1
|
Iserson KV. From magical thinking to suicide: Understanding emergency physicians' psychological struggle. Am J Emerg Med 2024; 78:37-41. [PMID: 38183885 DOI: 10.1016/j.ajem.2024.01.001] [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: 12/05/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
Recent literature has explored the psychological well-being of physicians, addressing conditions like perfectionism, imposter phenomenon/syndrome (IP), depression, burnout, and, less frequently, magical thinking. But recognizing the connections among these psychological factors is vital for developing targeted interventions to prevent or alleviate their impact. This article examines the often-sequential emergence of these five conditions within a physician's career, with a specific emphasis on their prevalence among emergency physicians (EPs), who must manage a diverse array of acute illnesses and injuries. The descent into psychological distress initiates with magical thinking-in this case, the belief that perfection is possible despite evidence to the contrary-leading to the pursuit of maladaptive perfectionism. If unaddressed, this trajectory may lead to depression, burnout, and in some cases, suicide. Understanding this continuum lays the groundwork for devising a systematic approach to enhance physicians' mental health. The article delves into detailed descriptions of these psychological conditions, encompassing their prevalence, individual impact, how they are integrated into this continuum and potential preventive or corrective methods. Recognizing unrealistic expectations as a major contributor to burnout, depression, and even suicide within the medical profession, the article advocates for the development of targeted interventions and support structures to assist medical students and professionals in managing IP. Practical strategies involve acknowledging unrealistic expectations, setting attainable goals, seeking support, taking breaks, and prioritizing self-care. Addressing this pervasive issue aims to cultivate a culture where medical professionals can thrive, ensuring optimal care for patients.
Collapse
Affiliation(s)
- Kenneth V Iserson
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, United States of America
| |
Collapse
|
2
|
Lovink MH, Verbeek F, Persoon A, Huisman-de Waal G, Smits M, Laurant MGH, van Vught AJ. Developing an Evidence-Based Nursing Culture in Nursing Homes: An Action Research Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031733. [PMID: 35162756 PMCID: PMC8835437 DOI: 10.3390/ijerph19031733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023]
Abstract
Background: Nursing homes face challenges caused by increasing numbers of older adults with multimorbidity and the demand for quality of care. Developing an evidence-based nursing (EBN) culture is a promising strategy to face these challenges. Therefore, the aim of this study was to develop an EBN culture in nursing homes and gain insight into the influencing factors. Methods: An action research study was conducted with 12 nursing teams in 4 Dutch nursing homes, using the Practice Development approach to develop an EBN culture. The teams (mostly certified nurse assistants) were coached by internal facilitators (bachelor’s or master’s degree nurses) and external facilitators (nursing teachers). Data were gathered at baseline and after 15 months using questionnaires and individual and focus group interviews. Results: With varying degrees, most nursing teams implemented elements (related to values, attitudes, and behaviors) of an EBN culture with appropriate leadership, advocacy, and training. The team members became open to new insights and asked critical questions. During the project, participants learned how EBN could be incorporated into daily practice, for example, by keeping it small, discussing information from professional journals, and using creative methods such as quizzes. Influencing factors of an EBN culture were: (a) support of managers, (b) inspiring facilitators close to the team, and (c) stable teams with driving forces and student nurses. Conclusions: Integrating EBN into daily practice in creative and motivating ways contributes to the development of an EBN culture in nursing homes. To facilitate this, managers should support teams in the process and content of EBN, and internal facilitators should collaborate with driving forces on the teams.
Collapse
Affiliation(s)
- Marleen H. Lovink
- School of Health Studies, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.V.); (M.S.); (M.G.H.L.); (A.J.v.V.)
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands;
- Correspondence:
| | - Frank Verbeek
- School of Health Studies, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.V.); (M.S.); (M.G.H.L.); (A.J.v.V.)
| | - Anke Persoon
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands;
| | - Getty Huisman-de Waal
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands;
| | - Marleen Smits
- School of Health Studies, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.V.); (M.S.); (M.G.H.L.); (A.J.v.V.)
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands;
| | - Miranda G. H. Laurant
- School of Health Studies, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.V.); (M.S.); (M.G.H.L.); (A.J.v.V.)
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands;
| | - Anneke J. van Vught
- School of Health Studies, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.V.); (M.S.); (M.G.H.L.); (A.J.v.V.)
| |
Collapse
|
3
|
Rolt L, Gillett K. Employing newly qualified nurses to work in hospices: A qualitative interview study. J Adv Nurs 2020; 76:1717-1727. [PMID: 32189368 DOI: 10.1111/jan.14359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/28/2020] [Accepted: 03/09/2020] [Indexed: 11/27/2022]
Abstract
AIM To establish an understanding of the experiences of newly qualified nurses' working in hospices from the perspective of both newly qualified and senior nurses. DESIGN A qualitative interview study. METHODS Semi-structured interviews with six newly qualified nurses and five senior nurses from four UK hospices were conducted between March - July 2017. RESULTS The hospices involved in this study were among the first to recruit newly qualified nurses. Participants believed that newly qualified nurses coped well with hospice working and received unique opportunities for professional development. Participants identified the value of formal and informal support, however, newly qualified nurses faced negative attitudes from some established staff. Newly qualified nurses expressed concerns about a perceived lack of technical clinical skills training, however, they highlighted gaining end-of-life care and communication skills that would be transferrable to other settings. Participants highlighted the need to allocate more time for education and formal support including preceptorship. Senior staff did not necessarily expect newly qualified nurses to remain in long-term hospice employment suggesting that they could disseminate their hospice learning to future workplaces. CONCLUSION This study supports recruitment strategies that increasingly target newly qualified nurses to work in hospices with findings suggesting that hospices can be a suitable environment for recent graduates to work in. The senior nurses in this study viewed the employment of newly qualified nurses in a positive light but shared the concerns of newly qualified nurses regarding skills training. IMPACT At a time when hospices need to expand if they are going to meet demand for their services, they along with most areas of healthcare face difficulties recruiting and retaining registered nurses. To increase the appeal of hospice employment, recruitment campaigns aimed at newly qualified nurses should emphasize the transferability of skills gained in hospice settings.
Collapse
Affiliation(s)
- Lucy Rolt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Karen Gillett
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| |
Collapse
|
4
|
Gross IT, Whitfill T, Redmond B, Couturier K, Bhatnagar A, Joseph M, Joseph D, Ray J, Wagner M, Auerbach M. Comparison of Two Telemedicine Delivery Modes for Neonatal Resuscitation Support: A Simulation-Based Randomized Trial. Neonatology 2020; 117:159-166. [PMID: 31905354 DOI: 10.1159/000504853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous research has described technical aspects of telemedicine and the clinical impact of provider-to-patient telemedicine; however, little is known about provider-to-provider telemedical interventions. OBJECTIVE The primary aim of this study was to compare two telemedicine delivery modes on the quality of a simulated neonatal resuscitation. Our secondary aim was to evaluate the providers' task load. METHODS This was a prospective, single-center, randomized, simulation-based trial comparing a remote neonatal team leader ("teleleader") versus a remote consultant ("teleconsultant"). Participants resuscitated a simulated, apneic, and bradycardic neonate. Performance was assessed by video review and task load was measured by the self-reported NASA task load index (NASA-TLX) tool. In the teleleader group, one remote neonatal specialist assumed the role of team leader in the resuscitation. In the teleconsultant group, the same remote specialist assumed the role of teleconsultant. RESULTS Twenty-two participants were included in the analyses. The teleleader group was associated with a higher overall checklist score compared to teleconsultants (median score 68%, interquartile range [IQR]: 66-69 vs. 58%, IQR: 42-62; p = 0.016). No significant difference was seen in overall subjective workload as measured by the NASA-TLX tool. However, mental demand and frustration were significantly greater with teleconsultants compared to teleleaders (mean mental demand: 14.1 vs. 17.0 out of 21; frustration: 7.9 vs. 14.7 out of 21). CONCLUSIONS Simulated neonates randomized to teams with teleleaders received significantly better resuscitative care compared to those randomized to teams with teleconsultants. Mental demand and frustration were higher for providers in the teleconsultant compared to teleleader teams.
Collapse
Affiliation(s)
- Isabel T Gross
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA,
| | - Travis Whitfill
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brooke Redmond
- Department of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katherine Couturier
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambika Bhatnagar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melissa Joseph
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Joseph
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jessica Ray
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Marc Auerbach
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
5
|
Riveros Perez E, Jimenez E, Yang N, Rocuts A. Evaluation of Anesthesiology Residents' Supervision Skills: A Tool to Assess Transition Towards Independent Practice. Cureus 2019; 11:e4137. [PMID: 31058020 PMCID: PMC6485533 DOI: 10.7759/cureus.4137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Problem Anesthesiologists are often expected to supervise residents, nurse anesthetists, and anesthesiologist assistants in their practice. Development of a supervisory skill set is important during anesthesiology training and has a potential impact on the quality of patient care. During anesthesiology residency training, residents develop different competencies through direct supervision by a staff anesthesiologist. However, there is significant variability among anesthesia residency programs in the United States in terms of the opportunity residents have to supervise other anesthesia providers. The supervisory competency is not routinely evaluated during residency training. Intervention This study aimed at evaluating an educational seminar to foster the competency of supervision in anesthesiology. The 90-minute seminar included a live lecture and a series of workshops. The lecture had a duration of 45 minutes followed by three workshops of 15 minutes each. The workshops consisted of different simulated case scenarios with the participation of actors and a manikin as a patient. A debriefing session took place after the scenarios. Every resident included in the study participated in the workshops. The workshops were aligned with the learning objectives of the educational strategy. Context The study included 12 junior anesthesiology residents supervised by 24 senior residents during simulated clinical encounters. Quality of supervision, using the nine-item Quality of Supervision Questionnaire validated by De Oliveira Filho, and self-perception were evaluated before and after the educational intervention consisting of a face-to-face seminar and individual workshops administered during each encounter. Impact There was a significant difference between the overall means among senior residents for the quality of supervision measured by a nine-item quality of supervision questionnaire before and after the educational intervention program (3.11 ± 0.29 vs 3.96 ± 0.17, p < 0.01). There was no significant difference between the overall means for the self-perception of the senior residents before and after the intervention program (3.51 ± 0.54 vs. 3.48 ± 0.20). Lessons learned A bimodal educational intervention combining face-to-face seminars and workshops is effective to improve the quality of supervision in senior residents; however, it does not change the self-perception of the supervisory process. Addition of this type of educational intervention to the anesthesiology residency curriculum would add to the development of the supervisory competency and warrants further research in clinical situations.
Collapse
Affiliation(s)
- Efrain Riveros Perez
- Anesthesiology, The Medical College of Georgia, Augusta University, Augusta, USA
| | - Enoe Jimenez
- Anesthesiology, The Medical College of Georgia, Augusta University, Augusta, USA
| | - Nianlan Yang
- Anesthesiology, The Medical College of Georgia, Augusta University, Augusta, USA
| | - Alexander Rocuts
- Anesthesiology, The Medical College of Georgia, Augusta University, Augusta, USA
| |
Collapse
|
6
|
Must we get it wrong again? A simple intervention to reduce medical error. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|