existed with personal accomplishment. Not having children and less experience increased burnout in both groups studied.

CONCLUSIONS

The hospital management and the heads of departments should be knowledgeable of ways to prevent burnout in their staff. Strategies targeting role clarity and wishful thinking are useful toward this goal.

A survey of the 16 Canadian child and youth protection programs: A threadbare patchwork quilt

BACKGROUND

Child abuse and neglect (CAN) represents an international public health and societal problem, the extent and nature of which are inadequately understood. Child and youth protection programs (CYPPs), based in 16 Canadian paediatric academic health science centres, identify, manage, treat and prevent cases of CAN.

OBJECTIVES

To ascertain the structure, resources and functioning of Canadian CYPPs.

METHODS

Telephone interviews were conducted with the directors of the 16 CYPPs.

RESULTS

Full-time equivalent staffing ranged from 0.25 to 18.7 people. All programs were staffed with physicians. The majority of programs had social workers (14 of 16) and administrative staff (12 of 16), while fewer programs had a dedicated nurse (nine of 16) or psychologists (six of 16). All CYPPs provided medical examinations and psychosocial assessments, consultation and coordination of CAN cases within the hospital and with community professionals, expert medico-legal opinions and representation in court, and hospital in-service and community outreach education and advocacy. Nine centres participated in regular multi-agency reviews of cases. Fourteen centres had specialized teams for acute sexual assault. Academic activities include lectures to medical students (16 of 16), undergraduate clinical electives (11 of 16), mandatory clinical rotations for paediatric residents (10 of 16) and/or electives (15 of 16), a fellowship (one of 16) and research on CAN-related issues (11 of 16). CAN documentation was inconsistent and limited, underestimating the number of cases assessed within the CYPPs.

CONCLUSION

CYPPs appear to need further resources to care for maltreated children and their families. A national, standardized database to document CAN cases would aid in the allocation of resources to help develop policies and programs that effectively address the needs of CAN victims and their families, and to prevent CAN.

Improving child protection: a systematic review of training and procedural interventions

AIM

To synthesise published evidence regarding the effectiveness of training and procedural interventions aimed at improving the identification and management of child abuse and neglect by health professionals.

METHODS

Systematic review for the period 1994 to 2005 of studies that evaluated child protection training and procedural interventions. Main outcome measures were learning achievement, attitudinal change, and clinical behaviour.

RESULTS

Seven papers that examined the effectiveness of procedural interventions and 15 papers that evaluated training programmes met the inclusion criteria. Critical appraisal showed that evaluation of interventions was on the whole poor. It was found that certain procedural interventions (such as the use of checklists and structured forms) can result in improved recording of important clinical information and may also alert clinical staff to the possibility of abuse. While a variety of innovative training programmes were identified, there was an absence of rigorous evaluation of their impact. However a small number of one-group pre- and post-studies suggest improvements in a range of attitudes necessary for successful engagement in the child protection process.

CONCLUSION

Current evidence supports the use of procedural changes that improve the documentation of suspected child maltreatment and that enhance professional awareness. The lack of an evidence based approach to the implementation of child protection training may restrict the ability of all health professionals to fulfil their role in the child protection process. Formal evaluation of a variety of models for the delivery of this training is urgently needed with subsequent dissemination of results that highlight those found to be most effective.