The measured impact of the COVID-19 pandemic on nursing students' wellbeing, clinical placement and learning experiences: a cross sectional study

Background: The epidemiological patterns of COVID-19 varied across Australia and differed from most other countries. Few studies describe the impact that the pandemic had on nursing student wellbeing, education and career.Aim: This study aimed to investigate how the COVID-19 pandemic impacted on nursing students' well-being, clinical placement and learning.Design: Cross-sectional survey.Setting: Sydney, Australia.Participants: Second- and third-year nursing students.Methods: Second- and third-year nursing degree students were asked to participate in an ethically approved study during March to May 2021. The de-identified on-line survey consisted of 63 closed end question and one open ended question. On completion, the dataset was exported from Redcap and imported into SPSS for analysis. Open ended text data were analysed by two researchers.Results: Of the 105 participating nursing students, a third (n = 26/83, 31%) thought about changing their degree to a non-nursing degree. The acknowledged risk of caring for a COVID-19 patient incrementally increased stress (β-coefficient = 0.6, p value = 0.009, 95% CI 0.2-0.9). Conversely students who intended to complete their degree were less likely to report stress. Students who had prior nursing experience were three times more likely to report an increased generalised anxiety level (OR 3.8, p-value = 0.02, 95% CI 1.2-12.2), yet they were less likely to experience personal accomplishment burnout compared to other students. Nursing students who contemplated a change of degree to a non-nursing degree were 15.7 times more likely to experience emotional exhaustion and were 3.5 times more likely to be report a risk of depersonalisation (p = 0.03, 95% CI, 1.3-11.5).Conclusion: The COVID-19 pandemic compromised nursing student well-being, and theoretical and practical learning. Findings have implications for healthcare and academic staff who teach nursing students. Implementation of student-centred evidence-based strategies to manage stress, burnout and anxiety, and to sustain a healthy student cohort is essential to retain the future nursing workforce.

A system science perspective on burn-out: development of an expert-based causal loop diagram

Introduction

Burn-out leads to reduced worker well-being, long-term absenteeism, and high costs for employers and society. Determinants at different levels may affect burn-out in an interrelated and dynamic manner. The aim of the present study was to apply a broader systems perspective by exploring and visualizing the complex system of determinants at different levels (living conditions, working conditions, and societal developments) underlying the prevalence of burn-out in the Netherlands.

Methods

During three group model building (GMB) sessions with in total eight experts on workers' mental health, a causal loop diagram (CLD) was developed and relevant feedback loops were identified. For the selection of determinants to be included in the CLD a recently published overview of determinants on burn-out at different levels was used. Experts could also add factors that were not listed in the overview.

Results

The final CLD consists of 20 factors and depicts a central position of working conditions. Societal developments (e.g., access to mental health care, size of the working population, rougher social climate, etc.) were mostly located at the outside of the CLD and barely integrated in feedback loops. Several reinforcing feedback loops resulting in an increase of the prevalence of burn-out were identified in which the factors (very) high workload, imbalance between work and private life, and insufficient recovery time play an important role. Also, several balancing loops were found that visualize the crucial role of functional support from supervisors to prevent burn-out among workers.

Discussion

Applying a broader systems perspective, including determinants at different levels, offers new insights into dynamic feedback loops that contribute to the prevalence of burn-out. Supervisors, amongst others, have a considerable impact on the system underlying the high prevalence of burn-out and may therefore contribute to its prevention. Even though societal developments were less integrated in feedback loops, they might be considered drivers of existing feedback loops. The results from this study confirm that determinants at various levels underly the prevalence of burn-out. To be able to address the diversity of determinants underlying a high prevalence of burn-out, a complex system approach can be helpful.

Prevalence of anxiety and depression of health care workers during COVID-19 - a systematic review and meta-analysis

Introduction

During the COVID-19 pandemic, the workload of healthcare workers managing the disease, increased significantly. The objective of this review is to determine the anxiety and depression prevalence among healthcare workers during the pandemic period.

Methods

We searched systematically the literature in five electronic databases such as PubMed, CINAHL, ScienceDirect, MEDLINE, and Cochrane COVID-19 study register. The last online research was performed in May 2022. We included only cross-sectional studies and performed a meta-analysis of pooled prevalence. Publication bias was assessed with a funnel plot and Egger's and Begg's tests. A random effect was applied and heterogenicity I2 was calculated. Quality assessment of included studies was performed using the Joanna Briggs Institute tool.

Results

In this review, we included 14 cross-sectional studies comprising 7780 healthcare workers. Participants were from the whole spectrum of healthcare workers. The pooled prevalence of depression was 33.8% (95% CI: 24.6 - 43.6), heterogenicity I2: 98.69%. The pooled prevalence of anxiety was 41.3% (95% CI: 30.2 - 52.9), heterogenicity I2: 99.01%.

Conclusion

One-third of healthcare workers suffered from depression, and more than one-third suffered from anxiety during the COVID-19 pandemic. Increased measures of surveillance of mental health should have been taken, as well as the support of healthcare workers running a high risk of psychological distress during the COVID-19 pandemic.

[Shared experience, multiple experiences: paramedics facing death in intensive care]

Accompanying death is part of the daily life of intensive care workers. However, far from being a trivial experience, it mobilizes the teams emotionally and requires them to constantly adjust in order to carry out their mission of care for the patient and his or her loved ones. How do nurses and orderlies deal with end-of-life care and the particularities of death in an intensive care unit?

Attachment anxiety, reflective functioning and well-being as predictors of burn-out and psychological distress among psychotherapists: A longitudinal study

OBJECTIVE

This study aims to longitudinally investigate the effects of individual's factors on subsequent burn-out/psychological distress in a sample of mental health practitioners, testing if higher attachment anxiety and avoidance and lower reflective functioning (i.e., certainty and uncertainty of mental states) and well-being at baseline may lead to a greater psychological distress and burn-out 1 year later.

METHODS

The sample consisted of 40 experienced psychotherapists (females: 72.5%; mean age: 47.40 ± 9.48 years) who completed a battery of questionnaires at baseline and 1 year later. Statistical analyses were conducted with Bayesian multiple linear regressions.

RESULTS

Greater attachment anxiety and certainty about mental states and lower individual's well-being at baseline predicted greater burn-out 1 year later. Similarly, greater attachment anxiety and lower individual's well-being at baseline predicted psychological distress at 1 year follow-up. Of note, uncertainty of mental states and avoidant attachment were not associated with outcomes.

CONCLUSION

These findings suggest that the levels of burn-out and psychological distress among psychotherapists may be alleviated with interventions targeting attachment insecurity, specific aspects of reflective functioning (i.e., certainty about mental states) and well-being.

[Supporting caregivers of children and adolescents with cancer]

Caring for a child or adolescent with cancer remains a perilous professional exercise. Caregivers are not only subject to high technical demands (oncological treatments, surgery and resuscitation, rehabilitation and equipment) but also to an emotional and relational involvement inherent to their function. However, the regulation and transformation of affects mobilize a great deal of psychic energy in professionals who must preserve their internal resources as best they can. The point of view of the clinical psychologist will shed light on the mechanisms to be considered in order to support the capacity of the teams to care for and accompany sick children and their families throughout the care process.

[Influence of the work environment on burn-out and depression in nurses]

Burn out is defined as a state of psychological exhaustion in the face of an unfavourable work environment. In the health sector, this includes, among other things, an excessive care burden, the lack of autonomy or control over work, the vicious circle of absenteeism, the lack of support, moral and sexual harassment, discrimination or the Covid-19 health crisis. Burn-out also increases the risk of depression among care workers.

Ambivalent heroism? - Psychological burden and suicidal ideation among nurses during the Covid-19 pandemic

AIM

During the Covid-19 pandemic, the risk for nurses' mental health has rapidly increased. The two main goals of this study were the examination of (1) the psychological burden and (2) of suicidal ideation and its associated risk factors one year after the Covid-19 pandemic begun.

DESIGN

This was a cross-sectional online survey.

METHODS

N = 1311 nurses (96.9% female) aged 18-63 years (M = 30.96, SD = 8.48) were assessed for various symptoms of psychological burden, suicidal ideation and behaviour and its risk factors.

RESULTS

Almost half of participants (41.5%) reported heightened levels of depressive symptoms, 691 (52.7%) reported a medium to high risk for burnout. One fifth of participants (21.7%) reported suicidal ideation in the past 4 weeks. The direct contact to people with Covid-19 was not related to the extent of the psychological burden. Depression, agitation, perceived burdensomeness and previous suicide attempt were associated with suicidal ideation.

[Intervention of the medical-psychological emergency unit with the carers during Covid-19]

The medical-psychological emergency units have been meeting with care teams to discuss their experiences and feelings about Covid-19 for a little over a year. This preventive approach allows for psycho-education and the identification of stressful states.

'Should I Stay, or Should I Go?' Psychological Distress Predicts Career Change Ideation among Intensive Care Staff in Lithuania and the UK Amid COVID-19 Pandemic

The COVID-19 pandemic had a significant effect on healthcare globally. Additional pressure created by coronavirus adversely affected the mental health and psychological well-being of healthcare workers, leading many to question their desire and willingness to continue working in healthcare. This study aimed to identify predictors for career change ideation among healthcare professionals in two countries; Lithuania and the United Kingdom amid the coronavirus pandemic. In total, 610 healthcare professionals from Lithuania and the UK (285 and 325, respectively) participated in a survey from May to August 2020. Psychological distress and psychological well-being were measured using the self-report scales "DASS-21" and "WHO-5". Almost half of the sample (49.2%), 59.6% and 40.0% in Lithuanian and the UK, respectively, exhibited career change ideation, the country effect was significant (AOR = 2.21, p < 0.001). Stronger ideation to leave healthcare was predicted by higher levels of depression (AOR = 1.10, p = 0.005), stress (AOR = 1.10, p = 0.007), anxiety surrounding inadequate personal protective equipment (AOR = 2.27, p = 0.009), and lower psychological well-being scores (AOR = 1.10, p = 0.007). We conclude that psychosocial support must be provided for healthcare professionals to prevent burnout and loss of staff amid the pandemic.

Analysis of the prevalence of musculoskeletal disorders and occupational stress in professors of a higher education institution in the state of Pernambuco

Introduction:

The consequences of technological innovations and current ways of work organization have prompted the appearance of various health conditions, namely repetitive strain disorders, work-related musculoskeletal disorders, and burn-out; these can emotionally and physically overload workers.

Objectives:

To evaluate the prevalence of musculoskeletal disorders and occupational stress in professors of the Serra Talhada campus of Instituto Federal do Sertão Pernambucano.

Methods:

Participants signed a free and informed consent form and answered to the Nordic Musculoskeletal Questionnaire. Subsequently, we applied the Maslach Burnout Inventory-Human Services Survey and evaluated the participants’ postures during teaching by using the Rapid Upper Limb Assessment tool (Ergolândia software).

Results:

We observed that 82% of the participants presented musculoskeletal symptoms, mainly in the lower back and lower limbs. Professors presented high scores for the burn-out syndrome, and posture evaluation indicated action levels of 3-4 (suggesting immediate intervention).

Conclusions:

The implementation of an occupational physical therapist in this higher education institution is recommended in order to promote ergonomic adaptations and to elaborate a protocol for workplace physical activity, ultimately aiming to prevent musculoskeletal disorders and occupational stress.

An Exploration of the Emotive Experiences and the Representations of Female Care Providers Working in a Perinatal Hospice. A Pilot Qualitative Study

Congenital anomalies are the principal cause of neonatal mortality in the United States. Families who decide to continue gestation and reject termination of pregnancy benefit from the experience of Perinatal Hospice (PH). There are no current studies that show if there may be positive outcomes for care-providers as well. The first step is exploration of their emotive experiences and representations beyond burnout or stress disorders and the possible negative outcomes. With this aim, semi-structured interviews were conducted with 10 specialists. An Elementary Context analysis was performed with T-Lab software. Providers experience positive elements even though they work in a painful reality and face the possibility of 'failure' of medical science or the loss of a patient. They declare themselves to be satisfied and do not demonstrate deep suffering or particular psychophysical disorders. They consider their job as a 'gift'. There is a lack of research exploring the encouraging aspects of their work, such as coping strategies or positive emotions.

Fighting from the COVID-19 Frontline: A Junior Doctor's Perspective on Fear, Duty and Calling

As the COVID-19 pandemic ravages the whole world, the frontline clinicians are tirelessly fighting to contain and manage the disastrous effects of the virus from their communities. Stress, despair, fear, physical and psychological burn out, decreased work out put and lowered morale are some side effects this endless battle has had on the frontline healthcare worker. Although there have been many accounts of surgeons working in the frontline, there have only been few reflections on this ongoing battle from the junior clinician’s point of view. In this article, we feature the perspectives of young residents from the orthopaedic unit at the epicenter of the COVID-19 fight in Singapore. We highlight the thoughts, fears, emotions, morale, motivating factors and reflections of junior clinicians while they work at frontlines. Fear in a dangerous new environment and amidst uncertainty is natural. However, a doctor’s call of duty goes far above fear.

Mental Health and Self-Care Practices Among Dental Hygienists

Purpose: Occupational stress and burn-out among dental hygienists may produce a decrease in overall mental health and well-being. The purpose of this study was to determine prevalence of mental health concerns as well as perceived stressors and self-care strategies among dental hygienists in Oregon.Methods: Dental hygienists belonging to the Oregon Dental Hygienists' Association were invited to participate in an electronic survey. The validated and pilot tested-survey consisted of 28 items that addressed experiences with stress, mental health issues and coping mechanisms. Descriptive and inferential statistics were used to analyze the data.Results: Of the email invitations that were successfully delivered (n=251), 83 dental hygienists volunteered to participate (n=83), for a 33% response rate. Difficulty maintaining work-life balance (35%, n=28), dysfunctional work teams (34%, n=28), and not enough time in the work schedule (65%, n=54) were the most common stressors. Respondents who worked ≥20 hours per week were more likely to attribute their daily stress primarily or entirely to work (p=0.009). Self-care methods included exercise, quiet time, spending time with loved ones, and self-care activities. Only 21% of respondents (n=17) reported that they received information or training on stress management and or burn-out in as part of their dental hygiene education.Conclusion: Symptoms linked to depression and anxiety are common among dental hygienists in Oregon. Stress management education and training should be incorporated in dental hygiene educational programs to prepare graduates to effectively manage the stressors that may lead to burn-out. Additional research should be conducted on a national level to gain a more representative sample.

Peer support for junior doctors: a positive outcome of the COVID-19 pandemic?

The COVID-19 pandemic has imposed new, intense and, as yet, unquantifiable strain on the wellbeing of healthcare professionals. Similarities are seen internationally with regards to the uptake of psychological support offered to healthcare professionals during a pandemic. Junior doctors are in a unique position to offer and access peer support; this is an evidence-based strategy to promote psychological wellbeing of junior doctors through the COVID-19 pandemic and into the future. The development of peer support networks during the pandemic may lead to reduced physician burnout and improved patient care in the future. We discuss a peer support initiative to support medical trainees during the COVID-19 pandemic, discuss the barriers to the success of such schemes, and reflect on the value of grass-roots peer support initiatives.

The Impact of Quarantine and Physical Distancing Following COVID-19 on Mental Health: Study Protocol of a Multicentric Italian Population Trial

The COVID-19 pandemic and its related containment measures-mainly physical distancing and isolation-are having detrimental consequences on the mental health of the general population worldwide. In particular, frustration, loneliness, and worries about the future are common reactions and represent well-known risk factors for several mental disorders, including anxiety, affective, and post-traumatic stress disorders. The vast majority of available studies have been conducted in China, where the pandemic started. Italy has been severely hit by the pandemic, and the socio-cultural context is completely different from Eastern countries. Therefore, there is the need for methodologically rigorous studies aiming to evaluate the impact of COVID-19 and quarantine measures on the mental health of the Italian population. In fact, our results will help us to develop appropriate interventions for managing the psychosocial consequences of pandemic. The "COVID-IT-mental health trial" is a no-profit, not-funded, national, multicentric, cross-sectional population-based trial which has the following aims: a) to evaluate the impact of COVID-19 pandemic and its containment measures on mental health of the Italian population; b) to identify the main areas to be targeted by supportive long-term interventions for the different categories of people exposed to the pandemic. Data will be collected through a web-platform using validated assessment tools. Participants will be subdivided into four groups: a) Group 1-COVID-19 quarantine group. This group includes the general population which are quarantined but not isolated, i.e., those not directly exposed to contagion nor in contact with COVID-19+ individuals; b) Group 2-COVID-19+ group, which includes isolated people directly/indirectly exposed to the virus; c) Group 3-COVID-19 healthcare staff group, which includes first- and second-line healthcare professionals; d) Group 4-COVID-19 mental health, which includes users of mental health services and all those who had already been diagnosed with a mental disorder. Mental health services worldwide are not prepared yet to manage the short- and long-term consequences of the pandemic. It is necessary to have a clear picture of the impact that this new stressor will have on mental health and well-being in order to develop and disseminate appropriate interventions for the general population and for the other at-risk groups.

Work Addiction, Obsessive-Compulsive Personality Disorder, Burn-Out, and Global Burden of Disease: Implications from the ICD-11

Occupational stress and high workload are being increasingly recognized as significant contributors to the diseases and disorders constituting major components of the global burden of disease. A more detailed definition of burn-out was recently included by the World Health Organization (WHO) in the eleventh revision of the International Classification of Diseases (ICD-11) which reflects a growing acknowledgment of the role of professional work in mental health. One of the symptoms of obsessive-compulsive personality disorder/anankastic personality disorder (OCPD/APD) is an undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships. This compulsive overworking is closely related to the concept of work addiction, and OCPD/APD was suggested to be its major risk factor. OCPD/APD is the most prevalent personality disorder and one that appears to produce the highest direct and indirect medical costs. At the same time, it is vastly understudied. In recent years, it has been repeatedly emphasized that it requires consistent conceptualization and clarification of its overlapping with similar conditions. Even though the limited existing studies suggest its strong relationship with burn-out and depression among employed individuals, there has been no systematic effort to investigate its role in the consequences of occupational stress and high workload. This paper identifies several substantial gaps in the current understanding of the relationships between work addiction, OCPD/APD, burn-out, and the global burden of disease within the context of the WHO's plan of developing evidence-based guidelines on mental wellbeing in the workplace.

Professional Longevity as a Problem of the Value-Semantic Regulation of Teacher Activity

The aim of this research is to establish proper external and internal conditions for conducting pedagogical activity that reveal the value basis of professional education. The research justifies the need to analyse the guidelines of a person’s professional self-identity, contents of professional activity motivation, peculiarities of maintaining the mental and physical health of a person, and the capacity of an educational institution’s organisational culture. A number of indicators of value mechanisms of a teacher’s professional longevity is revealed. A diagnostic program of the project, aimed at studying the value content of a teacher’s behaviour strategies during the process of professional activity, was designed. The content of the hypothesis is connected with the assumption of value-semantic inter-conditionality of professional longevity. The research revealed significant interrelations of professional longevity with some psychological factors of value-semantic nature. Analysis of the organisational culture of an educational institution as a factor providing (preventing) the professional longevity of a teacher was carried out. The dominant tendency of describing the interconnection between an educational institution’s organisational culture and the level of emotional burnout syndrome of teachers working within certain cultural models is revealed.

[Professional stress and social support feelings, coping strategies, and burn-out of caregivers in care facilities for dependent elderly people]

Caregivers in dependent elderly people facilities may develop a burn-out, but few studies have been conducted on the subject. The aim of this study is to evaluate the feelings of professional stress and social support, coping strategies and caregivers' burn-out including nurses, caregivers and medical psychologists, to identify the different coping strategies according to the burn-out level, and to analyze the links between burn-out, perceived work stress and perceived social support. Seven facilities were contacted, but only three sent back valid response questionnaires. Twenty-one caregivers completed the questionnaires (socio-demographic data, MBI, Brief Cope, SSQ6, JSS). Results showed a low level of burn-out and perceived stress and a satisfactory perceived social support. Functional coping strategies were used, especially by caregivers with lower burn-out level (positive reinterpretation) unlike caregivers with moderate or high burn-out level that used more dysfunctional strategies (substance abuse). Significant links were found between perceived work stress and emotional exhaustion, and between personal accomplishment, perceived social support and emotional exhaustion, and between perceived work stress and perceived social support. These results show the relevance of creating working groups for caregivers in stress situations. The groups help to develop or maintain functional coping strategies and provide adequate social support for the healthcare team. Taking into account burn-out improves caregivers' job satisfaction and care quality for the residents.

A Cross-Sectional Study of Emotional Intelligence in Military General Surgery Residents

OBJECTIVE

Higher emotional Intelligence (EI) is linked to improved doctor-patient relationships, empathy, teamwork, communication skills, stress management, and leadership in medicine. This study analyzes the effects of age, postgraduate year (PGY), gender, and prior military experience on EI in military general surgery residents, and compares these to the general population and civilian surgery residents.

DESIGN

This is a retrospective, observational study. Results were analyzed using independent sample t test and linear regression to compare general surgery residents with the normative population and civilian general surgery residents.

SETTING

The general surgery department at Walter Reed National Military Medical Center, a single-center, academic institution.

PARTICIPANTS

All general surgery residents, PGY 1 to 6, were surveyed at the beginning of academic year, in June 2016.

RESULTS

There were no statistically discernable differences in global EI between male (n = 27) and female residents (n = 19), PGY, or prior military experience. Female general surgery residents show higher global EI, and both males and females scored higher in the self-control factor than the normative population. Mid-residency, there is a nonstatistically discernible dip in many factors and facets of EI.

CONCLUSIONS

Gender differences in EI present in the general population were not appreciated in our cohort of surgery residents, which confirms the results of previous studies. This may be due to the fact that general surgery residents are a more uniform group than the population at large. Additionally, our cohort of military surgery residents demonstrated similar global EI to civilian surgery residents. While PGY had no statistically discernable affect on global, facet, or factor EI, more studies are needed to longitudinally follow changes in EI over the course of surgery residency.

Improvement in quality of life of Chinese chronic heart failure patients with neuropsychiatric complications over 12-months post-treatment with metoprolol

Psychological disorders, such as depression and anxiety, are known to be associated with chronic heart failure (CHF). The present study was conducted to evaluate the effect of mental status on quality of life (QoL) in metoprolol treated CHF patients with depression, anxiety, and burn-out.This single-center prospective study was conducted between February 2013 and April 2016, enrolled CHF patients (resting heart rate >80 bpm) with depression, anxiety, and burn out at baseline. Hospital anxiety and depression scale (HADS) and Copenhagen burnout inventory (CBI) were used to assess the depression-anxiety status and burn-out status, respectively. Change in QoL was evaluated as the endpoint at 1st, 3rd, 6th, and 12th month from baseline using Minnesota Living with Heart Failure Questionnaire (MLHFQ) and short form-8 (SF-8) scales. A student t test was used to determine the change and P value < .05 was considered statistically significant. One hundred fifty-four patients were enrolled (median age 66 years; 65.58% males) and divided into 8 groups based on the HADS and CBI scores at baseline. Overall, the mean SF8 score and MLHFQ scores in different mental status groups showed a significant improvement (P < .05) in QoL from baseline to 12th month, with no significant difference reported between the groups. With regard to the follow-up periods, there was a deterioration in QoL until 3rd month, after which there was a significant improvement (P < .05).There was a significant improvement in QoL in metoprolol treated CHF patients with depression, anxiety, and burn-out.

[Communication technologies, time pressure and the right to disconnect]

Essential tools in the constant race against time endured by companies, communication technologies also bring with them a new time pressure, emergency situations and information overload which can lead to new types of disorders, stress and sometimes burnout. One of the ways to escape these negative consequences is to implement sustainable practices within the telecommunications environment, in particular through the creation of a time buffer zone and the opportunity to partially disconnect.

[Occupational burnout in geriatrics, an Echo complex]

Caregivers in nursing homes are exposed to numerous risk factors of occupational burnout. Lack of time, work overload, caring for frail people, an imbalance between hierarchical demands and the amount of decision-making power accorded to them, as well as insufficient resources: it is difficult to provide individualised care to patients in these conditions. There are, however, ways to improve this situation.

[Occupational burnout in a nursing home]

Working in a nursing home leads to specific problems for caregivers. For example, being confronted with an ageing body and a declining mind or enduring inadequate work organisations can cause occupational exhaustion and burnout. The quest for job satisfaction at work then becomes a challenge.

[The meaning of nursing work, a fragile collective construction]

The meaning of nursing work depends on many personal, social and structural aspects: choices, standards, expectations, resources, training, team, management and organisation. It is a fragile construction, which must be re-examined every day to ensure nurses are not over-committed and to avoid burnout.

[Promoting the holistic dimension of nursing care]

Ingrid Schivre's nursing practice in an emergency department has evolved towards more relaxing approaches which allow for a greater focus on the notion of caring.

Facing death in the intensive care unit. A phenomenological study of nurses' experiences

BACKGROUND

Nurses may experience considerable emotional burden due to patient death, in part as they are generally the professionals who have the most contact with patients.

OBJECTIVE

To describe the lived experience of Spanish nurses working in intensive care units regarding how they face the death of their patients.

METHODS

A qualitative phenomenological study was performed. A purposeful sample was used. The data collection strategies used included in-depth unstructured and semi-structured interviews, field notes and personal documents. Afterwards, data were analyzed using the Giorgi proposal.

RESULTS

22 nurses participated, with a mean age of 40.8 years and a mean work experience of 13.8 years. Three themes were identified: 1) dealing with expectations of recovery, 2) accepting the age of death, and 3) experiencing emotional attachment.

CONCLUSIONS

Nurses in intensive care units report a great emotional burden derived from patients death, Support programs for nurses should be organised within these units.

Work-home interface stress: an important predictor of emotional exhaustion 15 years into a medical career

The importance of work-home interface stress can vary throughout a medical career and between genders. We studied changes in work-home interface stress over 5 yr, and their prediction of emotional exhaustion (main dimension of burn-out), controlled for other variables. A nationwide doctor cohort (NORDOC; n=293) completed questionnaires at 10 and 15 yr after graduation. Changes over the period were examined and predictors of emotional exhaustion analyzed using linear regression. Levels of work-home interface stress declined, whereas emotional exhaustion stayed on the same level. Lack of reduction in work-home interface stress was an independent predictor of emotional exhaustion in year 15 (β=-0.21, p=0.001). Additional independent predictors were reduction in support from colleagues (β=0.11, p=0.04) and emotional exhaustion at baseline (β=0.62, p<0.001). Collegial support was a more important predictor for men than for women. In separate analyses, significant adjusted predictors were lack of reduction in work-home interface stress among women, and reduction of collegial support and lack of reduction in working hours among men. Thus, change in work-home interface stress is a key independent predictor of emotional exhaustion among doctors 15 yr after graduation. Some gender differences in predictors of emotional exhaustion were found.

[Burnout is not a fatality]

How can the infernal spiral which leads to burnout be identified? What are the reflexes to adopt in order to protect against it? This article provides the keys to understanding and preventing burnout, in order to develop, instead, a real supply of wellbeing at work.

Psychometric properties of the Stress and Crisis Inventory (SCI-93) in females with fibromyalgia and chronic widespread pain

BACKGROUND

Fibromyalgia (FM) and chronic widespread pain (CWP) are commonly associated with symptoms such as fatigue, stiffness, tension, exhaustion and psychological distress. Research on biological markers of the degree of stress symptoms has been conducted for decades. However, biological markers do not offer sufficient information for clinical practice, and thus, validated rating scales are still the best assessment option. The Stress and Crisis Inventory-93 (SCI-93) was designed to assess the severity of symptoms that are primarily related to the autonomous nervous system.

OBJECTIVE

The purpose of this study was to evaluate the psychometric properties of the SCI-93 with regard to known-group validity, internal consistency and test-retest reliability.

METHODS

The study included 166 women with FM or CWP in addition to 157 age-matched healthy women. The test-retest reliability was investigated in 40 women with FM.

RESULTS

A one-factor solution was chosen, which explained 53% of the total variance; Cronbach's alpha was 0.98. The group of patients with FM and CWP showed significantly higher SCI-93 total scores than the healthy reference group (mean = 76.4 ± 24.9 vs. mean = 24.9 ± 21.3; P < 0.001), supporting known-group validity. In the test-retest reliability study, the intra class correlation for the SCI-93 total score was 0.95.

CONCLUSIONS

The SCI-93 demonstrated satisfactory known-group validity and test-retest reliability. The instrument appears to reflect well the severity of autonomous symptoms.

Differential diagnostic of the burnout syndrome

Introduction

There is no consistent definition of burnout. It is neither a defined diagnosis in ICD-10 nor in DSM-IV. Yet it is diagnosed by office-based doctors and clinicians. Mainly due to reimbursement reasons, diagnoses like depression are used instead of burnout diagnoses. Therefore burnout has a very high individual, social and economic impact.

Objectives

How is burnout diagnosed? Which criteria are relevant? How valid and reliable are the used tools?

What kind of disorders in case of burnout are relevant for a differential diagnosis?

What is the economic effect of a differential diagnosis for burnout?

Are there any negative effects of persons with burnout on patients or clients?

Can stigmatization of burnout-patients or -clients be observed?

Methods

Based on a systematic literature research in 36 databases, studies in English or German language, published since 2004, concerning medical and differential diagnoses, economic impact and ethical aspects of burnout, are included and evaluated.

Results

852 studies are identified. After considering the inclusion and exclusion criteria and after reviewing the full texts, 25 medical and one ethical study are included. No economic study met the criteria.

The key result of this report is that so far no standardized, general and international valid procedure exists to obtain a burnout diagnosis. At present, it is up to the physician’s discretion to diagnose burnout. The overall problem is to measure a phenomenon that is not exactly defined. The current available burnout measurements capture a three dimensional burnout construct. But the cutoff points do not conform to the standards of scientifically valid test construction.

It is important to distinguish burnout from depression, alexithymia, feeling unwell and the concept of prolonged exhaustion. An intermittent relation of the constructs is possible. Furthermore, burnout goes along with various ailments like sleep disturbance. Through a derogation of work performance it can have also negative effects on significant others (for example patients). There is no evidence for stigmatization of persons with burnout.

Discussion

The evidence of the majority of the studies is predominantly low. Most of the studies are descriptive and explorative. Self-assessment tools are mainly used, overall the Maslach Burnout Inventory (MBI). Objective data like medical parameters, health status, sick notes or judgements by third persons are extremely seldomly included in the studies. The sample construction is coincidental in the majority of cases, response rates are often low. Almost no longitudinal studies are available. There are insufficient results on the stability and the duration of related symptoms. The ambiguity of the burnout diagnosis is regularly neglected in the studies.

Conclusions

The authors conclude, that (1) further research, particularly high-quality studies are needed, to broaden the understanding of the burnout syndrome. Equally (2) a definition of the burnout syndrome has to be found which goes beyond the published understanding of burnout and is based on common scientific consent. Furthermore, there is a need (3) for finding a standardized, international accepted and valid procedure for the differentiated diagnostics of burnout and for (4) developing a third party assessment tool for the diagnosis of burnout. Finally, (5) the economic effects and implication of burnout diagnostics on the economy, the health insurances and the patients have to be analysed.