Efficacy of an Internet-based intervention for job stress and burnout among medical professionals: study protocol for a randomized controlled trial

Effects of internet-based, psychosocial, and early medical interventions on professional burnout in health care workers: Systematic literature review and meta-analysis

Background

The prevalence of professional burnout increased among healthcare workers during the coronavirus 2019 (COVID-19) pandemic, with negative effects on their mental health. Consequently, research interest in methods to decrease the prevalence of burnout and reduce the effects of burnout on healthcare workers has increased. Objective: This study was designed to evaluate the effects of Internet-based, psychosocial, and early medical interventions on professional burnout among healthcare workers.

Methodology

This systematic review and meta-analysis involved 8004 articles identified from four databases: Cochrane, Web of Science, PubMed/Medline, and clinical trials.

Results

Four articles were included in the systematic review, of which two could be meta-analyzed. The pooled effect of the group of interventions compared to control conditions was not statistically significant.

Discussion

Evaluating therapeutic effectiveness requires more clinical trials that allow its evaluation. Although we did not find improvements in the three intervention categories, the methodological heterogeneity in each intervention and the need for a standardized intervention guide for managing and decreasing professional burnout, subject to the evaluation of its impact, are highlighted.

Work-related psychosocial challenges and coping strategies among nursing workforce during the COVID-19 pandemic: a scoping review

BACKGROUND

Nurses and midwives have been stretched by the COVID-19 pandemic amidst the heroic roles they have played during the peak of the COVID-19 pandemic. Nurses stood tall among their peers in the healthcare industry saving lives. The pandemic has had a toll on nurses physically, psychologically, and socio-economically. The numerous deaths have traumatized nurses coupled with the fear of possible infection. Nurses have seen their colleagues and loved ones lose their lives to the pandemic, nevertheless, they still render care to patients no matter the circumstances. Due to that, it is imperative to ascertain the extent to which nurses who are much needed in healthcare delivery have been affected by this pandemic. This scoping review used Arksey and O'Malley's review methodology to investigate the nature of work-related psychosocial challenges nurses encountered during the peak of the pandemic, noting the major contributors to the challenges and the coping strategies used to address them.

METHODS

We performed a scoping review and searched for articles from five databases including PUBMED, CINAHL, SCOPUS, Google Scholar, and Grey literature from December 2019 to December 2021. A total of 7,334 articles were retrieved for the study but 45 met the inclusion criteria.

RESULTS

Work-related psychosocial challenges identified included stress, burnout (emotional exhaustion and depersonalization), Post-Traumatic Stress Disorder, depression, sleeplessness, and anxiety. Factors that accounted for the challenges were inadequate personal protective equipment (PPEs), discomfort using the PPEs, extreme workload, and fatigue. Nurses experienced job insecurity, business closure, and separation from family and loved ones, and these contributed to their challenges. Strategies used to deal with the challenges centred on emotion-focused and problem-focused coping.

CONCLUSIONS

The study recommends regular counselling and support for all nurses working at the frontline to help them better cope with the devastating effects of the pandemic so that they could build resilience towards future pandemics.

Effectiveness of Internet-based cognitive behavioural therapy for employees with depression: a systematic review and meta-analysis

Objectives. The effectiveness of Internet interventions for employees with depressive disorder remains controversial. We summarized all available evidence exploring the role of Internet interventions in reducing employees' depressive symptoms. Methods. This study was a comprehensive systematic review and meta-analysis that included acceptability and preliminary feasibility studies. We excluded programme descriptions, discussion articles and study protocols. We followed the PRISMA guidelines and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Library and Web of Science from database inception to May 2021 for articles published in English. We extracted data concerning demographics, intervention format, including Internet interventions, control group conditions and outcome measures. We used a random-effects model and calculated Hedges' g values for the scores of employees receiving Internet interventions versus control conditions. This systematic review is registered as INPLASY202160082. Results. Data from 19 studies were included. These 19 studies included 5898 participants (2813 participants received Internet interventions, 3085 participants were in control groups). Conclusions. The findings suggest that Internet interventions can be effective in improving depression in employees. However, more randomized controlled trials are needed to provide better evidence regarding Internet interventions for employees with depression, and robust studies are needed to observe the effectiveness of Internet interventions.

The effects of organizational silence on work engagement, intention to leave and job performance levels of nurses

BACKGROUND: Reducing the level of organizational silence can play an important role in the work-related decisions of nurses. However, to date a comprehensive study investigating the effect of organizational silence on work engagement, intention to leave, and job performance levels of nurses has yet to be conducted. OBJECTIVE: This study aimed to explain the effect of organizational silence on work engagement, intention to leave, and job performance of nurses. METHODS: The sample of the study consisted of 224 nurses. The Organizational Silence Scale, the Job Performance Scale, the Intention to Leave Scale, and the Work Engagement Scale were used to collect data in this study and the Pearson correlation test and regression tests were used in the data analysis. RESULTS: It was observed that organizational silence was negatively correlated with job performance (r = –0.455) and work engagement (r = –0.242), and positively correlated with intention to leave (r = 0.440) (p < 0.01). Regression analysis also illustrated that dimensions of organizational silence have a significant effect on job performance, intention to leave, and work engagement. CONCLUSION: A decrease in the organizational silence level of nurses is effective in decreasing intention to leave and increasing work engagement and job performance levels. Nurses should be able to express their opinions clearly towards other healthcare professionals and management and management should provide this working environment for nurses. To increase work engagement and job performance levels and decrease intention to leave, meetings and educational programs that reduce organizational silence might be developed at an organizational level by management.

Health Status Stability of Patients in a Medical Rehabilitation Program: What Are the Roles of Time, Physical Fitness Level, and Self-efficacy?

BACKGROUND

Individuals' physical and mental health, as well as their chances of returning to work after their ability to work is damaged, can be addressed by medical rehabilitation.

AIM

This study investigated the developmental trends of mental and physical health among patients in medical rehabilitation and the roles of self-efficacy and physical fitness in the development of mental and physical health.

DESIGN

A longitudinal design that included four time-point measurements across 15 months.

SETTING

A medical rehabilitation center in Germany.

POPULATION

Participants included 201 patients who were recruited from a medical rehabilitation center.

METHODS

To objectively measure physical fitness (lung functioning), oxygen reabsorption at anaerobic threshold (VO2AT) was used, along with several self-report scales.

RESULTS

We found a nonlinear change in mental health among medical rehabilitation patients. The results underscored the importance of medical rehabilitation for patients' mental health over time. In addition, patients' physical health was stable over time. The initial level of physical fitness (VO2AT) positively predicted their mental health and kept the trend more stable. Self-efficacy appeared to have a positive relationship with mental health after rehabilitation treatment.

CONCLUSIONS

This study revealed a nonlinear change in mental health among medical rehabilitation patients. Self-efficacy was positively related to mental health, and the initial level of physical fitness positively predicted the level of mental health after rehabilitation treatment.

CLINICAL REHABILITATION

More attention could be given to physical capacity and self-efficacy for improving and maintaining rehabilitants' mental health.

Blended Online Intervention to Reduce Digital Transformation Stress by Enhancing Employees' Resources in COVID-19

Generally, the solutions based on information and communication technologies (ICT) provide positive outcomes for both companies and employees. However, the process of digital transformation (DT) can be the cause of digital transformation stress (DTS), when the work demands caused by fast implementation of ICT are elevated and employees' resources are limited. Based on the Job Demand-Resources (JD-R) Model we claim that DT, rapidly accelerating in the COVID-19 pandemic, can increase the level of DTS and general stress at work. To reduce these negative effects of DTS, we propose the online intervention aimed to strengthen employees' resources, such as self-efficacy. In this article we evaluate the effectiveness of the blended intervention, based on cognitive behavioral therapy (CBT) and social cognitive therapy, composed of a prototyped online training (e-stressless) and series of interactive online workshops. In a longitudinal study, we examined the change in DTS, perceived stress at work, attitudes toward DT, self-efficacy and burnout in two time points, before and after the intervention. We compared five groups of participants (558 in total), three groups not qualified (n = 417), and two groups qualified to intervention (n = 141). Our results revealed that the designed blended intervention decreased DTS and one of the dimensions of burnout, namely disengagement. More specifically, the results showed that in the group of active participants of the blended intervention DTS significantly decreased [M _T1 = 3.23, M _T2 = 3.00, t(432) = 1.96, p = 0.051], and in the group of ineligible participants DTS significantly increased [M _T1 = 1.76, M _T2 = 2.02, t(432) = 4.17, p < 0.001]. This research paves way for the creation of blended online intervention which could help in addressing employee digital transformation stress before it starts having adverse effects on employee performance and well-being.

Prevalence and predictors of secondary traumatic stress symptoms in health care professionals working with trauma victims: A cross-sectional study

INTRODUCTION

Medical personnel is an occupational group that is especially prone to secondary traumatic stress. The factors conditioning its occurrence include organizational and work-related factors, as well as personal features and traits. The aim of this study was to determine Secondary Traumatic Stress (STS) indicators in a group of medical personnel, considering occupational load, job satisfaction, social support, and cognitive processing of trauma.

MATERIAL AND METHODS

Results obtained from 419 medical professionals, paramedics and nurses, were analyzed. The age of study participants ranged from 19 to 65 (M = 39.60, SD = 11.03). A questionnaire developed for this research including questions about occupational indicators as well as four standard evaluation tools: Secondary Traumatic Stress Inventory, Job Satisfaction Scale, Social Support Scale which measures four support sources (supervisors, coworkers, family, friends) and Cognitive Processing of Trauma Scale which allows to evaluate cognitive coping strategies (positive cognitive restructuring, downward comparison, resolution/acceptance, denial, regret) were used in the study.

RESULTS

The results showed that the main predictor of STS symptoms in the studied group of medical personnel is job satisfaction. Two cognitive strategies also turned out to be predictors of STS, that is regret (positive relation) and resolution/acceptance (negative relation). The contribution of other analyzed variables, i.e., denial, workload and social support to explaining the dependent variable is rather small.

CONCLUSIONS

Paramedics and nurses are at the high risk of indirect traumatic exposure and thus may be more prone to secondary traumatic stress symptoms development. It is important to include the medical personnel in the actions aiming at prevention and reduction of STS symptoms.

Resource-Based Internet Intervention (Med-Stress) to Improve Well-Being Among Medical Professionals: Randomized Controlled Trial

Background

Medical professionals are exposed to multiple and often excessive demands in their work environment. Low-intensity internet interventions allow them to benefit from psychological support even when institutional help is not available. Focusing on enhancing psychological resources—self-efficacy and perceived social support—makes an intervention relevant for various occupations within the medical profession. Previously, these resources were found to operate both individually or sequentially with self-efficacy either preceding social support (cultivation process) or following it (enabling process).

Objective

The objective of this randomized controlled trial is to compare the efficacy of 4 variants of Med-Stress, a self-guided internet intervention that aims to improve the multifaceted well-being of medical professionals.

Methods

This study was conducted before the COVID-19 pandemic. Participants (N=1240) were recruited mainly via media campaigns and social media targeted ads. They were assigned to 1 of the following 4 groups: experimental condition reflecting the cultivation process, experimental condition reflecting the enabling process, active comparator enhancing only self-efficacy, and active comparator enhancing only perceived social support. Outcomes included 5 facets of well-being: job stress, job burnout, work engagement, depression, and job-related traumatic stress. Measurements were taken on the web at baseline (time 1), immediately after intervention (time 2), and at a 6-month follow-up (time 3). To analyze the data, linear mixed effects models were used on the intention-to-treat sample. The trial was partially blinded as the information about the duration of the trial, which was different for experimental and control conditions, was public.

Results

At time 2, job stress was lower in the condition reflecting the cultivation process than in the one enhancing social support only (d=−0.21), and at time 3, participants in that experimental condition reported the lowest job stress when compared with all 3 remaining study groups (ds between −0.24 and −0.41). For job-related traumatic stress, we found a significant difference between study groups only at time 3: stress was lower in the experimental condition in which self-efficacy was enhanced first than in the active comparator enhancing solely social support (d=−0.24). The same result was found for work engagement (d=−0.20), which means that it was lower in exactly the same condition that was found beneficial for stress relief. There were no differences between study conditions for burnout and depression neither at time 2 nor at time 3. There was a high dropout in the study (1023/1240, 82.50% at posttest), reflecting the pragmatic nature of this trial.

Conclusions

The Med-Stress internet intervention improves some components of well-being—most notably job stress—when activities are completed in a specific sequence. The decrease in work engagement could support the notion of dark side of this phenomenon, but further research is needed.

Trial Registration

ClinicalTrials.gov NCT03475290; https://clinicaltrials.gov/ct2/show/NCT03475290

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-019-3401-9

Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: the REduction of STress (REST) study protocol for a randomized controlled trial

Background

The acknowledgment of the mental health toll of the COVID-19 epidemic in healthcare workers has increased considerably as the disease evolved into a pandemic status. Indeed, high prevalence rates of depression, sleep disorders, and post-traumatic stress disorder (PTSD) have been reported in Chinese healthcare workers during the epidemic peak. Symptoms of psychological distress are expected to be long-lasting and have a systemic impact on healthcare systems, warranting the need for evidence-based psychological treatments aiming at relieving immediate stress and preventing the onset of psychological disorders in this population. In the current COVID-19 context, internet-based interventions have the potential to circumvent the pitfalls of face-to-face formats and provide the flexibility required to facilitate accessibility to healthcare workers. Online cognitive behavioral therapy (CBT) in particular has proved to be effective in treating and preventing a number of stress-related disorders in populations other than healthcare workers. The aim of our randomized controlled trial study protocol is to evaluate the efficacy of the ‘My Health too’ CBT program—a program we have developed for healthcare workers facing the pandemic—on immediate perceived stress and on the emergence of psychiatric disorders at 3- and 6-month follow-up compared to an active control group (i.e., bibliotherapy).

Methods

Powered for superiority testing, this six-site open trial involves the random assignment of 120 healthcare workers with stress levels > 16 on the Perceived Stress Scale (PSS-10) to either the 7-session online CBT program or bibliotherapy. The primary outcome is the decrease of PSS-10 scores at 8 weeks. Secondary outcomes include depression, insomnia, and PTSD symptoms; self-reported resilience and rumination; and credibility and satisfaction. Assessments are scheduled at pretreatment, mid-treatment (at 4 weeks), end of active treatment (at 8 weeks), and at 3-month and 6-month follow-up.

Discussion

This is the first study assessing the efficacy and the acceptability of a brief online CBT program specifically developed for healthcare workers. Given the potential short- and long-term consequences of the COVID-19 pandemic on healthcare workers’ mental health, but also on healthcare systems, our findings can significantly impact clinical practice and management of the ongoing, and probably long-lasting, health crisis.

Trial registration

ClinicalTrials.gov NCT04362358, registered on April 24, 2020.

Occupational Burnout Syndrome in Polish Physicians: A Systematic Review

Due to the nature of their work, physicians are exposed to chronic stress. This may potentially lead to the widespread occurrence of occupational burnout syndrome (BS). The aim of this systematic review study was to summarize available published data concerning the prevalence of BS in Polish doctors. The literature search was performed using the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. The last search was performed on September 27th, 2019. Only articles in English or Polish on graduated doctors practicing in Poland were taken into account. All types of original research were considered eligible. However, review articles, book chapters, case reports, case series, conference papers, study protocols and articles in languages other than English and Polish were excluded. There were no restrictions on age, seniority or specialty of study participants. The literature search revealed a total of 21 studies that met the inclusion criteria. The results of individual studies were very diverse, which makes it difficult to draw specific conclusions. However, the problem of burnout among Polish doctors is valid and worth special attention from society, health policy leaders, and doctors themselves. High-quality research is essential to for a better understanding of this topic.