Prevalence of burnout among intensivists in mainland China: a nationwide cross-sectional survey

Cross-sectional study of the association between burnout and work overload and work-life imbalance among medical personnel in Liaoning, China: role of specialty

OBJECTIVES

Burnout is common among medical personnel in China and may be related to excessive and persistent work-related stressors by different specialties. The aims of this study were to assess the prevalence of burnout, work overload and work-life imbalance according to different specialties and to explore the effect of specialty, work overload and work-life imbalance on burnout among medical personnel.

DESIGN

A cross-sectional study.

SETTING

This study was conducted in 1 tertiary general public hospital, 2 secondary general hospitals and 10 community health service stations in Liaoning, China.

PARTICIPANTS

A total of 3299 medical personnel participated in the study.

METHODS

We used the 15-item Chinese version of the Maslach Burnout Inventory General Survey (MBI-GS) to measure burnout. Multivariable logistic regression models were used to explore the association between medical specialty, work overload, work-life imbalance and burnout.

RESULTS

3299 medical personnel were included in this study. The prevalence of burnout, severe burnout, work overload and work-life imbalance were 88.7%, 13.6%, 23.4% and 23.2%, respectively. Compared with medical personnel in internal medicine, working in obstetrics and gynaecology (OR=0.61, 95% CI 0.38, 0.99) and management (OR=0.45, 95% CI 0.28, 0.72) was significantly associated with burnout, and working in ICU （Intensive Care Unit）(OR=2.48, 95% CI 1.07, 5.73), surgery (OR=1.66, 95% CI 1.18, 2.35) and paediatrics (OR=0.24, 95% CI 0.07, 0.81) was significantly associated with severe burnout. Work overload and work-life imbalance were associated with higher ORs for burnout (OR=1.64, 95% CI 1.16, 2.32; OR=2.79, 95% CI 1.84, 4.24) and severe burnout (OR=4.33, 95% CI 3.43, 5.46; OR=3.35, 95% CI 2.64, 4.24).

CONCLUSIONS

Burnout, work overload and work-life imbalance were prevalent among Chinese medical personnel but varied considerably by clinical specialty. Burnout may be reduced by decreasing work overload and promoting work-life balance across different specialties.

Job burnout, cognitive functioning, and Brain-derived neurotrophic factor expression among hospital Mexican nurses

AIM

To analyze the relationship between burnout syndrome, cognitive functions, and sBDNF (Serum Brain-derived Neurotrophic Factor) in Mexican nurses.

METHOD

A descriptive cross-sectional design was used. This study target staff nurses working in hospitals in Guanajuato, México. Demographic and working condition data were collected via questionnaire. The Maslach Burnout Inventory (MBI) was used to evaluate burnout. A blood sample were collected and processed by ELISA technique to measure sBDNF. Finally, the General Cognitive Assessment (CAB) of the Cognifit© neuropsychological battery was used to evaluated cognitive functions.

RESULTS

Findings showed that there are sociodemographic characteristics and working conditions associated with burnout syndrome among nurses. Furthermore, the data demonstrated a significant decrease in sBDNF levels in burnout nurses and a negative correlation between BDNF levels and burnout syndrome. Additionally, these burnout nurse also revealed significant cognitive impairment in reasoning, memory, and attention as well as total scores of CAB. Interestingly, we found a positive correlation between sBDNF levels and the cognitive deficits in burnout nurse.

CONCLUSION

Reduced BDNF levels could be a biological indicator or part of the pathological process of burnout, which could affect cognitive abilities. Reduced cognitive function in nurses has relevant implications and emphasizes the need for specialized preventive strategies because nurses make clinical decisions concerning their patients, whose situations are constantly changing.

Moral distress, psychological capital, and burnout in registered nurses

AIMS

This study aimed to explore the relationship among moral distress, psychological capital, and burnout in registered nurses.

ETHICAL CONSIDERATION

The study was approved by the Ethics Committee of the School of Nursing, Hangzhou Normal University (Approval no. 2022001).

METHODS

A cross-sectional descriptive survey was conducted with a convenience sample of 397 nurses from three Grade-A tertiary hospitals in Zhejiang Province, China. Participants completed demographic information, the Nurses' Moral Distress Scale, the Nurses' Psychological Capital Scale, and the Maslach Burnout Inventory Scale. The data were analyzed using Pearson's correlation analysis, structural equation modeling, and hierarchical multiple regression analysis.

RESULTS

The study found that moral distress and burnout are positively correlated, while psychological capital is negatively correlated with both moral distress and burnout. The path analysis in structural equation modeling revealed that moral distress has a significant direct effect on psychological capital, while psychological capital has a significant direct effect on burnout. In addition, moral distress also had a significant indirect effect on burnout through psychological capital. Moreover, both the direct effect of moral distress on burnout and the total effect of moral distress on burnout were significant.

CONCLUSION

The findings suggest that psychological capital plays an important role in the relationship between moral distress and burnout. Promoting psychological capital among nurses may be a promising strategy for preventing moral distress and burnout in the workplace.

Surgeon Burnout-Time to Heal the Healers

Burnout could be understood by the Old Testament, in which Moses father-in-law rebukes, You will only wear yourselves out. The work is too heavy for you; you cannot handle it alone (Exodus 18:1718). Burnout syndrome was first introduced by Freudenberger in 1974 [1]. It is now a global concern, though it is very much under-reported and discussed in our country. Shanafelt et al. reported it in about 40% of physicians and a slightly higher rate of 53% among surgeons, by comparison [2]. On top of this ladder, orthopedic surgeons are just behind trauma surgeons in ranking [3]. Occupational burnout syndrome is a feeling of emotional exhaustion, depersonalization, and low sense of personal accomplishment secondary to chronic occupational stress [4]. In the high-stakes world of surgery, the demanding nature of the profession can take a toll on surgeons mental and physical well-being and disturb their healthy work–life balance. The etiology is multifactorial, including personal, working environment, and career ambitions, and surgeons often have a combination of these [5]. Long working hours, intense pressure during surgeries, and the emotional burden of dealing with life-and-death situations can lead to chronic stress [6]. Hierarchy in the workplace, over-demanding aggressive patients, and increasing medicolegal implications are additions to surgeon burnout. Due to the incorporation of new techniques and equipment, surgeons are compelled to be lifelong learners for their scientific and technical excellence in their practice. On top of these, the inclusion of administrative tasks takes away their time from patient care and contributes to stress. Limited emotional support, both within the workplace and personally, also contributes to feelings of isolation and burnout. All of these negatively impact personal well-being and threaten surgeons longevity and the safety of patients to whom they provide care. Therefore, burnout affects the well-being of surgeons and can have severe implications for the quality of patient care. Fatigued surgeons may experience reduced job performance and develop an emotional milieu that contributes to medical errors [7]. On the personal front, they suffer from poor physical quality of life, psychosomatic issues, stress, depression, insomnia, fatigue, relationship issues, substance abuse, and suicide. Recently, Jennings et al. reported that burnout-induced suicides are highest among orthopedic surgeons [8]. Therefore, recognizing burnout among surgeons is crucial for medical professionals well-being and the quality of patient care. Several tools have been devised to measure burnout, which include the Maslach Burnout Inventory, the Copenhagen Burnout Inventory, and the Mayo Clinic Physician Well-being Tool [2, 9, 10]. Addressing burnout needs social and institutional-level support. A few strategies are improving the workplace environment, promoting teamwork, and reducing the administrative workload. Darrell Cambell even suggested modifying the surgical curriculum to the extent of providing proper mentorship right from the trainees time [11]. He said, “In the classic training program, we have taught how to perform surgery but not how to live as a surgeon. Organizations can conduct regular surveys for feedback and support, flexible working hours when required, and medicolegal support in adverse outcomes or major complication cases. Regular and timely physical and mental health checkups and training programs focused on resilience, stress management, and coping strategies can enhance surgeons ability to navigate challenging situations [12]. At an individual level, one needs to chalk out a work–life balance. As rightly said, “If your compassion does not include yourself, it is incomplete. One needs to introspect, recognize one’s own limits, and not set unrealistic goals. We need to understand that burnout is a Choice that we make, and once we understand and deal with the choices that lead to burnout, we would understand that the choices are completely avoidable. Although our organizations and society would have us continuously work to our maximum capacity (as per their standards), we should define these work parameters for ourselves. Personal acceptance of burnout and insights into reasons for burnout with measures that will reduce these reasons are the main measures for dealing with burnout for professional reasons. In addition, inculcating some self-care practices such as exercise, yoga, meditation, sports, and music. would help too. Vacation and vocation should be an integral part of busy surgeons lives. Finally, one should be bold enough to communicate and seek help when required because burnout is real and not a sign of personal failure. We should all strive to be resilient health-care providers in a conducive professional environment.

Phenomenological characteristics of autobiographical future thinking in nurses with burnout: a case-control study

Objective

Nurses constitute the largest group of healthcare workers worldwide, and job burnout is very common among them. This study aims to explore abnormal future thinking in nurses with burnout. Additionally, the study investigates whether these manifestations worsen as burnout progresses.

Methods

The study was conducted in inpatient ward nurses at a tertiary hospital in Hangzhou, China. In the first phase, two group of nurses were recruited: nurses with burnout (N = 70) and nurses without burnout (N = 70). In the second phase, three groups were recruited according to the burnout levels: mild burnout (N = 43), moderate burnout (N = 42) and severe burnout (N = 43). Data on job burnout were obtained using the Chinese Maslach Burnout Inventory. The Sentence Completion for Events in the Future Test (SCEFT) was employed to measure the content of future thinking, which was evaluated by two raters in terms of the specificity, emotional valence, and concrete content of the imagined future events. The proportions of specific types of events among all the produced events were calculated.

Results

The results revealed that nurses with burnout, compared to nurses without burnout, imagined fewer specific future events, positive events, and events related to relationships and achievement. They also had more omissions. As the level of burnout increased, their impairment in future thinking worsened. Furthermore, the results also revealed that the scores of emotional exhaustion, depersonalization, and personal accomplishment had significant correlations with the proportions of positive events and events related to relationships and achievement/mastery in nurses' future thinking content.

Conclusion

The future thinking ability of nurses with burnout was impaired, and this impairment worsened as the symptoms of burnout progressed. The findings of the present study have important implications for nurse caring and advocate effective interventions targeting positive future thinking to mitigate nurses' burnout.

Prevalence of burnout among perfusionists in China: A nationwide survey

BACKGROUND

Burnout has gained increasing attention worldwide as a phenomenon that affects health care professionals. However, there is a lack of relevant research about its impact on practitioners in the field of cardiovascular perfusion in China. This study investigated the prevalence of and the factors associated with the burnout affecting perfusionists in mainland China.

METHODS

This national cross-sectional study included perfusionists from 31 provinces in mainland China. Participants were asked to complete a self-administered questionnaire, which included three parts: (1) demographic information, (2) work-related information, and (3) dissatisfaction with work and sources of pressure. The levels of burnout were calculated, and logistic regression was used to analyze the factors associated with burnout.

RESULTS

The questionnaire, created by the survey program "Questionnaire Star", was sent to 2211 perfusionists in mainland China. A final sample of 1813 perfusionists participated in the survey, with a participation rate of 82.0% (1813/2211). The prevalence of burnout and severe burnout was 86.0% (1559/1813, 95%CI: 84.3%-87.5%) and 13.3% (241/1813, 95%CI: 11.8%-15.0%), respectively. The logistic regression analysis revealed that age [20-29 years, odds ratio (OR) = 1; 30-39 years, OR = 2.009; 40-49 years, OR = 2.220], educational background (bachelor and below, OR = 1; postgraduate, OR = 1.472), and professional background (others, OR = 1; surgery, OR = 1.283; anesthesiology, OR = 2.004) were associated with burnout. We also found that age (20-29 years, OR = 1; 30-39 years, OR = 1.928), professional background (others, OR = 1; surgery, OR = 1.734; anesthesiology, OR = 2.257), annual cardiopulmonary bypass (CPB) case load in the most recent 3 years (< 50, OR = 1; 50-100, OR = 1.613; 100-300, OR = 1.702; ≥300, OR = 2.637), and income level [< 5000 (RMB/month), OR = 1; 5000-10,000, OR = 0.587; 10,000-20,000, OR = 0.366] were associated with severe burnout among perfusionists.

CONCLUSIONS

Cardiovascular perfusionists in mainland China experience high rates of burnout. Age, the professional background, annual CPB caseload in the most recent 3 years, and income level are independently associated with the burnout rates experienced by these health care professionals.

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.

Identifying Key Factors for Burnout Among Orthopedic Surgeons Using the Analytic Hierarchy Process Method

Objectives: To develop an evaluation model for, and identify key factors contributing to, burnout in orthopedic surgeons, providing a reference for the management of burnout among orthopedic surgeons in hospitals. Methods: We developed an analytic hierarchy process (AHP) model with 3 dimensions and 10 sub-criteria based on an extensive literature review and expert assessment. We used expert and purposive sampling and 17 orthopedic surgeons were selected as research subjects. The AHP process was then used to obtain the weights and to prioritize the dimensions and criteria for burnout in orthopedic surgeons. Results: The dimension of C ₁ (personal/family) was the key factor affecting burnout in orthopedic surgeons, and in the sub-criteria, the top four sub-criteria were C ₁₁ (little time for family), C ₃₁ (anxiety about clinical competence), C ₁₂ (work-family conflict), and C ₂₂ (heavy work load). Conclusion: This model was effective in analyzing the key factors contributing to job burnout risk, and the results can inform improved management of the levels of burnout affecting orthopedic surgeons in hospitals.

Burnout and job satisfaction among physicians working in urologic departments who immigrated to Germany, taking into account the income structure of their country of origin

BACKGROUND

Studies are available on physician burnout and job satisfaction (JS) in relation to the specific income structure of the country of residence. However, no studies exist that investigate burnout of immigrated physicians taking into account the income structure of their country of origin (IS-COO) as well as duration of immigration.

OBJECTIVE

To determine the influence of IS-COO on JS, income satisfaction, and critical burnout thresholds in the domains of emotional exhaustion (EE), depersonalization (DP) and reduction in personal accomplishment (RPA) among urologists with a migrant background working at German hospitals.

METHODS

A questionnaire (Survey-Monkey®/101-items) was conducted among urologists of German hospitals with a migrant background. The online questionnaire was open for study participation from 1 August to 31 October 2020. The study included all physicians with a migration background who were born in a country other than Germany and were currently employed in a German department of urology. Physician burnout (Maslach-Burnout-Inventory) and JS were assessed using validated instruments. The influence of IS-COO and different covariates on the designated endpoints was tested using multivariate-models.

RESULTS

96 urologists with a median stay in Germany of 7 years participated and were stratified according to low (LIC/41.7%), middle (MIC/36.5%) and high (HIC/21.9%) income based on IS-COO. No significant influence of IS-COO on critical thresholds in each burnout domain could be found. Of urologists from LIC, MIC and HIC, 42%, 59% and 57%, respectively, showed rather or extreme JS (p = .446). There was also no significant difference between groups in income satisfaction (p = .838). However, in multivariate-models, duration of stay in Germany (≥7 vs. <7 years) had significant effects on DP (OR: 0.28, p = .038) and RPA (OR: 0.09, p = .014), but not on EE and JS.

CONCLUSION

IS-COO has no impact on burnout and JS among urologists who immigrated to Germany. Similarly, income satisfaction in the country of residence is not influenced by IS-COO.

Association between high burn-out and workplace violence among healthcare workers in China: a WeChat-based survey

OBJECTIVES

This study is conducted to examine whether overall workplace violence (WPV) and its five types are associated with high burn-out among healthcare workers in China.

DESIGN

A WeChat-based cross-sectional survey. Snowball sampling was used in this study.

PARTICIPANTS

Front-line healthcare workers (N=3706) from 149 cities across 23 provinces in China responded to the survey, and 22 questionnaires were excluded because of incomplete data.

PRIMARY AND SECONDARY OUTCOME MEASURES

(1) The Chinese Maslach Burnout Inventory-General Survey was used to measure high burn-out. (2) WPV was assessed using the Chinese version of the Workplace Violence Scale. (3) An anonymous self-designed web-based questionnaire consisting of demographic, behavioural and occupational information was used to identify covariates.

RESULTS

A total of 3684 front-line healthcare workers (934 physicians and 2750 nurses) were included. Of all participants, 13.3% (491/3193) experienced high burn-out. Adjusted logistic regression revealed that experience of WPV in the past year was associated with high burn-out (OR 2.10, 95% CI 1.69 to 2.62). Healthcare workers who had suffered emotional abuse, threat or verbal sexual harassment were more vulnerable to high burn-out.

CONCLUSION

This study finds that healthcare workers with WPV, especially emotional abuse, threat and verbal sexual harassment, are more likely to experience burn-out. These types of WPV should be considered in interventions to reduce and prevent burn-out for healthcare workers.

Burnout and coping strategies among nurses in Malaysia: a national-level cross-sectional study

OBJECTIVE

This national-level study aimed to determine the prevalence and risk factors of burnout, as well as the coping strategies among nurses in the Ministry of Health (MOH) Malaysia.

DESIGN

Using a complex sampling design, a two-stage stratified cluster sampling was performed to recruit MOH nurses between August and November 2019.

SETTING AND PARTICIPANTS

A total of 2428 nurses from 32 hospitals and 28 district health offices answered the questionnaires based on Maslach Burnout Inventory for Human Services and Brief COPE. Complex sampling analysis was applied.

OUTCOME MEASURES

The outcome of interest was the prevalence of burnout and its three domains of emotional exhaustion (EE), depersonalisation (DP) and low personal accomplishment. ORs using 95% CIs were calculated. Significant factors at the univariate level were entered into the multivariate logistic regression to identify independent predictors of burnout.

RESULTS

One in four (24.4%) nurses experienced burnout. Younger, single, and childless nurses had a higher prevalence of burnout. Shift working nurses were 1.6 times more likely to develop burnout. Those who performed >6 night shifts per month were 1.5 times more predisposed to burnout (95% CI 1.01 to 2.36; p<0.05). While encountering traumatic events at work led to 4.2 times (95% CI 2.31, 7.63; p<0.05) higher risk of burnout, those who received post-traumatic psychological support were better protected. The use of dysfunctional coping strategies was detrimental as it was positively correlated with EE and DP.

CONCLUSION

Addressing modifiable stressors of burnout at individual and institutional levels identified in this study can be potentially beneficial in reducing burnout and its undesirable effects among nurses. Interventions that promote positive coping strategies should be implemented. Organisational-driven efforts must target the improvement of work schedules for nurses and the establishment of a structured debriefing service for post-trauma counselling.

Burnout among doctors in China through 2020: A systematic review and meta-analysis

Objective

To analyze surveys measuring the prevalence of burnout among Chinese doctors and reveal the overall prevalence, characteristics, timeline, and factors related to burnout.

Methods

A comprehensive search was conducted on China National Knowledge Infrastructure, WANFANG, PubMed, EMBASE, PsycINFO and Cochrane Library databases from their inception to 28 February 2021. Random-effects meta-analyses, meta-regression and planned subgroup analyses were performed, and the standardized mean difference was adopted for comparisons between subgroups. Egger’s and Begg’s tests were performed to evaluate publication bias. Heterogeneity across the studies was tested using the I² statistic. The study protocol was registered on PROSPERO (CRD42018104249).

Results

In total, 3,210 records were reviewed; 64 studies including 48,638 Chinese doctors were eligible for meta-analysis. The prevalence of burnout increased continuously from 2008 to 2017 and decreased significantly from 2018 to 2020, a little increase from 2020 to 2021. The overall prevalence of burnout was 75.48% (95% CI, 69.20 to 81.26; I² = 99.23%, P < 0.001), and high burnout was 9.37% (95% CI, 4.91 to 15.05, I² = 98.88%, P < 0.001). The prevalence of emotional exhaustion was 48.64% (95% CI, 38.73 to 58.59; I² = 99.53%, P < 0.001), depersonalization was 54.67% (95% CI, 46.95 to 62.27; I² = 99.20%, P < 0.001), and reduced personal accomplishment was 66.53% (95% CI, 58.13 to 74.44; I² = 99.37%, P < 0.001). Gender, marriage, professional title and specialty all influenced burnout.

Conclusions

The results showed that the total prevalence of doctor burnout in China is very high. The prevalence of burnout varies by location. Gender, marital status and professional title all affect burnout scores.

The meaning of patient deaths for professional caregivers: A quantitative construct validation

The meaning of patient deaths is key to understanding professional bereavement. To validate its construct, we applied partial least square structural equation modeling (PLS-SEM) to online survey data from 563 Chinese physicians and nurses. Both the personal meaning and professional meaning contribute significantly while not interchangeably to the meaning of patient deaths. In addition to the loss of an acquaintance, the loss of a valuable life, and the loss of a professional goal, patient deaths can also mean trauma, bad luck, identity crisis, a warning, a learning opportunity, and a time to empathize with others' sufferings.

Status and Influencing Factors of Social Media Addiction in Chinese Medical Care Professionals: A Cross-Sectional Survey

Background

In modern society, social media addiction (SMA) has become a serious problem in many countries, including China. Almost every medical care professional has their own social media account. They are also at risk for SMA, but no SMA studies in Chinese medical care professionals have been published. This study aims to investigate the status and influencing factors of SMA among Chinese medical care professionals.

Methods

A cross-sectional study was conducted among 519 physicians and nurses from two randomly selected hospitals using a questionnaire that included the Social Networking Service Addiction Scale (SNSAS), Maslach's Burnout Inventory-General Survey (MBI-GS), the General Self-efficacy Scale (GSES), and eight demographic datasets.

Results

This study's findings showed that most of the participants' (357,68.79%) scores reached 2.5 points (half of the highest possible score), indicating that SMA scores of Chinese medical care professionals were relatively high. Significant differences in SMA scores by age (p < 0.01), marital status (p < 0.01), professional title (p < 0.01), and working years (p < 0.01) were found. Income satisfaction (p < 0.01) and sleep quality (p < 0.05) were negatively correlated with SMA. The GSES score was not correlated with SMA (p = 0.377). Burnout significantly positively affected SMA (p < 0.01).

Conclusion

Our study found that the SMA scores of Chinese medical care professionals were relatively high. To reduce the SMA level of the medical care population, we should first start with reducing burnout, enabling medical care professionals to achieve sufficient sleep, increasing medical staff income, and providing more opportunities for promotion.

The story of critical care in Asia: a narrative review

Background

Asia has more critically ill people than any other part of our planet. The aim of this article is to review the development of critical care as a specialty, critical care societies and education and research, the epidemiology of critical illness as well as epidemics and pandemics, accessibility and cost and quality of critical care, culture and end-of-life care, and future directions for critical care in Asia.

Main body

Although the first Asian intensive care units (ICUs) surfaced in the 1960s and the 1970s and specialisation started in the 1990s, multiple challenges still exist, including the lack of intensivists, critical care nurses, and respiratory therapists in many countries. This is aggravated by the brain drain of skilled ICU staff to high-income countries. Critical care societies have been integral to the development of the discipline and have increasingly contributed to critical care education, although critical care research is only just starting to take off through collaboration across groups. Sepsis, increasingly aggravated by multidrug resistance, contributes to a significant burden of critical illness, while epidemics and pandemics continue to haunt the continent intermittently. In particular, the coronavirus disease 2019 (COVID-19) has highlighted the central role of critical care in pandemic response. Accessibility to critical care is affected by lack of ICU beds and high costs, and quality of critical care is affected by limited capability for investigations and treatment in low- and middle-income countries. Meanwhile, there are clear cultural differences across countries, with considerable variations in end-of-life care. Demand for critical care will rise across the continent due to ageing populations and rising comorbidity burdens. Even as countries respond by increasing critical care capacity, the critical care community must continue to focus on training for ICU healthcare workers, processes anchored on evidence-based medicine, technology guided by feasibility and impact, research applicable to Asian and local settings, and rallying of governments for support for the specialty.

Conclusions

Critical care in Asia has progressed through the years, but multiple challenges remain. These challenges should be addressed through a collaborative approach across disciplines, ICUs, hospitals, societies, governments, and countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40560-021-00574-4.

Burnout in Intensive Care Unit Workers during the Second Wave of the COVID-19 Pandemic: A Single Center Cross-Sectional Italian Study

The COVID-19 pandemic had a massive impact on the Italian healthcare systems, which became overwhelmed, leading to an increased risk of psychological pressure on ICU workers. The present study aimed to investigate the prevalence of distress (anxiety, depression and insomnia symptoms), burnout syndrome and resilience in healthcare workers during the COVID-19 pandemic and to detect potential factors associated with their psychological response. This cross-sectional, survey-based study enrolled 136 healthcare workers assisting COVID-19 patients in the new COVID-19 ward (Intensive Care Unit), at Milano Fiera, Lombardy. Participants completed an online survey that comprised different validated and standardized questionnaires: Maslach Burnout Inventory (MBI), Resilience Scale for adults (RSA), Hospital Anxiety and Depression scale (HADS) and Insomnia Severity Index (ISI). Socio-demographic and work characteristics were also collected. Out of 136 ICU specialists, there were 84 nurses (62%) and 52 physicians (38%). Over half (60%) met the criteria for burnout, with nearly the same percentages among nurses and physicians. Nurses reported significantly higher scores of anxiety and insomnia levels. Forty-five percent of participants reported symptoms of depression (of whom 13.9% in the clinical range) and most of the staff showed moderate to high levels (82.4%) of resilience. The COVID-19 pandemic can have a significant impact on ICU staff. Effective interventions are needed to maintain healthcare professionals' mental health and relieve burnout. Follow-up and tailored procedures should be provided to alleviate the psychological burden in the frontline staff at highest risk.

The prevalence and stressors of job burnout among medical staff in Liaoning, China: a cross-section study

BACKGROUND

Sustained attention to the prevalence and associated factors of burnout in China is important for the health care service quality and related reform. In this study, we investigated the prevalence of job burnout among medical staff in Liaoning province, China; performed a survey of subjective perception ranking for the main stressors among respondents; estimated the effect of stresses from work tasks and the relationship with patients on job burnout in order to provide improved strategy and suggestion for hospital administrators.

METHODS

The respondents were from 8 hospitals in 3 cities in Liaoning province, China. Data were collected and analyzed including the following sections: (1) demographic characteristics; (2) work situations; (3) ranking of six stressors; (4) job burnout scale; (5) effort-reward imbalance scale; (6) work violence scale; (7) fear of malpractice scale. A total of 1056 individuals became the study objects. A statistical analysis and hierarchical linear regression analysis were performed to explore the prevalence of burnout and the effects of stressors.

RESULTS

The prevalence of job burnout was 20.5, and 72.9% of all respondents reported a least one symptom of burnout. The respondents who were male, 30-39 years old, had a master's degree or high and working hours > 60 h per week, came from obstetrics and gynecology or pediatrics profession prone to job burnout. The relationship with patients and work tasks are the top two ranking stressors in the subjective perception survey. Regression analysis showed that the relationship with patients explained 19.2, 16.8 and 2.0% of variance in burnout subscales EE, DP and PA, respectively and work tasks explained 23.5, 16.0 and 5.24% of variance in burnout subscales EE, DP and PA, respectively.

CONCLUSION

The Chinese medical staff had high prevalence of job burnout. Some factors of demographic and work situations were associated with job burnout. The medical staff considered the relationship with patients and work tasks are the two major stressors. These two stressors are also the major indicators associated with job burnout. The hospital administrators should be aware of the risk of burnout. Efforts should be made to ameliorate the status of job burnout.