Workload, burnout, and medical mistakes among physicians in China: A cross-sectional study

A systematic review of major evaluation metrics for simulator-based automatic assessment of driving after stroke

Background: Simulator-based driving assessments (SA) have recently been used and studied for various purposes, particularly for post-stroke patients. Automating such assessment has potential benefits especially on reducing financial cost and time. Nevertheless, there currently exists no clear guideline on assessment techniques and metrics available for SA for post-stroke patients. Therefore, this systematic review is conducted to explore such techniques and establish guidelines for evaluation metrics. Objective: This review aims to find: (a) major evaluation metrics for automatic SA in post-stroke patients and (b) assessment inputs and techniques for such evaluation metrics. Methods: The study follows the PRISMA guideline. Systematic searches were performed on PubMed, Web of Science, ScienceDirect, ACM Digital Library, and IEEE Xplore Digital Library for articles published from January 1, 2010, to December 31, 2023. This review targeted journal articles written in English about automatic performance assessment of simulator-based driving by post-stroke patients. A narrative synthesis was provided for the included studies. Results: The review included six articles with a total of 239 participants. Across all of the included studies, we discovered 49 distinct assessment inputs. Threshold-based, machine-learning-based, and driving simulator calculation approaches are three primary types of assessment techniques and evaluation metrics identified in the review. Discussion: Most studies incorporated more than one type of input, indicating the importance of a comprehensive evaluation of driving abilities. Threshold-based techniques and metrics were the most commonly used in all studies, likely due to their simplicity. An existing relevant review also highlighted the limited number of studies in this area, underscoring the need for further research to establish the validity and effectiveness of simulator-based automatic assessment of driving (SAAD). Conclusions: More studies should be conducted on various aspects of SAAD to explore and validate this type of assessment.

The relationship between medical staff burnout and subjective wellbeing: the chain mediating role of psychological capital and perceived social support

Background

Medical staff play a crucial role in delivering healthcare services, especially during epidemics of infectious diseases such as coronavirus disease 2019 (COVID-19). However, there is a growing issue of burnout and low wellbeing among this group. While it is widely recognized that burnout has a negative impact on subjective wellbeing, the exact relationship between the two is not yet completely understood. The purpose of this study is to explore the chain mediating role of psychological capital and perceived social support between burnout and subjective wellbeing among medical staff.

Methods

Using the convenient sampling method, 604 medical staff were selected for a cross-sectional study. All participants completed a self-report questionnaire that collected demographic information, as well as data from the Maslach Burnout Inventory-Human Services Survey, General Wellbeing Schedule, Psychological Capital Questionnaire, and Perceived Social Support Scale. SPSS 27.0 and SPSS PROCESS macro were used for data analysis.

Results

There was a significant correlation between burnout, psychological capital, perceived social support, and subjective wellbeing (p < 0.01). Burnout not only has a direct negative impact on the subjective wellbeing of medical staff (effect: -0.2045; Bootstrap 95%CI: -0.2506, -0.1583), but also exerts an indirect influence on subjective wellbeing through three pathways: the independent mediating effect of psychological capital (effect: -0.0481; Bootstrap 95%CI: -0.0876, -0.0109), the independent mediating effect of perceived social support (effect: -0.0092; Bootstrap 95%CI: -0.0203, -0.0003), and the chained mediating effect of psychological capital and perceived social support (effect: -0.0092; Bootstrap 95%CI: -0.0183, -0.0019).

Conclusion

High burnout in medical staff can impair the level of psychological capital, leading to diminished perceived social support and ultimately reduced subjective wellbeing. The findings of this study contribute to understanding the potential pathways between burnout and subjective wellbeing and provide preliminary data support for developing strategies to improve the mental health of medical staff.

Validity of OSDI-6 questionnaire in a Chinese adult population

This study aimed to evaluate the validity of the Chinese translation version of OSDI-6 (C-OSDI-6) using a virtual set-up questionnaire for dry eye disease. A total of 270 participants (136 males, 50.4% and 134 females, 49.6%) with a mean age of 28.22 ± 9.01 years were assessed, diagnosed under the criteria put forth by Dry Eye Workshop completed the Chinese translated version of the OSDI-12 questionnaire (C-OSDI-12). Validity and psychometric properties were analyzed using the study data on the selected items (a new approach called virtual validation). The six items were extracted from the C-OSDI-12 as suggested by the authors of OSDI-6 and compared. The total scores of C-OSDI-12 and C-OSDI-6 were 30.27 ± 13.19 and 6.95 ± 3.53, respectively. Significant reliability was found between the total C-OSDI-6 score and the total C-OSDI-12 score (r = 0.865, p < 0.001). Infits and outfits of the C-OSDI-6 were between 1.26 and 0.78.The C-OSDI-6 proved valid and psychometrically responsive in Chinese adult dry eye participants. The findings of this virtual validation study need to be confirmed in a longitudinal validation study on real-world use.

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.

Mental health disparities between physicians and nurses: Analyzing the impact of occupational stress and work environment fitness using random forest algorithm

BACKGROUND

The impact of occupational stress and work environment fitness on mental health disparities between physicians and nurses are not well understood. This study aims to identify and rank key determinants of mental health in physicians and nurses in China and compare the differences in their impact on mental health between physicians and nurses.

METHODS

A large cross-sectional survey with multistage cluster sampling was conducted. The survey included the Self-Rating Anxiety Scale (SAS Scale), the Center for Epidemiologic Studies Depression Scale (CES-D Scale), the Maslach Burnout Inventory-General Survey (MBI-GS) and the Person-Environment (PE) Fit. We applied a principled, machine learning-based variable selection algorithm, using random forests, to identify and rank the determinants of the mental health in physicians and nurses.

RESULTS

In our study, we analyzed a sample of 9964 healthcare workers, and 2729 (27 %) were physicians. The prevalence of anxiety and depressive disorders among physicians and nurses was 31.0 % and 53.3 %, 30.8 % and 47.9 %, respectively. Among physicians with anxiety disorder, we observed a higher likelihood of cynicism, emotional exhaustion, reduced personal accomplishment, and poor organization fitness, job fitness, group fitness, and supervisor fitness, in order of importance. When comparing the effects on depressive disorder in physicians, group fitness and supervisor fitness did not have significant impacts. For nurses, emotional exhaustion had a more significant effect on depressive disorder compared to cynicism. Supervisor fitness did not have a significant impact on anxiety disorder in nurses.

LIMITATIONS

Cross-sectional design, self-reporting screening scales.

CONCLUSIONS

Compared to individual and hospital characteristics, the primary factors influencing mental health disorders are occupational burnout and the compatibility of the work environment. Additionally, the key determinants of depressive and anxiety disorders among doctors and nurses exhibit slight variations. Employing machine learning methods proves beneficial for identifying determinants of mental health disorders among physicians and nurses in China. These findings could help improve policymaking aimed at addressing the mental well-being of healthcare professionals.

A latent profile analysis of doctors' joy in work at public hospitals

Introduction

When doctors' work stress increases, their joy in work decreases, severely affecting the quality of care and threatening patient safety. Analysis of the latent categories of joy in work of doctors in public hospitals and the differences in the characteristics of each category can help uncover hidden messages that enhance doctors' joy in work.

Methods

Questionnaires were administered to 426 doctors working in public hospitals using the general information questionnaire and the public hospital doctor's joy in work evaluation scale. Upon identifying their potential categories using latent profile analysis, chi-square test, and multinomial logistic regression were performed to analyze the differences in the characteristics of each category.

Results

The 426 public hospital doctors could be divided into three potential categories: "low joy in work" (11.27%), "medium joy in work" (59.86%), and "high joy in work" (28.87%). Most of the doctors did not have much joy in work, with 71.13% of them having "low to medium joy in work." Doctors who work in secondary or tertiary hospitals, have a personnel agency or contract, and are older than 45 years are more likely to belong to the "low joy in work" category. Some of the protective factors are having an average monthly income (RMB) of 10,001-15,000 yuan and having a fair or good self-rated health status.

Conclusion

There are obvious classification characteristics of doctors' level of joy in work. Hospital managers can take commensurate actions to improve their joy in work, thereby improving patient safety and the quality of medical services.

Examination of workload perception, burnout, and perceived organizational support in emergency healthcare professionals: A structural equation model

Job stress is one of the important factors affecting employee behavior. One of the most important factors in reducing burnout caused by stress is organizational support. In this context, the aim of this study is to identify the moderating role of perceived organizational support in the effect of workload perception on burnout within the emergency healthcare professionals' universe. The data for this study were collected from 703 health professionals working in emergency health services in three major cities of Turkey. The relationships and the model of the study is analyzed by the Structural Equation Model technique. The results indicate that perceived workload is a factor that causes employee burnout, and perceived organizational support is a factor that reduces employee burnout. This study contributes to researchers and health managers by revealing the importance of workload planning and organizational activities that support employees to reduce burnout in health workers.

"The Cost in the Individual": Longitudinal Burnout Prevalence Among Pediatric Emergency Physicians Through 9 Months of the COVID-19 Pandemic

OBJECTIVES

Emergency medicine (EM) confers a high risk of burnout that may be exacerbated by the COVID-19 pandemic. We aimed to determine the longitudinal prevalence of burnout in pediatric EM (PEM) physicians/fellows working in tertiary PEM departments across Canada and its fluctuation during the pandemic.

METHODS

A national mixed-methods survey using a validated 2-question proxy for burnout was distributed monthly through 9 months. The primary outcome was the trajectory in probability of burnout, which was examined as both emotional exhaustion (EE) and depersonalization (DP), EE alone, and DP alone. Secondary outcomes investigated burnout and its association with demographic variables. Quantitative data were analyzed using logistic regression for primary outcomes and subanalyses for secondary outcomes. Conventional content analysis was used to analyze qualitative data and generate themes.

RESULTS

From February to October 2021, 92 of 98 respondents completed at least 1 survey, 78% completed at least 3 consecutive surveys, and 48% completed at least 6 consecutive surveys. Predicted probability of EE was bimodal with peaks in May (25%) and October (22%) 2021. Rates of DP alone or having both EE and DP were approximately 1% and stable over the study period. Mid-career physicians were at lower risk of EE (odds ratio, 0.02; 95% confidence interval, 0-0.22) compared with early-career physicians. Underlying drivers of burnout were multifaceted.

CONCLUSIONS

Our study suggests that increased COVID-19 case burden was correlated with EE levels during the third and fourth waves of the pandemic. Emotional exhaustion was worsened by systemic factors, and interventions must target common themes of unsustainable workloads and overwhelming lack of control.

Work Patterns and Intensity of Chinese Surgical Residents- A Multicenter Time-and-Motion Study

OBJECTIVE

This study aimed to record and analyze surgical resident trainee time allocation among junior doctors in China in order to understand the training environment and optimize realistic training and patient care objectives.

DESIGN

Multicenter observational time and motion study.

SETTING

Multicenter, carried out in 5 tier 3 public hospitals in 5 provinces across China.

PARTICIPANTS

Surgical resident trainees at various stages of training were eligible to enter the study, total n = 44. Registered nurses were eligible to be observers, n = 4 from each hospital.  An expert team comprising 4 chief surgeons and 10 surgical residents participated in establishing the clinical activity list.

RESULTS

Participants were observed during working hours (08.00-17.00) for 10 consecutive working days and time spent on different activities were recorded. Work patterns between hospitals were often dissimilar. Most time was spent on direct patient care (34.1%; 95% CI, 28.0%-40.1%) followed by indirect patient care (24.4%; 95% CI, 15.5%-33.2%), scholarly activity (21.1%; 95% CI, 13.7%-28.5%) and other (20.4%; 95% CI, 14.1%-26.8%). Subcategory analysis showed that the amount of time spent each day performing certain tasks was 137 minutes for operating theatre tasks, 103 minutes for medical record-keeping, 25 minutes for direct patient contact, 20 minutes being taught, 12 minutes teaching others, 12 minutes hand-over time, and 0 minutes of outpatient clinic attendance. Inter-observer reliability of 96.5% was obtained prior to recordings.

CONCLUSIONS

Chinese surgical resident work patterns fall within the range found in other international studies albeit with some exceptions. The training environment appears broadly suitable for competence-based surgical training in China. Inadequate outpatient activity has led to changes in trainee work rosters and trainer requirements. Both strengths and deficiencies were confirmed and addressed. Further audit is required.

The attitudes of postgraduate medical students towards the curriculum by degree type: a large-scale questionnaire survey

BACKGROUND

Chinese medical schools have offered both professional and academic degrees for postgraduate students. However, there is limited information about the attitudes of professional-degree and academic-degree students. We aimed to examine the attitudes of full-time postgraduate students towards the curriculum, stratified by degree type.

METHODS

A 29-item online questionnaire was distributed to postgraduate students in West China School of Medicine of Sichuan University in 2020. The questionnaire was designed to collect students' demographic characteristics, attitudes towards curricular provision and content, and classroom organization. A comparison was made between groups based on degree type (academic degree versus professional degree).

RESULTS

Overall, 645 out of 908 students at West China School of Medicine completed the questionnaire. Comparing with students pursuing academic degrees, professional-degree students were more interested if the curriculum included specialized knowledge and clinical skills, and expressed concerns over the excessive compulsory courses and inadequate optional courses (p < 0.001), particularly prominent among first-year postgraduate students. Besides, a greater proportion of professional-degree students thought the curriculum was conflict with clinical work to some extent, and they also rated taking attendance in class as less reasonable (p < 0.01). Conversely, students pursuing academic degrees expressed that the courses were inadequate in interdisciplinary curriculum and had some crossover or repetition, and they assigned a higher importance rating for the curriculum when comparing professional-degree students (all p < 0.05).

CONCLUSIONS

Different attitudes toward the curriculum are observed between students pursuing professional degrees and those pursuing academic degrees. This study provides benchmark data for future postgraduate course reforms in China.

On the Asymmetric Relationship Between Physician Mental Health Disorders on Quality of Healthcare Under the COVID-19 Pandemic in Taiwan: Quantile on Quantile Regression Analyses

Purpose

When examining the nexus of physician mental health disorders and healthcare quality from the empirical perspective, mental health disorders are frequently associated with cyclical patterns corresponding to cyclic seasonality, mood swings, emission of air pollution and business cycles, the potential asymmetric effects of physician mental health disorders on healthcare quality have not received adequate attention from researchers. Therefore, the purpose of this study is to explore the asymmetric relationship between physician mental health disorders and healthcare quality during the pandemic outbreak in Taiwan.

Methods

Daily data for care quality indicators and physician mental health disorders were collected from the National Insurance Research Database in Taiwan, and the quantile-on-quantile regression model was applied to proceed with our analyses.

Results

Our results indicated that the overall aggregate effects of each quantile of physician mental health disorders on the cumulative quantiles of healthcare quality are negative (positive) for the 14-day readmission rate (preventable hospitalization rate and non-urgent ED-visit rate). Positively (negatively) cumulative effects of each quantile of physician mental health disorders were detected in the middle (low and high) quantiles of the preventable hospitalization rate. The cumulative effects of each quantile of physician mental health disorders on the high (low and middle) quantiles of the 14-day readmission rate are negative (positive), but the cumulative effects on various quantiles of the non-urgent ED-visit rate exhibit the opposite pattern.

Conclusion

The observed variation in the relationship between physician mental health disorders and different quantiles of healthcare quality suggests the need for tailored strategic interventions based on distinct levels of healthcare quality when addressing the higher risk of physician mental health disorders during the pandemic outbreak conditions.

Association of Job Characteristics and Burnout of Healthcare Workers in Different Positions in Rural China: A Cross-Sectional Study

Objectives: Health workers in rural primary care systems are at increased risk of job burnout, but their associations with different positions have received scant attention in the literature. Thus, this study aims to measure job burnout in different positions in rural China and to identify factors associated with it. Methods: A cross-sectional survey was conducted with a total of 15,627 participants from six provinces in China. And job burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS). Multilevel regression analyses were used in examining factors potentially associated with job burnout in different positions. Results: Overall, more than half of providers suffered from moderate burnout. The degree of job burnout varied among different positions. Middle managers showed higher levels personal stress, while general staff showed the lowest interpersonal and self-evaluation dimensions of burnout. Job duty, job capability, job treatment, and career advancement are potential factors affecting these results. Conclusion: Interventions aimed at providing appropriate training and development opportunities, developing relevant career planning and management strategies, and implementing reasonable staffing and job design may be promising strategies for alleviating burnout in different positions and improving health system performance.

Salient Measures of Hospitalist Workload

Importance

The ideal hospitalist workload and optimal way to measure it are not well understood.

Objective

To obtain expert consensus on the salient measures of hospitalist workload.

Design, Setting, and Participants

This qualitative study used a 3-round Delphi technique between April 5 and July 13, 2022, involving national experts within and external to the field. Experts included hospitalist clinicians, leaders, and administrators, as well as researchers with expertise in human factors engineering and cognitive load theory.

Main Outcomes and Measures

Three rounds of surveys were conducted, during which participants provided input on the salient measures of hospitalist workload across various domains. In the first round, free-text data collected from the surveys were analyzed using a directed qualitative content approach. In the second and third rounds, participants rated each measure's relevance on a Likert scale, and consensus was evaluated using the IQR. Percentage agreement was also calculated.

Results

Seventeen individuals from 14 organizations, encompassing clinicians, leaders, administrators, and researchers, participated in 3 rounds of surveys. In round 1, participants provided 135 unique qualitative comments across 10 domains, with 192 unique measures identified. Of the 192 measures presented in the second round, 6 (3%) were considered highly relevant, and 25 (13%) were considered moderately relevant. In round 3, 161 measures not meeting consensus were evaluated, with 25 (16%) considered highly relevant and 95 (59%) considered moderately relevant. Examples of measures considered highly relevant included a patient complexity score and outcome measures such as savings from hospital days avoided and clinician turnover.

Conclusions and Relevance

In this qualitative study measuring hospitalist workload, multiple measures, including those quantifying work demands and the association of those demands with outcomes, were considered relevant for measuring and understanding workloads. The findings suggest that relying on traditional measures, such as productivity-related measures and financial measures, may offer an incomplete understanding of workloads and their association with key outcomes. By embracing a broader range of measures, organizations may be able to better capture the complexity and nuances of hospitalist work demands and their outcomes on clinicians, patients, and organizations.

Healthcare Professionals' Own Experiences of Domestic Violence and Abuse: A Meta-Analysis of Prevalence and Systematic Review of Risk Markers and Consequences

Background: Globally, healthcare professionals (HCPs) are increasingly asked to identify and respond to domestic violence and abuse (DVA) among patients. However, their own experiences of DVA have been largely ignored.Aim: To determine the prevalence of current and lifetime DVA victimisation among HCPs globally, and identify risk markers, consequences and support-seeking for DVA.Method: PubMed, EMBASE, PsycINFO, CINAHL ASSIA and ProQuest were searched. Studies about HCPs' personal experience of any type of DVA from any health service/country were included. Meta-analysis and narrative synthesis were adopted.Results: Fifty-one reports were included. Pooled lifetime prevalence was 31.3% (95% CI [24.7%, 38.7%] p < .001)) and past-year prevalence was 10.4% (95% CI [5.8%, 17.9%] p <.001). Pooled lifetime prevalence significantly differed (Qb=6.96, p < .01) between men (14.8%) and women (41.8%), and between HCPs in low-middle income (64.0%) and high-income countries (20.7%) (Qb = 31.41, p <.001). Risk markers were similar to those in the general population, but aspects of the HCP role posed additional and unique risks/vulnerabilities. Direct and indirect consequences of DVA meant HCP-survivors were less able to work to their best ability. While HCP-survivors were more likely than other HCPs to identify and respond to DVA among patients, doing so could be distressing. HCP-survivors faced unique barriers to seeking support. Being unable to access support - which is crucial for leaving or ending relationships with abusive people - leaves HCP-survivors entrapped.Conclusion: Specialised DVA interventions for HCPs are urgently needed, with adaptations for different groups and country settings. Future research should focus on developing interventions with HCP-survivors.

Slack resources and individual performance of clinicians: the mediating role of job satisfaction and empirical evidence from public hospitals in Beijing, China

BACKGROUND

Clinicians in Chinese public hospitals face a complex and severe clinical practice environment, and the individual performance of clinicians is key to improving the output of the healthcare industry. This study aims to explore the mechanism of slack resources in improving individual performance of clinicians and the role of job satisfaction in this process, while the study framework is based on the widely applied Job-Demands Resources theory.

METHODS

Based on the study framework composed of slack resources, individual performance, and job satisfaction, hypotheses have been put forward, and questionnaires have been distributed to representative clinicians in tertiary public hospitals. Finally, 318 valid data collected from clinicians have been obtained. To verify the hypotheses, multiple linear regression models have been established to explore the relationship between variables, and the three-stage regression models have been used to verify the presence of mediating role.

RESULTS

All four hypotheses proposed in this study have been proved to be held. Clinicians' job satisfaction has played a mediating role in the impact of slack resources and its three dimensions on individual performance. Among them, there has been a complete mediating role for staff slack, while time and space dimensions have played a partial mediating role in the impact of slack resources on individual performance.

CONCLUSIONS

In public hospitals in environments where behavior is subject to significant government interference, it is necessary and feasible to retain appropriate slack resources to improve individual performance. From the perspective of resources management in hospitals, it is necessary for public hospitals to implement a strategy of reserving an appropriate portion of time, staff and space in order to have the conditions to improve clinicians' satisfaction. The existence of slack resources in public hospitals can improve the job satisfaction of clinicians, and then improve the individual performance through the process.

Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory

BACKGROUND

The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals.

OBJECTIVE

This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor.

METHODS

A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses.

RESULTS

The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value (β=.131, P=.01; β=.638, P<.001; β=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention (β=.725, P<.001), perceived risk negatively correlated with perceived value (β=-.083, P<.001), and perceived value negatively correlated with employee burnout (β=-.308, P<.001). In addition, employee burnout was negatively related to adoption intention (β=-.170, P<.001) and mediated the relationship between perceived value and adoption intention (β=.052, P<.001).

CONCLUSIONS

Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals' adoption intention regarding IHT.

Bereavement After Patient Deaths Among Chinese Physicians and Nurses: A Qualitative Description Study

In order to achieve an in-depth understanding of professional caregivers' experiences of bereavement after patient deaths in Mainland China, qualitative description was employed. 24 physicians and nurses from hospitals in Nanjing, China, participated in one-to-one, semi-structured interviews. Thematic analysis was adopted for data analysis. Five themes were generated: the nature of professional bereavement experiences, the meaning of patient deaths, immediate bereavement reactions, long-term changes, and coping strategies. Each theme included personal and professional dimensions. Professional bereavement experiences in Mainland China were found to be influenced by workplace violence against professional caregivers, traditional Chinese medical ethics, the strong death taboo, and inadequacies of the healthcare system. Professional bereavement experiences are meaning-driven, comprehensive, and usually disenfranchised. They involve multidimensional reactions and have both short-term and long-lasting, both event-specific and accumulated impacts. Cultural and systemic factors could shape professional bereavement experiences.

Hospital Work Conditions and the Mediation Role of Burnout: Residents and Practicing Physicians Reporting Adverse Events

Background

"Patient Safety" in everyday practices is a target of healthcare leaders, and adverse events reported by healthcare providers directly reflect patient safety in the health system. Recognising how residents and practising physicians rate adverse events concerning their work conditions and burnout must be explored.

Objective

This study aims to explore the mediation effect of burnout dimensions (emotional exhaustion and burnout-interpersonal disengagement) between the effects of work conditions on perceived patient safety by exploring the adverse events that residents and practising physicians reported.

Methods

A quantitative and cross-sectional study collected data from 249 residents and practising physicians in a huge teaching hospital and primary health care centre (PHC) in the Eastern Province of Saudi Arabia. Hayes Macro regression analysis was employed to evaluate the multiple mediation effect of burnout dimensions, with 5000 bootstrapping and a confidence interval (CI) of 95% for statistical inference and p≤0.05 for the significance level.

Results

Leadership support (B= 0.39, t= 6.24, p<0.001) and physician engagement (B=0.43, t=6.50, p<0.001) were associated with a decreased rate of adverse events to patient safety, whereas workload (B=-0.23, t=-3.73, p<0.001) was negatively associated with an increased rate of adverse events. Burnout was shown to mediate the relationship between the effects of physician's leadership support (R²=0.26, F=27.50, p<0.001), work engagement (R²=0.25, F=27.07, p<0.001) and workload (R²=0.23, F=24.23, p<0.001) on the rate of adverse events.

Conclusion

This study provides insights into burnout dimensions and their consequences on patient safety indicators (ie, adverse events). Work conditions (ie, leadership support, physician engagement, and workload) directly affect the rate of adverse events and indirectly through mediators like burnout-emotional exhaustion and burnout-interpersonal disengagement.

"It really puts me in a bind", professionalism dilemmas reported by Chinese residents

Residents play a pivotal role in the healthcare system. However, few tools have systematically revealed the dilemmas and challenges faced by residents. This study aimed to develop a checklist for professionalism dilemmas based on a behavior-based professionalism framework and to examine the range and proportion of professionalism dilemmas heard of, witnessed, or experienced by Chinese residents. Mixed methods were used, comprising qualitative (document analysis and focus group interviews) and quantitative (a small-scale questionnaire survey) data. Document analysis summarized professionalism dilemma items from previous publications. For focus group interviews, we used narrative inquiry to explore and make sense of residents' experiences and perceptions of professionalism dilemmas. A small-scale questionnaire survey was conducted during each focus group to investigate the proportion of professionalism dilemma items that residents reported to have heard of, witnessed, or experienced. Through document analysis and focus group interviews, we developed a checklist of professionalism dilemmas based on a behavior-based professionalism framework. The checklist included 58 items over four domains, with 10 sub-domains (compassion, respect, communication, collaboration, integrity, duty, pursuit of excellence, fair stewardship of health care resources, patient confidentiality, and informed consent). We also sought a preliminarily subjective impression by exploring the proportion of residents who have heard of, witnessed, and experienced each of the professionalism dilemma items and residents' perspectives when faced with professionalism dilemmas. Residents inevitably encounter or experience a diverse range of professionalism dilemmas. This checklist of professionalism dilemmas that was developed could prove to be a significant reference for targeted professionalism education, both for the resident as well as for faculty. It can also act as a helpful tool for improving hospital management guidelines and patient education.

Occurrence of self-perceived medical errors and its related influencing factors among emergency department nurses

AIMS AND OBJECTIVES

To determine the prevalence and the associated factors of self-perceived medical errors among Chinese emergency department nurses.

BACKGROUND

The emergency department is a place with a high incidence of medical errors. Studies about the occurrence and related influencing factors of medical errors among emergency nurses in China are very insufficient.

DESIGN

A nationwide cross-sectional study.

METHODS

A nationwide cross-sectional study was conducted from July 2018-August 2018. A total of 17,582 emergency department nurses from 31 provinces across China were eventually included in the analysis. Logistic regression is applied to examine the association of the independent variables with the perceived medical errors. The reporting of this study was compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

RESULTS

Of 17,582 participating nurses, 4445 (25.28%) reported self-perceived medical errors in the past 3 months. Nurses who were serving as nurses-in-charge; who reported fair or bad physical health; who reported staff shortage; who were exposed to more verbal abuse at work; who experienced effort-reward imbalance; who reported more over-commitment; or who had depressive symptoms were more likely to report medical errors. Older age and female gender were protective factors.

CONCLUSIONS

In this study, a quarter of the emergency nurses reported that they had made medical errors in the past 3 months. Self-perceived medical errors are associated with multiple domains of work-related factors and personal distress. Feasible measures should be taken to reduce nurses' workload, improve their working environment, monitor and minimise the occurrence of medical errors among emergency department nurses.

RELEVANCE TO CLINICAL PRACTICE

Emergency nurses, who are the most frequently in contact with patients, play an important role in identifying risk factors and preventing medical errors. Identifying risk factors that may lead to medical errors in the medical environment from both internal and external aspects will help nursing practitioners, hospital administrators and policy makers to take timely preventive measures to reduce the occurrence of medical errors and reduce harm to patients.

Associated factors of burnout among Chinese vaccination staff during COVID-19 epidemic: A cross-sectional study

Objective

During the COVID-19 epidemic, vaccination staff had three main aspects of work: routine vaccination for children and adults, COVID-19 vaccination and COVID-19 prevention and control. All these works significantly increased the workload of vaccination staff. This study aimed to investigate the prevalence and influencing factors of burnout among vaccination staff in Hangzhou, China.

Methods

A total of 501 vaccination staff from 201 community/township healthcare centers in Hangzhou were recruited using a cross-sectional survey through WeChat social platform. The Maslach Burnout Inventory-General Scale (MBI-GS) was used to assess the level of burnout. Descriptive statistics were made on the characteristics of participants. Univariate analysis using the chi-square test and multivariable analysis using binary logistic regression were conducted to determine the relative predictors of burnout. Univariate analysis and multiple linear regression were used to determine the relative predictors of exhaustive emotion, cynicism, and personal accomplishment.

Results

During the COVID-19 pandemic, 20.8% of the vaccination staff experienced burnout. Educational level above undergraduate education level, medium professional title, and more working time in COVID-19 vaccination work reported a higher degree of job burnout. The vaccination staff was experiencing a high degree of exhaustive emotion, cynicism, and low personal accomplishment. Professional title, working place, and working time for COVID-19 vaccination were associated with exhaustive emotion and cynicism. Professional title and participation time for COVID-19 prevention and control were associated with personal accomplishment.

Conclusions

Our findings suggest that the prevalence rate of burnout is high among vaccination staff during the COVID-19 pandemic, especially with a low level of personal accomplishment. Psychological intervention for vaccination staff is urgently needed.

Analysis of patient medication compliance and quality of life of physician-pharmacist collaborative clinics for T2DM management in primary healthcare in China: A mixed-methods study

Background: Physician-pharmacist collaboration is a well-established care mode for the management of type 2 diabetes mellitus (T2DM) in developed countries, but no study has been conducted in primary healthcare in China. This study aims to evaluate the effects of physician-pharmacist collaborative clinics to manage T2DM in primary healthcare in China, and to better understand the factors influencing the implementation of physician-pharmacist collaborative clinics. Methods: Two hundred and sixty-seven patients involved in a 12-month randomized controlled trial were assigned to physician-pharmacist collaborative clinics and usual clinics, completing surveys regarding medication compliance, quality of life (QoL) and care-seeking behavior at the baseline, 3rd, 6th, 9th and 12th month respectively, and diabetes knowledge at baseline and 12th month. A sample of twenty-two Patients, nine physicians and twelve pharmacists participated in semi-structured face-to-face interviews. The quantitative and qualitative data was integrated by triangulation. Results: Patients in physician-pharmacist collaborative clinics had significant improvements in medication compliance (p = 0.009), QoL (p = 0.036) and emergency visits (p = 0.003) over the 12-month. Pairwise comparison showed the medication compliance score in the intervention group had been significantly improved at 3rd month (p = 0.001), which is more rapidly than that in the control group at 9th month (p = 0.030). Factors influencing the implementation of physician-pharmacist collaborative clinics were driven by five themes: pharmaceutical service, team-base care, psychological support, acceptability of care and barriers to implementation. Conclusion: Integration of quantitative and qualitative findings showed the effectiveness of physician-pharmacist collaborative clinics in patient medication compliance and QoL in primary healthcare. The qualitative study uncovered barriers in insufficient clinical experience and understaffing of pharmacist. Therefore, the professional training of the primary pharmacist team should be improved in the future. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR2000031839.

Comparison of General Anxiety among Healthcare Professionals before and after COVID-19 Vaccination

Vaccination plays a crucial role in controlling the rate of coronavirus transmission and infectivity. Healthcare professionals are, in fact, at the greatest risk of contracting coronavirus due to their proximity and prolonged exposure to infected patients; this certitude alone enhances the stress and anxiety among patients and professionals alike. In this study, we aimed to assess the levels of anxiety experienced by healthcare professionals in their practices before and after getting vaccinated. This cross-sectional study was carried out in 2021. An electronic survey was distributed among the non-vaccinated and vaccinated healthcare workers. The survey consisted of the following parts: demographic characteristics, coronavirus-related questions, questions related to the specific field of healthcare professions, general anxiety questions, and working-hour-related questions. The Modified General Anxiety Scale (GAD-7) was used along with the paired t-test, Mann-Whitney U test, and Spearmen's test for comparison. p ≤ 0.05 was considered statistically significant. A total of 798 healthcare professionals participated in the study. In this study, the majority of participants were females, with 598 (74.9%) being between the ages of 21 and 30, and 646 (80.9%) participants were graduates, with the majority being dentists. Non-vaccinated healthcare professionals had severe anxiety (30.9%), whereas, in vaccinated participants, anxiety levels were minimal (56.9%). A statistically significant correlation was discovered when comparing the scores of the vaccinated and non-vaccinated individuals as well as when comparing the professions of vaccinated participants, whereas no association was found with the gender and education level of participants. Vaccination is necessary for all entitled individuals to control the spread of coronavirus. It was discovered that there was an increase in anxiety levels before the vaccination was introduced. The anxiousness was greatly lessened following mass immunizations. Our research will help to raise public awareness of stigmatized mental health disorders in the healthcare industry.

Rates of perceived medical errors and its correlation with work-related factors and personal distress among emergency physicians in China: a national cross-sectional study

Purpose

Medical errors are a global concern, and specifically, EDs are at considerable risk for medical errors. Few studies focus on the healthcare provider’s self-perceived medical errors in hospitals, let alone the ED. Hence, this study explored perceived medical errors and their correlation with work-related factors and personal distress among physicians in EDs in China.

Methods

From July 2018 to August 2018, a national web-based cross-sectional study was conducted. The link to the web-based questionnaire was posted on the emergency physicians’ working platform, inviting Chinese licensed emergency physicians to participate anonymously in this survey. Our outcome of interest, medical errors, was investigated using self-reporting methods. Occupational stress was assessed using the Chinese version of the Effort-Reward Imbalance scale. The Patient Health Questionnaire, the subscale of the 10-item Positive and Negative Affect Schedule, the subscale of the validated Leiden Quality of Work Questionnaire and the 10-item Generalised Self-efficacy Scale were used to assess personal distress. Logistic regression analysis was used to determine factors significantly associated with perceived medical errors.

Results

A sample of 10 457 emergency physicians completed the survey. Almost half (43.63%) of physicians reported self-perceived medical errors during the previous 3 months. The rate of workplace verbal aggression, effort-reward imbalance and depressive symptoms were 81.81%, 78.39% and 35.71%, respectively. Medical errors were more likely to be reported among chief physicians, and those who reported the department was short-staffed for physicians, and who experienced workplace verbal aggression and intense work stress. Medical errors were significantly associated with negative affect and lower self-efficacy.

Conclusion

Self-perceived medical errors are prevalent among physicians working in EDs and are associated with their workplace environment and personal distress. Targeted interventions are required to reduce physicians’ workload and improve their working environment. Accounting for healthcare providers’ distress is imperative for reducing the incidence of medical errors and improving their health.

The influence of job burnout on the attention ability of army soldiers and officers: Evidence from ERP

Job burnout is one of the most widespread mental problems in today's society and seriously affects the mental health and combat effectiveness of soldiers and officers. Herein, the effect of burnout on individual attention is studied from the perspective of neuroelectrophysiology. A total of 1,155 army soldiers and officers were included in this investigation and completed the Job Burnout Scale for Military Personnel. A total of 42 soldiers and officers were randomly selected from those with and without burnout to participate in an event-related potential (ERP) study using a visual oddball task. The characteristics of visual P3a and P3b at Fz, FCz, Cz, CPz, and Pz were recorded and analyzed by repeated-measures analysis of variance (ANOVA). P < 0.05 was the criterion for a significant difference. The total average score on the Job Burnout Scale for Military Personnel among the participants was 0.74 ± 0.46, and the detection rate of job burnout was 29.85%. In the Oddball task, the average number of target stimuli counted in the burnout group was lower than that in the control group, but no significant difference was found. For P3a, the Fz, FCz, Cz, CPz, and Pz amplitudes in the burnout group were significantly lower than those in the control group. The average amplitude of P3a evoked in the central parietal area was larger than that in the prefrontal area. For P3b, the amplitudes of the five electrodes in the burnout group were significantly lower than those in the control group. The average amplitude of P3b evoked in the parietal region was larger than those in the prefrontal and central parietal regions. A certain degree of job burnout is evident in army soldiers and officers. The voluntary attention and involuntary attention of individuals with burnout are both affected to some extent, as reflected by the lower amplitudes of P3a and P3b. The results suggest that P3a and P3b can be used as indicators to monitor cognitive neural function in soldiers and officers with burnout and can also be used as references for evaluating the effects of cognitive training and screening methods. In this study, ERP was used to research the attention ability of soldiers and officers with job burnout, and related issues were discussed from the aspects of the burnout results, behavioral results, ERP results, compensation effect of cognitive resources, application in the military field, limitations, and prospects.

Mediation role of work motivation and job satisfaction between work-related basic need satisfaction and work engagement among doctors in China: a cross-sectional study

OBJECTIVES

This study aims to examine the association of work-related basic need satisfaction (W-BNS) with doctors' work engagement and explore the mediating role of work motivation and job satisfaction between the two variables.

DESIGN

This was a cross-sectional study.

SETTING

The study was conducted in four public grade A tertiary hospitals in China.

PARTICIPANTS

A total of 1000 doctors were invited to participate; 849 doctors completed questionnaires validly.

PRIMARY AND SECONDARY OUTCOME MEASURES

Questionnaires were administered online and offline to collect data, consisting of six parts: social demographic characteristics, work-related characteristics, and scales related to W-BNS, work motivation, job satisfaction and work engagement. One-way analysis of variance, Pearson correlation analysis were performed using SPSS, and mediation analysis was carried out via PROCESS macro.

RESULTS

Our research showed that W-BNS, work motivation, job satisfaction and work engagement were positively correlated. Work engagement was significantly predicted by W-BNS (β＝0.15, p<0.001) through motivation at work (β＝0.23, p<0.001) and job satisfaction (β＝0.44, p<0.001), respectively. Compared with work motivation, the mediating effect of job satisfaction was stronger (95% CI -0.22 to -0.06).

CONCLUSION

The findings suggest that job satisfaction and work motivation may be important pathways through which doctors' W-BNS may influence their work engagement. In order to maintain and promote doctors' work engagement, hospital administrators should consider strengthening the internal motivation of doctors and improving their job satisfaction.

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 association between fear of malpractice and burnout among Chinese medical workers: The mediating role of legal consciousness

BACKGROUND

As a major reason for defensive medicine, the status and effect of "fear of malpractice" among Chinese medical staff is an important topic that needs to be studied. Our study investigated fear of malpractice among Chinese medical workers, assessed its association with burnout, and explored the mediating role of legal consciousness between these factors.

DESIGN

A quantitative, cross-sectional study.

SETTING

All respondents were investigated using a self-report questionnaire. Demographic characteristics and measurements including a fear of malpractice scale, and a burnout and legal consciousness scale were employed. The effect of fear of malpractice on burnout was examined by carrying out a binary regression analysis. A mediation model was used to test the mediating role of legal consciousness.

PARTICIPANTS

The study sample included 1031 doctors and nurses (297 male and 734 female; age = 36.3 ± 8.98).

RESULTS

The average score of fear of malpractice was 20.97 ± 5.34. Respondents with higher levels of fear of malpractice were more prone to burnout ([OR] = 2.865; 95% CI 1.942-4.226). Legal consciousness partially and negatively mediated the effect of fear of malpractice on burnout.

CONCLUSION

High levels of fear of malpractice were found among Chinese medical workers, and this fear had a significant effect on burnout. Legal consciousness may be a resource that can alleviate burnout.

Developing an Integrated Evaluation Model for Physician Comprehensive Workload Tethered to Outpatient Practice: An Empirical Study From China

Background

Previous studies, often simply using either objective workload or mental workload as a measure of physician workload in various healthcare settings might have failed to comprehensively reflect the real workload among physicians. Despite this, there is little research that further explores a comprehensive workload evaluation framework with the integration of objective workload and mental workload to describe their comprehensive workload.

Methods

A comprehensive evaluation framework for physician workload was proposed based on the combination of objective workload and task-level mental workload also with the consideration of quality of provided medical services and served patient complexity; and accordingly, an integrated evaluation model for physician comprehensive workload (PCW) tethered to outpatient practice was developed and further applied to perform a PCW analysis using cross-sectional data on outpatient workload of 1,934 physicians mainly from 24 hospitals in 6 provinces in Eastern, Central, and Western China. Multiple linear regression and multinomial logistic regression analyses were established to identify significant factors influencing the PCW.

Results

Overall, the average score of PCW tethered to outpatient practice Chinese physicians experienced was 811.30 (SD=494.98) with concentrating on between 200 and 1,200. Physicians who were female, from Eastern or Western China, and those who worked >60 h per week and longer outpatient hours per week were more likely to experience a higher PCW. 11.2% of participating physicians were identified as very high PCW physicians, compared with 11.6% as low PCW physicians, 45.5% as medium PCW physicians and 30.7% as high PCW physicians. Those who were female, older, from Western China, those who had lower educational levels, lower professional titles and longer working years in the current institution, and those who worked in tertiary A hospitals and Internal or Surgical, and worked >60 h per week and longer outpatient hours per week were more likely to be very high PCW physicians.

Conclusions

Our work has a potential application for comprehensively assessing physician workload tethered to outpatient practice and could provide a solid foundation for hospital managers to further accurately determine and identify physicians with high workload, who would otherwise be missed in either objective workload or mental workload.

A Latent Profile Analysis of Chinese Physicians' Workload Tethered to Paperwork During Outpatient Encounters

Background

Physician dissatisfaction with more time spent on related paperwork but less time available for direct interaction with patients is increasing internationally. Increased physician workload resulting from paperwork might negatively affect their interaction with patients and increase the risk for burnout. This study aimed to investigate the level of physician workload tethered to paperwork during outpatient encounters and explore its latent workload subgroups among Chinese physicians.

Methods

A cross-sectional survey was conducted via online questionnaire primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China from November 2020 to February 2021. The Chinese physician mental workload scale developed by our research team was used for assessment of physician workload tethered to paperwork. Physicians were categorized into different subgroups of workload via latent profile analysis. Multinomial logistic regression was subsequently performed to examine how demographic variables differ among physicians belonging to different subgroups.

Results

A total of 1,934 valid questionnaires were received. Chinese physicians reported medium levels of workload while performing non-physician-patient communication work tasks characterized by paperwork during outpatient encounters. Four latent workload subgroups were identified: "low workload group" (8.8%), "medium workload group" (34.0%), "high workload group" (42.1%) and "very high workload group" (15.1%). Compared with the other latent workload subgroups, physicians belonging to the "very high workload group" were more likely to be younger, married, those who had worse health status, lower educational levels and lower average monthly incomes, those who worked more years in the current institution, more hours per week and longer outpatient hours per week, and those who worked in public general hospitals, tertiary B hospitals and Obstetrics and Gynecology, and saw more than 50 outpatients per day, with more time spent on per patient.

Conclusions

There exit four latent workload subgroups among Chinese physicians tethered to paperwork during outpatient encounters along with great individual variations among these subgroups. The characteristics of the latent "very high workload group" can help permit more targeted guidance for developing interventions with optimized human resource allocation to, in turn, increase the time available for direct interaction with patients, thereby resulting in improved quality of physician-patient interactions and decreased risk for physician burnout.

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.

Brief Mindfulness Intervention for Emotional Distress, Resilience, and Compassion in Family Physicians During COVID-19: A Pilot Study

Background and Objective

There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program.

Methods

A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures.

Results

Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P<.004), stress (P<.001), perceived resilience (P<.001), and compassion (P<.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21.

Conclusion

This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.

Sociodemographic and Occupational Factors Associated With Burnout: A Study Among Frontline Healthcare Workers During the COVID-19 Pandemic

Purpose

To describe the prevalence of burnout among frontline healthcare workers (HCWs) during the COVID-19 pandemic and the associated sociodemographic and occupational factors.

Methods

A cross sectional survey study was carried out to study HCWs burnout using the 19-item Full Copenhagen Burnout Inventory (CBI) that includes personal, work, and patient-related burnout subscales. Bivariate analysis was used to test for associations and p < 0.05 was considered statistically significant.

Results

A total of 207 responses received; where the mean score of personal burnout was 67.23, the mean of work-related burnout was 61.38, and the mean of patient-related burnout was 54.55. Significant associations were found; where female HCWs, those working in rotating day-and-night shifts, working more than 55-h per week, and who had their shift time and hours changed during the pandemic, had higher levels of personal and work-related burnout (P < 0.05). Patient-related burnout was higher among those who were single (divorced or separated), nurses, non-Citizens, those with fewer years of experience, and who were infected by COVID-19 and have been quarantined (P < 0.05). Age was not a significant factor of burnout in any of the CBI subscales.

Conclusions

There is a prevalent level of burnout among frontline HCWs during the COVID-19 pandemic. Findings highlight key sociodemographic and occupational factors affecting burnout; which can help planning for psychological support strategies. Furthermore, effective administrative control is important to institute policies and mechanisms to identify, and freely report burnout symptoms among HCWs to promote their wellbeing.

Sanctioned licensing board violations for marriage and family therapists spanning a 10-year period

Although disciplinary data on violations committed by licensed mental health professionals are important information for training programs, supervisors, and regulators, little disciplinary information is available on licensed marriage and family therapists (MFTs). This study collected data publicly available from state regulatory board websites and open records requests from 35 states for a total of 1241 separate cases, 889 of which were from CA. The findings indicated that the five most common violations for MFTs in 34 states (not including CA) were nonsexual dual relationships, failure to meet CE hour requirements, sexual dual relationships, unlicensed practice, and misrepresentation on licensing applications or renewals. For CA, the most common violations included criminal charges-misdemeanor, DUI/inappropriate substance use, unprofessional conduct, misrepresentation on licensure paperwork, and failure to meet CE hour requirements. MFTs licensed between 2 and 5 years committed the majority of violations. Implications for training programs, supervisors, and regulators are discussed.

Current State and Future Perspectives of Artificial Intelligence for Automated Coronary Angiography Imaging Analysis in Patients with Ischemic Heart Disease

Purpose of Review

Artificial intelligence (AI) applications in (interventional) cardiology continue to emerge. This review summarizes the current state and future perspectives of AI for automated imaging analysis in invasive coronary angiography (ICA).

Recent Findings

Recently, 12 studies on AI for automated imaging analysis In ICA have been published. In these studies, machine learning (ML) models have been developed for frame selection, segmentation, lesion assessment, and functional assessment of coronary flow. These ML models have been developed on monocenter datasets (in range 31–14,509 patients) and showed moderate to good performance. However, only three ML models were externally validated.

Summary

Given the current pace of AI developments for the analysis of ICA, less-invasive, objective, and automated diagnosis of CAD can be expected in the near future. Further research on this technology in the catheterization laboratory may assist and improve treatment allocation, risk stratification, and cath lab logistics by integrating ICA analysis with other clinical characteristics.

Psychological Status and Job Burnout of Nurses Working in the Frontline of the Novel Coronavirus in China During the Delta Variant Outbreak: A Cross-Sectional Survey

Purpose

Investigating psychological status and job burnout of nurses working in the frontline of the novel coronavirus in Zhangjiajie city in China during the Delta variant outbreak, comparing differences and analyzing factors of these two variables between the nurses from different nucleic acid testing (NAT) sites.

Patients and methods

This survey was conducted from August 1 to 31, 2021. The participants were 512 nurses, 198 nurses of whom were from temporary NAT sites in communities/towns in Zhangjiajie city, and the rest were from NAT sites inside hospitals. The psychological status and the job burnout were measured by the Symptom Checklist-90 (SCL-90) and the Maslach Burnout Inventory-General Scale (MBI-GS).

Results

The prevalence of the SCL-90 positive result and job burnout were 49.4% and 61.1%, respectively. The factors influencing the psychological status of nurses included the contact with COVID-19 patients or their body fluids and specimens, working seniority and the duration of working in the frontline of the novel coronavirus. The independent risk factors of nurses’ job burnout included the following four factors. Firstly, the contact with COVID-19 patients or their body fluids and specimens (OR=150.95, 95% CI=(44.87,507.77), P<0.001). Secondly, five to nine years of working seniority (OR=8.91, 95% CI=(3.59,22.14), P<0.001). Thirdly, 10 to 19 days (OR=2.63, 95% CI=(1.19,5.82), P=0.017), 20 to 29 days (OR=161.31, 95% CI=(49.48,525.9), P<0.001). Lastly, more than 30 days (OR=92.05, 95% CI=(33.88,250.14), P<0.001) of working in the frontline of the novel coronavirus.

Conclusion

The prevalence of psychological problems and job burnout were at a high level among nurses working in the frontline of the novel coronavirus in different NAT sites. The nurses from NAT sites inside hospitals and temporary NAT sites in communities/towns in Zhangjiajie city had an equal risk of developing psychological problems and job burnout. Interventions need to be immediately implemented to promote psychological well-being and decrease job burnout of nurses.

Attitudes of medical professionals towards patient-centredness: a cross-sectional study in H City, China

OBJECTIVES

Patient-centred communication improves patient experiences and patient care outcomes. This study aimed to assess the preference of medical professionals in China towards patient-centred communication under the context of the deteriorating doctor-patient relationship.

METHODS

A cross-sectional survey of medical professionals was conducted in January and February 2018 in H City of Heilongjiang province, the northeast of China. The Chinese-Revised Patient-Practitioner Orientation Scale (CR-PPOS) was adopted to measure the individual preference of respondents towards patient-centredness in clinical communication. Multivariate logistic regression models were established to identify the sociodemographic (gender, age, marital status and educational attainment) and work experience (years of working, seniority, satisfaction with income, daily workload and perceived doctor-patient relationship) predictors of the preference towards patient-centredness.

PATIENT AND PUBLIC INVOLVEMENT

Not applicable.

RESULTS

A total of 618 valid questionnaires were returned. The CR-PPOS demonstrated acceptable reliability and validity. Overall, a low level of preference towards patient-centredness in clinical communication was found. Relatively higher scores on 'caring for patients' (20.42±4.42) was found compared with those on 'information/responsibility sharing' (15.26±4.21). Younger age, higher educational attainment, lower daily workload and a perception of harmonious doctor-patient relationship were associated with a higher preference towards patient-centredness in clinical communication.

CONCLUSIONS

A low level of preference towards patient-centredness in clinical communication was found in medical professionals in the northeast of China, which may further jeopardise the efforts to improve doctor-patient relationship.

Burnout and Well-Being Among Medical Professionals in China: A National Cross-Sectional Study

Objective

To determine the profile of Chinese medical professionals with burnout symptoms at the national level and identify the association between capability well-being and burnout.

Design and Setting

A cross-sectional study in a nonrandom national sample of medical staff from 6 provinces across western, central and eastern China.

Participants

Physicians, medical laboratory scientists, nurses, and general practitioners aged 18 years or above who submitted a completed online questionnaire from June 2019 to January 2020 successfully (N = 25,120).

Main Outcome Measures

The prevalence of burnout symptoms was assessed by the 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which consists of three domains: emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). The overall high burnout was defined as EE score ≥27 or DP score ≥10. The capability well-being was measured by the Investigating Choice Experiments Capability Measure for Adults (ICECAP-A) and the overall ICECAP-A score was calculated using the UK value set, ranging from a score of 0–1. Multivariable logistic regression analysis was used to identify the association between well-being and the overall high burnout.

Results

Among the 25,120 participants, 60.8% of the participants reported at least one symptom of burnout, whereas 11.2% reported all three symptoms of burnout. In the adjusted model, ICECAP-A score was independently associated with high burnout (AOR = 0.018, 95% CI = 0.015–0.022). Medical staff who were males, with shorter working years, working in tertiary hospitals, and those with the specialties of psychiatry, intensive care, emergency medicine, internal medicine, oncology, and pediatrics were at higher risk of reporting burnout symptoms.

Conclusion

The burnout symptoms were relatively common among Chinese medical staff and they were found to be independently associated with capability well-being in health professionals. Interventions should be enhanced on vulnerable groups to reduce burnout and promote well-being in future studies.

Association Between Physician Burnout and Self-reported Errors: Meta-analysis

OBJECTIVES

Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians.

METHODS

This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studies were hand searched. Data were extracted from published reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I2), publication bias (Begg-Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval.

RESULTS

Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19-3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I2 = 67% (36%-83%).

CONCLUSIONS

The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.

Correlation analysis between physicians' evaluations of doctor-patient relationship and their preferences for shared decision-making in China

Shared decision-making (SDM) is a scientific and reasonable decision-making model. However, whether physicians choose SDM is usually influenced by many factors. It is not clear whether the strained doctor-patient relationship will affect physicians' willingness to choose SDM. Through a survey by questionnaire, 304 physicians' evaluations of doctor-patient relationship (DPR) were quantified by the difficult DPR questionnaire-8. Their preferences for SDM and the reasons were also evaluated. The correlation between physicians' evaluations of DPR and their preferences for SDM were analyzed. 84.5% physicians perceived DPR as poor or strained, 53.3% physicians preferred SDM, mainly because of the influences of medical ethics and social desirability bias. Their preferences for SDM were not significantly correlated with their evaluations of DPR (P > 0.05). Physicians with different evaluations of DPR (good, poor, and strained) all had similar preferences for SDM (42.6, 56.4, and 42.9%), with no significant difference (P > 0.05). There was no correlation between physicians' evaluations of DPR and their preferences for SDM. Physicians' evaluations of poor DPR did not affect their preferences for SDM. This may be influenced by the medical ethics and social desirability bias.

Association Between Physicians' Workload and Prescribing Quality in One Tertiary Hospital in China

BACKGROUND

Alarming increasing trends in physician workload have attracted much attention in recent years. Heavy workload may compromise the quality of medication use. Previous studies have identified a series of factors contributing to inappropriate prescribing; however, there is no demonstrated evidence supporting an association between workload and the appropriateness of physicians' prescriptions in China. This study aimed to investigate the relationship between physician workload and prescription quality in a tertiary hospital in Beijing, China.

METHODS

Our study was a single-center, retrospective study, with all outpatient electronic health records extracted from hospital information system of a tertiary hospital in Beijing from July 1 to November 30, 2015. We used outpatient volume in each 5-hour shift as the measure of physician workload. The evaluation of prescribing quality was based on the Rational Drug Use System. Generalized linear models with a γ distribution and a log link were used to explore factors associated with inappropriate prescribing, and we undertook a series of robustness tests with respect to different exclusion criteria.

RESULTS

A total of 457,784 prescriptions from 502 physicians were included in the study. Physicians had an average workload of 34.3 (±19.8) patients per shift, and the mean rate of inappropriate prescribing per shift was 14.1% (±14.6%). Higher rates of inappropriate prescribing were associated with heavier workloads (P < 0.001). Physicians who worked in the afternoon, chief physicians, those working in surgical department, males, and those with more than 20-year experience had higher rates of inappropriate prescribing with increasing workload.

CONCLUSIONS

Heavier workload was associated with higher risk of prescribing inappropriately. It requires great efforts to determine optimal physician workloads and mitigate the potential adverse effects on the prescription quality.

A Proposed Framework for Machine Learning-Aided Triage in Public Specialty Ophthalmology Clinics in Hong Kong

The public specialty ophthalmic clinics in Hong Kong, under the Hospital Authority, receive tens of thousands of referrals each year. Triaging these referrals incurs a significant workload for practitioners and the other clinical duties. It is well-established that Hong Kong is currently facing a shortage of healthcare workers. Thus a more efficient system in triaging will not only free up resources for better use but also improve the satisfaction of both practitioners and patients. Machine learning (ML) has been shown to improve the efficiency of various medical workflows, including triaging, by both reducing the workload and increasing accuracy in some cases. Despite a myriad of studies on medical artificial intelligence, there is no specific framework for a triaging algorithm in ophthalmology clinics. This study proposes a general framework for developing, deploying and evaluating an ML-based triaging algorithm in a clinical setting. Through literature review, this study identifies good practices in various facets of developing such a network and protocols for maintenance and evaluation of the impact concerning clinical utility and external validity out of the laboratory. We hope this framework, albeit not exhaustive, can act as a foundation to accelerate future pilot studies and deployments.

Work-related potential traumatic events and job burnout among operating room nurses: Independent effect, cumulative risk, and latent class approaches

AIMS

The objective of this study is to explore and compare the strength of associations between work-related potential traumatic events and burnout among operating room nurses based on three different approaches.

DESIGN

The study followed a multisite cross-sectional design.

METHODS

A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work-related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis-derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis.

RESULTS

Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work-related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work-related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization.

CONCLUSION

Operating room nurses who reported specific or multiple work-related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support.

IMPACT

This study is the first to focus on work-related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health.

Burnout prevalence among European physicians: a systematic review and meta-analysis

PURPOSE

Our objective was to assess burnout prevalence rates among physicians practicing in Europe (regardless of their specialty) taking into account the main approaches used to define burnout with the Maslach Burnout Inventory (MBI) tool.

METHODS

A systematic review was carried out from 2006 to 2018. A keyword request was obtained using the PubMed/Medline, Web of Science and Banque de Données en Santé Publique search engine. Studies written in English measuring burnout with the MBI tool among a population of practicing European physicians were selected. Data were extracted and classified according to burnout's definition provided by the authors. Three definitions using the MBI dimensions were considered: tri-, bi- and unidimensional definition. A meta-analysis was then performed on burnout prevalence rates according to the dimensional definition of burnout.

RESULTS

From 2378 search results, we selected 56 studies including from up to 41 European countries. Depending upon the study, physicians' burnout prevalence rates ranged from 2.5% to 72.0%. The pooled prevalence rate of burnout was estimated at 7.7% [5.3-10.4%] with the tridimensional definition, 19.7% [13.5-26.3%] with the bidimensional definition and 43.2% [29.0-57.6%] with the unidimensional definition.

CONCLUSION

Burnout pooled prevalence among physicians varies from single to fivefold depending on the method employed to assess burnout with the MBI tool. Medical community should determine a standardized method to assess burnout prevalence rates to best evaluate this phenomenon.

The item network and domain network of burnout in Chinese nurses

Background

As a common social phenomenon, nurses’ occupational burnout has a high incidence rate, which seriously affects their mental health and nursing level. The current assessment mostly uses the total score model and explores the influence of external factors on burnout, while the correlation between burnout items or dimensions is less explored. Ignoring the correlation between the items or dimensions may result in a limited understanding of nurse occupational burnout. This paper explores the item and dimension network structure of the Maslach Burnout Inventory-General Survey (MBI-GS) in Chinese nurses, so as to gain a deeper understanding of this psychological construct and identify potential targets for clinical intervention.

Methods

A total of 493 Chinese nurses were recruited by cluster sampling. All participants were invited to complete the survey on symptoms of burnout. Network analysis was used to investigate the item network of MBI-GS. In addition, community detection was used to explore the communities of MBI-GS, and then network analysis was used to investigate the dimension network of MBI-GS based on the results of community detection. Regularized partial correlation and non-regularized partial correlation were used to describe the association between different nodes of the item network and dimension network, respectively. Expected influence and predictability were used to describe the relative importance and the controllability of nodes in both the item and dimension networks.

Results

In the item network, most of the strongly correlated edges were in the same dimension of emotional exhaustion (E), cynicism (C) and reduced professional efficacy (R), respectively. E5 (Item 5 of emotional exhaustion, the same below) “I feel burned out from my work”, C1 “I have become more callous toward work since I took this job”, and R3 “In my opinion, I am good at my job” had the highest expected influence (z-scores = 0.99, 0.81 and 0.94, respectively), indicating theirs highest importance in the network. E1 “I feel emotionally drained from my work” and E5 had the highest predictability (E1 = 0.74, E5 = 0.74). It shows that these two nodes can be interpreted by their internal neighbors to the greatest extent and have the highest controllability in the network. The spinglass algorithm and walktrap algorithm obtained exactly the same three communities, which are consistent with the original dimensions of MBI-GS. In the dimension network, the emotional exhaustion dimension was closely related to the cynicism dimension (weight = 0.65).

Conclusions

The network model is a useful tool to study burnout in Chinese nurses. This study explores the item and domain network structure of nurse burnout from the network perspective. By calculating the relevant indicators, we found that E5, C1, and R3 were the most central nodes in the item network and cynicism was the central node in the domain network, suggesting that interventions aimed at E5, C1, R3 and cynicism might decrease the overall burnout level of Chinese nurses to the greatest extent. This study provides potential targets and a new way of thinking for the intervention of nurse burnout, which can be explored and verified in clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00670-8.

Where There’s Smoke: Validating a Nonproprietary Single-Item Burnout-Impacting-Safety Scale

This study aimed to assess the utility of a single survey item to predict the impact of burnout on safety and quality of healthcare providers as perceived by their colleagues. The primary objective is to determine if the item predicts the frequency of patient safety event reports within certain clinical departments. The secondary objective will be to determine if there is an acceptable cutoff score for the item which predicts low versus high numbers of safety events reported by healthcare providers in each clinical department. Participants were 424 healthcare providers in an academic medical center in the mid-Atlantic region of the United States. The item was designed to assess for the perception of the impact of burnout on work in terms of quality or safety using a 5-point Likert scale. Data from a patient safety event reporting system was accessed for the year of survey completion (2017). A negative binomial regression was used to assess the ability of the item to predict reported patient safety event reports. The item was found to significantly predict objective safety event data. Sensitivity and specificity, as well as receiver operating characteristic (ROC) curve analyses, were conducted to determine appropriateness of cutoff scores to identify low- and high-risk clinical departments. The item was found to demonstrate adequate sensitivity (82%) using a cutoff score of 4 on the survey item. However, the area under the curves (AUCs) which assess diagnostic accuracy fell in the poor range. These results suggest that healthcare administrators could deploy this single item as a brief pulse or screener of teams of individuals who are within a work unit and use a cutoff score of 4 as a means to assess for hot spots where healthcare provider burnout may be putting patients at high risk in terms of safety.

Anxiety in Residents in China: Prevalence and Risk Factors in a Multicenter Study

PURPOSE

To explore the prevalence of major anxiety and its associated risk factors in residents in China.

METHOD

This multicenter, cross-sectional study was conducted from December 2019 to February 2020; 1,343 residents from 8 hospitals in Northeast China were included in the final analysis (effective response rate of 86.48%). Demographic characteristics, dietary habits, life-related factors, work-related factors, and psychological characteristics were collected from participants via a self-reported questionnaire. This questionnaire measured sleep quality, physical activity, anxiety, perceived organizational support, psychological capital, and burnout. Adjusted odds ratios (ORs) and 95% confidence intervals were determined using binary logistic regression. Cutoff values and the area under the curve were calculated for risk factors using receiver operating characteristic curve analysis.

RESULTS

Of participants, 441 (32.80%) reported anxiety symptoms and 133 (9.90%) reported major anxiety symptoms. Four independent risk factors for major anxiety were identified: poor sleep quality (OR = 1.282, P < .001) and 3 dimensions of burnout: higher emotional exhaustion (OR = 1.085, P < .001), higher depersonalization (OR = 1.064, P = .002), and reduced personal accomplishment (OR = 0.951, P < .001). The optimal cutoff values for these risk factors were 7, 10, 9, and 22 scores, respectively.

CONCLUSIONS

This study found a considerable prevalence of major anxiety symptoms in residents in China and identified poor sleep quality and higher levels of burnout as having a close association with major anxiety. These findings enrich the existing literature on anxiety and demonstrate a critical need for additional studies that investigate intervention strategies to improve sleep quality and combat burnout, which could improve the mental health of residents.

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.

Primary care nurse practitioner burnout and perceptions of quality of care

BACKGROUND

Burnout threatens patient care and clinicians are experiencing challenges within the practice environment. Little is known about nurse practitioner (NP) perceptions of burnout and its relationship to care quality and practice environment. We investigate the relationship between primary care NP burnout on perceptions of care quality and if the practice environment moderates the relationship between burnout and care quality.

METHODS

This is a secondary analysis of cross-sectional survey data from 396 NPs. Burnout and care quality were measured using a single item, but the practice environment was measured using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. Multi-level proportional odds cumulative logit models were built to test for associations between burnout and care quality and for moderation.

RESULTS

Total, 25.3% of NPs reported burnout. Odds of perceiving higher quality of care was 85% less for NPs experiencing burnout compared to those not experiencing burnout. Practice environment did not moderate the relationship between burnout and care quality, but with a one unit increase in the practice environment subscales, the odds of NPs perceiving higher care quality increased anywhere from 3.83 to 7.57 times.

CONCLUSION

Burnout is related to lower perceptions of care quality but favorable environments were related to higher perceptions of quality.

Driver-passenger communicative stress and psychological distress among Chinese bus drivers: the mediating effect of job burnout

BACKGROUND

This study aimed to investigate the relationship between driver-passenger communicative stress and psychological distress among bus drivers, as well as whether job burnout mediates the effect of driver-passenger communicative stress on psychological distress.

METHODS

A questionnaire consisting of a 12-item version of the General Health Questionnaire (GHQ-12), a one-item driver-passenger communicative stress scale, the Maslach Burnout Inventory-General Survey (MBI-GS), as well as sociodemographic and work factors, was distributed to 310 bus drivers in Shanghai, of which 307 completed it (99.0% response rate). A parallel multiple mediation model with bootstrap approach, was calculated to test the mediating effect.

RESULTS

Driver-passenger communicative stress, emotional exhaustion and cynicism were positively associated with psychological distress. Communicative stress was significantly positively linked with two of the three dimensions of burnout (emotional exhaustion and cynicism) and dependent variable. Emotional exhaustion and cynicism were positively associated with the dependent variable. The results indicate that emotional exhaustion and cynicism partially mediated the effect of communicative stress on psychological health, and that 60.0% of this effect can be explained by mediating effects, in which emotional exhaustion and cynicism weighed 63.2% and 36.8%, respectively.

CONCLUSIONS

Communicative stress had effects on psychological distress among Chinese bus drivers, and job burnout was a mediator in this relationship.