Mindfulness-Based Interventions to Reduce Burnout in Primary Healthcare Professionals: A Systematic Review and Meta-Analysis

The relationship between mindfulness and burnout in physicians

BACKGROUND

To investigate the relationship between mindfulness and burnout in physicians and its underlying mechanisms.

METHODS

Study 1 employed a multiverse-style analysis based on a large sample of 8,462 physicians to examine the robust relationship between mindfulness(MAAS) and burnout(MBIES). Study 2 conducted a 21-day intensive longitudinal assessment on 471 physicians to explore the internal mechanisms by which mindfulness affects burnout.

RESULTS

Study 1 found that the negative association between mindfulness and burnout is robust. Study 2 discovered that Perceived Organizational Support(POS) and Psychological Safety(PS) play a sequential mediating role in the effect of mindfulness on burnout.

CONCLUSIONS

These findings provide a theoretical basis for formulating interventions at the organizational level and have important practical and theoretical significance for optimizing physicians' work environments and improving the medical quality.

CLINICAL TRIAL NUMBER

Not applicable.

Yoga, mindfulness and acupuncture impact on burnout: a preliminary meta-analysis

Mindfulness, yoga, and acupuncture are three practices that have received little attention in stress management literature, with scholars suggesting that they can improve physical and mental health, reduce stress and burnout, and boost productivity and job satisfaction. However, while there is growing interest in these practices, many employers remain sceptical about their potential benefits and are hesitant to invest resources in implementing them. This meta-analysis aimed to examine the impact of these practices on burnout and explore potential moderators. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure comprehensive and transparent reporting in the identification of eligible studies. Overall, 21 studies were included (8 on mindfulness, 7 on yoga, and 6 on acupuncture), all involving independent samples, with a total of 1,364 participants. The meta-analytic results showed that all three therapeutic practices have consistent and beneficial effects on reducing burnout. Furthermore, moderation analyses indicated that mindfulness interventions conducted within the work schedule have a significant reduction in burnout, while acupuncture interventions with between 4 or 8 weeks (the more weeks, the better) also reduced burnout. However, no significant moderation effect was observed for yoga interventions. Overall, the findings provide insights into the effectiveness of these complementary practices in reducing burnout and highlight the need for further research in this area.

AI-Assisted Tailored Intervention for Nurse Burnout: A Three-Group Randomized Controlled Trial

BACKGROUND

High-stress environments, heavy workloads, and the emotional demands of patient care, which are common challenges faced by nurses, are factors that can lead to burnout. Shift work can make traditional burnout interventions costly and difficult to implement. Artificial intelligence (AI) could offer solutions that are less constrained by time, resources, and labor.

AIM

To investigate the effectiveness of an AI-assisted intervention in reducing nurse burnout.

METHODS

A single-blind, three-group, randomized controlled trial of 120 nurses (40 per group) was conducted from June 2023 to July 2023. The AI-assisted tailored intervention included two 2-week programs, delivering one of four programs to the intervention group: mindfulness meditation, acceptance commitment therapy, storytelling and reflective writing, or laughter therapy. The experimental group received tailored programs based on demographic and work-related characteristics, job stress, stress response, coping strategy, and burnout dimensions (client-related, personal, and work-related). Control Group 1 self-selected their programs, while Control Group 2 was provided with online information on burnout reduction. Primary outcomes, client-related, personal, and work-related burnout, were measured at baseline, week 2, and week 4. Secondary outcomes, job stress, stress responses, and coping strategies, were assessed at baseline and week 4. Data were analyzed using ANOVA, repeated measures ANOVA, and the Scheffé test for post hoc analysis.

RESULTS

The experimental group showed significant reductions in client-related burnout (F = 7.725, p = 0.001) and personal burnout (F = 10.967, p < 0.0001) compared to the other groups. Significant effects of time and time × group interactions were observed for client-related and personal burnout, with time effects noted for work-related burnout. Stress response reduction was highest in Control Group 1, followed by the experimental group and Control Group 2 (F = 3.07, p = 0.017).

LINKING EVIDENCE TO ACTION

AI algorithms could provide tailored programs to mitigate nurse burnout, particularly in client-related and personal burnout. Reducing nurse burnout could contribute to the quality of care.

TRIAL REGISTRATION

This trial is registered with the Clinical Research Information Service (KCT0008546).

Prevalence and influencing factors of occupational burnout among healthcare workers in the Chinese mainland during the late 2022 Omicron COVID-19 outbreak: a multicenter cross-sectional study

China witnessed an Omicron COVID-19 outbreak at the end of 2022. During this period, medical crowding and enormous pressure on the healthcare systems occurred, which might result in the occurrence of occupational burnout among healthcare workers (HCWs). This study aims to investigate the prevalence of occupational burnout and associated mental conditions, such as depressive symptoms, anxiety, PTSD symptoms, perceived social support, resilience, and mindfulness among HCWs of the Chinese mainland during the Omicron COVID-19 outbreak, and to explore the potential risk and protective factors influencing occupational burnout of HCWs. A multicenter cross-sectional study was conducted among HCWs working in the Chinese mainland from January 5 to February 9, 2023. A total of 6552 participants were recruited by convenience sampling. Data were collected on demographic characteristics, occupational burnout, depressive symptoms, anxiety, PTSD, perceived social support, resilience, and mindfulness by online questionnaires. Descriptive analyses were performed to describe the participants' demographic characteristics. Univariate-Multivariate analyses were used to determine the influencing factors of occupational burnout. The results showed that the prevalence of occupational burnout and associated mental disorders, such as depressive symptoms, anxiety, and PTSD in HCWs were 44.56%, and 70.75%, 47.87%, and 37.49%, respectively. Older age, female gender, higher income, more doses of COVID-19 vaccine, a higher level of mindfulness, resilience, and perceived social support were protective factors of occupational burnout. Working as nurses, in a department currently taking charge of the treatment of COVID-19 patients, perceived high risk of contracting COVID-19 due to work, perceived high work intensity, and a higher level of anxiety and depressive symptoms were risk factors of occupational burnout. Tailored interventions on perceived social support, resilience, and mindfulness should be implemented to alleviate occupational burnout and associated mental disorders among HCWs.

Psilocybin-Assisted Group Psychotherapy + Mindfulness Based Stress Reduction (MBSR) for Frontline Healthcare Provider COVID-19 Related Depression and Burnout: A Randomized Clinical Trial

Objective

This clinical trial sought to evaluate the safety and preliminary efficacy of psilocybin and MBSR for frontline healthcare providers with symptoms of depression and burnout related to the COVID-19 pandemic.

Methods

This was a randomized controlled trial that enrolled physicians and nurses with frontline clinical work during the COVID-19 pandemic and symptoms of depression and burnout. Participants were randomized in a 1:1 ratio to either an 8-week MBSR curriculum alone or an 8-week MBSR curriculum plus group psilocybin-assisted psychotherapy (PAP) with 25mg psilocybin. Symptoms of depression and burnout were assessed at baseline, and 2-weeks and 6-months post intervention utilizing the Quick Inventory of Depressive Symptoms (QIDS-SR-16) and Maslach Burnout Inventory Human Services Survey for Medical Professionals (MBI-HSS-MP), respectively. Secondary outcome measures included the Demoralization Scale (DS-II) and the Watt's Connectedness Scale (WCS). Adverse events and suicidality were assessed through 6-month follow-up.

Results

25 participants were enrolled and randomized. There were 12 study-related AEs recorded that were Grade 1-2 and no serious AEs. There was larger decrease in QIDS score for the MBSR+PAP arm compared to MBSR-only from baseline to 2-weeks post-intervention and significant between-group differences favoring MBSR+PAP on subscales of the MBI-HSS-MP as well as the DS-II and WCS.

Conclusions

Group psilocybin-assisted therapy plus MBSR was associated with clinically significant improvement in depressive symptoms without serious adverse events and with greater reduction in symptoms than MBSR alone. Study findings suggest that integrating psilocybin with mindfulness training may represent a promising treatment for depression and burnout among physicians and nurses.

Resident physician depression: systemic challenges and possible solutions

Resident physicians face intense stressors that significantly heighten their depression risk. This article discusses research findings on critical factors contributing to depression among resident physicians. Understanding these factors is essential to developing targeted interventions, fostering healthy work environments, and ultimately improving physician wellbeing and patient care.

Mindfulness and Voice Behaviour: A Diary Study of Ego Depletion and Work-Related Self-Efficacy Among Nurses

AIM

This study examined how mindfulness affects voice behaviour by altering nurses' daily resource levels.

BACKGROUND

Mindfulness is an essential personal resource; it can enhance the accumulation of resources and empower individuals to engage in adaptive resource regulation. This study suggests that on days when nurses' mindfulness is higher than average, they may accumulate more resources that facilitate their voice behaviour.

DESIGN

We employed an intensive longitudinal design in the form of a daily diary. Participants were asked to complete both one-time and daily surveys.

METHODS

We collected data between March and September 2024, and 119 nurses were tracked over seven workdays. We tested the hypothesised relationships using a multilevel analysis.

RESULTS

Mindfulness was positively related to nurses' voice behaviour; this relationship was mediated by work-related self-efficacy (WRSE). Moreover, ego depletion and WRSE played a chain-mediating role between mindfulness and nurses' voice behaviour.

CONCLUSION

Mindfulness enhances nurses' voice behaviour as well as an individual's resource level and enables him/her to obtain more resources through voice behaviour.

IMPACT

Given the positive impact of mindfulness, we advocate for expanding mindfulness training for nurses to boost their resource levels and consequently encourage voice behaviour. In addition, given the mediating role of ego depletion and WRSE, we emphasise the importance of identifying and mitigating factors that contribute to nurses' ego depletion. Furthermore, we call for training on professional skills to be provided to enhance nurses' confidence in their abilities.

PATIENT OR PUBLIC CONTRIBUTION

There are no patient or public contributions. This study did not involve patients or the public in the design and implementation process because it focused on investigating the work behaviour of nurses, where the involvement of patients and the public may not have been essential.

A Call to Arms for Professional Sustainability and Practitioner's Mental Health

Despite professional commitment to wellness, supporting and addressing clinician mental health and professional sustainability has not been historically prioritized or well-understood within the occupational therapy profession. This paper discusses how to build a mentally strong, resilient, sustainable current and future occupational therapy workforce at the personal and systemwide levels to prioritize practitioner mental health. Specific barriers to and support for practitioner occupational balance and mental health as well as systemwide professional sustainability are discussed highlighting a Model of the Interplay of Occupational Balance and Professional Sustainability.

Multidimensional factors of burnout in general practice: a cross sectional survey

BACKGROUND

GPs are particularly vulnerable to job burnout. Tailored prevention and intervention strategies are needed.

AIM

To investigate organisational, interpersonal, and individual factors contributing to exhaustion and disengagement at work among GPs.

DESIGN & SETTING

We conducted a cross-sectional study in a sample of Belgian GPs.

METHOD

A total of 358 doctors (73% females, 301 with complete data) completed an online anonymous questionnaire assessing job burnout, psychosocial characteristics of the work environment, perceived social support in the private domain, emotional competence, and self-compassion.

RESULTS

GPs reported moderate levels of exhaustion and disengagement. Regression models showed that included factors jointly explained 69% of the variance in exhaustion and 63% in disengagement. Exhaustion was significantly predicted by female sex (β effect size = -0.1), high perceived emotional demands (β = 0.19), as well as low self-compassion (β = -0.14) and low emotional competence (β = 0.09). Disengagement was significantly predicted by low seniority (β = -0.12) and limited opportunities for development (β = -0.16). Both exhaustion and disengagement were predicted by low perceived quality of work (β = -0.19 and -0.14, respectively), meaning of work (β = -0.17 and -0.31, respectively), and role clarity (β = 0.09 and 0.12, respectively), as well as high perceived work-life conflict (β = 0.46 and 0.21, respectively). Moreover, GPs working in a multidisciplinary group reported lower levels of exhaustion and disengagement than those working in a monodisciplinary group or a solo practice, and this difference was associated with factors such as work-life conflict.

CONCLUSION

Organisational, interpersonal, and intrapersonal factors interact to predict a substantial part of burnout in general practice. The most significant risk factors were perceived work-life conflict and poor meaning of work. Policymakers should work to support more sustainable practices based on the specific needs and constraints reported by GPs.

Improving patient-centered mental health promotion in primary care in vulnerable communities through mindfulness training in Rio de Janeiro, Brazil

Introduction

Brazilian Primary Health Care (PHC) is responsible for all-sanitary actions for a community-based population, including health promotion and mental health care. Mindfulness Based Health Promotion (MBHP) is an intervention that can promote self-care and psychosocial support in PHC.

Objective

To discuss the effects of mindfulness based psychosocial group interventions for health promotion in primary care units in Rio de Janeiro, Brazil.

Methods

The intervention was based on the MBHP model adapted for SUS. Nine groups were held in Rio de Janeiro. A quali-quanti research was held with two parts: (a) quantitative study, pre and after the 8 weeks intervention, evaluating the effect on mindfulness and self-compassion and their association with levels of anxiety, depression, and quality of life. (b) Qualitative research using Focus Groups with the participants to investigate their experience at the end of the mindfulness groups.

Results and discussion

Sixty-two participants finished the 9 groups where 86% were women, mostly between 30 and 59 years of age and low income, and around 80% under regular medical care in PHC in SUS. In the studied sample 80% had at least one chronic health condition under treatment, including 42% with anxiety and 35% with depression. The effects included significant improvement in Anxiety and Depression and in Quality of Life, mainly in the psychological but also in the physical and interrelation domains. The qualitative study showed that most patients joined the group on the recommendation of health professionals for managing physical and mental health symptoms. Patients reported being able to use the practices taught in the sessions to manage symptoms such as insomnia and emotionally distressing situations in their daily lives. Including family members in mindfulness practices was a strategy to negotiate not only a space at home to meditate, but also to obtain a different approach to health problems. Participants pointed to mindfulness as a complementary therapeutic option to medication and psychotherapy.

Conclusion

Mindfulness-Based Intervention have shown to be a feasible, well-accepted and efficacious method of offering psychosocial support and promoting well-being for low-income patients in primary care in LAMIC.

Development of an Artificial Intelligence-Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial

BACKGROUND

Nurse burnout leads to an increase in turnover, which is a serious problem in the health care system. Although there is ample evidence of nurse burnout, interventions developed in previous studies were general and did not consider specific burnout dimensions and individual characteristics.

OBJECTIVE

The objectives of this study were to develop and optimize the first tailored mobile intervention for nurse burnout, which recommends programs based on artificial intelligence (AI) algorithms, and to test its usability, effectiveness, and satisfaction.

METHODS

In this study, an AI-based mobile intervention, Nurse Healing Space, was developed to provide tailored programs for nurse burnout. The 4-week program included mindfulness meditation, laughter therapy, storytelling, reflective writing, and acceptance and commitment therapy. The AI algorithm recommended one of these programs to participants by calculating similarity through a pretest consisting of participants' demographics, research variables, and burnout dimension scores measured with the Copenhagen Burnout Inventory. After completing a 4-week program, burnout, job stress, stress response using the Stress Response Inventory Modified Form, the usability of the app, coping strategy by the coping strategy indicator, and program satisfaction (1: very dissatisfied; 5: very satisfied) were measured. The AI recognized the recommended program as effective if the user's burnout score reduced after the 2-week program and updated the algorithm accordingly. After a pilot test (n=10), AI optimization was performed (n=300). A paired 2-tailed t test, ANOVA, and the Spearman correlation were used to test the effect of the intervention and algorithm optimization.

RESULTS

Nurse Healing Space was implemented as a mobile app equipped with a system that recommended 1 program out of 4 based on similarity between users through AI. The AI algorithm worked well in matching the program recommended to participants who were most similar using valid data. Users were satisfied with the convenience and visual quality but were dissatisfied with the absence of notifications and inability to customize the program. The overall usability score of the app was 3.4 out of 5 points. Nurses' burnout scores decreased significantly after the completion of the first 2-week program (t=7.012; P<.001) and reduced further after the second 2-week program (t=2.811; P=.01). After completing the Nurse Healing Space program, job stress (t=6.765; P<.001) and stress responses (t=5.864; P<.001) decreased significantly. During the second 2-week program, the burnout level reduced in the order of participation (r=-0.138; P=.04). User satisfaction increased for both the first (F=3.493; P=.03) and second programs (F=3.911; P=.02).

CONCLUSIONS

This program effectively reduced burnout, job stress, and stress responses. Nurse managers were able to prevent nurses from resigning and maintain the quality of medical services using this AI-based program to provide tailored interventions for nurse burnout. Thus, this app could improve qualitative health care, increase employee satisfaction, reduce costs, and ultimately improve the efficiency of the health care system.

Mindfulness-based interventions for improving mental health of frontline healthcare professionals during the COVID-19 pandemic: a systematic review

BACKGROUND

Mindfulness-based interventions (MBIs) appear to be effective for improving the mental health of healthcare professionals (HCPs). However, the effectiveness of MBIs on extreme psychological trauma caused by the coronavirus disease 2019 (COVID-19) pandemic is largely unknown. The aim of this paper was to systematically review empirical studies of MBIs for HCPs carried out during the COVID-19 pandemic, to evaluate them and their effectiveness in different areas of mental health.

METHODS

The electronic databases searched were Web of Science, Scopus, PubMed, and PsycINFO. The date when each database was last searched was September 15, 2023. Randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and non-randomized non-controlled trials (NRNCTs) focused on MBIs for health care staff who were working in healthcare centers during the COVID-19 pandemic were included. All of them employed standardized measures of mental health. The review followed the best practices and reported using PRISMA guidelines. A data collection form, adapted from the Cochrane handbook for systematic reviews of interventions, was used to extract and synthesize the results. The methods used to assess the risk of bias in the included studies were the Cochrane Risk of Bias Tool and the ROBINS-I Tool.

RESULTS

Twenty-eight studies were included in the systematic review. Overall, the methodological quality of the studies was moderate. The results showed the effectiveness of MBIs in improving levels of stress, mindfulness, and mental well-being. However, no conclusive results were found regarding the effectiveness of MBIs in improving the levels of burnout, anxiety, depression, sleep quality, and resilience of HCPs.

CONCLUSIONS

The MBIs for HCPs carried out during the COVID-19 pandemic have mainly contributed to improving stress, mindfulness, and mental well-being at a time of serious health emergency. However, more robust studies at a methodological level would have been desirable.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021267621.

Addressing Burnout and Enhancing Well-Being Among Academic Physicians: A Call for Future Research and Organizational Support

Description Burnout among academic physicians, who navigate multiple roles beyond the clinical environment, is a pressing issue. However, the factors driving burnout among academic physicians are not fully understood. Prior research has revealed differences in burnout dimensions between clinical and basic science faculty, but the impact of balancing research, education, and clinical demands on academic physicians is still unclear. This knowledge gap negatively affects the clinical, translational science, research, and medical education workforces and has particular implications for minoritized and marginalized groups working in academic medical centers. Creating a culture of well-being has been vital in addressing burnout. Further research is needed to explore the unique experiences and demands of academic physicians- particularly those from minoritized and marginalized backgrounds-and to develop effective strategies to promote well-being as they balance diverse roles and contexts. This commentary highlights gaps in understanding burnout among academic physicians and proposes guidelines for future research as well as strategies to improve well-being at academic medical centers.

Mindfulness training in healthcare professions: A scoping review of systematic reviews

PURPOSE

The effectiveness of mindfulness training (MT) on mental health and wellbeing in different groups and contexts is well-established. However, the effect of MT on different healthcare professionals' (HCPs) mental health and wellbeing needs to be synthesised, along with a focus on outcomes that are specifically relevant to healthcare settings. The aim of this study is to summarise the effect of MT interventions on HCPs' mental health and wellbeing, to explore its effect on communication skills and to identify potential gaps in the literature.

METHODS

A scoping review of systematic reviews (SRs) investigating MT interventions in HCPs was conducted. A comprehensive systematic search was conducted from database inception to 22 February 2023 on Ovid MEDLINE, Ovid Embase, Scopus, Cochrane (CENTRAL), EBSCHOhost CINAHL, Ovid PsycINFO, Web of Science (Core Collection), OpenGrey, TRIP Database and Google Scholar. Snowballing of reference lists and hand-searching were utilised. Risk of bias and quality of included SRs were assessed using the ROBIS and AMSTAR2 tools.

RESULTS

Sixteen SRs were included in this review. We found substantial evidence for MT interventions improving mental health and wellbeing across different HCPs, with the exception of burnout, where evidence is mixed. There is a paucity of SRs evaluating communication skills other than empathy. However, the available evidence is suggestive of improvements in self-reported empathy. Details of MT fidelity and dosage are largely absent in the SRs, as is study populations from representative EDI samples.

CONCLUSIONS

Synthesis of SRs suggests that MT improves mental health and wellbeing in HCPs. The exception is burnout, where results are inconclusive. Insufficient data exists to evaluate effects of MT on the full spectrum of communication skills. Other HCPs than medicine and nursing are inadequately represented. Further research is required that considers the specific target population of HCPs and MT curriculum, and reports on fidelity, dosage and the effects on communication skills.

Effects of standardized mindfulness programs on burnout: a systematic review and original analysis from randomized controlled trials

According to the World Health Organization (WHO), burnout is a syndrome conceptualized as resulting from chronic occupational stress that has not been successfully managed. It is characterized by emotional exhaustion, cynicism toward work, and a lack of personal accomplishment at work. Recent WHO guidelines on mental health suggest that mindfulness could have beneficial effects in a professional environment, but to the best of our knowledge, there is currently no study that has made a large inventory of research focused specifically on the effects of standardized programs on burnout. Which professional populations have already been studied? What are the characteristics of the programs? Have studies shown a significant effect and on what indicator?

Objective

To assess the effects of standardized programs of mindfulness on burnout, we carried out a systematic review using an exhaustive inventory of the international literature based on randomized controlled trials (RCTs).

Methods

The articles were selected according to PRISMA recommendations. The Embase, PubMed/MEDLINE, EBSCOhost, HAL databases were searched with the keywords "mindfulness," "burnout," and "randomized" in the title and abstract of each article. The data were all collected in an Excel spreadsheet and analyzed in pivot tables, which were then presented in graphs and maps.

Results

A total of 49 RCTs were thus selected, the majority of which were of good methodological quality, of American origin (43% of studies), concerned professionals in the health sector (64% of participants included), and mostly women (76%). The RCTs assessed the effects of 31 different mindfulness programs, mostly with the Maslach Burnout Inventory (78% of RCTs). More than two-thirds of RCTs (67%) showed a significant beneficial effect on burnout measurement indicators, with emotional exhaustion being the most impacted component.

Conclusion

This systematic review shows that mindfulness-based interventions could be approaches of choice to prevent emotional distress of burnout. Further studies are still needed to determine which type of program is best suited to impact the two other components of burnout.

Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study

BACKGROUND

Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited.

OBJECTIVE

This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees.

METHODS

The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data.

RESULTS

After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=-0.38, 95% CI -0.67 to -0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=-0.31, 95% CI -0.51 to -0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment.

CONCLUSIONS

The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism.

Organizational interventions and occupational burnout: a meta-analysis with focus on exhaustion

PURPOSE

To assess whether organizational interventions are effective to prevent or reduce exhaustion, the core dimension of occupational burnout.

METHODS

We searched in PubMed, EMBASE, PsycINFO, and Cochrane Library databases randomized and non-randomized controlled trials conducted among active workers and reporting the outcome as exhaustion score. We calculated the effect sizes using the pre-test-post-test control group design's estimate. We used the random effects model in meta-analysis and Cochrane collaboration's tool for interventions to assess the risk of bias. Overall quality of evidence was appraised using the GRADE.

RESULTS

From the 2425 identified records, we assessed 228 full texts for eligibility and included 11 original articles describing 13 studies, 11 on organizational interventions, and 2 on combined inventions. The interventions were participatory (n = 9), focused on workload (n = 2), or on work schedule (n = 2). The overall effect size was - 0.30 ((95% CI = - 0.42; - 0.18), I2 = 62.28%), corresponding to a small reduction in exhaustion with a very low quality of evidence. Combined interventions had a larger effect (- 0.54 (95% CI = - 0.76; - 0.32)) than organizational interventions. When split by type of intervention, both participatory interventions and interventions focused on workload had a benefic effect of exhaustion reduction, with an estimated effect size of - 0.34 (95% CI = - 0.47; - 0.20) and - 0.44 (95% CI = - 0.68, - 0.20), respectively.

CONCLUSION

Interventions at combined level in workplaces could be helpful in preventing exhaustion. However, the evidence is still limited, due to a high heterogeneity between studies, bias potential, and small number of eligible studies. This calls for further research, using workload interventions at organizational level, especially in sectors with high risk of job stress and exhaustion.

An Overview of Reviews to Inform Organization-Level Interventions to Address Burnout in Rheumatologists

OBJECTIVE

To identify organization-directed strategies that could be implemented to prevent burnout among rheumatologists.

METHODS

A search of English language articles published 2011 or later was conducted on Cochrane Database of Systematic Reviews, Embase, Medline, and PsycInfo on January 25, 2022. Included reviews had ≥ 1 primary studies with ≥ 10% of participants who were physicians, recorded burnout as an outcome, and described an organization-directed intervention to prevent burnout. Overlap of primary studies across reviews was assessed. The final review inclusion was determined by study quality, minimization of overlap, and maximization of intervention breadth. The A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool was used for quality assessment. Included studies and interventions were assessed by rheumatologists for their applicability to rheumatology.

RESULTS

A total of 17 reviews, including 15 systematic reviews, 1 realist review, and 1 umbrella review were included. AMSTAR 2 quality ratings classified 5 systematic reviews as low quality, 1 as moderate, and 9 as critically low. There was significant heterogeneity between and within reviews. Six conducted a metaanalysis and 11 provided a qualitative summary of findings. The following intervention types were identified as having possible applicability to rheumatology: physician workflow and organizational strategies; peer support and formal communication training; leadership support; and addressing stress, mental health, and mindfulness. Across interventions, mindfulness had the highest quality of evidence to support its effectiveness.

CONCLUSION

Although the quality of evidence for interventions to prevent burnout in physicians is low, promising strategies such as mindfulness have been identified.

Sources of stress and coping mechanisms: Experiences of maternal health care providers in Western Kenya

The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt. Data were collected in Migori County in western Kenya utilizing quantitative surveys with n = 101 maternity providers and in-depth interviews with a subset of n = 31 providers. We conducted descriptive analyses for the quantitative data. For qualitative data, we conducted thematic analysis, where codes were deductively developed from interview guides, iteratively refined based on emergent data, and applied by a team of five researchers using Dedoose software. Code queries were then analysed to identify themes and organized using the socioecological (SE) framework to present findings at the individual, interpersonal, and organizational levels. Providers reported stress due to high workloads (61%); lack of supplies (37%), poor salary (32%), attitudes of colleagues and superiors (25%), attitudes of patients (21%), and adverse outcomes (16%). Themes from the qualitative analysis mirrored the quantitative analysis with more detailed information on the factors contributing to each and how these sources of stress affect providers and patient outcomes. Coping mechanisms adopted by providers are captured under three themes: addressing stress by oneself, reaching out to others, and seeking help from a higher power. Findings underscore the need to address organizational, interpersonal, and individual level stressors. Strategies are needed to support staff retention, provide adequate resources and incentives for providers, and ultimately improve patient outcomes. Interventions should support and leverage the positive coping mechanisms identified.

The First Attempt to Apply an Online Mindfulness Program to Nursing Staff in a Traditional Korean Medicine Clinic in COVID-19 Era: A Case Series

The importance of medical personnel's mental health is emphasized in the COVID-19 era. The characteristics of traditional Korean medicine (KM) may affect the mental health of nursing staff working at KM clinics. In this case series, we report the first attempt to apply an online mindfulness program to the nursing staff in a KM clinic in Korea. For three female nursing assistants, an online mindfulness program consisting of five sessions was offered for two months. After the program, a decrease in emotional labor was observed in two participants, and a decrease in the level of burnout was observed in all participants. One participant showed an increase in their emotional labor level, which was associated with an increase in deep acting. The participants expressed a high level of satisfaction with this program in terms of recommendations for peers and willingness to participate again. As this report is a case series, larger studies are needed to fully evaluate the benefits of the program on emotional labor and burnout of KM clinic nursing staff. However, the potential benefits of emotional labor and burnout, high satisfaction, and some challenges identified in this case series can be considered in future extensions and modifications of the program.

Journey Mapping Healthcare Worker Experience With Heart Rhythm Meditation

BACKGROUND

Levels of stress and burnout continue to rise amongst healthcare workers. In addition to systemic and institution-level changes to healthcare practice environments, well-being interventions, resources, and support to assist healthcare providers are necessary. Meditation practices like Heart Rhythm Meditation (HRM) may provide benefits to healthcare workers, but healthcare worker experiences with HRM are not well understood.

OBJECTIVE

To explore healthcare worker experiences with HRM using a journey mapping approach.

METHODS

An exploratory cross-sectional online survey was administered between May and July of 2020 to a purposeful sample of 25 healthcare workers currently practicing HRM. Surveys consisted of 5 open-ended and 36 multiple-choice items mapped to five journey mapping domains: Discover, Search, Assess, Decide, Assist. Descriptive statistics for survey items were generated in addition to a visual representation of a Persona and associated journey map for HRM. Content analysis was performed on open-ended responses using a general inductive approach to code responses and identify representative quotes.

RESULTS

Twenty surveys were completed for a response rate of 80%. The majority of respondents identified as women (n = 14). From the journey mapping output, the overall emotional experience score was an 8.2/10, suggesting respondents had positive experiences with HRM. Open-ended comments suggest that HRM provides important benefits to the personal and professional lives of healthcare workers. A small number of participants reported challenges like feeling difficult emotions during HRM practice.

CONCLUSION

Mapping the healthcare worker journey with HRM identified generally positive experiences with personal and professional benefits. While experiences were largely positive, HRM elicited difficult emotions from some individuals, suggesting that appropriate resources and support are required when considering HRM and other meditation forms.

Behaviour Patterns between Academic Motivation, Burnout and Academic Performance in Primary School Students

BACKGROUND

The final years of primary school (early adolescence) are regarded as key for the academic and personal development of students. This study aims to analyze the relationship between academic motivation, academic burnout, and academic performance, differentiating between adaptive and non-adaptive patterns according to the results of the three constructs studied.

METHODS

The sample comprised 398 students, both male (N = 224; 56.28%) and female (N = 174; 43.71%) with ages ranging from 11 to 13 years (M = 11.49; DT = 0.52). The instruments used were the Maslach Burnout Inventory-Student Survey (MBI-SS) and the Academic Motivation Scale (AMS), as well as academic marks as a measure of performance.

RESULTS

The results revealed significant correlations between the three constructs under study, the variables that can be used to predict academic performance, and both adaptive and non-adaptive behavior patterns.

CONCLUSIONS

The importance of motivation, burnout, and academic performance in primary education is manifested, whose interrelation can give rise to adaptive behaviors based on high school motivation away from academic burnout that leads to a higher academic performance in students.

Are yoga and physical activity determinants of quality of life in Polish adults? a cross-sectional study

OBJECTIVES

Yoga is an ancient form of physical activity (PA) that encompasses meditation, stretching and breathing techniques. Although the benefits of PA and associated lifestyle interventions are clear, we here addressed the paucity of evidence regarding the specific relationship between yoga and quality of life (QOL) in adults in Poland. We hypothesised that participation in PA and yoga could result in a positive impact on QOL.

DESIGN

Cross-sectional, self-administered questionnaire-based survey. Both the quantitative and qualitative variables were statistically compared. Multivariate analyses were performed using linear regression. Results were determined based on age, sex and education level; a p<0.05 was considered significant.

SETTING

Questionnaires were delivered to participants online, at high schools and universities, and in elderly communities in Poland.

PARTICIPANTS

714 polish citizens aged over 18 participated in the study; there are no specific entry and exclusion criteria besides age.

RESULTS

Statistically significant differences (p<0.05) were observed between the QOL of the physically active group (PAG) and non-PAG (N-PAG). Meanwhile, yoga practice was revealed to have a significant effect on QOL; QOL was found to be statistically higher (p<0.001) in the PAG with yoga (PAG-Y) (4.29±0.66) than in the N-PAG (3.83±0.92) and PAG without yoga (4.07±0.68).

CONCLUSIONS

The study shows that both regular PA and yoga practices could improve QOL; however, PAG-Y produced higher QOL scores than PA of other types. This outcome may be explained by the impact of physiological and psychological aspects within yoga practice. These results suggest that this unique combination impacts health more positively than other kinds of PA alone.

Mindfulness–based positive transformative leadership development for health organisations

Purpose

Positive transformative leadership development practices in health care are perhaps the most important pathway that, collectively, can be pursued while heading towards a post-corona virus disease 2019 world, and race towards 2030. As a practitioner paper, based on front line and leadership experience, this study aims to argue that we need transformational leaders who will go beyond knowing to practice and implementation. While the findings from research is presented from different organisations and companies, they all have something in common – people. Hence, important lessons can be extrapolated to health-related organisations in the future.

Design/methodology/approach

The approach is based on practical research findings based on the literature. The approach uses real practical examples from companies and organisations to demonstrate the need for a new, radical way forward.

Findings

The findings from the literature clearly indicate that mindfulness-based transformative leadership development program is a worthwhile investment for decision-makers and organisations. A new transformative leader for the future of health care needs to be developed with care with investment in that development.

Research limitations/implications

Implications of this paper show that health-care organisations need to begin this journey. There is a paucity in the literature to demonstrate the implementation of mindfulness-based transformative leadership development programs.

Practical implications

Organisations of the future face even greater challenges brought about by intelligent technology, new pandemics and even tighter government regulation. The time to prepare for such eventualities is now. This is not a choice but an imperative for organisations to know what to do rather than react with regret.

Originality/value

There is a paucity in the health-care literature that tracks, measures, and reports on the long-term results of a mindfulness-based transformative leadership development program. This needs to be addressed, and health care should be a leader in the field of mindfulness and transformative leadership of the future.

An Integrative Review on the Research Progress of Mindfulness and Its Implications at the Workplace

Mindfulness has rapidly become a significant subject area in many disciplines. Most of the work on mindfulness has focused on the perspective of health and healthcare professionals, but relatively less research is focused on the organizational outcomes at the workplace. This review presents a theoretical and practical trajectory of mindfulness by sequential integration of recent fragmented scholarly work on mindfulness at the workplace. The review showcases that most contemporary practical challenges in organizations, such as anxiety, stress, depression, creativity, motivation, leadership, relationships, teamwork, burnout, engagement, performance, well-being, and physical and psychological health, could be addressed successfully with the budding concept of mindfulness. The causative processes due to higher mindfulness that generate positive cognitive, emotional, physiological, and behavioral outcomes include focused attention, present moment awareness, non-judgmental acceptance, self-regulatory functions, lower mind wandering, lower habit automaticity, and self-determination. Employee mindfulness could be developed through various mindfulness interventions in order to improve different organizational requirements, such as psychological capital, emotional intelligence, prosocial behavior, in-role and extra-role performance, financial and economic performance, green performance, and well-being. Accordingly, this review would be beneficial to inspire academia and practitioners on the transformative potential of mindfulness in organizations for higher performance, well-being, and sustainability. Future research opportunities and directions to be addressed are also discussed.