A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action

Implementation of a routine post-shift debriefing program in ICU aiming at quality-of-care improvement: A primary analysis of feasibility and impacts

OBJECTIVES

This report describes the implementation of a clinical debriefing (CD) program in intensive care units (ICU) and analyses its feasibility and its impact on staff well-being.

DESIGN

Observational study.

SETTING

From April to September 2023, post-shift CDs were run once a week in 2 out of 7 units in our department, using an adapted version of the DISCOVER-PHASE tool. CD sessions were performed face-to-face with volunteer members of the multidisciplinary ICU team.

MAIN OUTCOME MEASURES

After 6 months, a survey assessing the satisfaction of the debriefed teams was conducted. The impact of CD on staff well-being was assessed using three validated questionnaires (Maslach Burnout Inventory, Ways of Coping Checklist, Professional Quality of Life Scale) administered in the 7 units before and after the CD period.

RESULTS

A total of 44 CDs were performed, lasting 15 (4-35) min. There were 6 (1-9) attendees per CD, mainly nurses (64.6%). Discussions focused mainly on basic problems related to dysfunctional material, communication and organization inside the team. The two debriefed teams were satisfied of the program and gave 9, 8 and 8 out of 10 on a visual analogical scale for the climate of confidence of the DC, their organisation, and their ability to improve working conditions and quality of care, respectively. Subscores at the three questionnaires assessing staff well-being before and after the CD period were similar, whether teams experienced CD or not.

CONCLUSIONS

Implementing of post-shift debriefings in our ICU was feasible and well accepted. More prolonged programs are probably needed to demonstrate benefits on staff well-being.

IMPLICATIONS FOR CLINICAL PRACTICE

This report offers elements that other teams can use to successfully conduct post-shift debriefings and to plan future research on longer-term programs.

Prevalence and factors associated with burnout among health professionals of a public hospital network during the COVID-19 pandemic

Burnout is most commonly defined as a syndrome characterized by emotional exhaustion, cynicism, and ineffectiveness, which occurs in response to chronic stressors at work. It can adversely affect health workers' physical and mental health, and the quality of care provided. The COVID-19 pandemic increased stressors and could impact burnout prevalence in this group. There is a lack of information regarding the prevalence of burnout among hospital health workers in Brazil. A newer definition of burnout has been proposed that considers three different clinical profiles: the frenetic, underchallenged and worn-out subtypes. This differentiation could lead to interventions tailored for each subtype. The present study aimed to estimate the prevalence of burnout, its subtypes, and associated factors in workers of a public hospital network in Brazil, during the pandemic. A total of 143 randomly selected participants answered an online form that included sociodemographic and occupational items, and the Burnout Clinical Subtypes Questionnaire, a summarized version. This questionnaire evaluates three burnout dimensions (overload, lack of development, neglect) that can be used to discriminate the three burnout subtypes (frenetic, underchallenged, worn-out, respectively); higher scores indicate higher burnout levels. The prevalence of burnout was high (53.85%), similar to other studies during the pandemic. The most common subtypes were 'frenetic' (34.97%), characterized by increased efforts to meet work demands, to the point of neglecting personal needs, and 'lack of development' (23.78%), characterized by a sense that work is uninteresting and does not contribute to personal development, and a perfunctory behavior towards tasks. Age was associated with burnout: workers with less than 51 years presented higher levels of burnout. These findings indicate the need for effective interventions to prevent and/or treat burnout. The assessment of burnout subtypes can allow managers to better understand the processes affecting employees, and inform actions to improve workforce health.

Through the looking glass: qualitative study of critical care clinicians engaging in humanities

PURPOSE

Critical care medicine is facing an epidemic of burnout and consequent attrition. Interventions are needed to re-establish the medical field as a place of professional growth, resilience, and personal well-being. Humanities facilitate creation, reflection, and meaning-making, holding the promise of personal and community transformation. This study aimed to explore how clinicians engage with a humanities program, and what role and impact do the humanities play in their individual and collective journey.

METHODS

This is a qualitative study employing a phenomenological approach. Participants were faculty and trainees who participated in the program. Data consisted of (a) 60-h observations of humanities evenings, (b) more than 200 humanities artifacts brought by participants, and (c) 15 in-depth participant interviews. Data were analyzed inductively and reflectively by a team of researchers.

RESULTS

Participants were motivated to engage with the humanities curriculum because of past experiences with art, identifying a desire to re-explore their creativity to make meaning from their clinical experiences and a wish to socialize with and understand their colleagues through a different lens. The evenings facilitated self-expression, and inspired and empowered participants to create art pieces and re-engage with art in their daily lives. More importantly, they found a community where they could be vulnerable and supported, where shared experiences were discussed, emotions were validated, and relationships were deepened between colleagues.

CONCLUSIONS

Humanities may impact resilience and personal and community well-being by facilitating reflection and meaning-making of challenging clinical work and building bonds between colleagues.

Burnout Syndrome Among Critical Care Health Providers in Saudi Arabia

Background

Burnout Syndrome constitutes a critical concern in healthcare, particularly among practitioners operating in high-stress, critical care settings. Understanding the multifaceted factors contributing to burnout in this context is pivotal for devising effective interventions and promoting the well-being of critical care professionals.

Objective

To investigate the prevalence, contributing factors, and potential interventions related to Burnout Syndrome among critical care health providers in Saudi Arabia.

Methods

A cross-sectional research design was employed, gathering data from a sample of critical care health providers, including medical practitioners. A self-administered structured electronic questionnaire was used, incorporating the Maslach Burnout Inventory (MBI) with its three subscales: emotional exhaustion, depersonalization, and personal accomplishment. The target population was male and female critical care health providers over 18 years age, most participants lies between 25 years to 34 years.

Results

Statistical analysis shows significant disparities in response distribution (p<0.05), highlighting the importance of understanding encounters with emotional exhaustion, personal accomplishment, and depersonalization. The Durbin-Watson statistic indicated limited autocorrelation, and collinearity tolerance values suggested nominal intercorrelations among predictors. A significant positive correlation was found between the "Depersonalization Loss of Empathy MBI" factor and the outcome variables, indicating complex relationships between emotional exhaustion, personal accomplishment, and depersonalization.

Conclusion

The study highlights the multifaceted nature of burnout, revealing intricate relationships between emotional exhaustion, personal accomplishment, and depersonalization. These findings collectively form an important foundation for future guidelines and interventions to enhance the well-being of healthcare professionals.

Resilience and empathy in pharmacy interns: Insights from a three-year cohort study

Background

Resilience and empathy are important attributes for healthcare professionals to navigate challenging work environments and providing patient-centred care. Knowledge about pharmacists' levels of resilience and empathy, particularly during the early stages of their careers, is limited.

Objectives

To explore pharmacy interns' levels of resilience and empathy using the Connor-Davidson-Resilience-Scale-25 (CD-RISC-25) and the Kiersma-Chen-Empathy-Scale (KCES), examine potential associations with demographic characteristics and ascertain what challenges interns' resilience and which support mechanisms they identify.

Methods

Hard copies of the surveys were distributed to three cohorts during face-to-face intern pharmacy workshops from 2020 to 2022. Additionally, a qualitative questionnaire explored interns' experiences while completing an accredited internship program during the COVID-19 pandemic. Data were analysed using descriptive and inferential statistics, open-ended questions were analysed through qualitative and quantitative content analysis.

Results

Among 134 completed surveys, most respondents were female, aged 18-22, and worked in hospitals. The CD-RISC-25 mean score was 66.6 (SD 11.7) and the KCES mean was 84.3 (SD 9.23) indicative of intermediate levels of resilience and empathy. Resilience and empathy scores did not significantly differ between the three cohorts (p-value > 0.05), and both were not consistently correlated with each other (p-value > 0.05). No significant associations were found between demographic characteristics and resilience scores. However, age and pre-internship employment history showed a statistically significant association with empathy scores (p-value < 0.05), with younger age groups and those who worked part-time during undergraduate studies demonstrating higher levels of empathy. Challenges undermining interns' resilience included the COVID-19 pandemic, internship requirements, and feelings of inadequacy and inexperience.

Conclusions

This study showed that resilience and empathy scores among interns were at what can be regarded as intermediate levels, largely unaffected by the COVID-19 pandemic or cohort demographics. It highlights professional aspects and strategies which are professionally sustaining and may assist interns in navigating challenges to their resilience and empathy.

Exploring nurses' well-being and strategies to support self-care

Nurses experience a range of challenges in their practice that can adversely affect their well-being, for example work-related stress and workforce issues. These challenges may have been intensified by various factors, such as the coronavirus disease 2019 (COVID-19) pandemic and shift working. This article considers the concept of well-being and explores nurses' well-being in the context of ongoing stressors and workforce issues. It also examines some of the effects of shift work on nurses' well-being and how these could be mitigated. The authors outline a range of self-care practices that nurses could engage in and consider how they may be supported in this by their line managers and healthcare organisations.

Influence of work and family environment on burnout among emergency medical technicians

OBJECTIVE

Burnout among emergency medical technicians is a serious problem affecting delivery of quality emergency medical services. Although the repetitive nature of the job and lower education level requirements for technicians have been reported as risk factors, little is known about the influence of burden of responsibility, degree of supervisor support, and home environment on burnout among emergency medical technicians. This study aimed to test the hypothesis that burden of responsibility, degree of supervisor support, and home environment increase burnout probability.

METHODS

A web-based survey was conducted among emergency medical technicians in Hokkaido, Japan from July 26, 2021 to September 13, 2021. A total of 21 facilities were randomly selected from 42 fire stations. Prevalence of burnout was measured using the Maslach Burnout-Human Services Survey Inventory (MBI-HSS). Burden of responsibility was measured using a visual analog scale. Occupational background was also measured. Supervisor support was measured using the Brief Job Stress Questionnaire (BJSQ). Family-work negative spillover was measured using the Japanese version of Survey Work-Home Interaction-NijmeGen (SWING). The cutoff value for burnout syndrome was defined as emotional exhaustion≥27 and/or depersonalization≥10.

RESULTS

A total of 700 survey respondents were included, and 27 surveys with missing data were excluded. The suspected burnout frequency was 25.6%. Covariates were adjusted using multilevel logistic regression model analysis. Low supervisor support (odds ratio, 1.421; 95% confidence interval, 1.136-1.406; P<0.001) and high family-work negative spillover (odds ratio, 1.264; 95% confidence interval, 1.285-1.571; P<0.001) were independent factors associated with higher probability of burnout.

CONCLUSION

This study indicated that focusing on improvement of supervisor support for emergency medical technicians and creating supportive home environments may assist in reducing burnout frequency.

Facilitators and Barriers to Interacting With Clinical Decision Support in the ICU: A Mixed-Methods Approach

OBJECTIVES

Clinical decision support systems (CDSSs) are used in various aspects of healthcare to improve clinical decision-making, including in the ICU. However, there is growing evidence that CDSS are not used to their full potential, often resulting in alert fatigue which has been associated with patient harm. Clinicians in the ICU may be more vulnerable to desensitization of alerts than clinicians in less urgent parts of the hospital. We evaluated facilitators and barriers to appropriate CDSS interaction and provide methods to improve currently available CDSS in the ICU.

DESIGN

Sequential explanatory mixed-methods study design, using the BEhavior and Acceptance fRamework.

SETTING

International survey study.

PATIENT/SUBJECTS

Clinicians (pharmacists, physicians) identified via survey, with recent experience with clinical decision support.

INTERVENTIONS

An initial survey was developed to evaluate clinician perspectives on their interactions with CDSS. A subsequent in-depth interview was developed to further evaluate clinician (pharmacist, physician) beliefs and behaviors about CDSS. These interviews were then qualitatively analyzed to determine themes of facilitators and barriers with CDSS interactions.

MEASUREMENTS AND MAIN RESULTS

A total of 48 respondents completed the initial survey (estimated response rate 15.5%). The majority believed that responding to CDSS alerts was part of their job (75%) but felt they experienced alert fatigue (56.5%). In the qualitative analysis, a total of five facilitators (patient safety, ease of response, specificity, prioritization, and feedback) and four barriers (excess quantity, work environment, difficulty in response, and irrelevance) were identified from the in-depth interviews.

CONCLUSIONS

In this mixed-methods survey, we identified areas that institutions should focus on to improve appropriate clinician interactions with CDSS, specific to the ICU. Tailoring of CDSS to the ICU may lead to improvement in CDSS and subsequent improved patient safety outcomes.

The longitudinal study of subjective wellbeing and absenteeism of healthcare workers considering post-COVID condition and the COVID-19 pandemic toll

Experts have warned against the pandemic burden on healthcare workers early on, however little is known about the evolution of this burden with time, in addition to the long-term effects of post-COVID symptoms in healthcare workers. Staff at the Geneva University Hospitals in Switzerland had an online follow-up in July and December 2021, on their physical and mental health, quality of life and functional capacity using validated scales. Descriptive analyses compared the prevalence of symptoms, functional impairment and quality of life in SARS-CoV-2 positive and negative individuals at baseline and at follow-up. Out of the initial n = 3,083 participants that answered at baseline in July 2021, n = 900 (mean age of 46.4 years, 70.1% women) completed the follow-up in December 2021. With time, more individuals reported fatigue (+ 9.4%), headache (+ 9.0%), insomnia (+ 2.3%), cognitive impairment (+ 1.4%), stress/burnout (+ 8.8%), pain (+ 8.3%), digestive symptoms (+ 3.6%), dyspnea (+ 1.0%), and cough (+ 7.7%) compared to baseline, with a differentially larger increase in symptoms in the SARS-CoV-2 negative group. Individuals had more functional impairment (12.7% at baseline and 23.9% at follow-up), with more absenteeism and worsening quality of life. Healthcare workers are potentially suffering from long term consequences of the pandemic burden, calling for urgent action and solutions.

Critical Care Pharmacists: A Focus on Horizons

Critical care pharmacy has evolved rapidly over the last 50 years to keep pace with the rapid technological and knowledge advances that have characterized critical care medicine. The modern-day critical care pharmacist is a highly trained individual well suited for the interprofessional team-based care that critical illness necessitates. Critical care pharmacists improve patient-centered outcomes and reduce health care costs through three domains: direct patient care, indirect patient care, and professional service. Optimizing workload of critical care pharmacists, similar to the professions of medicine and nursing, is a key next step for using evidence-based medicine to improve patient-centered outcomes.

Self-Compassion, Work Engagement and Job Performance among Intensive Care Nurses during COVID-19 Pandemic: The Mediation Role of Mental Health and the Moderating Role of Gender

(1) Background: The COVID-19 pandemic has highlighted attention on the importance of certain variables in predicting job performance. Among these, mental health is one of the main variables affected by this pandemic. It can have an important mediating role in predicting job performance by individual, occupational, and organizational variables, especially in the nursing community. However, there is little information about its mediation role among the predictors of job performance. This cross-sectional study aimed to examine the role of mental health as a mediating factor in the influence of self-compassion and work engagement on ICU nurses' job performance during the COVID-19 pandemic, as well as the moderating effect of gender on all model relations. A survey of 424 ICU nurses (men 193 and women 231) was undertaken in three Coronavirus hospitals in Isfahan, Iran. (2) Method: Questionnaires were distributed and collected among the statistical sample, and the data from the questionnaires were analyzed using AMOS24 software (version 24). The research model was evaluated in two stages (the main model and the two sub-models in two gender groups). (3) Result: The analysis revealed that work engagement (β = 0.42, p < 0.001), mental health (β = 0.54, p < 0.001) and job performance (β = 0.51, p < 0.001) were discovered to be positively related to self-compassion. Work engagement is positively associated with mental health (β = 0.16, p < 0.01) and job performance (β = 0.21, p < 0.001), and mental health is linked positively to job performance (β = 0.23, p < 0.001). Furthermore, the effects of self-compassion and work engagement on job performance are mediated by mental health. According to the findings, gender moderates the link between self-compassion and work engagement, work engagement and job performance, and self-compassion and job performance. (4) Conclusion: Mental health has a mediating role in the effect of self-compassion and work engagement on ICU nurses' job performance. Gender also acted as a moderator in some relationships. Males are dominant in all of these relationships as compared to females.

Mapping the process of ICU care delivery to improve treatment decisions in acute respiratory failure

Evidence suggests system-level norms and care processes influence individual patients' medical decisions, including end-of-life decisions for patients with critical illnesses like acute respiratory failure. Yet, little is known about how these processes unfold over the course of a patient's critical illness in the intensive care unit (ICU). Our objective was to map current-state ICU care delivery processes for patients with acute respiratory failure and to identify opportunities to improve the process. We conducted a process mapping study at two academic medical centers, using focus groups and semi-structured interviews. The 70 participants represented 17 distinct roles in ICU care, including interprofessional medical ICU and palliative care clinicians, surrogate decision makers, and patient survivors. Participants refined and endorsed a process map of current-state care delivery for all patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation. The process contains four critical periods for active deliberation about the use of life-sustaining treatments. However, active deliberation steps are inconsistently performed and frequently disrupted, leading to prolongation of life-sustaining treatment by default, without consideration of patients' individual goals and priorities. Interventions to standardize active deliberation in the ICU may improve treatment decisions for ICU patients with acute respiratory failure.

High-level burnout in physicians and nurses working in adult ICUs: a systematic review and meta-analysis

PURPOSE

The prevalence of burnout in intensive care unit (ICU) professionals is difficult to establish due to the variety of survey instruments used, the heterogeneity of the targeted population, the design of the studies, and the differences among countries regarding ICU organization.

METHODS

We performed a systematic review and meta-analysis examining the prevalence of high-level burnout in physicians and nurses working in adult ICUs, including only studies that use the Maslach Burnout Inventory (MBI) as a tool to evaluate burnout and involving at least 3 different ICUs.

RESULTS

Twenty-five studies with a combined population of 20,723 healthcare workers from adult ICUs satisfied the inclusion criteria. Combining 18 studies including 8187 ICU physicians, 3660 of them reported a high level of burnout (prevalence 0.41, range 0.15-0.71, 95% CI [0.33; 0.5], I2 97.6%, 95% CI [96.9%; 98.1%]). The heterogeneity can be at least in part explained by the definition of burnout used and the response rate as confirmed by the multivariable metaregression done. In contrast, there was no significant difference regarding other factors such as the study period (before or during the coronavirus disease 2019 (COVID-19) pandemic), the income of the countries, or the Healthcare Access and Quality (HAQ) index. Combining 20 studies including 12,536 ICU nurses, 6232 of nurses were reporting burnout (prevalence 0.44, range 0.14-0.74, [95% CI 0.34; 0.55], I2 98.6% 95% CI [98.4%; 98.9%]). The prevalence of high-level burnout in ICU nurses for studies performed during the COVID-19 pandemic was higher than that reported for studies performed before the COVID-19 pandemic (0.61 [95% CI, 0.46; 0.75] and 0.37 [95% CI, 0.26; 0.49] respectively, p = 0.003). As for physicians, the heterogeneity is at least in part explained by the definition used for burnout using the MBI but not by the number of participants. When compared, the prevalence of high-level burnout was not different between ICU physicians and ICU nurses. However, the proportion of ICU nurses with a high level of emotional exhaustion was higher than for ICU physicians (0.42 [95% CI, 0.37; 0.48] and 0.28 [0.2; 0.39], respectively, p = 0.022).

CONCLUSION

According to this meta-analysis, the prevalence of high-level burnout is higher than 40% in all ICU professionals. However, there is a great heterogeneity in the results. To evaluate and to compare preventive and therapeutic strategies, there is the need to use a consensual definition of burnout when using the MBI instrument.

The impact of positive reinforcement on teamwork climate, resiliency, and burnout during the COVID-19 pandemic: The TEAM-ICU (Transforming Employee Attitudes via Messaging strengthens Interconnection, Communication, and Unity) pilot study

Burnout is an internationally recognized occupational phenomenon that negatively impacts the healthcare workforce and its recipients. The aim of this pilot study was to test whether positive reinforcement and integrating a language of support among co-workers can enhance resiliency, facilitate psychological wellness, and encourage hope. This embedded mixed methods prospective, behavioral, interventional study evaluated the effects of positive feedback on wellness among intensive care unit clinicians during the COVID-19 pandemic in a single center, quaternary care medical center. The deliberate positive feedback paradigm has the potential to augment resiliency and improve attitudes toward a teamwork climate. The routine use of deliberate positivity may represent a scalable, low-cost initiative to enhance wellness in a healthcare organization.

How early career pharmacists understand resilience - A qualitative study of experiences, challenges and strategies

INTRODUCTION

Resilience assists healthcare professionals in negotiating challenges, remaining positive when experiencing adversity, and in constructively dealing with difficult work situations and environments. There is increasing research about how early career healthcare professionals, understand and maintain resilience but little is known about support early career pharmacists may need and value.

AIMS

To explore early career pharmacists' understanding of resilience, their strategies to enhance and maintain resilience as healthcare professionals and to identify resilience-fostering programmes they perceive could be implemented to support them.

METHODS

Three focus groups and 12 semi-structured interviews with a total of 15 hospital pharmacists and 10 community pharmacists (both less than 3 years post-registration) were conducted. An inductive thematic analysis of transcripts was performed to identify main themes and subthemes.

RESULTS

Pharmacists understood resilience as the capability to adapt to and learn from challenges and setbacks, which they can build through experience and exposure. Resilience in the workplace was challenged by their working environment and workload, which could lead to ego depletion, the transition from intern to registered pharmacist and working during the COVID-19 pandemic, which both added pressure and uncertainty to their role. Professional resilience was supported on individual, social and organisational levels and through self-care strategies. Pharmacists perceived mentorship and sharing experiences, experiential placements and constructive but challenging role play as potentially beneficial in building resilience during undergraduate studies and internship.

DISCUSSION

Pharmacists defined resilience constructively and identified challenges testing but also strategies supporting their resilience in the workplace. Workplaces can support pharmacists by monitoring workload and workplace relationships, creating opportunities for peer and mentor support and by allowing pharmacists to implement their personal, individualised resilience maintaining strategies. Early career pharmacists' experiences and insights would be valuable when considering the design and implementation of resilience-fostering programmes.

Psychopathological Factors Associated With Burnout in Intensive Care Nurses: A Cross-Sectional Study

BACKGROUND

Although previous studies have separately revealed that parameters such as anxiety, depression, and secondary traumatic stress (STS) are associated with burnout, there is still a limited understanding of the relationship between anxiety, depression, and STS and burnout in intensive care unit (ICU) nurses.

AIMS

To investigate the relationship between levels of burnout, anxiety, depression, and STS in ICU nurses.

METHODS

A cross-sectional study was conducted with ICU nurses (N = 164) from a university hospital in eastern Turkey. The participants completed the anxiety, depression, STS, and burnout scales along with the descriptive characteristics form. The data were analyzed using descriptive statistics, correlation, and logistic regression analysis.

RESULTS

The mean scores for STS, anxiety, depression, and burnout were 40.60 ± 13.77, 17.14 ± 12.90, 13.28 ± 9.75 and 41.39 ± 14.87, respectively. The results showed that, in the ICU nurses, anxiety, depression, and STS components explained 61% of emotional exhaustion, 38% of depersonalization, and 13% of personal accomplishment.

CONCLUSIONS

While the present findings supported the paradigm that burnout in ICU nurses is associated with STS, anxiety, and depression, they also revealed some details about the psychopathological factors associated with burnout. These details were as follows: (1) individuals who resorted to avoidance as a component of STS on a high level were more likely to experience emotional exhaustion and depersonalization, (2) individuals with severe depressive symptoms were more likely to experience a decrease in their personal accomplishment, and (3) individuals with anxiety symptoms were more likely to experience both emotional exhaustion and personal accomplishment.

Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the Longevity of a Critical Specialty

A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical care physicians are especially affected. This article reviews the history of burnout in health care workers, presents the signs and symptoms, discusses the specific impact of the COVID-19 pandemic on intensive care unit caregivers, and attempts to identify potential strategies to combat the Great Resignation disproportionately affecting health care workers. The article also focuses on how the specialty can amplify the voices and highlight the leadership potential of underrepresented minorities, physicians with disabilities, and the aging physician population.

A Multicenter Survey of Pediatric-Neonatal Transport Teams in the United States to Assess the Impact of the Coronavirus Disease 2019 Pandemic on Staffing

Objective

The coronavirus disease 2019 pandemic has resulted in unprecedented burnout in frontline health care providers. However, the impact of the pandemic on interfacility pediatric and neonatal transport team members has not been studied. The current study uses a survey design to document the impact of the pandemic on pediatric and neonatal transport team members with a focus on staffing and resilience promotion strategies.

Methods

Data for this study came from a short cross-sectional survey distributed to members of the American Academy of Pediatrics Section on Transport Medicine.

Results

Sixty-six teams responded (around 45%). Forty-one respondents (62%) reported vacancies on their transport teams, with 35 (53.8%) reporting more vacancies during the pandemic. Forty percent of highly trained registered nurses and respiratory therapists from specialty teams left their positions for those with better compensation during the pandemic. Forty-two percent of respondents were not trained to recognize burnout, stress, or compassion fatigue.

Conclusion

Our study shows that half of the respondents had more vacancies during the pandemic than in previous years and reported difficulty in filling those positions. We were unable to link the vacancies to the pandemic and burnout because hospitalizations and transports in the pediatric facilities decreased during the pandemic; however, we do report that coronavirus disease 2019 exposure before the vaccine was a source of stress for team members. There are opportunities to improve the identification of burnout and to foster resilience and boost retention of this highly skilled niche workforce.

Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council

Coronavirus disease 2019 (COVID-19) has increased the demand for extracorporeal membrane oxygenation (ECMO) and introduced distinct challenges to patient selection for ECMO. Standardized processes for patient selection amidst resource limitations are lacking, and data on ECMO consults are underreported. We retrospectively reviewed consecutive adult ECMO consults for acute respiratory failure received at a single academic medical center from April 1, 2020, to February 28, 2021, and evaluated the implementation of a multidisciplinary selection committee (ECMO Council) and standardized framework for patient selection for ECMO. During the 334-day period, there were 202 total ECMO consults; 174 (86.1%) included a diagnosis of COVID-19. Among all consults, 157 (77.7%) were declined and 41 (20.3%) resulted in the initiation of ECMO. Frequent reasons for decline included the presence of multiple relative contraindications (n = 33), age greater than 60 years (n = 32), and resource limitations (n = 27). The ECMO Council deliberated on every case in which an absolute contraindication was not present (n = 96) via an electronic teleconference platform. Utilizing multidisciplinary consensus together with a standardized process for patient selection in ECMO is feasible during a pandemic and may be reliably exercised over time. Whether such an approach is feasible at other centers remains unknown.

Clinician perceptions of the impact of ICU family visiting restrictions during the COVID-19 pandemic: an international investigation

PURPOSE

To guarantee the safety of the public, clinicians and patients during the COVID-19 pandemic, hospital visits were severely restricted internationally. There are limited data on the precise impact of these visiting restrictions on Intensive Care Unit clinicians. Our objectives therefore were to explore the impact of family visitation restrictions on clinicians and care delivery and describe innovation alongside areas for potential improvement.

METHODS

A qualitative approach using focus groups was employed. We recruited members of the multi-disciplinary team from Spain, France and the UK. Framework analysis was used to synthesize and interpret data.

RESULTS

In total, 28 staff from multiple international sites contributed to data across six focus groups: 12 from the UK, 9 from France and 7 from Spain. In relation to the key aims, we derived four themes: the emergence of new technologies, relationships and rapport establishment, communication challenges and end-of-life care provision. Across each theme, the overarching concepts of clinician emotional exhaustion and emotional distress emerged alongside the negative impact on job satisfaction.

CONCLUSION

The impact of COVID-19 family visitation restrictions is far reaching. Future research should examine the wider impact of family presence in the ICU.

Global critical care: a call to action

Critical care is underprioritized. A global call to action is needed to increase equitable access to care and the quality of care provided to critically ill patients. Current challenges to effective critical care in resource-constrained settings are many. Estimates of the burden of critical illness are extrapolated from common etiologies, but the true burden remains ill-defined. Measuring the burden of critical illness is epidemiologically challenging but is thought to be increasing. Resources, infrastructure, and training are inadequate. Millions die unnecessarily due to critical illness. Solutions start with the implementation of first-step, patient care fundamentals known as Essential Emergency and Critical Care. Such essential care stands to decrease critical-illness mortality, augment pandemic preparedness, decrease postoperative mortality, and decrease the need for advanced level care. The entire healthcare workforce must be trained in these fundamentals. Additionally, physician and nurse specialists trained in critical care are needed and must be retained as leaders of critical care initiatives, researchers, and teachers. Context-specific research is mandatory to ensure care is appropriate for the patient populations served, not just duplicated from high-resourced settings. Governments must increase healthcare spending and invest in capacity to treat critically ill patients. Advocacy at all levels is needed to achieve universal health coverage for critically ill patients.

Burnout and quality of life in nursing staff during the COVID-19 pandemic

OBJECTIVE

To investigate the association between burnout and quality of life among nursing staff at intensive care units during the new coronavirus pandemic and identify the influence of sociodemographic variables.

METHODS

A cross-sectional study was conducted with 109 nursing staff members at intensive care units of a public hospital in Brazil. Data collection involved the administration of a sociodemographic questionnaire as well as the WHOQOL-Bref and Oldenburg Burnout Inventory.

RESULTS

The participants presented a high state of burnout and a low score in the physical domain of the quality-of-life instrument. Men (p = 0.037), income (p = 0.011) and burnout (p < 0.001) independently influenced quality-of-life (p < 0.01). Age, being a nursing technician and working at two hospitals exerted an influence on burnout status (p < 0.05). A negative association was found between quality of life and burnout (p < 0.01).

CONCLUSION

Our findings showed that burnout due to occupational circumstances affected negatively the quality of life perceptions of nursing staff working at intensive care units during the COVID-19 pandemic.

The Association of Professional Burnout and Turnover Intentions Among Intensive Care Units Physicians: A Cross-Sectional Study

Intensive Care Units (ICU) workers work in highly stressful conditions that make them prone to professional burnout, which can lead to high turnover rates. This study explores professional burnout levels among ICU workers in Kuwait general governmental hospitals (GGHs), their turnover intentions, and the correlation factors. A cross-sectional self-administered survey study was conducted. Professional burnout level was measured using the Copenhagen Burnout Inventory (CBI), while turnover intention was measured using the Turnover Intention Scale (TIS-6). Data were analyzed using STATA software, and descriptive, correlative, and comparative analyses were performed. Eighty-nine ICU physicians filled out the questionnaire. Most of the participants were males, married, non-Kuwaiti nationals, with 10 to 20 years of experience, and the mean age of respondents was 39.2. The total professional burnout score was high was 54.7 (17.6). There were high total average scores for the personal and work-related domains. Participants who were younger than 35 years of age and graduated before 5 to 10 years had higher levels of professional burnout compared to other groups. More than half of the sample expressed their intention to leave their current job as an ICU physician. However, no association was found between turnover intentions and levels of burnout. High levels of professional burnout of turnover intentions were seen among ICU physicians in Kuwait. Policies should be adopted to reduce and mitigate professional burnout among ICU physicians and increase their retention. Future research should further investigate professional burnout among ICU staff, the associated factors, and its relation to their turnover intention.

The impact of the COVID-19 pandemic on critical care healthcare professionals' work practices and wellbeing: A qualitative study

BACKGROUND

Burnout and other psychological comorbidities were evident prior to the COVID-19 pandemic for critical care healthcare professionals (HCPs) who have been at the forefront of the health response. Current research suggests an escalation or worsening of these impacts as a result of the COVID-19 pandemic.

OBJECTIVES

The objective of this study was to undertake an in-depth exploration of the impact of the evolving COVID-19 pandemic on the wellbeing of HCPs working in critical care.

METHODS

This was a qualitative study using online focus groups (n = 5) with critical care HCPs (n = 31, 7 medical doctors and 24 nurses) in 2021: one with United Kingdom-based participants (n = 11) and four with Australia-based participants (n = 20). Thematic analysis of qualitative data from focus groups was performed using Gibbs framework.

FINDINGS

Five themes were synthesised: transformation of anxiety and fear throughout the pandemic, the burden of responsibility, moral distress, COVID-19 intruding into all aspects of life, and strategies and factors that sustained wellbeing during the pandemic. Moral distress was a dominant feature, and intrusiveness of the pandemic into all aspects of life was a novel finding.

CONCLUSIONS

The COVID-19 pandemic has adversely impacted critical care HCPs and their work experience and wellbeing. The intrusiveness of the pandemic into all aspects of life was a novel finding. Moral distress was a predominate feature of their experience. Leaders of healthcare organisations should ensure that interventions to improve and maintain the wellbeing of HCPs are implemented.

Fostering positive emotions, psychological well-being, and productive relationships in the intensive care unit: A before-and-after study

BACKGROUND

Intensive care units (ICUs) are emotionally demanding workplaces. Exposure to stress can negatively impact ICU staff members' emotional resilience, health, and capacity to provide care. Despite recognition of the benefits of promoting "healthy workplaces", there are limited interventional studies aimed at improving the well-being of ICU staff.

AIM

The aim of this study was to assess the effectiveness of a multifaceted intervention for improving well-being of staff working in a tertiary ICU.

METHODS

A before-and-after interventional study was conducted over a 2-year period, between 2019 and 2021. Interventions included social activities, fitness, nutrition, and emotional support. An electronic version of the PERMA-Profiler questionnaire was used to assess the well-being of a convenience sample of ICU staff before (n = 96) and after (n = 137) the intervention. Ten focus groups (each involving 12-18 nurses) were held to explore nurses' perceptions of the intervention's effectiveness.

RESULTS

After the intervention, a significantly greater proportion of participants described their work week as draining (32% vs 19%, χ² = 4.4 df + 1, P = 0.03) and at least a bit harder than normal (38% vs 22%, χ² = 6.4 df + 1, p = 0.01) compared to baseline surveys. However, well-being scores after the intervention (mean = 6.95, standard deviation = 1.28) were not statistically different (p = 0.68) from baseline scores (mean = 7.02, standard deviation = 1.29). Analysis of focus groups data revealed three key categories: boosting morale and fostering togetherness, supporting staff, and barriers to well-being.

CONCLUSIONS

After the intervention, there was a preserved level of well-being from baseline despite a statistically significant increase in staff reporting the work week as draining and at least a little bit harder than normal. These findings must be considered in light of the COVID-19 pandemic, which started after baseline data collection and continues to impact the community, including staff workload and pressures in intensive care. The study findings may inform strategies for improving ICU staff members' well-being.

Burnout among ICU Healthcare Workers at Two Tertiary Care Hospitals in Makkah during the Hajj Season

Background

The Hajj season results in increased workload and longer shift hours for healthcare workers at the intensive care units (ICUs), which may result in burnout.

Objective

To determine the point prevalence of professional burnout and its predictors among healthcare workers at the ICUs of two tertiary care hospitals in Makkah during the Hajj season.

Methods

This cross-sectional descriptive study included all healthcare professionals working at the ICU departments of two of the largest tertiary care hospitals in the Makkah region during the 1439/2018 Hajj season. The original Maslach Burnout Inventory (MBI) questionnaire was used to measure burnout. Logistic regression models were fitted to estimate the effect size of the associated risk factors.

Results

A total of 354 participants completed the questionnaire. Moderate to severe burnout was found in each of the three subscales: emotional exhaustion, 56%; depersonalization, 82%, and impaired personal achievement, 72%. Nurses were significantly more likely to experience burnout compared with physicians (P = 0.017). Independent predictors of moderate or severe burnout were being aged ≤40 years (odds ratio [OR]: 2.1, 95% CI: 0.395-4.002; P = 0.045), female gender (OR: 2.2, 95% CI: 0.242-4.346; P = 0.037); work having a negative impact on family (OR: 3, 95% CI: 0.164-5.504; P = 0.019); unsatisfaction with salary (OR: 2.8, 95% CI: 0.28-5.056; P = 0.025); and working at the cardiac critical care unit (OR: 2.6, 95% CI: 0.440-4.467; P = 0.035).

Conclusion

This study revealed that the point prevalence of burnout is common among ICU healthcare workers during the Hajj season. These findings can be used by policymakers to devise strategies to mitigate the risks of burnout during the Hajj season.

Evaluation of Medical Staff Satisfaction for Workplace Architecture in Temporary COVID-19 Hospital: A Case Study in Gdańsk, Poland

This article analyses the architecture that was used in the temporary AmberExpo hospital in Gdańsk, Poland which was installed during the COVID-19 pandemic. The construction of this type of facility is often based on experimental approaches, aimed at caring for patients suffering from an infectious disease in emergency conditions. In order to assess the level of employee satisfaction with the architectural and technical elements used in the first period of the hospital's activity, medical staff were asked to fill out a questionnaire. The analysis of the survey's results indicated that the majority of employees expressed satisfaction with the architectural and technical elements, with the design of the spatial layout of the individual medical zones receiving the most positive feedback. However, frequently selected drawbacks in the design included the lack of natural daylight, the artificial light that was used and the acoustics of the facility. This detailed examination of the satisfaction and feedback from medical employees working in this type of emergency facility enables the development of solutions that in the future will allow for the improved adaptive reuse and implementation of such structures, with enhanced time and economic efficiency, and most importantly, the ability to provide a safer workplace.

Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers

PURPOSE OF REVIEW

We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW.

RECENT FINDINGS

The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14-47%), burnout (45-85%), anxiety (31-60%), and depression (16-65%) have been reported, and these mental health symptoms are often interrelated. Most studies suggest that nurses and female HCW are at highest risk for developing mental health symptoms. The main personal concerns associated with reporting mental health symptoms among ICU HCW were worries about transmitting COVID-19 to their families, worries about their own health, witnessing colleagues contract the disease, and experiencing stigma from their communities. Major modifiable work-related risk factors were experiencing poor communication from supervisors, perceived lack of support from administrative leadership, and concerns about insufficient access to personal protective equipment, inability to rest, witnessing hasty end-of-life decisions, and restriction of family visitation policies.

SUMMARY

The COVID-19 pandemic has severely impacted ICU HCW worldwide. The psychological trauma, manifesting as posttraumatic stress disorder, burnout, anxiety, and depression, is substantial and concerning. Urgent action by lawmakers and healthcare administrators is required to protect ICU HCW and sustain a healthy workforce.

Employment Status of Nurses After a Psychoeducational Group Intervention: A Matched Case-Control Study

OBJECTIVE

This matched case-control study compared the long-term employment status of direct care nurses based on participation in a psychoeducational group intervention and calculated the estimated cost savings.

BACKGROUND

Chronic stress, in addition to lack of support and low autonomy, can lead to burnout among nurses. Burnout is a common reason for job dissatisfaction and turnover. Interventions combining education with therapeutic processing and peer support may lead to healing and growth in nurses already experiencing the effects of chronic stress and burnout. The COVID-19 pandemic also contributed to stress among nurses.

METHODS

Fifty-four direct care nurses who participated in the intervention were paired with 54 direct care nurses who did not participate, matched on the following variables: age, gender, race, work setting, and campus.

RESULTS

This study found a higher percentage of direct care nurses who participated in the intervention remained employed compared with the matched control subjects who did not participate.

CONCLUSION

At a relatively low cost compared with the cost of turnover by each nurse, the psychoeducational group intervention may provide an opportunity to improve retention among nurses.

Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors

BACKGROUND

The COVID-19 pandemic has strained hospitals and healthcare workers engaged in combating the virus with limited knowledge and resources. Intensive care unit (ICU) nurses are among the healthcare workers most affected by the pandemic and are at risk for developing burnout syndrome.

OBJECTIVE

The present study aims to explore burnout symptoms prevalence among ICU nurses and to identify the individual, organizational, and contextual risk, and protective factors of burnout in ICU nurses during the COVID-19 pandemic.

METHODS

A scoping review was conducted by searching PubMed, Scopus, and Web of Science. Only papers with empirical data and referred to ICU nurses were included. A total of 350 initial results were yielded, and 40 full texts were screened. Twelve papers constituted the final sample in the analysis.

RESULTS

High levels of symptoms of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) were registered among ICU nurses during the COVID-19 pandemic. Increased workload, lack of equipment, social stigma, and fear of contagion emerged as key risk factors. Social support from leaders and colleagues, professional recognition, use of personal protective tools, and witnessing patients' successful recovery emerged as major protective factors.

CONCLUSIONS

The results may inform the development of timely actions to counter burnout in ICU nurses during this COVID-19 pandemic and in a post-COVID-19 scenario.

The Effect of Creative Arts Therapy on Psychological Distress in Health Care Professionals

BACKGROUND

Work-related psychological distress is common among health care professionals. We determined whether 4 creative arts therapy (CAT) programs were acceptable, feasible, and improved psychological distress and job turnover intention in health care professionals with burnout symptoms.

METHODS

Health care professionals were enrolled during the coronavirus disease (COVID-19) pandemic from September 2020 until July 2021. Participants attended in-person weekly 90-minute group session for 12 consecutive weeks. Intervention and control subjects completed surveys before the beginning and after the end of their cohort. The study outcomes were session attendance (feasibility), program satisfaction (acceptability), and change in symptoms of anxiety, depression, burnout, posttraumatic stress disorder (PTSD), and job turnover intention.

RESULTS

We randomized 165 participants into 4 CAT interventions and 1 common control group across 3 sequential cohorts. Thirty-five randomized participants dropped out before the start of the cohort, and 16 were replaced from a waiting list. Therefore, the cohort consisted of 146 participants. On average, participants were 35 years old, white (85%), and female (92%). Overall, 52% were nurses, 10% were doctors, and 16% were behavioral health specialists. Participants attended a median of 9.5 [8-11] sessions. Program satisfaction was high with a median Client Satisfaction Questionnaire (CSQ-8) score of 31 [17-32] out of a possible score of 32. Participants randomized to the intervention had improvements in anxiety (P < .0001) and depression scores (P = .0007), total posttraumatic stress disorder score (P =.0002), burnout scores (P = .001, .003, .008), and turnover intention (P = .001).

CONCLUSIONS

A CAT program is feasible, acceptable, and may reduce psychological distress and turnover intention for health care professionals.

What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care

OBJECTIVE

To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals.

DESIGN

This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme.

RESULTS

A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience.

CONCLUSIONS

These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.

Mindfulness as an Antidote to Burnout for Nursing and Support Staff in an Oncological Intensive Care Unit: A Pilot Study

We set out to implement a pilot mindfulness-based intervention (MBI) to alleviate burnout, stress, anxiety, and depression in nursing and support staff of an oncological intensive care unit. We created an 8-week personalized yoga therapy MBI for nurses and patient care technicians in an oncological intensive care unit. Validated self-report scale tools were used to measure burnout, stress, anxiety, and depression in the intervention and control groups (Institutional Quality Improvement Registry no. 296, 2018). Changes in scores from baseline to postintervention were evaluated between groups. Forty-five staff, 21 in the control group and 24 in the intervention group, participated. Both groups at baseline had low prevalence of stress, anxiety, and depression (13% vs 36.8%, P = .11; 21.7% vs 52.6%, P = .17; 17.4% vs 26.3%, P = .48; respectively). Low rates of high emotional exhaustion, depersonalization, and low professional efficacy were observed for both groups (41.7% vs 35.0%, P = .65; 20.8% vs 15%, P = .71; 58.3% vs 50.0%, P = .58, respectively). Post-MBI, prevalence of depression, anxiety, stress, emotional exhaustion, and depersonalization remained low and similar between both groups. Notwithstanding, professional efficacy scores significantly improved in a between-group comparison (0.063 vs -0.25; P = .0336). We observed that burnout, stress, anxiety, and depression were remarkably low in our study relative to the literature. Implementation of the MBI faced many obstacles and had low compliance during participation. This presumably influenced results and should be addressed prior to any future intervention. Despite this, professional efficacy improved significantly.

TRIAL REGISTRATION

Approved by MD Anderson Cancer Center Quality Improvement Registry (no. 296, 2018).

Patient-Centered and Family-Centered Care in the Intensive Care Unit

Patient-centered and family-centered care (PFCC) is widely recognized as integral to high-quality health-care delivery. The highly technical nature of critical care puts patients and families at risk of dehumanization and renders the delivery of PFCC in the intensive care unit (ICU) challenging. In this article, we discuss the history and terminology of PFCC, describe interventions to promote PFCC, highlight limitations to the current model, and offer future directions to optimize PFCC in the ICU.

An exploration of burnout and resilience among emergency physicians at three teaching hospitals in the English-speaking Caribbean: A cross-sectional survey

Background

Burnout is common among doctors working in emergency departments. It has significant consequences and is multifactorial. Self-care and resilience tendencies may contribute to being burnt out, or not. This study explores burnout and resilience amongst physicians working in Caribbean emergency departments.

Methods

Data were collected from 111 participants using the Maslach Burnout Inventory (MBI) and the Resilience Scale-14 (RS14) as measures of burnout and resilience, respectively. Questions collected data on participant demographics and characteristics related to self-care. The associations between demographic characteristics and total burnout and resilience scales were explored.

Findings

Among participants, 88.6% had medium to high range emotional exhaustion, 82.8% exhibited medium to high range depersonalization, and 19.6% had low to medium range personal accomplishment. Participants in Barbados had higher emotional exhaustion and depersonalization scores (p=0.009), and those in a postgraduate programme had higher depersonalization scores (p=0.047). The mean RS-14 score was 81.1 out of a maximum of 98.0 with a standard deviation of 13.1 and a range of 26 to 98. Depression correlated with high emotional exhaustion scores (p=0.004) and low resilience scores (p<0.0001). Emotional exhaustion scores increased among participants using alcohol daily (p=0.01), using recreational drugs (p=0.021) and sleeping aids (p=0.028).

Interpretation

High burnout, despite high resilience, is present in this sample of physicians working in emergency departments of teaching hospitals in the Caribbean. Although resilience scores were high, those with lower resilience tendencies had poorer self-care habits.

Funding

No external funding.

The Influence of the COVID-19 Pandemic on Intensivists' Well-Being: A Qualitative Study

BACKGROUND

The COVID-19 pandemic has strained health care systems and has resulted in widespread critical care staffing shortages, negatively impacting the quality of care delivered.

RESEARCH QUESTION

How have hospitals' emergency responses to the pandemic influenced the well-being of frontline intensivists, and do any potential strategies exist to improve their well-being and to help preserve the critical care workforce?

STUDY DESIGN AND METHODS

We conducted semistructured interviews of intensivists at clusters of tertiary and community hospitals located in six regions across the United States between August and November 2020 using the "four S" framework of acute surge planning (ie, space, staff, stuff, and system) to organize the interview guide. We then used inductive thematic analysis to identify themes describing the influence of hospitals' emergency responses on intensivists' well-being.

RESULTS

Thirty-three intensivists from seven tertiary and six community hospitals participated. Intensivists reported experiencing substantial moral distress, particularly because of restricted visitor policies and their perceived negative impacts on patients, families, and staff. Intensivists also frequently reported burnout symptoms as a result of their experiences with patient death, exhaustion over the pandemic's duration, and perceived lack of support from colleagues and hospitals. We identified several potentially modifiable factors perceived to improve morale, including the proactive provision of mental health resources, establishment of formal backup schedules for physicians, and clear actions demonstrating that clinicians are valued by their institutions.

INTERPRETATION

Restrictive visitation policies contributed to moral distress as reported by intensivists, highlighting the need to reconsider the risks and benefits of these policies. We also identified several interventions as perceived by intensivists that may help to mitigate moral distress and to improve burnout as part of efforts to preserve the critical care workforce.

Could the complying with WHO physical activity recommendations improve stress, burnout syndrome, and resilience? A cross-sectional study with physical education teachers

Purpose

Teachers are exposed to inherent psychosocial risks in the workplace such as chronic stress, psychological distress, exhaustion, and burnout syndrome. To compare the values in psychosocial variables based on compliance with the recommendations for physical activity by the World Health Organization (WHO) and the type of physical activity performed.

Methods

The study had a non-experimental and comparative design, with measurements in a single group. The sample was composed of 415 physical education teachers from Spain, with an age range of 21–53 years (28.78 ± 6.15) and a heterogeneous distribution of gender (69.4% male; 30.6% women). The Perceived Stress Scale, the Maslach Burnout Inventory, the Connor–Davidson Resilience Scale, and an Ad-Hoc questionnaire were used to record the sociodemographic aspects and physical-sports practice.

Results

Most of the teachers complied with the recommendations for physical activity practice (n = 335; 80.7%). Physical activity was associated with lower signs of burnout and a greater ability to overcome. Although, teachers who did not comply with WHO recommendations, showed greater stress and emotional exhaustion. In conclusion, enough practice of physical activity based on WHO was shown as a preventive factor of stress and signs of burnout.

Conclusions

The findings suggest that perform physical activity based on the WHO recommendations helps for work stress prevention and burnout syndrome in teachers, as well as to overcome work adversities.

Hospital Outdoor Spaces as Respite Areas for Healthcare Staff During the COVID-19 Pandemic

The COVID-19 pandemic has created considerable implications for healthcare staff around the globe. During the pandemic, the frontline healthcare workers experience intense anxiety, stress, burnout, and psychological breakdown, with severe implications on their mental and physical well-being. In addition to these implications, anxiety and stress can hinder their productivity and ability to perform their duties efficiently. The literature indicates that hospital gardens and contact with nature can help alleviate psychological distress among hospital staff. However, few studies investigated the role of outdoor spaces as areas for respite and work breaks in healthcare facilities during the pandemic. The present opinion paper highlights the challenges of job stress and psychological distress health workers face during the pandemic. This article also underscores the role of hospital outdoor spaces and garden facilities in coping with the challenges. While other measures to reduce stress among hospital staff and ensure their health and safety are important, hospital administrators and relevant government agencies should also emphasize the provision of gardens and open spaces in healthcare facilities. These spaces can act as potential areas for respite for hospital staff to help them cope with the stress and anxiety accumulated through working under crises.

The Impact of COVID-19 on the Clinical Practices, Working Environment, and Social Life of Intensivists in Non-COVID ICU

Purpose

Enlightening the changes in the usual clinical practices, working environment, and social life of Intensivists working in noncoronavirus disease intensive care units (non-COVID ICU) during the COVID pandemic.

Materials and methods

Observational cross-sectional study for Indian intensivists working in non-COVID ICUs conducted between July and September 2021. A 16-question online survey consisting of the work and social profile of the participating intensivists, changes in the usual clinical practices, working environment, and impact on their social life was administered. For the last three sections, intensivists were asked to compare pandemic times to prepandemic times (pre-mid-March 2020).

Results

The number of invasive interventions performed by intensivists working in the private sector with lesser clinical experience (<12 years) were significantly less as compared to the government sector (p = 0.07) and clinically experienced (p = 0.07). Intensivists without comorbidities performed significantly lesser number of patient examinations (p = 0.03). The cooperation from healthcare workers (HCWs) decreased significantly with lesser experienced intensivists (p = 0.05). Leaves were significantly reduced in case of private sector intensivists (p = 0.06). Lesser experienced intensivists (p = 0.06) and intensivists working in the private sector (p = 0.06) spent significantly lesser time with family.

Conclusion

Coronavirus disease-2019 (COVID-19) affected the non-COVID ICUs as well. Young and private sector intensivists were affected due to less leaves and family time. HCWs need proper training for better cooperation during the pandemic time.

How to cite this article

Ghatak T, Singh RK, Kumar A, Patnaik R, Sanjeev OP, Verma A, et al. The Impact of COVID-19 on the Clinical Practices, Working Environment, and Social Life of Intensivists in Non-COVID ICU. Indian J Crit Care Med 2022;26(7):816-824.

Perceived risk of contracting COVID-19 among healthcare workers in Ghana: A cross-sectional study

Background and Aims

The COVID-19 pandemic has stretched many healthcare systems, and it is having detrimental impacts on healthcare workers at the forefront, fighting to save lives. This study sought to assess the relationship between job factors and the perceived risk of contracting COVID-19 at the workplace among healthcare workers and how the relationships are augmented when sociodemographic characteristics are taken into consideration in a limited resource setting (Ghana).

Methods

A cross-sectional survey of 455 respondents was conducted.

Results

Overall, 5.93% of the respondents perceived low risk of contracting COVID-19 while 69.45% and 24.62% perceived medium and high risks of contracting COVID-19 at the workplace, respectively. The odds of a high perceived risk versus the combined medium and low perceived risk of contracting COVID-19 at the workplace was 0.461 times lower for healthcare workers who rated their workplace safety systems as good and 0.515 and 0.170 times lower for healthcare workers who indicated occasional and frequent work environment situational assessment (situational awareness), respectively. The odds of high perceived risk were 2.239 times higher for workers who are always emotionally fatigued and 1.829 times higher for healthcare workers who frequently contribute personally to workplace decision-making. The perceived risk of contracting COVID-19 at the workplace was also 1.780 times higher for healthcare workers with tertiary education.

Conclusion

In terms of health and safety at work, this study recommends that there should be an improvement in implementing safety protocols at health facilities to increase the confidence of healthcare workers. Furthermore, social and psychological support and work environment situational assessment, which can reduce stress and anxiety levels among the healthcare workers, should be implemented if contributing factors such as working outside their area of expertise or job scope cannot be eliminated.

Exploring the role of authentic leadership in nursing

Authentic leadership is a relatively new concept in nursing, with limited studies undertaken into its application in healthcare. Authentic leadership emphasises the importance of the leader being true to their personal core values and developing honest relationships with team members, valuing their contributions, and behaving ethically and transparently. Trust is a central tenet of authentic leadership that aims to lead to increased staff engagement, and enhanced individual and team performance. This article explores the principles, benefits and challenges of authentic leadership, as well as examining its potential role in nursing.

Drivers of Burnout Among Critical Care Providers: A Multicenter Mixed-Methods Study

BACKGROUND

Critical care practitioners have some of the highest levels of burnout in health care.

RESEARCH QUESTION

What are key drivers of burnout across the multidisciplinary ICU team?

STUDY DESIGN AND METHODS

We conducted a multicenter mixed-methods cohort study in ICUs at three diverse hospitals. We recruited physicians, nurses, respiratory therapists, and other staff members who worked primarily in an ICU. Participants completed the Maslach Burnout Inventory for Human Services Survey for Medical Personnel (MBI) and a qualitative focus group or interview using a phenomenologic approach. MBI subscales for emotional exhaustion, depersonalization, and lack of personal accomplishment were calculated. Emergent shared themes contributing to burnout were identified from qualitative interviews.

RESULTS

Fifty-eight providers (26 physicians, 22 nurses, six respiratory therapists, three pharmacists, and one case manager) participated. Ten participants (17.9%) described their burnout as moderate to high. However, participants scored moderate or high levels across the three MBI subscales (emotional exhaustion, 71.4%; depersonalization, 53.6%; and lack of personal achievement, 53.6%). Drivers of burnout aligned with three core themes: patient factors, team dynamics, and hospital culture. Individual drivers included medically futile cases, difficult families, contagiousness of burnout, lack of respect between team members, the increasing burden of administrative or regulatory requirements at the cost of time with patients, lack of recognition from hospital leadership, and technology. All were highly interconnected across the three larger domains. Despite differences in MBI scores, most provider types described very similar drivers of burnout.

INTERPRETATION

High levels of burnout were identified through the MBI, but participants did not self-report high levels of burnout, suggesting a lack of awareness. Drivers of burnout were highly interconnected, but factors related to team dynamics and hospital culture were most prominent and shared across provider types. The shared drivers of burnout across multiple provider types highlights the need for interventions focused on team- and system-level drivers.

PERSonality, Ehical, and PROfessional quality of life in Pediatric/Adult Intensive Nurses study: PERSEPRO PAIN study

BACKGROUND

The World Health Organization included burnout syndrome criteria that reduce both professional quality of life and work satisfaction in its 11th Revision of the International Classification of Diseases in 2019 while nursing bodies have issued action calls to prevent burnout syndrome. Despite this, the effect of social factors, personality traits and cross-interaction on professional quality of life is still unclear.

AIM

To reveal the association between ethical climate, personal trait and professional quality of life.

METHOD

An online survey of registered nurses working in adult, pediatric or both ICUs. We used the ten-item personality measure based on The Big Five theory and Type-D personality Scale-14 then measured the ethical climate with the Hospital Ethical Climate Survey and the professional domains of burnout syndrome, secondary traumatic stress and compassion satisfaction by the Professional Quality of Life Scale Version 5 simultaneously. Multivariate analysis confirmed the triangular association of hospital ethical climate, personality traits and professional quality of life.

RESULT

We enrolled 310 participants from September 2019 to February 2020. Mean age was 33.1 years (± 5.9) and about 70% were female. In the multivariate analysis, neuroticism (p = 0.03, p = 0.01) and Type D personality (both of p<0.01) were associated with burnout syndrome and secondary traumatic stress while agreeableness (p<0.01) was associated with secondary traumatic stress. Conversely, extraversion (p = 0.01), agreeableness (p<0.01) and openness (p<0.01) were associated with compassion satisfaction. We also observed interactions between hospital ethical climate and conscientiousness (p = 0.01) for burnout syndrome and secondary traumatic stress. Neuroticism was related to (p<0.01) BOS and compassion satisfaction while Type D personality (p<0.01) correlated with burnout syndrome and secondary traumatic stress.

CONCLUSION

Hospital ethical climate strongly affects professional quality of life in nurses with specific personality traits. Therefore, it is important to maintain an ethical hospital climate, considering individual personalities to prevent burnout syndrome.