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Sexton JB, Adair KC. Well-Being Outcomes of Health Care Workers After a 5-Hour Continuing Education Intervention: The WELL-B Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2434362. [PMID: 39298170 PMCID: PMC11413716 DOI: 10.1001/jamanetworkopen.2024.34362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/14/2024] [Indexed: 09/25/2024] Open
Abstract
Importance Compromised well-being in health care workers (HCWs) is detrimental to the workforce, organizations, and patients. Objective To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program to deliver brief, evidence-based, reflective, psychological interventions to improve 4 dimensions of HCW well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration). Design, Setting, and Participants A randomized clinical trial (RCT) of US inpatient and outpatient HCWs randomized 1:1 was conducted from January 3 through May 31, 2023, using a web-based intervention. Cohort 1 received 5 hours of WELL-B over 8 days; cohort 2 acted as the control group and received WELL-B after the end of the RCT. Eligibility criteria were US HCWs aged 18 years or older, including clinical (physician, nurse, and respiratory therapist) and nonclinical (administrative, information technology, and finance) roles. Interventions Continuing education sessions exposed participants to positive psychology interventions (gratitude letter, work-life integration, self-compassion and cultivating awe). Main Outcomes and Measures The primary outcome was emotional exhaustion on day 8; secondary outcomes included emotional thriving, emotional recovery, and work-life integration. All outcomes were measured using psychometrically valid scales previously reported in well-being RCTs and were assessed on days 1 and 8 (primary end point). Differences in outcome measures between the WELL-B intervention group and controls were assessed using t tests. Baseline-adjusted multiple linear regression models were evaluated to examine the association between the WELL-B intervention and the outcome measures after adjusting for additional covariates (sex, race and ethnicity, age, HCW role, and discipline). Intention-to-treat analysis was performed. Results The cohorts were similar at baseline, mostly female (528 [89%]) and nurses (177 [30%]). A total of 643 respondents participated in the study. In cohort 1, 331 participants initiated WELL-B, and 262 (71%) completed the day 8 follow-up; in cohort 2, 312 participants initiated WELL-B and 291 (77%) completed the day 8 follow-up. Compared with the control cohort, WELL-B significantly improved emotional exhaustion (estimate: -9.0; 95% CI, -13.1 to -4.9; P < .001), emotional thriving (estimate: 6.6; 95% CI, 3.2-10.0; P < .001), emotional recovery (estimate: 5.5; 95% CI, 2.0-9.0; P = .002), and work-life integration (estimate: -5.0; 95% CI, -8.2 to -1.9; P = .002). After adjusting for baseline outcome measures, sex, race and ethnicity, age, HCW role, and discipline, the linear regression model showed WELL-B improved day 8 emotional exhaustion (estimate: -9.6; 95% CI, -12.5 to -6.6; P < .001) compared with the control group. Favorable impressions of WELL-B were reported by more than 90% of the participants. Conclusions and Relevance In this RCT, brief well-being activities delivered during continuing education sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration, with and without adjusting for covariates. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention. Trial Registration ClinicalTrials.gov Identifier: NCT05636072.
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Affiliation(s)
- J. Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, North Carolina
- Duke Center for the Advancement of Well-being Science, Duke University Health System, Durham, North Carolina
| | - Kathryn C. Adair
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, North Carolina
- Duke Center for the Advancement of Well-being Science, Duke University Health System, Durham, North Carolina
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Reece J, Yu M, Bevens W, Simpson-Yap S, Davenport R, Jelinek G, Neate S. Sociodemographic, Health, and Lifestyle-Related Characteristics Associated With the Commencement and Completion of a Web-Based Lifestyle Educational Program for People With Multiple Sclerosis: Randomized Controlled Trial. J Med Internet Res 2024; 26:e58253. [PMID: 39197163 PMCID: PMC11391162 DOI: 10.2196/58253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/10/2024] [Accepted: 07/02/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Digital health interventions increase access to multiple sclerosis (MS)-related knowledge for people living with MS; however, our understanding of factors associated with engagement in web-based learning is limited. OBJECTIVE This study aims to examine associations between participant sociodemographic, health, and lifestyle-related characteristics and the commencement and completion of the Multiple Sclerosis Online Course (MSOC) in a randomized controlled trial (RCT). METHODS An intervention course was developed based on the Overcoming MS Program-an evidence-based lifestyle modification program for MS, and a standard care course was developed based on international MS website information. An RCT was conducted to compare the effectiveness of the intervention course versus the standard care course in improving health outcomes in people living with MS. Participant data were collected from a baseline survey. Associations between baseline participant characteristics and MSOC commencement and completion, respectively, were assessed using multivariate log-binomial regression. RESULTS Overall, 1893 participants enrolled in the RCT, and 45.27% (n=857) completed the baseline survey: 23.5% (n=444) in the intervention course and 21.8% (n=413) in the standard care course. Of these 857 participants, 631 (73.6%) commenced the standard care course or intervention course, and 49.1% (218/444) and 54.2% (224/413) completed the intervention course and standard care course, respectively. University education, partnered relationship status, and higher mental and physical quality of life were associated with 19%, 12%, 20%, and 22% higher rates of course commencement, respectively. Clinically significant fatigue was associated with a 10% reduction in the likelihood of commencement. Strongest associations with intervention course completion included middle and older adulthood, male sex, fatigue, and preexisting adherence to a diet program, with 96%, 27%, 24%, and 19% higher rates of completion observed, respectively, whereas higher self-efficacy was associated with up to 35% lower intervention course completion. Associations with standard care course completion included practicing meditation (20% higher completion), whereas employment was associated with 22% lower completion. CONCLUSIONS Sociodemographic and clinical factors, as well as lifestyle-related factors, were important factors in MSOC commencement and completion. These data may help guide the design and enhancement of digital health interventions tailored for people living with MS. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001605886; https://tinyurl.com/2vyve9p9. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12883-023-03298-0.
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Affiliation(s)
- Jeanette Reece
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Maggie Yu
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - William Bevens
- Institute for Clinical and Translational Science, University of California, Irvine, CA, United States
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Rebekah Davenport
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - George Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sandra Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Chan KKY, Yeung NCY, Mo PKH, Yang X. Common stressors, coping processes, and professional help-seeking of medical professionals in Hong Kong: A qualitative study. J Health Psychol 2024; 29:891-904. [PMID: 38160404 DOI: 10.1177/13591053231218658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Despite the high prevalence of perceived stress and mental health problems among medical professionals (MPs), their professional help-seeking is extremely low. This qualitative study explored MPs' stressors, stress-coping, barriers and facilitators of professional help-seeking. 10 MPs (30% male, Mage = 34.8 years) were recruited by purposive-sampling for views from different roles/settings. Thematic analyses revealed five central stressors: emerging novel diseases, challenges from technology-advancement, patient-communication difficulties, lack of workplace mental health care culture, excessive workload/manpower shortage. Participants predominantly used peer support/supervision and de-stress activities for stress-coping. Five factors affecting professional help-seeking were time constraint versus flexibility, mental health stigma versus de-stigmatization, concern over confidentiality/anonymity versus sense of privacy, worry about damage on professional role versus least work disruption, doubts of service providers versus perceived efficacy. All participants indicated a preference for online mental health service delivery. Results reflected unmet needs and service gaps from MPs' perspectives for the development of future interventions.
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Affiliation(s)
| | | | | | - Xue Yang
- The Chinese University of Hong Kong, Hong Kong
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Tönis KJM, Drossaert CHC, Ten Klooster PM, Schaer M, Bourgeron T, Buitelaar JK, Sadaka Y, Freitag CM, Lapidus KM, Chiocchetti AG, Staal WG, Bohlmeijer ET. Effectiveness of a positive psychology and mindfulness-based app on mental health for parents of children with a neurodevelopmental disorder: study protocol of a pragmatic international randomized controlled trial. Trials 2024; 25:412. [PMID: 38926739 PMCID: PMC11210113 DOI: 10.1186/s13063-024-08256-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Parents of children with a neurodevelopmental disorder (NDD) experience more stress than parents of typically developing children. In a cocreation process with experts and parents, a low-threshold application that uses exercises based on the principles of positive psychology and mindfulness was developed. This application, called "Adappt," aims at enhancing the ability to adapt of the parents and caregivers of children with NDDs and at supporting their mental health. This protocol describes the evaluation study of the effectiveness of Adappt, its core working mechanisms and user experiences. METHOD A pragmatic international multicenter randomized controlled trial will compare the effectiveness of Adappt with a (delayed) waitlist control condition. At least 212 parents or primary caregivers of children younger than 18 years diagnosed with or suspected of a NDD will be randomly assigned to the intervention or waitlist control condition. Participants are excluded if they have severe anxiety or depression levels or are in treatment for mental health issues. Measures will be collected online at baseline, post-intervention (1 month after baseline), and 4 and 7 months after baseline. The primary outcome is the improvement in generic sense of ability to adapt as measured with the Generic Sense of Ability to Adapt Scale (GSAAS; (Front Psychol 14:985408, 2023)) at 4-month follow-up. Secondary outcomes are mental well-being, (parental) distress, and client satisfaction with "Adappt." DISCUSSION Results of this study will contribute to knowledge on the effectiveness of a low-threshold application for parents of children with a NDD in multiple countries. If the application is found to be effective in improving mental health, recommendations will be made for implementation in health care. TRIAL REGISTRATION This study is registered on clinicaltrials.gov (NCT06248762) on February 8, 2024, and the Open Science Framework ( https://osf.io/5znqv ).
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Affiliation(s)
- Kim J M Tönis
- Faculty of Behavioural, Management and Social Sciences, Section of Psychology, Health and Technology, University of Twente, 217 , Enschede, The Netherlands.
| | - Constance H C Drossaert
- Faculty of Behavioural, Management and Social Sciences, Section of Psychology, Health and Technology, University of Twente, 217 , Enschede, The Netherlands
| | - Peter M Ten Klooster
- Faculty of Behavioural, Management and Social Sciences, Section of Psychology, Health and Technology, University of Twente, 217 , Enschede, The Netherlands
| | - Marie Schaer
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thomas Bourgeron
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, IUF, Université Paris Cité, Paris, France
| | - Jan K Buitelaar
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Yair Sadaka
- Pediatric Neurology Unit, Pediatric Division, Soroka Medical Center of the Negev, Beer Sheva, Israel
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Goethe University, Frankfurt Am Main, Germany
| | - Keren Mayer Lapidus
- Negev Child Development Center of the Israel Ministry of Health, Beer Sheva, Israel
| | - Andreas G Chiocchetti
- Department of Child and Adolescent Psychiatry, Goethe University, Frankfurt Am Main, Germany
| | - Wouter G Staal
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
- Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Ernst T Bohlmeijer
- Faculty of Behavioural, Management and Social Sciences, Section of Psychology, Health and Technology, University of Twente, 217 , Enschede, The Netherlands
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Profit J, Cui X, Tawfik D, Adair KC, Sexton JB. "WISER" intervention to reduce healthcare worker burnout - 1 year follow up. J Perinatol 2024:10.1038/s41372-024-01993-5. [PMID: 38734802 DOI: 10.1038/s41372-024-01993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Test sustainability of Web-based Implementation for the Science of Enhancing Resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) emotional exhaustion (EE), a key component of burnout. DESIGN One-year follow-up of WISER RCT using two cohorts (one waitlist control with shortened intervention period) of HCWs of four NICUs each, to improve HCW well-being (primary outcome: EE). RESULTS In Cohorts 1 and 2, 194 and 312 WISER initiators were identified by 1-year, and 99 and 80 completed 1-year follow-up, respectively. Combined cohort results showed that relative to baseline, at 1-year WISER decreased EE (-7.07 (95%CI: -10.22, -3.92), p < 0.001), depression (-4.49 (-6.81, -2.16), p = <0.001), and improved work-life integration (6.08 (4.25, 7.90), p = <0.001). EE continued to decline between 6-month and 1-year follow-up (p = 0.022). The percentage of HCWs reporting concerning outcomes was significantly decreased for EE (-10.9% (95%CI: -17.9%, -4.9%); p < 0.001), and secondary outcomes depression and work-life integration. CONCLUSION WISER improves HCW well-being for at least 1 year. CLINICAL TRIALS NUMBER NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133.
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Affiliation(s)
- Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
| | - Xin Cui
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Daniel Tawfik
- Division of Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Kathryn C Adair
- Department of Psychiatry, Duke University School of Medicine; Duke University Health System, Durham, NC, USA
- Duke Center for the Advancement of Well-being Science, Duke University Health System, Durham, NC, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine; Duke University Health System, Durham, NC, USA
- Duke Center for the Advancement of Well-being Science, Duke University Health System, Durham, NC, USA
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Dean A. This Is PHM: A Lesson in Mindfulness From Global Health for the Mental Health Crisis. Hosp Pediatr 2024; 14:e240-e242. [PMID: 38646686 DOI: 10.1542/hpeds.2023-007611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Andrea Dean
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Powell M, Sexton B, Adair KC. Self-compassion letter tool for healthcare worker well-being: a qualitative descriptive analysis. BMJ Open 2024; 14:e078784. [PMID: 38580364 PMCID: PMC11002434 DOI: 10.1136/bmjopen-2023-078784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/10/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE This qualitative study aimed to identify categories within therapeutic self-compassion letters written by healthcare workers. Resulting categories were assessed for their relevance to the construct of self-compassion. DESIGN This was a qualitative descriptive study that used summative content analysis and inductive coding. SETTING A US-based academic healthcare system. PARTICIPANTS Healthcare workers who attended a self-compassion webinar were recruited. INTERVENTION The online self-compassion tool asked participants to write a letter to themselves from the perspective of a friend providing support and encouragement. RESULTS 116 letters were analysed. Five major categories emerged: Looking Forward, Reaffirming Self, Reaffirming Reminders, Hardships and Self-Disparagement. Respondents' letters were mostly positively framed and forward thinking, including their hopes of improving themselves and their lives in the future. Negative content generally described hardships and often served to provide self-validation or perspective on obstacles that had been overcome. CONCLUSION The writing prompt elicited content from the writers that reflected the core elements of self-compassion (ie, self-kindness, common humanity, mindfulness). Continued research to further understand, refine and improve the impact of therapeutic letter writing to enhance well-being is warranted to reduce burnout and promote quality patient care.
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Affiliation(s)
- Melissa Powell
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Bryan Sexton
- Duke Center for the Advancement of Well-Being Science, Duke University, Durham, North Carolina, USA
| | - Kathryn C Adair
- Duke Center for the Advancement of Well-Being Science, Duke University, Durham, North Carolina, USA
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Brouwer KR, Melander S, Walmsley LA, Norton J, Okoli C. A Mindfulness-Based Intervention for Acute Care Nursing Staff: A Pilot Study. J Holist Nurs 2024; 42:24-33. [PMID: 38459934 DOI: 10.1177/08980101231181004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
Purpose:The purpose of this study was to determine if a mindfulness-based smartphone application, used for 5 minutes a day for 30 days, could address burnout among acute care nursing staff. Methods: A pretest-posttest design with a midpoint evaluation was utilized. The sample included 31 nursing staff from cardiovascular acute care units. The Copenhagen Burnout Inventory, Cognitive and Affective Mindfulness Scale-Revised, Perceived Stress Scale, and Brief Resilience Scale were used to measure the impact of the intervention on participants. Findings: In a repeated measures analysis, there were no statistically significant changes in scores on the Brief Resilience Scale across the three timeframes (F = 0.64, df = 1.42, p = .49). There were significant reductions over time for perceived stress (F = 10.56, df = 1.74, p = .002) and personal burnout (F = 11.8, df = 1.10, p = .007), and increased scores on mindfulness (F = 4.76, df = 1.57, p = .039). Conclusions: The utilization of a mindfulness-based smartphone application may promote the health and well-being of cardiovascular nurses in acute care units. Mindfulness-based smartphone apps should be considered as a method of self-care, along with other holistic approaches to improve well-being.
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Cohen C, Pignata S, Bezak E, Tie M, Childs J. Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. BMJ Open 2023; 13:e071203. [PMID: 37385740 PMCID: PMC10314589 DOI: 10.1136/bmjopen-2022-071203] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
There is a growing need for interventions to improve well-being in healthcare workers, particularly since the onset of COVID-19. OBJECTIVES To synthesise evidence since 2015 on the impact of interventions designed to address well-being and burnout in physicians, nurses and allied healthcare professionals. DESIGN Systematic literature review. DATA SOURCES Medline, Embase, Emcare, CINAHL, PsycInfo and Google Scholar were searched in May-October 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that primarily investigated burnout and/or well-being and reported quantifiable preintervention and postintervention outcomes using validated well-being measures were included. DATA EXTRACTION AND SYNTHESIS Full-text articles in English were independently screened and quality assessed by two researchers using the Medical Education Research Study Quality Instrument. Results were synthesised and presented in both quantitative and narrative formats. Meta-analysis was not possible due to variations in study designs and outcomes. RESULTS A total of 1663 articles were screened for eligibility, with 33 meeting inclusion criterium. Thirty studies used individually focused interventions, while three were organisationally focused. Thirty-one studies used secondary level interventions (managed stress in individuals) and two were primary level (eliminated stress causes). Mindfulness-based practices were adopted in 20 studies; the remainder used meditation, yoga and acupuncture. Other interventions promoted a positive mindset (gratitude journaling, choirs, coaching) while organisational interventions centred on workload reduction, job crafting and peer networks. Effective outcomes were reported in 29 studies, with significant improvements in well-being, work engagement, quality of life and resilience, and reductions in burnout, perceived stress, anxiety and depression. CONCLUSION The review found that interventions benefitted healthcare workers by increasing well-being, engagement and resilience, and reducing burnout. It is noted that the outcomes of numerous studies were impacted by design limitations that is, no control/waitlist control, and/or no post intervention follow-up. Suggestions are made for future research.
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Affiliation(s)
- Catherine Cohen
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Silvia Pignata
- STEM, University of South Australia, Adelaide, South Australia, Australia
| | - Eva Bezak
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Mark Tie
- Australian Radiology Clinics, Adelaide, South Australia, Australia
| | - Jessie Childs
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Fahey DM, Rumaker K, Ordille J. Grieving while you work, working while you grieve: Grieving while you work. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2023; 31:100604. [PMID: 36688205 PMCID: PMC9844257 DOI: 10.1016/j.xjep.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/14/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
This work discusses the real and personal cost of the COVID-19 pandemic on the mind, body, and spirit of healthcare workers. It suggests a proactive and reactive response that participants can activate within themselves, their clinical teams, and their organizations. The pervasive losses, both death and non-death-related, have transformed how healthcare workers deliver care while grieving their personal and professional losses. This grief further complicates the mental health of healthcare workers. Evidence from previous outbreaks suggests that the psychological burden of the pandemic will have both short and long-term effects. Recovery involves healing the body with physical compassion, healing the mind by exploring difficult emotions, and healing the spirit by recognizing and reclaiming one's purpose and meaning. Three strategies: Spark Joy, Ambiguity Bookmark, and Healing and Restoration: a Nautical Journey through Grief demonstrate how small and intentional changes provide momentum and set the course for long-term transformation.
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Miller AG, Burr KL, Juby J, Hinkson CR, Hoerr CA, Roberts KJ, Smith BJ, Strickland SL, Rehder KJ. Enhancing Respiratory Therapists' Well-Being: Battling Burnout in Respiratory Care. Respir Care 2023; 68:692-705. [PMID: 37076431 PMCID: PMC10171344 DOI: 10.4187/respcare.10632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Burnout is a major problem in health care and is associated with adverse sequelae for patients, health care workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inadequate staffing, high work load, non-leadership position, and work environment. An understanding of burnout is necessary for both staff and leadership to ensure RT well-being. This narrative review will discuss the psychology of burnout, prevalence, drivers, mitigation strategies, and future directions for research.
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Affiliation(s)
| | | | - Jerin Juby
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Karsten J Roberts
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian J Smith
- University of California, Davis, Sacramento, California
| | - Shawna L Strickland
- Rush University, Chicago, Illinois; and American Epilepsy Society, Chicago, Illinois
| | - Kyle J Rehder
- Duke University Medical Center, Durham, North Carolina
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Kok N, Van Gurp J, van der Hoeven JG, Fuchs M, Hoedemaekers C, Zegers M. Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study. BMJ Qual Saf 2023; 32:225-234. [PMID: 34187883 PMCID: PMC10086276 DOI: 10.1136/bmjqs-2020-012239] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Burnout threatens intensive care unit (ICU) professionals' capacity to provide high-quality care. Moral distress is previously considered a root cause of burnout, but there are other risk factors of burnout such as personality, work-life balance and culture. This study aimed to disentangle the associations of ICU professionals' moral distress and other risk factors with the components of burnout-emotional exhaustion, depersonalisation and personal accomplishment-suggesting informed burnout prevention strategies. METHODS Cross-sectional survey completed in 2019 of ICU professionals in two Dutch hospitals. The survey included validated measure for burnout (the Dutch Maslach Burnout Inventory), moral distress (Moral Distress Scale), personality (short Big Five Inventory), work-home balance (Survey Work-Home Interaction Nijmegen) and organisational culture (Culture of Care Barometer). Each of the three components of burnout was analysed as a separate outcome, and for each of the components, a separate regression analysis was carried out. RESULTS 251 ICU professionals responded to the survey (response rate: 53.3%). Burnout prevalence was 22.7%. Findings showed that moral distress was associated with emotional exhaustion (β=0.18, 95% CI 0.9 to 0.26) and depersonalisation (β=0.19, 95% CI 0.10 to 0.28) and with increased emotional exhaustion mediated by negative work-to-home spillover (β=0.09, 95% CI 0.04 to 0.13). Support from direct supervisors mitigates the association between moral distress and emotional exhaustion (β=0.16, 95% CI 0.04 to 0.27). CONCLUSIONS Understanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work-home imbalance. Interventions that support individual coping with moral distress and a work-home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses.
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Affiliation(s)
- Niek Kok
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Malaika Fuchs
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cornelia Hoedemaekers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Mak S, Hunt M, Riccio SS, Razack S, Root K, Thomas A. Attrition and Retention of Rehabilitation Professionals: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; Publish Ahead of Print:00005141-990000000-00060. [PMID: 36881451 DOI: 10.1097/ceh.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Attrition is defined as a permanent departure from one's profession or the workforce. Existing literature on retention strategies, contributing factors to the attrition of rehabilitation professionals and how different environments influence professionals' decision-making to stay in/leave their profession, is limited in scope and specificity. The objective of our review was to map the depth and breadth of the literature on attrition and retention of rehabilitation professionals. METHODS We used Arksey and O'Malley's methodological framework. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, Scopus, and ProQuest Dissertations and Theses from 2010 to April 2021 for concepts of attrition and retention in occupational therapy, physical therapy, and speech-language pathology. RESULTS Of the 6031 retrieved records, 59 papers were selected for data extraction. Data were organized into three themes: (1) descriptions of attrition and retention, (2) experiences of being a professional, and (3) experiences in institutions where rehabilitation professionals work. Seven factors across three levels (individual, work, and environment) were found to influence attrition. DISCUSSION Our review showcases a vast, yet superficial array of literature on attrition and retention of rehabilitation professionals. Differences exist between occupational therapy, physical therapy, and speech-language pathology with respect to the focus of the literature. Push , pull , and stay factors would benefit from further empirical investigation to develop targeted retention strategies. These findings may help to inform health care institutions, professional regulatory bodies, and associations, as well as professional education programs, to develop resources to support retention of rehabilitation professionals.
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Affiliation(s)
- Susanne Mak
- Ms. Mak: Assistant Professor (professional), School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada, Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada, and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Québec, Canada. Dr. Hunt: Associate Professor, School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Québec, Canada. Ms. Riccio: Physical Therapist, PhysioMobile Inc., Montréal, Québec, Canada. Dr. Razack: Professor, Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada and Department of Pediatrics, McGill University, Montréal, Québec, Canada. Ms. Root: Assistant Professor (professional), School of Communication Sciences and Disorders, McGill University, Montréal, Québec, Canada. Dr. Thomas: Associate Professor, School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada, Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada, and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Québec, Canada
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Pilot Study on the Impact of Gratitude Journaling or Cognitive Strategies on Health Care Workers. J Pediatr Health Care 2023:S0891-5245(23)00029-9. [PMID: 36882351 PMCID: PMC9985770 DOI: 10.1016/j.pedhc.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has significantly impacted the mental well-being of health care workers (HCWs). This study assessed the feasibility, acceptability, and preliminary efficacy of two psychological interventions, gratitude journaling or cognitive strategies, on pediatric HCWs. METHOD A pilot randomized parallel repeated measures design was used, with a convenience sample of 59 HCWs. Data were collected before and after the intervention period, 2 weeks after, and again 6 months later. Outcomes included depression, anxiety, meaning and purpose, feasibility, and acceptability. RESULTS Thirty-seven participants completed the study. The majority were nurses (registered nurses and advanced practice registered nurses) and physicians. In both groups, depression and anxiety scores diminished, but changes were not statistically significant. The study was feasible to conduct, and subjects reported high acceptability. DISCUSSION Gratitude journaling and cognitive strategies may help mental well-being in HCWs; however, future studies with larger samples are needed.
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Rony MKK, Md Numan S, Alamgir HM. The association between work-life imbalance, employees' unhappiness, works impacts on family, and family impacts on work among nurses: A Cross-sectional Study. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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16
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Tawfik DS, Adair KC, Palassof S, Sexton JB, Levoy E, Frankel A, Leonard M, Proulx J, Profit J. Leadership Behavior Associations with Domains of Safety Culture, Engagement, and Health Care Worker Well-Being. Jt Comm J Qual Patient Saf 2023; 49:156-165. [PMID: 36658090 PMCID: PMC9974844 DOI: 10.1016/j.jcjq.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Leadership is a key driver of health care worker well-being and engagement, and feedback is an essential leadership behavior. Methods for evaluating interaction norms of local leaders are not well developed. Moreover, associations between local leadership and related domains are poorly understood. This study sought to evaluate health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey. METHODS The SCORE survey was administered to 31 Midwestern hospitals as part of a broad effort to measure care context, with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Mixed-effects hierarchical logistic regression was used to evaluate the relationships between local leadership scores and related domains, adjusted for role and work-setting characteristics. RESULTS Of the 23,853 distributed surveys, 16,797 (70.4%) were returned. Local leadership scores averaged 68.8 ± 29.1, with 7,338 (44.2%) reporting emotional exhaustion, 9,147 (55.9%) reporting concerning safety climate, 10,974 (68.4%) reporting concerning teamwork climate, 7,857 (47.5%) reporting high workload, and 3,436 (20.7%) reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 (95% confidence interval [CI] 0.71-0.73) for burnout, 0.48 (95% CI 0.47-0.49) for concerning safety climate, 0.64 (95% CI 0.63-0.66) for concerning teamwork climate, 0.90 (95% CI 0.89-0.92) for high workload, and 0.80 (95% CI 0.78-0.81) for intentions to leave, after adjustment for unit and provider characteristics. CONCLUSION Local leadership behaviors are readily measurable using a five-item scale and strongly associate with established domains of health care worker well-being, safety culture, and engagement.
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Proactive Patient Safety: Focusing on What Goes Right in the Perioperative Environment. J Patient Saf 2023; 19:281-286. [PMID: 36849540 DOI: 10.1097/pts.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Adverse events in the perioperative environment, a potential risk to patients, may be mitigated by nurturing staff adaptability and resiliency. An activity called "One Safe Act" (OSA) was developed to capture and highlight proactive safety behaviors that staff use in their daily practice to promote safe patient care. METHODS One Safe Act is conducted in-person in the perioperative environment by a facilitator. The facilitator gathers an ad hoc group of perioperative staff in the work unit. The activity is run as follows: staff introductions, purpose/instructions of the activity, participants self-reflect about their OSA (proactive safety behavior) and record it as free text in an online survey tool, the group debriefs with each person sharing their OSA, and the activity is concluded by summarizing behavioral themes. Each participant completed an attitudinal assessment to understand changes in safety culture perception. RESULTS From December 2020 to July 2021, a total of 140 perioperative staff participated (21%, 140/657) over 28 OSA sessions with 136 (97%, 140/136) completing the attitudinal assessment. A total of 82% (112/136), 88% (120/136), and 90% (122/136) agreed that this activity would change their practices related to patient safety, improve their work unit's ability to deliver safe care, and demonstrated their colleagues' commitment to patient safety, respectively. CONCLUSIONS The OSA activity is participatory and collaborative to build shared, new knowledge, and community practices focused on proactive safety behaviors. The OSA activity achieved this goal with a near universal acceptance of the activity in promoting an intent to change personal practice and increasing engagement and commitment to safety culture.
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Shahid M. Physician Well-Being and the Promise of Positive Psychology. Ochsner J 2023; 23:2-4. [PMID: 36936482 PMCID: PMC10016205 DOI: 10.31486/toj.22.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Affiliation(s)
- Mahum Shahid
- Director of Program Diversity and Early Career Development for Women in Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD
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Rehder KJ, Adair KC, Eckert E, Lang RW, Frankel AS, Proulx J, Sexton JB. Teamwork Before and During COVID-19: The Good, the Same, and the Ugly…. J Patient Saf 2023; 19:36-41. [PMID: 35948315 PMCID: PMC9788875 DOI: 10.1097/pts.0000000000001070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The COVID 19 pandemic placed unprecedented strain on healthcare systems and workers, likely also impacting patient safety and outcomes. This study aimed to understand how teamwork climate changed during that pandemic and how these changes affected safety culture and workforce well-being. METHODS This cross-sectional observational study of 50,000 healthcare workers (HCWs) in 3 large U.S. health systems used scheduled culture survey results at 2 distinct time points: before and during the first year of the COVID 19 pandemic. The SCORE survey measured 9 culture domains: teamwork climate, safety climate, leadership engagement, improvement readiness, emotional exhaustion, emotional exhaustion climate, thriving, recovery, and work-life balance. RESULTS Response rate before and during the pandemic was 75.45% and 74.79%, respectively. Overall, HCWs reporting favorable teamwork climate declined (45.6%-43.7%, P < 0.0001). At a facility level, 35% of facilities saw teamwork climate decline, while only 4% saw an increase in teamwork climate. Facilities with decreased teamwork climate had associated decreases in every culture domain, while facilities with improved teamwork climate maintained well-being domains and saw improvements in every other culture domain. CONCLUSIONS Healthcare worker teamwork norms worsened during the COVID-19 pandemic. Teamwork climate trend was closely associated with other safety culture metrics. Speaking up, resolving conflicts, and interdisciplinary coordination of care were especially predictive. Facilities sustaining these behaviors were able to maintain other workplace norms and workforce well-being metrics despite a global health crisis. Proactive team training may provide substantial benefit to team performance and HCW well-being during stressful times.
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Affiliation(s)
- Kyle J. Rehder
- From the Duke Center for Healthcare Safety and Quality
- Department of Pediatrics, Duke University, Durham, North Carolina
| | | | - Erin Eckert
- From the Duke Center for Healthcare Safety and Quality
| | - Richard W. Lang
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, California
| | | | | | - J. Bryan Sexton
- From the Duke Center for Healthcare Safety and Quality
- Department of Psychiatry, Duke University, Durham, North Carolina
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Muacevic A, Adler JR, Katta R. Healthcare Workers' Well-Being: A Systematic Review of Positive Psychology Interventions. Cureus 2023; 15:e34102. [PMID: 36843822 PMCID: PMC9946896 DOI: 10.7759/cureus.34102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/25/2023] Open
Abstract
Given persistent occupational stressors and multiple challenges in the delivery of healthcare, there is an increased focus on the well-being of healthcare workers. Responding to these challenges will require a multipronged approach, focusing on system level, organization, and individual actions. Positive psychology interventions (PPIs) represent a promising area for individual action. This systematic review indicates that PPI, delivered via many methods, holds promise for improving the well-being of healthcare workers, although there is a clear need for additional randomized controlled trials utilizing defined and standardized outcome measures. In this review, the most commonly evaluated PPIs were mindfulness-based or gratitude-based interventions. These were delivered via different methods, with many administered in the workplace and commonly in the form of courses ranging from two days to eight weeks. Researchers documented measurable improvements in multiple studied outcomes, noting reductions in symptoms of depression, anxiety, burnout, and stress. Some interventions increased well-being, job and life satisfaction, self-compassion, relaxation, and resilience. Most studies emphasized that these are simple, accessible, low-cost interventions. Limitations included some nonrandomized or quasi-experimental designs, alongside generally small sample sizes and varying methods of intervention delivery. Another concern is the lack of standardized outcome assessments and long-term follow-up data. As almost all studies included were performed before the pandemic, further research will be required post-pandemic. Overall, however, PPI shows promise as one arm of a multipronged approach to improving the well-being of healthcare workers.
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Belz FF, Adair KC, Proulx J, Frankel AS, Sexton JB. The language of healthcare worker emotional exhaustion: A linguistic analysis of longitudinal survey. Front Psychiatry 2022; 13:1044378. [PMID: 36590605 PMCID: PMC9800594 DOI: 10.3389/fpsyt.2022.1044378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Importance Emotional exhaustion (EE) rates in healthcare workers (HCWs) have reached alarming levels and been linked to worse quality of care. Prior research has shown linguistic characteristics of writing samples can predict mental health disorders. Understanding whether linguistic characteristics are associated with EE could help identify and predict EE. Objectives To examine whether linguistic characteristics of HCW writing associate with prior, current, and future EE. Design setting and participants A large hospital system in the Mid-West had 11,336 HCWs complete annual quality improvement surveys in 2019, and 10,564 HCWs in 2020. Surveys included a measure of EE, an open-ended comment box, and an anonymous identifier enabling HCW responses to be linked across years. Linguistic Inquiry and Word Count (LIWC) software assessed the frequency of one exploratory and eight a priori hypothesized linguistic categories in written comments. Analysis of covariance (ANCOVA) assessed associations between these categories and past, present, and future HCW EE adjusting for the word count of comments. Comments with <20 words were excluded. Main outcomes and measures The frequency of the linguistic categories (word count, first person singular, first person plural, present focus, past focus, positive emotion, negative emotion, social, power) in HCW comments were examined across EE quartiles. Results For the 2019 and 2020 surveys, respondents wrote 3,529 and 3,246 comments, respectively, of which 2,101 and 1,418 comments (103,474 and 85,335 words) contained ≥20 words. Comments using more negative emotion (p < 0.001), power (i.e., references relevant to status, dominance, and social hierarchies, e.g., own, order, and allow) words (p < 0.0001), and words overall (p < 0.001) were associated with higher current and future EE. Using positive emotion words (p < 0.001) was associated with lower EE in 2019 (but not 2020). Contrary to hypotheses, using more first person singular (p < 0.001) predicted lower current and future EE. Past and present focus, first person plural, and social words did not predict EE. Current EE did not predict future language use. Conclusion Five linguistic categories predicted current and subsequent HCW EE. Notably, EE did not predict future language. These linguistic markers suggest a language of EE, offering insights into EE's etiology, consequences, measurement, and intervention. Future use of these findings could include the ability to identify and support individuals and units at high risk of EE based on their linguistic characteristics.
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Affiliation(s)
- Franz F. Belz
- Duke School of Medicine, Duke University, Durham, NC, United States
| | - Kathryn C. Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| | - Joshua Proulx
- Safe and Reliable Healthcare, Evergreen, CO, United States
| | | | - J. Bryan Sexton
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
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Sexton JB, Adair KC, Cui X, Tawfik DS, Profit J. Effectiveness of a bite-sized web-based intervention to improve healthcare worker wellbeing: A randomized clinical trial of WISER. Front Public Health 2022; 10:1016407. [PMID: 36568789 PMCID: PMC9773843 DOI: 10.3389/fpubh.2022.1016407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
Importance Problems with the wellbeing of healthcare workers (HCWs) are widespread and associated with detrimental consequences for the workforce, organizations, and patients. Objective This study tested the effectiveness of the Web-based Implementation for the Science of Enhancing Resilience (WISER) intervention, a positive psychology program, to improve six dimensions of the wellbeing of HCWs. Design We conducted a randomized controlled trial of HCWs between 1 April 2018 and 22 July 2019. Cohort 1 received WISER daily for 10 days. Cohort 2 acted as a waitlist control before receiving WISER. Setting Web-based intervention for actively employed HCWs across the United States. Participants Eligibility criteria included being ≥18 years old and working as a HCW. Each participant was randomized to start the intervention or serve as a waitlist control for 14 days before starting the intervention. Interventions Cohorts received links via 10 texts exposing them to introductory videos and positive psychology exercises (3 good things, cultivating awe, random acts of kindness, cultivating relationships, and gratitude letters). Main outcomes and measures The primary outcome was emotional exhaustion; secondary outcomes included depressive symptoms, work-life integration, happiness, emotional thriving, and emotional recovery. All outcomes were assessed at baseline, 1-week post-intervention (primary endpoint), and 1, 6, and 12-month post-intervention. Outcomes were measured using six validated wellbeing instruments, rescaled to 100-point scales for comparison. Six items assessed participants' WISER experience. The analysis employed mixed-effects models. Results In cohorts 1 and 2, 241 and 241 initiated WISER, and 178 (74%) and 186 (77%) completed the 6-month follow-up, respectively. Cohort populations were similar at baseline, mostly female (81; 76%) and nurses (34; 32%) or physicians (22; 23%), with 1-10 years of experience in their current position (54; 52%). Relative to control, WISER significantly improved depressive symptoms [-7.5 (95%CI: -11.0, -4.0), p < 0.001], work-life integration [6.5 (95%CI: 4.1, 8.9), p < 0.001], happiness [5.7 (95%CI: 3.0, 8.4), p < 0.001], emotional thriving [6.4 (95%CI: 2.5, 10.3), p = 0.001], and emotional recovery [5.3 (95%CI: 1.7, 8.9), p = 0.004], but not emotional exhaustion [-3.7 (95%CI: -8.2, 0.8), p = 0.11] at 1 week. Combined cohort results at 1, 6, and 12 months showed that all six wellbeing outcomes were significantly improved relative to baseline (p < 0.05 for all). Favorable impressions of WISER were reported by 87% of participants at the 6-month post-assessment. Conclusion and relevance WISER improved HCW depressive symptoms, work-life integration, happiness, emotional thriving, and emotional recovery. Improvements in all HCW wellbeing outcomes endured at the 1-, 6-, and 12-month follow-ups. HCW's impressions of WISER were positive. Clinical trials number https://clinicaltrials.gov/ct2/show/, identifier: NCT02603133. Web-based Implementation for the Science of Enhancing Resilience Study (WISER).
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Affiliation(s)
- J. Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States,*Correspondence: J. Bryan Sexton
| | - Kathryn C. Adair
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| | - Xin Cui
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States,California Perinatal Quality Care Collaborative, Palo Alto, CA, United States
| | - Daniel S. Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, United States,California Perinatal Quality Care Collaborative, Palo Alto, CA, United States
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Fessell DP. Mentors Matter: A Few Words Can Change a Life. Acad Radiol 2022; 29:1885-1886. [PMID: 35513956 DOI: 10.1016/j.acra.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 01/26/2023]
Affiliation(s)
- David P Fessell
- University of Michigan Health System, Department of Radiology, Ann Arbor, Michigan.
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Kulchar RJ, Haddad MB. Preventing burnout and substance use disorder among healthcare professionals through breathing exercises, emotion identification, and writing activities. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2022; 29:100570. [PMID: 36349226 PMCID: PMC9633656 DOI: 10.1016/j.xjep.2022.100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
The introduction of the COVID-19 pandemic has placed additional strain on healthcare workers, inducing immense levels of stress and workplace burnout. Health care professionals are acutely susceptible to COVID-19 exposure, ultimately leading to elevated levels of anxiety and mental illness. For example, dental professionals are at high risk due to their close work with the oral cavity. To provide temporary relief to the stress, some may turn toward substance use, especially if that individual has some form of mental illness. To curb the onset of burnout and its byproduct of substance use disorder, it is crucial to be equipped with proper tools and healthy habits that can counteract extreme levels of stress. In this article, a time-effective, 3-step method is introduced, with each activity proven to lessen the symptoms of burnout. When followed, an individual can navigate burnout's symptoms through a healthy mind and body approach. Additionally, resources to find resilience-building and mentorship programs are provided. Common substance use support groups and information regarding group meetings and contact information are listed.
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McClafferty HH, Hubbard DK, Foradori D, Brown ML, Profit J, Tawfik DS. Physician Health and Wellness. Pediatrics 2022; 150:189767. [PMID: 36278292 DOI: 10.1542/peds.2022-059665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.
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Affiliation(s)
- Hilary H McClafferty
- Department of Pediatrics, Section Chief, Pediatric Emergency Medicine, Tucson Medical Center, Tucson, Arizona
| | - Dena K Hubbard
- Children's Mercy Kansas City, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Dana Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Melanie L Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel S Tawfik
- Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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McGinness A, Raman M, Stallworth D, Natesan S. App-Based Three Good Things and Gratitude Journaling Incentive Program for Burnout in Pediatric Residents: A Nonrandomized Controlled Pilot. Acad Pediatr 2022; 22:1532-1535. [PMID: 35718285 DOI: 10.1016/j.acap.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Anelah McGinness
- UCSF Benioff Children's Hospital Oakland (A McGinness, M Raman, and S Natesan), Department of Pediatrics and Emergency Medicine, Oakland, Calif.
| | - Maya Raman
- UCSF Benioff Children's Hospital Oakland (A McGinness, M Raman, and S Natesan), Department of Pediatrics and Emergency Medicine, Oakland, Calif
| | - Daniel Stallworth
- Massachusetts Institute of Technology (D Stallworth), Cambridge, Mass
| | - Sinthumathi Natesan
- UCSF Benioff Children's Hospital Oakland (A McGinness, M Raman, and S Natesan), Department of Pediatrics and Emergency Medicine, Oakland, Calif
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Cline M, Roberts P, Werlau T, Hauser P, Smith-Miller C. Three good things: Promote work-life balance, reduce burnout, enhance reflection among newly licensed RNs. Nurs Forum 2022; 57:1390-1398. [PMID: 36347533 DOI: 10.1111/nuf.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022]
Abstract
AIMS This study assessed the feasibility of delivering three good things (3GTs) practice as part of professional nurse residency program, measured the degree to which it influenced work-life balance, resilience, and burnout, and explored what newly licensed nurses (NLRNs) identified as good things. BACKGROUND Burnout occurs in response to chronic work-related emotional and interpersonal stress, negatively impacting nurses and patients. However, research shows that 3GT practice can increase positive emotions, enhance resilience, and reduce burnout. METHODS In this study, 3GT was introduced to a convenience sample of 115 NLRNs during their professional residency program. For 14 days, participants received daily 3GT prompts. Individualized survey links were sent via SMS message at baseline, postsurvey (T1), and 6 months (T2). Survey data were collected about work-life balance, burnout, and resilience, and text data from participants' daily 3GT notations from March through November 2021. RESULTS Seventy-one participants were recruited. T1 survey results indicated significant improvements in survey measures but only emotional recovery improvement was sustained at T2. Burnout was the only variable that correlated to participants' number of 3GT days practice. Simple joys, reflections about work, self-care activities, and relationships were major identified themes. CONCLUSIONS The results demonstrate the generalizability, value, and feasibility of implementing a web-based 3GT intervention in a nurse residency program. Additional benefits may be those gained by the reflection that is prompted, thereby facilitating professional development among NLRNs.
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Affiliation(s)
| | | | | | - Paloma Hauser
- UNC-CH School of Public Health, Chapel Hill, NC, USA
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Sexton JB, Adair KC, Proulx J, Profit J, Cui X, Bae J, Frankel A. Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021. JAMA Netw Open 2022; 5:e2232748. [PMID: 36129705 PMCID: PMC9494188 DOI: 10.1001/jamanetworkopen.2022.32748] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Extraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being. OBJECTIVE To determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US. EXPOSURES Safety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate. MAIN OUTCOMES AND MEASURES The percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree); neutral or higher scores were counted as "percent concerning" for exhaustion. RESULTS Electronic surveys were returned by 37 187 (of 49 936) HCWs in 2019, 38 460 (of 45 268) in 2020, and 31 475 (of 41 224) in 2021 to 2022 for overall response rates of 74.5%, 85.0%, and 76.4%, respectively. The overall sample comprised 107 122 completed surveys. Nursing was the most frequently reported role (n = 43 918 [40.9%]). A total of 17 786 respondents (16.9%) reported less than 1 year at their facility, 59 226 (56.2%) reported 1 to 10 years, and 28 337 (26.9%) reported 11 years or more. From September 2019 to September 2021 through January 2022, overall %EE increased from 31.8% (95% CI, 30.0%-33.7%) to 40.4% (95% CI, 38.1%-42.8%), with a proportional increase in %EE of 26.9% (95% CI, 22.2%-31.8%). Physicians had a decrease in %EE from 31.8% (95% CI, 29.3%-34.5%) in 2019 to 28.3% (95% CI, 25.9%-31.0%) in 2020 but an increase during the second year of the pandemic to 37.8% (95% CI, 34.7%-41.3%). Nurses had an increase in %EE during the pandemic's first year, from 40.6% (95% CI, 38.4%-42.9%) in 2019 to 46.5% (95% CI, 44.0%-49.1%) in 2020 and increasing again during the second year of the pandemic to 49.2% (95% CI, 46.5%-51.9%). All other roles showed a similar pattern to nurses but at lower levels. Intraclass correlation coefficients revealed clustering of exhaustion within work settings across the 3 years, with coefficients of 0.15 to 0.17 for emotional exhaustion and 0.22 to 0.24 for emotional exhaustion climate, higher than the .10 coefficient typical of organizational climate (a medium effect for shared variance), suggestive of a social contagion effect of HCW exhaustion. CONCLUSIONS AND RELEVANCE This large-scale survey study of HCWs spanning 3 years offers substantial evidence that emotional exhaustion trajectories varied by role but have increased overall and among most HCW roles since the onset of the pandemic. These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions.
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Affiliation(s)
- J. Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
- Duke University Health System, Durham, North Carolina
| | - Kathryn C. Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
- Duke University Health System, Durham, North Carolina
| | - Joshua Proulx
- Safe & Reliable Healthcare, LLC, Evergreen, Colorado
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
- California Perinatal Quality Care Collaborative, Palo Alto, California
| | - Xin Cui
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
- California Perinatal Quality Care Collaborative, Palo Alto, California
| | - Jon Bae
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
- Duke University Health System, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Allan Frankel
- Safe & Reliable Healthcare, LLC, Evergreen, Colorado
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Neuhaus M, Young T, Ferris LJ, Grimmel CLM, Reid N. A Narrative Review of Peer-Led Positive Psychology Interventions: Current Evidence, Potential, and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138065. [PMID: 35805719 PMCID: PMC9265263 DOI: 10.3390/ijerph19138065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
Positive psychology interventions are an effective means for cultivating flourishing, addressing low levels of wellbeing, and preventing languishing. Peer-led interventions can be a particularly advantageous delivery method of positive psychology interventions, as participants tend to respond more favourably to people that they can identify with personally. Such interventions have been applied in a variety of settings and populations, but the literature on peer-led positive psychology interventions has not yet been summarised. This paper provides a narrative overview of peer-led positive psychology interventions. We reviewed relevant peer-led interventions, assessed the available evidence on their effectiveness, and highlighted promising opportunities for peer-led positive psychology interventions. We found that the majority of the studies were observational in design but showed a high level of acceptability for participants across the reviewed domains. In particular, schools, workplaces, the aged care sector, and community settings are noted as promising target domains for these interventions. However, more studies—particularly high-quality research—will be needed to comprehensively test the effectiveness of peer-led positive psychology interventions. We discuss opportunities for future research in this field.
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Affiliation(s)
- Maike Neuhaus
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD 4102, Australia;
- Correspondence:
| | - Tarli Young
- School of Psychology, The University of Queensland, St Lucia, QLD 4067, Australia;
| | - Laura J. Ferris
- School of Business, The University of Queensland, St Lucia, QLD 4067, Australia;
| | | | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD 4102, Australia;
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Wolfer TA, Pooler DK, Graves BD. Finding Joy in Social Work: Practical Strategies. SOCIAL WORK 2022; 67:266-275. [PMID: 35535509 DOI: 10.1093/sw/swac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
Based on the broaden-and-build theory of positive emotion, this article suggests that efforts by social workers to find joy in the profession may help them broaden their scope of attention, cognition, and action; build physical, intellectual, and social resources for future use; and increase resilience. This article explains Fredrickson's broaden-and-build theory as a basis for exploring and seeking positivity and outlines several practical strategies that social workers or their leaders can adopt to promote joy and other positive emotions. The strategies can be implemented at individual or group levels in classrooms or agencies. Finally, this article considers how these strategies may contribute to social worker self-care, self-awareness, and ongoing growth and development.
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Dennis A, Ogden J, Hepper EG. Evaluating the impact of a time orientation intervention on well-being during the COVID-19 lockdown: past, present or future? THE JOURNAL OF POSITIVE PSYCHOLOGY 2022. [DOI: 10.1080/17439760.2020.1858335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Amelia Dennis
- School of Psychology, University of Surrey, Guildford, UK
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, UK
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Godfrey KM, Kozar B, Morales C, Scott SD. The wellbeing of peer supporters in a pandemic: A mixed-methods study. Jt Comm J Qual Patient Saf 2022; 48:439-449. [DOI: 10.1016/j.jcjq.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
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The Second Side of the Coin-Resilience, Meaningfulness and Joyful Moments in Home Health Care Workers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073836. [PMID: 35409520 PMCID: PMC8997992 DOI: 10.3390/ijerph19073836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/22/2022]
Abstract
Nursing literature predominantly focuses on job demands but is scarce for resources related to nurses' work. In the face of the COVID-19 pandemic, resources that can buffer the health-impairing effects of increased demands gain importance. The aim of this study is to explore resilience, meaning of work and joyful moments in home health care workers in South Germany during the pandemic. Resilience and meaning of work were measured quantitatively; moments of joy were investigated qualitatively by audio diaries and analyzed with qualitative content analysis. In all, 115 home health care workers (mean age = 47.83 ± 11.72; 81.75% female) filled in the questionnaires and 237 diary entries were made by 23 persons (mean age = 46.70 ± 10.40; 91.30% female). The mean scores of resilience (5.52 ± 1.04; 1-7) and meaning of work (4.10 ± 0.92; 1-5) showed high levels, with significantly higher values in females. Home care workers experienced joyful moments 334 times in 60 different types in the categories of social relationships, work content, work organization, work environment and self-care. A deeper understanding of resilience, meaning of work and joyful moments provides a basis for the development of worksite health promotion programs that address both demands and resources in home health care workers.
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Zehner N, Polding L, Faraci Sindra V, Shieh L. Prospective pilot study of the Three Good Things positive psychology intervention in short-term stay hospitalised patients. Postgrad Med J 2022; 99:postgradmedj-2021-141010. [PMID: 35302042 DOI: 10.1136/postgradmedj-2021-141010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The 'Three Good Things' (3GT) positive psychology protocol developed at Duke University has been shown to decrease depressive symptoms and emotional exhaustion in healthcare providers. Whether hospitalised patients may also benefit from the 3GT protocol has not previously been explored. OBJECTIVES To determine the impact and efficacy of the 3GT protocol with hospitalised patients experiencing serious/chronic illness. DESIGN Patient-level randomised control trial. SETTING Medical units of an academic, tertiary care medical centre. PATIENTS 221 adults over the age of 18 years admitted to inpatient wards (intensive care units excluded) at Stanford Hospital between January 2017 and May 2018. INTERVENTIONS Patients were randomised to the 3GT intervention arm or the control arm with no intervention. MEASUREMENTS AND MAIN RESULTS There was no significant difference between the intervention and control groups in the primary outcomes of improved positivity scores, decreased negativity scores or increased positive-to-negative emotional ratios. CONCLUSIONS A journal-based application of the 3GT protocol did not result in a statistically significant improvement in patient's emotional health.
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Affiliation(s)
- Nicholas Zehner
- School of Medicine, Stanford University, Stanford, California, USA
| | - Laura Polding
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | | | - Lisa Shieh
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
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Ding G, Xu L, Sun L. Association Between Parental Parenting Style Disparities and Mental Health: An Evidence From Chinese Medical College Students. Front Public Health 2022; 10:841140. [PMID: 35296043 PMCID: PMC8918520 DOI: 10.3389/fpubh.2022.841140] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background The associations between parental parenting styles and adolescents' development and health problems were also identified in a series of studies. However, the interactive impact of mother's and father's parenting style was less reported, which was implied in previous studies. In this study, we aim to analyze the associations between parental parenting style disparities and mental health among medical college students. Method A cross-sectional study was conducted among medical college students in Shandong province, China, and 2,598 medical college students with parents were analyzed in this study. Items in a short form of Egna Minnen av Barndoms Uppfostran (EMBU) were used to calculate the parental parenting style disparities. Mental health was evaluated by the Kessler 10 scale. Results The results of linear regressions showed that parental nurture reject disparities (RDs, β = 0.50, p < 0.001), parental emotional warmth disparities (WDs, β = 0.33, p < 0.001), parental overprotective disparities (ODs, β = 0.25, p < 0.001), and total disparities in parenting styles (TDs, β = 0.15, p < 0.001) were associated with mental health among medical college students, respectively. The other associated factors were age, ethnicity, chronic disease, above average family economic status, and good parental relationship. Conclusion Our findings supported the positive association between parental parenting style disparities and mental health problems. Further studies can test the mechanism and intervention of the findings about the importance of parental parenting style consistence on mental health.
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Affiliation(s)
- Gan Ding
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Lingzhong Xu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, China
- *Correspondence: Long Sun
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King AT, Sherrod B, Orto V, Crenshaw L, Miles JM, Maske-Neptune J, Cobden K, Allen DH. The effect of a nurse manager's authentic leadership intervention on nurses' well-being: A single unit QI project. Nurs Forum 2022; 57:694-702. [PMID: 35187672 DOI: 10.1111/nuf.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/07/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Nurse well-being is at the forefront of nursing leadership's focus, particularly with the impact of the ongoing COVID-19 pandemic. Nurse managers, as authentic leaders, should understand their role in supporting the spectrum of nurse well-being. At the negative end of well-being, leaders must address staff burnout as it increases nurse turnover, shortage of nurses, and poor patient outcomes. PURPOSE The specific aim for this quality improvement (QI) project was to implement a program that could guide a nurse manager of a single inpatient unit on how to improve well-being in their nursing staff as measured by: (a) improved well-being scores to a composite score of 3.5 or greater as indicated by follow-up Culture Pulse surveys distributed in 2021; and (b) reduced absenteeism among nursing staff by 18%. RESULTS Five surveys identical to the organization's work culture survey, that measures well-being, were sent to staff each month starting in January 2021 and ending in May 2021. The average composite score from all five surveys was 2.8, indicating an overall improvement. Absenteeism was reduced during implementation by 39%. DISCUSSION This QI project guides nurse managers in the evidence-based interventions that can promote well-being in their staff.
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Affiliation(s)
- Ashley T King
- General Surgery Unit 6-3, Duke Regional Hospital, Durham, North Carolina, USA
| | | | - Victoria Orto
- General Surgery Unit 6-3, Duke Regional Hospital, Durham, North Carolina, USA
| | - Ludmila Crenshaw
- Short Stay Unit, Duke University Hospital, Durham, North Carolina, USA
| | - Jason M Miles
- General Surgery Unit 6-3, Duke Regional Hospital, Durham, North Carolina, USA
| | | | - Kelly Cobden
- General Surgery Unit 6-3, Duke Regional Hospital, Durham, North Carolina, USA
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Physician wellbeing during the COVID-19 pandemic: an acute on chronic condition. Pediatr Res 2022; 91:19-20. [PMID: 34615999 PMCID: PMC8493539 DOI: 10.1038/s41390-021-01750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022]
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Trinkoff AM, Baldwin CM, Chasens ER, Dunbar-Jacob J, Geiger-Brown J, Imes CC, Landis CA, Patrician PA, Redeker NS, Rogers AE, Scott LD, Todero CM, Tucker SJ, Weinstein SM. CE: Nurses Are More Exhausted Than Ever: What Should We Do About It? Am J Nurs 2021; 121:18-28. [PMID: 34743129 DOI: 10.1097/01.naj.0000802688.16426.8d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.
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Affiliation(s)
- Alison M Trinkoff
- Alison M. Trinkoff is a professor at the University of Maryland School of Nursing, Baltimore. Carol M. Baldwin is professor emeritus and a Southwest Borderlands Scholar at Arizona State University's Edson College of Nursing and Health Innovation, Phoenix. Eileen R. Chasens is a professor and chair of the Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, where Jacqueline Dunbar-Jacob is dean and a distinguished service professor and Christopher C. Imes is an assistant professor. Now retired, at the time of this writing Jeanne Geiger-Brown was a professor and associate dean for research at the George Washington University School of Nursing, Washington, DC. Carol A. Landis is a professor emeritus at the University of Washington School of Nursing, Seattle. Patricia A. Patrician is a professor and the Rachel Z. Booth Endowed Chair at the University of Alabama at Birmingham School of Nursing, and a retired U.S. Army colonel. Nancy S. Redeker is the Beatrice Renfield Term Professor of Nursing at the Yale University School of Nursing, New Haven, CT. Ann E. Rogers is a professor at the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta. Linda D. Scott is a professor and dean of the University of Wisconsin-Madison School of Nursing. Catherine M. Todero is dean of the College of Nursing and vice provost of Health Sciences at Creighton University, Omaha, NE, and Phoenix, AZ. Sharon J. Tucker is the Grayce Sills Endowed Professor in Psychiatric-Mental Health Nursing and director of the Translational/Implementation Research Core at the Ohio State University College of Nursing, Columbus. Sharon M. Weinstein is chief executive officer of the Global Education Development Institute, and SMW Group LLC, North Bethesda, MD, and a clinical assistant professor at the College of Nursing, University of Illinois, Chicago. This article was a collaborative effort by the Fatigue Subgroup of the Health Behavior Expert Panel, American Academy of Nursing. The authors acknowledge Claire C. Caruso, PhD, RN, a research health scientist at the National Institute for Occupational Safety and Health, for her help in reviewing the manuscript. Contact author: Alison M. Trinkoff, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com
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Olson ME, Smith ML, Muhar A, Paul TK, Trappey BE. The strength of our stories: a qualitative analysis of a multi-institutional GME storytelling event. MEDICAL EDUCATION ONLINE 2021; 26:1929798. [PMID: 34096480 PMCID: PMC8189054 DOI: 10.1080/10872981.2021.1929798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 06/10/2023]
Abstract
Context: Storytelling is a powerful tool for encouraging reflection and connection among both speakers and listeners. While growing in popularity, studying the benefits of formal oral storytelling events within graduate medical education remains rare. Our research question was: could an oral storytelling event for GME trainees and faculty be an effective approach for promoting well-being and resilience among participants?Methods: We used multiple approaches to gather perspectives from physician participants (storytellers and audience members) at an annual oral storytelling event for residents, fellows, and faculty from seven academic health systems in Minnesota. Data sources included short reflections written by participants during the event, an immediate post-event survey exploring participants' experiences during the event, social media postings, and targeted follow-up interviews further exploring the themes of connection and burnout that were raised in post-event survey responses. We performed a qualitative analysis using both deductive and inductive coding to identify themes.Results: There were 334 participants, including 197 physicians. At the event, 129 real-time written reflections were collected. There were also 33 Twitter posts related to the event. Response rate for the post-event survey was 65% for physicians, with 63% of physician respondents volunteering for targeted follow-up interviews. Of those, 38% completed the follow-up interview. Themes that emerged from the multi-modal qualitative analysis included a sense of connection and community, re-connection with meaning and purpose in work, renewal and hope, gratitude, and potential impact on burnout.Conclusion: The large turnout and themes identified show how an oral storytelling event can be a powerful tool to build community in graduate medical education. Qualitative analysis from multiple sources obtained both in real-time at the event and upon deeper reflection afterwards showed the event positively impacted the well-being of participants and that oral storytelling events can be an effective approach for promoting resilience in GME.
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Affiliation(s)
- Maren E. Olson
- Department of Medical Education, Children’s Minnesota; Department of Pediatrics, Center for the Art of Medicine, University of Minnesota, Minneapolis, USA
| | - M. Lynne Smith
- Department of Educational Foundations, College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, USA
| | - Alexandra Muhar
- Department of Pediatrics, Division of Neonatology, Vanderbilt University, Nashville, USA
| | | | - Bernard E. Trappey
- Departments of Internal Medicine and Pediatrics, Center for the Art of Medicine, University of Minnesota, USA
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Tran Y, Liao HH, Yeh EH, Ellis LA, Clay-Williams R, Braithwaite J. Examining the pathways by which work-life balance influences safety culture among healthcare workers in Taiwan: path analysis of data from a cross-sectional survey on patient safety culture among hospital staff. BMJ Open 2021; 11:e054143. [PMID: 34728459 PMCID: PMC8565544 DOI: 10.1136/bmjopen-2021-054143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study is to examine the pathways by which work-life balance influences safety climate in hospital settings. DESIGN A national cross-sectional survey on patient safety culture. SETTINGS Healthcare workers from 56 hospitals in Taiwan, covering three work settings: intensive care units, operation rooms and emergency departments. PARTICIPANTS 14 345 healthcare workers took part in the survey and were included in the present analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The Safety Attitudes, Maslach's Burn-out Inventory and Work-life balance questionnaires were used to measure patient safety culture, teamwork, leadership, emotional exhaustion and work-life balance. Path analysis was conducted to determine the relationship between work-life balance and safety climate. We tested for mediating and moderating factors influencing this relationship. RESULTS The path between work-life balance and safety climate was found to be significant (b=0.32, p<0.001) and explained through a serial mediation. This relationship was found to be mediated by emotional exhaustion followed by teamwork climate in a full mediation. Leadership factors such as identifying as a manager, moderated the indirect pathway between work-life balance and safety climate through teamwork climate (index of moderation: b=0.083, bias corrected 95% CI 0.044 to 0.120) but not through emotional exhaustion or the serial pathway. Subgroup analysis from non-managers on their perception of management was also found to moderate this relationship. CONCLUSION We found work-life balance to be associated with safety climate through a fully mediated model. The mediation pathways are moderated by self-identified leadership and perceptions of leadership. Understanding the pathways on how work-life balance influences safety climate provides an explanatory model that can be used when designing effective interventions for implementation in system-based approaches to improve patient safety culture in hospital settings.
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Affiliation(s)
- Yvonne Tran
- MU Hearing, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Hsun-Hsiang Liao
- Joint Commission of Taiwan, Banciao, Taiwan
- Departmment of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - En-Hui Yeh
- Joint Commission of Taiwan, Banciao, Taiwan
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Valiente Millán ML, Méndez Iglesias SM, Morales Serrano JM, Arroyo de la Rosa A. Cansados de estar cansados. El impacto de la pandemia en el colectivo de Medicina Familiar: valoración y propuestas de mejora. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2021. [DOI: 10.55783/rcmf.140312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- M.ª Luisa Valiente Millán
- Especialista en Medicina Familiar y Comunitaria. Servicio de Urgencias Hospital Sierrallana. Servicio Cántabro de Salud. Torrelavega. Cantabria (España). Coordinadora del Grupo de Trabajo de Salud Basada en las Emociones de la semFYC
| | - Stella Maris Méndez Iglesias
- Especialista en Medicina Familiar y Comunitaria. Área Sanitaria Pontevedra y Salnés. Servicio Gallego de Salud (SERGAS). Miembro del Grupo de Trabajo de Salud Basada en las Emociones de la semFYC
| | - José Manuel Morales Serrano
- Especialista en Medicina Familiar y Comunitaria. Gerencia de Atención Primaria de Gran Canaria. Servicio Canario de Salud. Miembro del Grupo de Trabajo de Salud Basada en las Emociones de la semFYC
| | - Ana Arroyo de la Rosa
- Especialista en Medicina Familiar y Comunitaria. Servicio Extremeño de Salud (SES). Mérida. Badajoz (España). Vicepresidenta 3.ª de la Junta Directiva de la semFYC
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Kelly LA, Schaeffer R, Roe S, Buchda VL. Using Text Messages to Support Nurse Well-being. Nurs Adm Q 2021; 45:338-345. [PMID: 34469392 DOI: 10.1097/naq.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The COVID-19 pandemic caused significant nurse stress and contributed to burnout for a number of reasons, including but not limited to personal protective equipment shortages, furloughs, overtime, reassignment to unfamiliar work environments, and alternate staffing patterns, all of which contribute to grief, loss, fear, and anger. While the nursing profession and employers offered support and psychological first-aid resources, there was a disconnect in effectively linking stressed nurses with these needed resources. An innovative statewide pilot project in Arizona, RNconnect 2 Wellbeing, was created to determine whether nurses might respond to and use supportive resources via opt-in text messages. Over a 12-week enrollment trial, 2997 nurse users opted to receive brief, twice weekly, well-being text messages about subjects, such as increasing awareness, self-care, and gratitude. By the end of the pilot, 2777 nurse users remained enrolled (7% opt out). Convenience evaluation surveys were conducted at midpoint (n = 294) and pilot completion (n = 404). Satisfaction with the messages ranged from 73% to 86%. Forty-eight percent indicated they had integrated the resources into their daily lives. RNconnect 2 Wellbeing, an innovative and cost-effective approach to communicating with nurses, has laid the groundwork for the use of technology via brief text messages to improve nurse well-being.
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Affiliation(s)
- Lesly A Kelly
- CommonSpirit Health, Chicago, Illinois, and Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Dr Kelly); Arizona Nurses Association, Tempe (Ms Schaeffer); The Roe Group Enterprises, LLC, Tucson, Arizona (Dr Roe); and Arizona Hospital and Healthcare Association, Phoenix (Ms Buchda)
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Ravi D, Tawfik DS, Sexton JB, Profit J. Changing safety culture. J Perinatol 2021; 41:2552-2560. [PMID: 33024255 DOI: 10.1038/s41372-020-00839-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/31/2020] [Accepted: 09/18/2020] [Indexed: 02/02/2023]
Abstract
Safety culture, an aspect of organizational culture, that reflects work place norms toward safety, is foundational to high-quality care. Improvements in safety culture are associated with improved operational and clinical outcomes. In the neonatal intensive care unit (NICU), where fragile infants receive complex, coordinated care over prolonged time periods, it is critically important that unit norms reflect the high priority placed on safety. Changing the safety culture of the NICU involves a systematic process of measurement, identifying strengths and weaknesses, deploying targeted interventions, and learning from the results, to set the stage for an iterative process of improvement. Successful change efforts require: effective partnerships with key stakeholders including management, clinicians, staff, and families; using data to make the case for improvement; and leadership actions that motivate change, channel resources, and support active problem- solving. Sustainable change requires buy-in from NICU staff and management, resources, and long-term institutional commitment.
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Affiliation(s)
- Dhurjati Ravi
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. .,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
| | - Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA.,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
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Stress and Resilience Among Healthcare Workers During the COVID-19 Pandemic: Consideration of Case Studies. Rehabil Nurs 2021; 46:300-304. [PMID: 34469405 PMCID: PMC8565454 DOI: 10.1097/rnj.0000000000000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic has caused a significant increase in stress for frontline healthcare workers, including rehabilitation workers. Contributing factors include disrupted workflows, heavier workloads, increased time restraints, and fear of contracting/passing the virus. Prolonged high stress levels can produce adverse health outcomes when unaddressed. Resilience can mitigate the negative effects of prolonged stress. Four healthcare workers relate their experiences from the frontlines of the pandemic, discussing their strategies to build resilience and maintain health. Highlighted strategies include mindfulness (the purposeful act of paying attention to the present moment without judgment), gratitude (the practice of being grateful for the positive things in life), self-care (the maintenance of a healthy lifestyle using physical, psychological, and emotional tools), and social support (the sense of belonging that comes from being cared for and valued). These strategies reduce negative outcomes produced by elevated stress levels and promote resilience in frontline healthcare workers.
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45
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Profit J, Adair KC, Cui X, Mitchell B, Brandon D, Tawfik DS, Rigdon J, Gould JB, Lee HC, Timpson WL, McCaffrey MJ, Davis AS, Pammi M, Matthews M, Stark AR, Papile LA, Thomas E, Cotten M, Khan A, Sexton JB. Randomized controlled trial of the "WISER" intervention to reduce healthcare worker burnout. J Perinatol 2021; 41:2225-2234. [PMID: 34366432 PMCID: PMC8440181 DOI: 10.1038/s41372-021-01100-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout. DESIGN RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control. RESULTS Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (-5.27 (95% CI: -10.44, -0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (-6.3% (95%CI: -11.6%, -1.0%); p = 0.008), and secondary outcomes depression (-5.2% (95%CI: -10.8, -0.4); p = 0.022) and work-life integration (-11.8% (95%CI: -17.9, -6.1); p < 0.001). Improvements endured at 6 months. CONCLUSION WISER appears to durably improve HCW well-being. CLINICAL TRIALS NUMBER NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133.
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Affiliation(s)
- Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Kathryn C Adair
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA
| | - Xin Cui
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Briana Mitchell
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Debra Brandon
- Duke University School of Nursing, Durham, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, USA
| | - Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeffrey B Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Henry C Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Wendy L Timpson
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martin J McCaffrey
- Division of Neonatal-Perinatal Medicine, University of North Carolina Chapel Hill School of Medicine and University of North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Mohan Pammi
- Section of Neonatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Melissa Matthews
- Department of Pediatrics-Neonatology, The University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Ann R Stark
- Department of Pediatrics, Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA
| | - Lu-Ann Papile
- Division of Neonatology, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Eric Thomas
- Department of Internal Medicine, The University of Texas Health Science Center and Memorial Hermann Medical Center, Houston, TX, USA
| | - Michael Cotten
- Division of Pediatrics-Neonatology, Duke University School of Medicine and Duke University Hospital, Durham, NC, USA
| | - Amir Khan
- Division of Neonatology, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA.
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA.
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Rehder K, Adair KC, Sexton JB. The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being. Arch Pathol Lab Med 2021; 145:1095-1109. [PMID: 34459858 DOI: 10.5858/arpa.2020-0557-ra] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover. OBJECTIVE.— To describe the state of the science regarding HCW well-being, including how it is measured, what outcomes it predicts, and what institutional and individual interventions appear to reduce it. DATA SOURCES.— Peer review articles as well as multiple large data sets collected within our own research team are used to describe the nature of burnout, associations with institutional resources, and individual tools to improve well-being. CONCLUSIONS.— Rates of HCW burnout are alarmingly high, placing the health and safety of patients and HCWs at risk. To help address the urgent need to help HCWs, we summarize some of the most promising early interventions, and point toward future research that uses standardized metrics to evaluate interventions (with a focus on low-cost institutional and personal interventions).
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Affiliation(s)
- Kyle Rehder
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
| | - Kathryn C Adair
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
| | - J Bryan Sexton
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
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Overcoming Obstacles to Develop High-Performance Teams Involving Physician in Health Care Organizations. Healthcare (Basel) 2021; 9:healthcare9091136. [PMID: 34574910 PMCID: PMC8469144 DOI: 10.3390/healthcare9091136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
Many health care organizations struggle and often do not succeed to be high-performance organizations that are not only efficient and effective but also enjoyable places to work. This review focuses on the physician and organizational roles in limiting achievement of a high-performance team in health care organizations. Ten dimensions were constructed and a number of competencies and metrics were highlighted to overcome the failures to: (i) Ensure that the goals, purpose, mission and vision are clearly defined; (ii) establish a supportive organizational structure that encourages high performance of teams; (iii) ensure outstanding physician leadership, performance, goal attainment; and (iv) recognize that medical team leaders are vulnerable to the abuses of personal power or may create a culture of intimidation/fear and a toxic work culture; (v) select a good team and team members—team members who like to work in teams or are willing and able to learn how to work in a team and ensure a well-balanced team composition; (vi) establish optimal team composition, individual roles and dynamics, and clear roles for members of the team; (vii) establish psychological safe environment for team members; (viii) address and resolve interpersonal conflicts in teams; (xi) ensure good health and well-being of the medical staff; (x) ensure physician engagement with the organization. Addressing each of these dimensions with the specific solutions outlined should overcome the constraints to achieving high-performance teams for physicians in health care organizations.
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Tawfik DS, Sinha A, Bayati M, Adair KC, Shanafelt TD, Sexton JB, Profit J. Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study. J Med Internet Res 2021; 23:e26817. [PMID: 34255674 PMCID: PMC8292941 DOI: 10.2196/26817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/08/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND New technology adoption is common in health care, but it may elicit frustration if end users are not sufficiently considered in their design or trained in their use. These frustrations may contribute to burnout. OBJECTIVE This study aimed to evaluate and quantify health care workers' frustration with technology and its relationship with emotional exhaustion, after controlling for measures of work-life integration that may indicate excessive job demands. METHODS This was a cross-sectional, observational study of health care workers across 31 Michigan hospitals. We used the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey to measure work-life integration and emotional exhaustion among the survey respondents. We used mixed-effects hierarchical linear regression to evaluate the relationship among frustration with technology, other components of work-life integration, and emotional exhaustion, with adjustment for unit and health care worker characteristics. RESULTS Of 15,505 respondents, 5065 (32.7%) reported that they experienced frustration with technology on at least 3-5 days per week. Frustration with technology was associated with higher scores for the composite Emotional Exhaustion scale (r=0.35, P<.001) and each individual item on the Emotional Exhaustion scale (r=0.29-0.36, P<.001 for all). Each 10-point increase in the frustration with technology score was associated with a 1.2-point increase (95% CI 1.1-1.4) in emotional exhaustion (both measured on 100-point scales), after adjustment for other work-life integration items and unit and health care worker characteristics. CONCLUSIONS This study found that frustration with technology and several other markers of work-life integration are independently associated with emotional exhaustion among health care workers. Frustration with technology is common but not ubiquitous among health care workers, and it is one of several work-life integration factors associated with emotional exhaustion. Minimizing frustration with health care technology may be an effective approach in reducing burnout among health care workers.
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Affiliation(s)
- Daniel S Tawfik
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Amrita Sinha
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mohsen Bayati
- Operations, Information, and Technology, Stanford University Graduate School of Business, Stanford, CA, United States
- Department of Biomedical Informatics, Stanford University School of Medicine, Stanford, CA, United States
| | - Kathryn C Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- WellMD Center, Stanford University School of Medicine, Stanford, CA, United States
| | - J Bryan Sexton
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States
| | - Jochen Profit
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
- California Perinatal Quality Care Collaborative, Palo Alto, CA, United States
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Sexton JB, Adair KC, Profit J, Bae J, Rehder KJ, Gosselin T, Milne J, Leonard M, Frankel A. Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds. Jt Comm J Qual Patient Saf 2021; 47:403-411. [PMID: 34024756 PMCID: PMC8240670 DOI: 10.1016/j.jcjq.2021.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Interventions to decrease burnout and increase well-being in health care workers (HCWs) and improve organizational safety culture are urgently needed. This study was conducted to determine the association between Positive Leadership WalkRounds (PosWR), an organizational practice in which leaders conduct rounds and ask staff about what is going well, and HCW well-being and organizational safety culture. METHODS This study was conducted in a large academic health care system in which senior leaders were encouraged to conduct PosWR. The researchers used data from a routine cross-sectional survey of clinical and nonclinical HCWs, which included a question about recall of exposure of HCWs to PosWR: "Do senior leaders ask for information about what is going well in this work setting (e.g., people who deserve special recognition for going above and beyond, celebration of successes, etc.)?"-along with measures of well-being and safety culture. T-tests compared work settings in the first and fourth quartiles for PosWR exposure across SCORE (Safety, Communication, Operational Reliability, and Engagement) domains of safety culture and workforce well-being. RESULTS Electronic surveys were returned by 10,627 out of 13,040 possible respondents (response rate 81.5%) from 396 work settings. Exposure to PosWR was reported by 63.1% of respondents overall, with a mean of 63.4% (standard deviation = 20.0) across work settings. Exposure to PosWR was most commonly reported by HCWs in leadership roles (83.8%). Compared to work settings in the fourth (< 50%) quartile for PosWR exposure, those in the first (> 88%) quartile revealed a higher percentage of respondents reporting good patient safety norms (49.6% vs. 69.6%, p < 0.001); good readiness to engage in quality improvement activities (60.6% vs. 76.6%, p < 0.001); good leadership accessibility and feedback behavior (51.9% vs. 67.2%, p < 0.001); good teamwork norms (36.8% vs. 52.7%, p < 0.001); and good work-life balance norms (61.9% vs. 68.9%, p = 0.003). Compared to the fourth quartile, the first quartile had a lower percentage of respondents reporting emotional exhaustion in themselves (45.9% vs. 32.4%, p < 0.001), and in their colleagues (60.5% vs. 47.7%, p < 0.001). CONCLUSION Exposure to PosWR was associated with better HCW well-being and safety culture.
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50
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Fessell D. Unlocking Humor for Coping & Resilience. Acad Radiol 2021; 28:995-996. [PMID: 34053860 DOI: 10.1016/j.acra.2021.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022]
Affiliation(s)
- David Fessell
- University of Michigan Health System, Department of Radiology, Ann Arbor, Michigan.
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