Prevalence of and factors associated with burnout among health care professionals in Arab countries: a systematic review

Burnout, Depression and Sense of Coherence in Nurses during the Pandemic Crisis

During the COVID-19 pandemic, the risk to nurses' mental health has increased rapidly. The aim of the study was to investigate the prevalence of depression and burnout and to evaluate their possible association with the sense of coherence in nursing staff during the pandemic crisis. The Copenhagen Burnout Inventory questionnaire, Beck's Depression Inventory, and the Sense of Coherence questionnaire were completed by 101 male and 559 female nurses. Individual and demographic data were recorded. Regarding depression, 25.5% of respondents exhibited mild depression, 13.5% moderate depression and 7.6% severe depression. In the burnout scale, 47.1% had a pathological value. Female nurses had higher burnout (t test p < 0.01, 49.03 vs. 38.74) and depression (t test p < 0.01, 11.29 vs. 6.93) scores compared to men and lower levels in the sense of coherence (p < 0.05, 59.45 vs. 65.13). Regression evidenced that 43.7% of the variation in the BDI rating was explained by the CBI, while an additional 8.3% was explained by the sense of coherence. Mediation analysis indicated a partial mediation of burnout in the correlation between sense of coherence and depression. The sense of coherence acted as a negative regulator between burnout and depression.

Prevalence and risk factors of burnout among Lebanese community pharmacists in the era of COVID-19 pandemic: results from the first national cross-sectional survey

BACKGROUND

Community pharmacists (CPs) are increasingly facing occupational challenges as a result of the COVID-19 pandemic, putting them at high risk of burnout. This study aimed to assess the prevalence of burnout among Lebanese CPs during the COVID-19 pandemic and to identify its associated factors.

METHODS

An online survey was conducted among Lebanese CPs between February 1st and March 30, 2021. Collected data included information on sociodemographic characteristics, exposure and work-related variables, the Copenhagen burnout inventory (CBI), and the COVID-19 threat perception scale. Prevalence of burnout was calculated. Multiple logistic regressions were performed to identify the factors associated with the three burnout domains.

RESULTS

A total of 387 CPs participated in the survey. Of the total, 53.7% were females; and 43.2% were aged less than 40 years old. The prevalence of moderate-to-high personal, work-related and client-related burnout was 77.8%, 76.8, and 89.7%, respectively. Younger age, staff pharmacist, working more than 40 h per week, high perceived COVID-19 threat were associated with a moderate-to-high likelihood of burnout in all three domains. However, altruistically accepting the risks of caring for COVID-19 patients was the only variable that was associated with a lower likelihood of burnout in all three domains.

CONCLUSION

An alarming prevalence of personal, work-related and client-related burnout was revealed among Lebanese CPs. This study has many implications for practice and provides a framework for establishing policy interventions to reduce burnout levels among Lebanese CPs. Preventive strategies and interventions on individual and organizational basis are recommended.

Effect of soft skills and emotional intelligence of health-care professionals on burnout: a Lebanese cross-sectional study / Effekte von Soft Skills und emotionaler Intelligenz auf Burnout von Fachkräften im Gesundheitswesen: eine Querschnittsstudie aus dem Libanon

Objectives

The main objective of this study is to assess the effect of soft skills and emotional intelligence on burnout among health-care professionals in Lebanon.

Materials and methods

A cross-sectional study was conducted among health-care professionals working all over Lebanon for a period of 3 months starting from March till June 2021. In total, 324 out of 345 contacted health-care professionals responded. The survey was anonymous and administered via social networks as a link to an electronic form. The study included general sociodemographic questions and validated scales to measure emotional intelligence (Trait Meta-Mood Scale [TMMS-24]), burnout (Maslach Burnout Inventory for Health Services Survey [MBI-HSS]), and soft skills.

Results

Higher burnout was associated with lower soft skills (β = −0.137). Job satisfaction was negatively associated with burnout (β = −8.064). Nurses had higher burnout levels than dentists, radiologists, midwives, nutritionists, psychotherapists, and speech therapists (β = −4.595). Also, people working in Baalbek, Akkar, Beqaa, North and South had lower burnout levels compared to those working in Beirut (β = −9.015). As for emotional intelligence, no statistically significant association was found with burnout (P = 0.116).

Conclusion

This study showed that soft skills and emotional intelligence can affect job burnout. Additional research should be conducted in order to support our findings.

Occupational burnout among radiation therapy technologists in Italy before and during COVID-19 pandemic

Introduction

Radiation therapy technologists (RTTs) are exposed to high stress levels which may lead to burnout, which could be further increased by the current pandemic. The aim of our study was to assess burnout and stress among Italian RTTs before and during the pandemic.

Methods

The Italian Association of Radiation Therapy and Medical Physics Technologists (AITRO) and the Italian Federation of Scientific Radiographers Societies (FASTeR) proposed a national online survey, including the Maslach Burnout Inventory assessing emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA) to RTTs before and during the pandemic. Multivariate regression analyses and χ² tests were used for data analysis.

Results

We obtained 367 answers, 246 before and 121 during the pandemic. RTTs before and during the pandemic showed high EE and DP, intermediate PA. Median EE was 37 (interquartile range [IQR] 31–46] before and 37 (IQR 30–43) during the pandemic, median DP was 16 (IQR 13–21) and 15 (IQR 12–20), respectively. PA was 31 (IQR 28–34) and 32 (IQR 28–34), respectively. Through multivariate analysis, being female and having children led to higher EE scores before and during the pandemic (p≤0.026). Only the presence of workplace stress management courses was related to lower DP before and being female was related to higher DP during the pandemic (p<0.001). Being female, having children, and working with paediatric patients were related to lower PA before and during the pandemic (p≤0.015).

Conclusion

Our study highlighted high burnout levels for RTTs regardless of the pandemic. Future interventions aimed at preventing burnout should be implemented in their work environment, independently of the impact of exceptional events.

Assessment and correlation between job satisfaction and burnout among radiographers

INTRODUCTION

Previous research on job satisfaction (JS) and burnout has focused on physicians and nurses. However, limited work has evaluated radiographers' JS and burnout, factors affecting them and the correlation between them. The aim of this study is to assess the level and specific factors affecting burnout and JS among radiographers and to examine the correlation between them.

METHODS

A questionnaire consisting of socio-demographic information and two validated instruments (Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)) and JS Survey (JSS)) was distributed to radiographers. The MBI included 22 questions and JSS consisted of 36 questions. Mean scores were used to compare responses between participants according to demographic characteristics. Correlation between JS and burnout was examined using Pearson correlation test, with P < 0.05 determining statistical significance.

RESULTS

308 radiographers returned a completed questionnaire, 48.4% of participants were male, 48.7% had 1-6 years of experience and 61.4% examined >25 patients per day. Total emotional exhaustion, depersonalization and personal accomplishment scores were 28.7, 11.3 and 35.8 respectively. Most participants felt dissatisfied with pay (n = 221, 71.8%), opportunities for promotion (n = 202, 65.6%), fringe benefits (n = 239, 77.6%), contingent rewards (n = 231, 75.0%), operating procedures (n = 190, 61.7%) and communication (n = 162, 52.6%). Burnout was associated with work experience and caseload and JS was associated with section of work. Most of the JS domains were significantly inversely related to emotional exhaustion and depersonalisation domains. Emotional exhaustion and depersonalization drew a significant positive correlation. Emotional exhaustion and depersonalization drew a significant positive correlation.

CONCLUSION

Participating radiographers are mostly dissatisfied about their jobs and they suffer a high level of emotional exhaustion.

IMPLICATIONS FOR PRACTICE

To avoid the consequences of burnout and decreased JS on individuals and organizations, efforts should be done in alleviating the main factors affecting them.

Nursing workplace and its relation to occupational health outcomes and physical activity

BACKGROUND

Working in hospitals entails several risks to nurses. A better nursing workplace can help in improving physical activity and reducing adverse occupational health outcomes among nurses.

AIM

This study aimed to investigate the relationships of the nursing workplace with occupational health outcomes and physical activity.

METHODS

A cross-sectional correlation study was conducted with 623 nurses. Data were collected through report self-administered questionnaires that included employment and occupational conditions, hospital workplace environment, and adverse occupational health outcomes as well as physical activity pattern.

RESULTS

The current study showed that the nursing workplace environment and conditions had a negative effect on occupational health outcomes and physical activity among nurses in the study units. Nurses in this study reported a high prevalence of low back pain (82.7%), burnout (78.3%), and occupational injuries (70.5%). They also reported insufficient physical activities (90.6%). High prevalence of burnout and low back pain were associated with low levels of physical activities among nurses.

CONCLUSION

A fair working environment and conditions have been implicated as a causative factor of negative occupational health outcomes and limitations of physical activity among nurses. Adverse occupational health outcomes also affect the nurses engaging in physical activity.

Occupational Health of Frontline Healthcare Workers in the United Arab Emirates during the COVID-19 Pandemic: A Snapshot of Summer 2020

The study aim was to understand the availability of personal protective equipment (PPE) and the levels of anxiety, depression, and burnout of healthcare workers (HCWs) in the United Arab Emirates (UAE). This study was an online-based, cross-sectional survey during July and August 2020. Participants were eligible from the entire country, and 1290 agreed to participate. The majority of HCWs were females aged 30-39 years old, working as nurses, and 80% considered PPE to be available. Twelve percent of respondents tested positive for SARS-CoV-2. Half of HCWs considered themselves physically tired (52.2%), reported musculoskeletal pain or discomfort (54.2%), and perceived moderate-to-high levels of burnout on at least one of three burnout domains (52.8%). A quarter of HCWs reported anxiety (26.3%) or depression (28.1%). HCWs reporting not having musculoskeletal pain, having performed physical activity, and higher scores of available PPE reported lower scores of anxiety, depression, and burnout. UAE HCWs experienced more access to PPE and less anxiety, depression, and burnout compared with HCWs in other countries. Study findings can be used by healthcare organizations and policymakers to ensure adequate measures are implemented to maximize the health and wellbeing of HCWs during the current COVID-19 and future pandemics.

The relationship between job stress and job burnout moderated by BDNF rs6265 polymorphism

RATIONALE

Job stress can lead to job burnout, and BDNF polymorphism has been found to be involved in its psychopathological mechanism. Research needs a better understanding of the important role of gene × environment (i.e., BDNF polymorphism × job stress) interaction on job burnout.

OBJECTIVE

This study aimed to explore how BDNF rs6265 polymorphism may moderate the relationship between job stress and job burnout.

METHODS

Three hundred forty-one healthy participants (187 males and 154 females) from a Chinese university were included. The present study used a standardized questionnaire including demographic characteristics, job stress assessed by the House and Rizzo's Work Stress Scale, and job burnout assessed by the Maslach Burnout Inventory-General Survey. The BDNF rs6265 polymorphism was genotyped.

RESULTS

Job stress showed a positive correlation with emotional exhaustion (p < 0.001), cynicism (p < 0.001), and reduced personal accomplishment (p < 0.01). The main effects of BDNF rs6265 polymorphism on emotional exhaustion and cynicism were significant [F_(1,333) = 5.136, p = 0.024; F_(1,333) = 4.175, p = 0.042, respectively]. The interaction between job stress and BDNF rs6265 on cynicism was significant (△ R² = 0.013, p = 0.014) after controlling for age, sex, education, and position, indicating that individuals with BDNF rs6265 TT genotype showed higher level of cynicism when in high job stress.

CONCLUSIONS

The results provided evidence for the association of BDNF gene rs6265 polymorphism, job stress, and their interaction with job burnout. Individuals with TT genotype in BDNF rs6265 might be susceptible to stressful situations, which would lead to cynicism.

The prevalence of burnout syndrome and its association with adherence to safety and practice standards among anesthetists working in Ethiopia

Background

Burnout amongst healthcare professionals is a serious challenge affecting health care practice and quality of care. The ongoing pandemic has highlighted this on a global level. This study aimed to determine the prevalence of burnout syndrome and its association with adherence to safety and practice standards among non-physician anesthetists in Ethiopia.

Methods

A cross-sectional survey was conducted amongst non-physician anesthetists throughout Ethiopia in January 2020 utilizing an online validated questionnaire containing sociodemographic characteristics, symptoms of burnout using the 22 items of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale, 10 questions designed to evaluate the best practice of providers, and 7 questions evaluating self-reported errors. The MBI-HSS questions assessed depersonalization, emotional exhaustion, and personal accomplishment. A high level of burnout was defined as a respondent with an emotional exhaustion score ≥27, a depersonalization score ≥10, and a personal accomplishment score ≤33 in the MBI-HSS subscales. Bi-variable and multivariable logistic regression were used to identify factors associated with burnout.

Results

Out of a total of 650 anesthetists approached, 400 responded, a response rate of 61.5%. High levels of burnout were identified in 17.3% of Ethiopian anesthesia providers. Significant burnout scores were found in academic anesthetists (p = 0.01), and were associated with less years of anesthesia experience (p < 0.001), consuming >5 alcoholic drinks per week (p = 0.02), and parenthood (p = 0.01).

Conclusion

We found that non physician anesthetists working in Ethiopia is suffering by high levels of burnout. The problem is alarming in those working at academic environments and less experienced.

•

Burnout were identified in 17.3% of Ethiopian anesthesia providers.

•

Significant burnout scores were found in academic anesthetists.

•

Anesthetists who have high burnout score committed medical malpractice.

The Impact of Burnout on Emergency Nurses' Intent to Leave: A Cross-Sectional Survey

INTRODUCTION

Emergency nurses work in one of the busiest and most stressful departments in a hospital and, as such, may experience burnout more often than nurses working in other nursing units. This study examined the relationship among orientation, burnout (emotional exhaustion, depersonalization, and low sense of personal accomplishment), and intent to leave.

METHODS

A cross-sectional survey design was used. Emergency nurses who were members of the Emergency Nurses Association were invited to participate in an anonymous survey. The Maslach Burnout Inventory tool was used to explore emotional exhaustion, depersonalization, and sense of personal accomplishment. Emergency nurses' intent to leave was assessed with the Turnover Intention Scale. A logistic regression analysis was used to investigate the odds of intent to leave for those who scored at or above versus below the median on each burnout subscale.

RESULTS

The findings revealed that a formal orientation enhanced emergency nurses' sense of personal accomplishment and was associated with lower intent to leave. The odds of intent to leave were almost 9 times greater for participants with 5 or more years of experience, approximately 13 times greater for those with above-median emotional exhaustion, and more than 6 times lower for those with above-median sense of personal accomplishment.

DISCUSSION

Emotional exhaustion and low sense of personal accomplishment were key factors influencing emergency nurses' intent to leave. Emergency nurse leaders may find that a formal orientation program enhances sense of personal accomplishment and decreases intent to leave. Creating work environments to help emergency nurses find joy in their work may be critical to work-life balance and staff retention.

Physician burnout in the Eastern Mediterranean region: influence of gender and related factors - Systematic review and meta-analysis

Background

While recent reviews highlight high burnout prevalence among physicians in the World Health Organization's (WHO) Eastern Mediterranean Region (EMR), there has been a limited exploration into the role of gender and related factors in this problem.

Methods

We conducted a systematic review and meta-analysis of studies on the prevalence of physician burnout and its relationship to gender, physician specialties, and age in the WHO's EMR based on the Cochrane Handbook for Systematic Reviews. We searched PubMed, Embase, PsycINFO, Google Scholar, and Al Manhal databases and synthesized the findings from the included studies.

Results

Among the 78 studies included, data was available from 16/22 (72.7%) countries and territories in the EMR covering a total of 16 016 physicians. The pooled prevalence of overall burnout among physicians in the region was estimated to be 24.5%. Among the sub-components of burnout, we estimated a high pooled prevalence of 44.26% for emotional exhaustion followed by 37.83% for depersonalization and 36.57% for low personal achievement. There was a statistically significant difference in the prevalence across the countries in the EMR and among the sub-categories of specialist medical practitioners. There was no statistically significant difference across the two genders at a regionally aggregated level.

Conclusions

The levels of physician burnout including the three sub-components in EMR are high by any standards. Based on our review of available studies, it is difficult to ascertain gender differences with certainty in burnout levels among physicians in the EMR nations. There is a need for better quality studies in this area.

Burnout profiles among French workers in health units for inmates: results of the EHCAU study

BACKGROUND

Health care personnel who work in penitentiary environments are at risk of burnout due to a variety of factors. Latest research have brought forward a classification system consisting of five burnout profiles on a continuum between engagement and burnout. The objective of this study was to measure the prevalence of these profiles among professionals working in French health units providing health services for inmates according to the three levels of care and to investigate their characteristics to propose appropriate management and prevention approaches.

METHODS

This study involved a cross-sectional analysis of data from the Evaluation of Health CAre in Units for inmates (EHCAU) study, a multicentric cohort study of professionals practising in health units for inmates in eastern France. Burnout was assessed by the Maslach Burnout Inventory (MBI) at the levels of emotional exhaustion, depersonalization and personal accomplishment. Job conditions and characteristics were measured using the Karasek Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire. Data on sociodemographic characteristics and self-reported health status were also collected. Differences between MBI profiles were identified using Fisher's exact test and the Wilcoxon test.

RESULTS

Of the 350 professionals surveyed, 150 responded (42.9%). The most frequent profiles were ineffective (36.9%) and engagement (34.8%). The burnout (7.8%), overextended (15.6%) and disengaged (5.0%) profiles made up the remaining quarter. Significant differences in the burnout profiles were observed in regard to professional occupation (p = 0.01), irregular eating hours (p = 0.04), history of complaint procedures (p = 0.05), anxiety (p < 0.0001), depression (p < 0.0001) and the mental component of self-reported quality of life (p < 0.0001).

CONCLUSIONS

These results confirm that special attention should be given to professionals working in these challenging settings. The results have important implications for theory and research and for more customized approach interventions.

TRIAL REGISTRATION

ID RCB: 2018-A03029-46.

Stress, anxiety, work-related burnout among primary health care worker: A community based cross sectional study in Kolar

Background:

Because of Primary Health care workers most of the national programmes run efficiently at grass root level. Workplace stress is alteration in one's physical or mental state in response to workplaces. Anxiety related to work among them is increasing and also Burnout.

Objectives of the Study:

To assess stress, anxiety and burnout related to work among ASHA workers and to assess the socio-demographic factors influencing the stress, anxiety and burnout related to work among ASHA workers.

Methodology:

This was a community based cross sectional study carried out for a period of 6 months from January 2019 to July 2019 at Kolar, India. Multistage cluster sampling was applied. From the selected 8 PHC all ASHA workers were part of the study. Sample size was calculated based on previous study with effect size of 1.5 from which final sample size was 150. Ethical clearance was obtained from the Institutional Ethical Committee (IEC) before the start of study. Written Informed consent was taken from the study. All data were entered in excel sheet and analyzed using SPSS version 22.

Results:

150 ASHA workers were interviewed. 75.5% belonged to Nuclear family, 50.7% belonged to age group of 31-40 years, 86.7% perceived that received payment for the work was low, 60.7% had to spend more than 2 hours for walking for the official work, 72% had work experience less than 10 years and 35.3% had working hours more than 8 hours. 45.3% had mild to moderate anxiety, 9.3% had Moderate Anxiety according to Zung Anxiety scale, 54% had moderate stress according to Cohen's perceived stress scale and 23.3% had personal burnout, 33 (22%) had work-related burnout and 4 (2.7%) had Client related Burnout of Moderate levels according to Copenhagen Burnout Inventory scale.

Conclusion:

Socioeconomic status, Training received before joining work, Type of work, perceptions regarding Work was found to be important factors affecting the mental health. Screening regularly for stress, anxiety and work-related burnout at work place is the need of the hour.

Burnout Impact of COVID-19 Pandemic on Health-Care Professionals at Assiut University Hospitals, 2020

BACKGROUND

burnout syndrome is a serious and growing problem among medical staff. Its adverse outcomes not only affect health-care providers' health, but also extend to their patients, resulting in bad-quality care. The COVID-19 pandemic puts frontline health-care providers at greater risk of psychological stress and burnout syndrome.

OBJECTIVES

this study aimed to identify the levels of burnout among health-care professionals currently working at Assiut University hospitals during the COVID-19 pandemic.

METHODS

the current study adopted an online cross-sectional design using the SurveyMonkey® website for data collection. A total of 201 physicians were included and the Maslach Burnout Inventory (MBI) scale was used to assess the three burnout syndrome dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment.

RESULTS

about one-third, two-thirds, and one-quarter of the respondents had high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Younger, resident, and single physicians reported higher burnout scores. The personal accomplishment score was significantly higher among males. Those working more than eight hours/day and dealing with COVID-19 patients had significantly higher scores.

CONCLUSION

during the COVID-19 pandemic, a high prevalence of burnout was recorded among physicians. Age, job title, working duration, and working hours/day were significant predictors for burnout syndrome subscale results. Preventive and interventive programs should be applied in health-care organizations during pandemics.

Working Hours, Job Burnout, and Subjective Well-Being of Hospital Administrators: An Empirical Study Based on China's Tertiary Public Hospitals

(1) Purpose: To analyze the role of job burnout in connection with working hours and subjective well-being (SWB) among hospital administrators in China’s tertiary public hospitals. (2) Methods: A multi-stage, stratified, cluster random sampling method was used to select 443 hospital administrators in six tertiary public hospitals for study. The data were collected and analyzed using the working hours measuring scale, Maslach burnout, and the subjective well-being schedule. Pearson correlation, structural equation model, and bootstrap tests were conducted to examine the association between job burnout, working hours, and SWB. (3) Results: Among the 443 respondents, 330 worked more than 8 h per day on average (76.2%), 81 had the longest continuous working time more than 16 h (18.7%), and 362 worked overtime on weekends (82.2%). The prevalence of job burnout in hospital administrators was 62.8%, among which, 59.8% have mild burnout and 3.00% have severe burnout. In the dimension of emotional exhaustion, depersonalization, and reduced personal achievement, the proportion of people in high burnout was 21.0% (91/433), 15.0% (65/433), and 45.3% (196/433), respectively. Job burnout has a mediating effect between working hours and SWB, which accounted for 95.5% of the total effect. (4) Conclusion: Plagued by long working hours and severe job burnout, the hospital administrators in China’s tertiary public hospitals may have low SWB. Working hours have a negative direct impact on job burnout and SWB, and an indirect impact on SWB through job burnout as a mediator. Targeted strategies should be taken to adjust working hours to promote the physical and mental health of hospital administrators.

The prevalence of burnout and its relationship with capital types among university staff in Tehran, Iran: A cross-sectional study

Background

Burnout is a job-related syndrome that is common among university staff, and it is caused by various factors. The purpose of this study was to investigate the prevalence of burnout and its relationship with capital types among university staff in Tehran, Iran.

Methods

A cross-sectional descriptive-analytical design was used in which 420 staff were randomly sampled from the Iran University of Medical Sciences. For data collection, the researchers used the Burnout Inventory of Maslach and Jackson and Capital Types Questionnaire. The data were entered into SPSS software (Version 22) and analyzed by descriptive and inferential statistics and regressions.

Results

The mean burnout of staff was 84.42, and 45.9% of them had high burnout. A significant relationship was found among capital types, work experience, gender, education, and burnout. Multiple linear regressions also showed that independent variables estimated about 32% of the variance of the dependent variable, social capital, gender, and work experience, contributed more to explaining and predicting burnout index.

Conclusion

Regarding the relationship between burnout and capital types (economic, cultural, and social), it is necessary to increase capital by increasing cultural activities, staff's knowledge level, income levels, informal groups, and finally, strengthening interpersonal relationships among staff.

Burnout in oncology: Magnitude, risk factors and screening among professionals from Middle East and North Africa (BOMENA study)

BACKGROUND

Burnout (BO) among oncology professionals (OP) is increasingly being recognized. Early recognition and intervention can positively affect the quality of care and patient safety. This study investigated the prevalence, work and lifestyle factors affecting BO among OPs in the Middle East and North Africa (MENA).

METHODS

An online survey was conducted among MENA OPs between 10 February and 15 March 2020, using the validated Maslach Burnout Inventory of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), including questions regarding demography/work-related factors and attitudes towards oncology. Data were analysed to measure BO prevalence and risk factors and explore a screening question for BO.

RESULTS

Of 1054 respondents, 1017 participants (64% medical oncologists, 77% aged less than 45 years, 55% female, 74% married, 67% with children and 40% practiced a hobby) were eligible. The BO prevalence was 68% with high levels of EE and DP (35% and 57% of participants, respectively) and low PA scores (49%). BO was significantly associated with age less than 44 years, administrative work greater than 25% per day and the thought of quitting oncology (TQ). Practising a hobby, enjoying oncology communication and appreciating oncology work-life balance were associated with a reduced BO score and prevalence. North African countries reported the highest BO prevalence. Lack of BO education/support was identified among 72% of participants and TQ-predicted burnout in 77%.

CONCLUSIONS

This is the largest BO study in MENA. The BO prevalence was high and several modifiable risk factors were identified, requiring urgent action. TQ is a simple and reliable screening tool for BO.

Lock-Down Effect on the Mental Health Status of Healthcare Workers During COVID-19 Pandemic

Background: The psychological impact that outbreaks and pandemics could inflict on healthcare workers has been widely studied; yet, little is known about the impact of the lockdown measures. Objectives: To assess the magnitude of depression and anxiety among healthcare professionals before and after lifting of the lockdown restrictions in Saudi Arabia. Methods: Surveys targeting healthcare workers were circulated twice: during the lockdown, and 8 weeks after lifting of lockdown. Anxiety and depressive symptoms were assessed using Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Results: A total of 947 healthcare workers, with the mean age of (37 ± 8.9) responded to the surveys. Among these, 23-27% respondents reported clinically significant levels of anxiety and depression. Whereas, easing of the lockdown restrictions was shown to be associated with decreasing mean scores of PHQ-9 and GAD-7. The noted burden fell heavily on female workers, those with a current or a history of psychiatric disorders, suffering from chronic diseases, being in workplaces with high exposure to COVID-19 or in contact with COVID-19 patients, nurses, as well as those who were living with elderly and perceived their physical and mental health as "much worse" compared to the time before the pandemic. Conclusion: Our findings identified several predictors for anxiety and depression at different time-points of the pandemic. Thus, priority to psychological support measures might be needed for these groups.

Burnout among Nurses Working in Ethiopia

Background

Burnout is a condition of emotional exhaustion, depersonalization, and low personal accomplishment that can occur among individuals who work with people in some capacity. Nursing is a stressful profession that deals with human aspects of health and illness and can ultimately lead to job dissatisfaction and burnout. Although burnout among nurses has been addressed in previous research, the heterogeneous nature of the result findings highlights the need for a detailed meta-analysis in Ethiopia. Thus, this review is aimed at identifying the prevalence of burnout among nurses in Ethiopia.

Methods

A search strategy was implemented using electronic databases (PubMed/MEDLINE, Google Scholar, Web of Science, Cochrane Library, Africa-Wide Information, and African Index Medicus) which were systematically searched online to retrieve related articles using keywords. Studies which were included in this review were written in the English language because writing articles in other languages in Ethiopia is uncommon. The combination of key terms including "burnout", "nurse" and "Ethiopia", "systematic review" and protocols was used. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist guideline was followed stepwise. All published articles starting from inception to February 2020 were included, and we did not find unpublished studies. Heterogeneity across the included studies was evaluated by the inconsistency index. All statistical analysis was done using R and RStudio software for Windows, and a random-effects model was applied to estimate the overall prevalence of burnout among nurses in Ethiopia. It is registered in PROSPERO (CRD42020188092).

Results

The database searched produced 1060 papers. After adjustment for duplicates and inclusion and exclusion criteria, seven articles with 1654 total nurses were found suitable for the review. Except for one cohort study, all studies were cross-sectional. The overall pooled prevalence of burnout among Ethiopian nurses was estimated to be 39% (95% CI: 27%-50%).

Conclusions

Burnout affects two out of five nurses in Ethiopia. Therefore, effective interventions and strategies are required to reduce burnout among nurses.

Clinicians' experience of providing care: a rapid review

BACKGROUND

Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation.

METHODS

A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health.

RESULTS

Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician's experience has been identified to have a paucity of measurement tools.

CONCLUSION

Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader 'clinician pulse' style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

Assessment of Occupational Stress Among Oral and Maxillofacial Surgeons and Residents in Saudi Arabia: A Cross-Sectional Study

PURPOSE

Considering the important role of oral and maxillofacial surgeons in healthcare services and the stressful nature of their job, this study aimed to assess the occupational stress among oral and maxillofacial surgeons and residents in Saudi Arabia.

MATERIALS AND METHODS

Cross-sectional questionnaires were developed, and they included the perceived stress scale and questions about potential sources of stress. A sample size of 180 was determined using a 0.05 level of significance and a precision of ±8%. The survey was distributed using a consecutive non-random sampling method to all oral and maxillofacial surgeons and residents in all regions in Saudi Arabia from May to December 2019.

RESULTS

One hundred and seventy-two responses were received. Males were the predominant gender. The perceived stress scale revealed a moderate stress level among surgeons and residents. However, residents had a significantly higher score (P = 0.005). Increased working days were significantly associated with higher stress levels (P = 0.006). Long on-call periods were significantly and positively correlated with increased stress levels among residents since their work schedule was not flexible (P = 0.000). The majority of surgeons and residents believe that they have unconducive and stressful work environments and that working as a maxillofacial surgeon is stressful.

CONCLUSION

The study results suggest that there is increased occupational stress among oral and maxillofacial surgeons and residents in Saudi Arabia. This study highlights the need for stress management programs to minimize stress factors at the workplace and to ensure a healthy working environment for the practitioners.

Investigation of Burnout, its Associated Factors and its Effect on the Quality of Life of Critical Care Nurses Working in Buraydah Central Hospital at Qassim Region, Saudi Arabia

Background:

Burnout is a grave problem for critical care workers because they are exposed to prolonged psychosocial stressors, including advanced technology, high responsibilities and great patient acuity. The aim of this study was to investigate burnout, its associated factors and its effect on self-care among critical care nurses.

Methods:

A descriptive correlational research design was carried out with 170 critical care nurses at Buraydah Central Hospital at Qassim Region in Saudi Arabia. A self-administered questionnaire including socio-demographic and work-related characteristics was used, as well as the Short Form SF12 to assess the quality of life, and the Maslach Burnout Inventory (MBI) to assess the level of burnout.

Results:

The three Maslach Burnout Inventory subscales, high emotional exhaustion and depersonalization, low personal accomplishment and moderate total burnout score were used. The quality of life measure (sF12) showed moderate levels of physical, mental component score and total score of quality for the critical care nurses. Factors associated with burnout include age, nationality, and years of experience and the wish to change department showed statistical significance. Burnout and quality of life score had a significant negative correlation.

Conclusion:

Age, nationality, years of experience and wish to change department are all significantly associated with burnout. Finally, burnout and quality of life score of these critical care nurses had a negative significant correlation.

Self-Compassion Explains Less Burnout Among Healthcare Professionals

Objectives

Healthcare professionals are prone to experience burnout-a psychological syndrome resulting from chronic stressors at work. Some individual differences, like self-compassion-the non-judgmental observation of one's own pain and failure, while understanding that these are part of being human-can protect against burnout.

Methods

We administered the Maslach Burnout Inventory, the Self-Compassion Scale, and the Stressful Life Events Scale to a sample of healthcare professionals (medical residents, nurses, and physicians) in Lebanon (N = 93).

Results

The sample demonstrated a high degree of Emotional Exhaustion (M = 27, SD = 11.79), average levels of Depersonalization (M = 9.46, SD = 6.35), and Personal Accomplishment (M = 34.95, SD = 6.58), and moderate levels of Self-compassion (M = 3.25). All burnout components were significantly and inversely associated with self-compassion, with the strongest association found between Emotional Exhaustion and Self-compassion (r = -.37, p < .001). Self-compassion significantly explained burnout, above and beyond sociodemographic and occupational variables (Emotional Exhaustion: ΔR ² = .11, F (1.85) = 12.71, p < .01; Depersonalization: ΔR ² = .07, F (1.85) = 6.73, p = .01; Low Personal Accomplishment: ΔR ² = .11, F (1.85) = 11.29, p < .01).

Conclusions

Burnout is prevalent in the sample, yet self-compassion may be a possible protective factor.

Characteristics and predictors of burnout among healthcare professionals: a cross-sectional study in two tertiary hospitals

BACKGROUND

The pattern and impact of burnout among the medical staff are not yet well defined. However, the consequences of burnout are not limited to the healthcare providers but also may affect their family, colleagues and patients in a negative manner. We aimed to assess the characteristics and predictors of burnout among health professionals at two large tertiary hospitals.

METHODS

We conducted a cross-sectional study during the period from July 2018 to 31 December 2018. Data, via Maslach Burnout Inventory survey, were collected from physicians and other healthcare workers in two hospitals.

RESULTS

A total of 624 responses to questionnaires were analysed. Half of the respondents were physicians, and men constituted the majority. About 10% (95% CI, 7.8 to 12.5) of the respondents satisfied the criteria of burnout. Emotional exhaustion (EE) was observed in 45.7%, depersonalisation (DP) in 26.9% and personal accomplishment (PA) in 41.2% of the respondents. There was a positive correlation between EE and DP (r=0.627, p=0.001), and a weak negative correlation between DP and PA (r=-0.195, p=0.001). Young age, less experience, trauma surgery, lack of habits and getting depressed ≥1 time/week were predictors of burnout.

CONCLUSIONS

Burnout affects one-tenth of the health professionals in the tertiary hospitals in Qatar. Physicians are more likely to have higher DP and lower PA, whereas nurses prone to have higher EE. In this study, no gender discrepancy is appreciated and the junior medical staff is at a higher risk of burnout.

Oncology Residency-a Burning Issue, Results of a Questionnaire-Based Survey on Psychological Well-being of Oncology Residents

Residency, in particular oncology residency, is a challenging time with extensive academic demands, long working hours, and uncertainty about the future. Our study aimed to evaluate the prevalence and factors associated with burnout, anxiety and depression among oncology residents at a tertiary cancer centre. An anonymised questionnaire-based study was conducted among medical, surgical, paediatric and radiation oncology resident doctors at a tertiary cancer centre in April 2019. We used Copenhagen Burnout Index (CBI) to assess burnout (which includes personal, work-related and patient-related burnout), Patient Health Questionnaire (PHQ9) for depression and Generalised Anxiety Disorder (GAD7) for anxiety. The questionnaire was served to 201 residents. The overall response rate was 70.6%. High personal, work-related and patient-related burnout was identified in 71.1%, 67.6% and 23.2% of the respondents respectively. Medical oncology residents had the highest rate of personal and work-related burnout (95% and 85%) while head and neck oncology residents had the highest rate of patient-related burnout (33.3%). 27.5% of participants were found to have high levels of anxiety on the GAD7 while 14.8% of participants were detected to have a high score on the PHQ9 for depression. High personal burnout and work-related burnout were associated with both high anxiety and depression scores (p < 0.05). There is a high prevalence of burnout, depression and anxiety among oncology residents. With an expected rise in cancer burden in the next decade, psychological issues in caregivers can be expected to increase. Further studies will be needed to determine interventions to reduce psychological distress.

Research trends and scientific analysis of publications on burnout and compassion fatigue among healthcare providers

Background

Burnout and compassion fatigue are closely related concepts. Burnout is thought to develop from occupational stress while compassion fatigue results from being in a caregiver role leading to inability to get engaged in a caring relation. The objective of the current study was to investigate research trends, themes, citations, and key players of publications on burnout and compassion fatigue among healthcare providers.

Methods

A validated search query was developed and implemented in the Scopus database. The study period was all times up to 2019.

Results

Research query found 4416 publications. Publications started in 1978. Steep growth in the number of publications was observed in the last decade. There were seven research themes in the retrieved publications; six for burnout and one for compassion fatigue. Approximately 36% of the retrieved publications were about nurses; 36% were about physicians, 10% were about medical residents and the remaining did not include a specific profession. The retrieved publications received an average of 22.2 citations per article. Four of the top 10 active journals were in the field of nursing and two in the field of general medicine, one in public health, one in neurology, one in psychology, and one was multidisciplinary. The USA ranked first with 1292 (29.3%) articles followed by Spain (n = 248; 5.6%) and the UK (n = 247; 5.6%). Mayo Clinic was the most active institution (n = 93; 2.1%) followed by Harvard University (n = 46; 1.0%) and University of Washington, Seattle (n = 45; 1.0%). A total of 16,108 authors participated in publishing the retrieved documents, an average of 3.6 authors per article. Shanafelt, T.D. was the most active author (n = 78; 1.8%) followed by Dyrbye, L.N. (n = 43; 1.0%), and West, C.P. (n = 37; 0.8%). A total of 472 (10.7%) articles declared funding.

Conclusion

The current study was carried out to draw attention to the wellbeing of healthcare providers. Retrieved literature was dominated by high-income countries. Lack of information from low- and middle-income countries will hinder planning for interventional strategies and will negatively affect the health system and the patients. Health researchers in low- and middle-income countries need to focus on burn out and compassion fatigue.

Work fatigue among Lebanese community pharmacists: prevalence and correlates

Objective:

To assess work fatigue and its associated factors among community pharmacists in Lebanon.

Methods:

This cross-sectional study was conducted between March and July 2018. A proportionate sample of 435 community pharmacists was selected from all regions of Lebanon. A standardized self-administered questionnaire, distributed by trained interviewers, was used to assess the studied variables.

Results:

The results showed that 50.12% of the pharmacists had emotional work fatigue [95%CI 0.454-0.549], 55.01% had mental work fatigue [95%CI 0.503-0.597], and 54.78% had physical work fatigue [95%CI 0.501-0.595]. Higher mental work fatigue was significantly associated with higher stress (Beta=0.185) and having a master’s degree compared to a bachelor’s degree (Beta=2.23). Higher emotional work fatigue was significantly associated with higher stress (Beta=0.219), working more than 40 hours compared to ≤ 16 hours (Beta=2.742), and having 6 months to less than 1 year of practice compared to less than 6 months (Beta=-5.238). Higher physical work fatigue was significantly associated with higher stress (Beta=0.169) and having better soft skills (Beta=-0.163).

Conclusions:

Work-related fatigue is high among community pharmacists and touches all aspects: physical, mental, and emotional. In our study, community pharmacists’ fatigue levels were associated with educational level, years of experience, working hours, stress, depression, and soft skills, while no relation was found with gender, age, position in the pharmacy, and economic status. Interventions are recommended to tackle this public health problem that affects pharmacists, and eventually, patients.

Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis

WHO recently declared burnout as a "occupational phenomenon" in the International Classification of Diseases 11th revision (ICD-11), recognizing burnout as a serious health issue. Amongst healthcare workers, nurses are known to struggle with burnout symptoms the most, carrying serious consequences for patients, other healthcare professionals and healthcare organisations. Evidence has suggested that burnout symptoms in nurses is high across specialties and countries, but no meta-analysis have been performed to investigate burnout symptoms prevalence in nurses globally. We conducted a systematic review and meta-analysis to examine burnout symptoms prevalence in nurses worldwide using 8 academic research databases. Risk of bias, heterogeneity and subgroup analyses were further conducted in the meta-analysis. 113 studies were included for systematic review and 61 studies for the meta-analysis, consisting 45,539 nurses worldwide in 49 countries across multiple specialties. An overall pooled-prevalence of burnout symptoms among global nurses was 11.23%. Significant differences were noted between geographical regions, specialties and type of burnout measurement used. Sub-Saharan African region had the highest burnout symptoms prevalence rate while Europe and Central Asia region had the lowest. Paediatric nurses had the highest burnout symptoms prevalence rates among all specialties while Geriatric care nurses had the lowest. This study is the first study to synthesize published studies and to estimate pooled-prevalence of burnout symptoms among nurses globally. The findings suggest that nurses have high burnout symptoms prevalence warranting attention and implementation. This study serves as an impetus for intervention studies and policy change to improve nurses' work conditions and overall healthcare quality.

Prevalence and Factors Associated with Burnout among Healthcare Professionals in India: A Systematic Review and Meta-Analysis

BACKGROUND

With increasing workload and dismal working conditions, healthcare professionals (HCPs) in India often suffer from burnout. Understanding the extent of these problems and the contributing factors is necessary to build a healthy workforce capable of serving the society. The purpose of this study was to systematically review and analyze: 1) the prevalence of burnout among HCPs in India and 2) the factors associated with burnout in this population.

METHODS

A systematic search of MEDLINE and EMBASE, from the inception of these databases to October 2019, was conducted using keywords. The search results were screened to identify studies evaluating burnout among HCPs in India using a standard burnout tool. Using a random effect model, the pooled prevalence of burnout was estimated using Maslach Burnout Inventory (MBI) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Risk factors for burnout were assessed qualitatively.

RESULTS

A total of 15 studies assessing burnout in 3845 Indian HCPs were identified. The pooled prevalence of burnout was 24% in the EE domain, 27% in the DP domain, and 23% in the PA domain. Younger age, female gender, unmarried status, and difficult working conditions were associated with increased risk of burnout.

CONCLUSION

Burnout is highly prevalent among Indian HCPs, with close to one-fourth of them suffering from burnout. A number of personal and professional factors are associated with burnout, and these should be considered while developing solutions to tackle burnout.

Barriers and facilitators to recruiting and retaining men on pre-registration nursing programmes in Western countries: A systemised rapid review

BACKGROUND

The recruitment of men to pre-registration nursing programmes in many Western countries has remained static at approximately 10% per year.

AIM

To identify the experiences and attitudes of men on pre-registration nursing programmes in Western countries and the barriers and enablers to their recruitment and retention.

DESIGN

Systematized rapid review.

METHODS

Searches were undertaken in Medline (Ovid), CINAHL (EBSCO) and PsychINFO (EBSCO) databases. Studies in English were included if they were from Western countries, were published since 2000 and related to men's experiences of, or attitudes to, applying for or studying pre-registration nursing. Included papers were quality appraised and findings were thematically analysed and presented in a narrative synthesis.

RESULTS

Records were de-duplicated and 2063 records were screened and 44 articles assessed for eligibility of which 23 articles relating to 22 empirical studies were included in the review. Findings were categorised into the following themes: recruitment experiences/reasons for studying nursing; gender experiences; barriers, difficulties and challenges with programme; and factors affecting retention.

CONCLUSION

Evidence suggests that many men who come into nursing have a family member or acquaintance who is a nurse or that they have had contact with a male nurse as a patient or carer. Motivating factors such as financial security, career mobility and the opportunity to have a job in a caring profession were reported. Improved career advice at school is needed and shortened graduate programmes could be attractive. On programme, some clinical areas were easier for male students, while in others, treatment refusal could cause difficulties. Being in a minority and gender stereotyping can affect experiences. Ensuring equitable treatment, providing additional support and placements in clinical areas with more men could minimise these challenges.

Burnout and imposter syndrome among Saudi young adults. The strings in the puppet show of psychological morbidity

OBJECTIVES

To determine the prevalence of imposter syndrome (IS) among Saudi adults and its association with burnout.

METHODS

Using non-probability convenience sampling, we carried out a cross-sectional analytical study among adults in Northern Saudi Arabia. Data collection toll was a self-administered questionnaire containing young imposter scale (YIS), Maslach burnout inventory (MBI) and depression, anxiety, and stress scale 21 (DASS 21). These 3 scales are valid and reliable measurement tools for measuring IS, burnout, and psychological morbidity.

RESULTS

In the study sample (n=384), imposterism was present among 222 adults (57.8%). Moderate and severe symptoms of depression were present in 217 (56.5%), symptoms of stress in 210 (54.7%), and symptoms of anxiety in 126 (32.8%). Burnout was measured in 3 domains of depersonalization, emotion exhaustion, and personal accomplishments. High degree of depersonalization was found in 221 (57.6%), higher emotional exhaustion in 246 (64.1%) while lower personal accomplishment was present in 126 (32.8%). We found statistical association between IS and gender (p less than 0.01), depression (p less than 0.001) stress (p less than 0.001) and all 3 domains of burnout (p less than 0.01). Imposter syndrome was not found associated with anxiety (p=0.97). Young imposter scale score was associated with all the 3 domains of burnout even after controlling for depression, anxiety, and stress.

CONCLUSION

Imposter syndrome is frequent among Saudi adults and associated with all 3 burnout domains. Mental health domains like burnout, depression, stress, and anxiety were found associated with IS.

Indicators Associated With Job Morale Among Physicians and Dentists in Low-Income and Middle-Income Countries: A Systematic Review and Meta-analysis

IMPORTANCE

Improving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear.

OBJECTIVE

To analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale.

DATA SOURCES

A comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed.

STUDY SELECTION

Studies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12 324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis.

DATA EXTRACTION AND SYNTHESIS

Data were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias.

MAIN OUTCOMES AND MEASURES

Levels of job burnout, job satisfaction, and job motivation as indicators of job morale.

RESULTS

Overall, 12 324 records were identified. Of them, 80 records, representing 79 studies and involving 45 714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I2 = 95.32%; P < .001) reported job burnout, and in 20 studies with 14 113 participants, 60% (95% CI, 53%-67%; I2 = 98.21%; P < .001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation.

CONCLUSIONS AND RELEVANCE

The findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.

Predicting Burnout Factors among Healthcare Providers at Private Hospitals in Saudi Arabia and United Arab Emirates: A Cross-Sectional Study

Background: Burnout is defined as a long-term work stress. The prevalence of burnout syndrome among nurses is 42% of nurses in England. Many countries have conducted studies to measure the level of burnout among health care providers. There is a lack of research on burnout among healthcare providers in the Arabic countries. Aims: This study aimed to assess the burnout level among healthcare providers in Saudi Arabia and United Arab Emirates and to predict the burnout factors of healthcare providers working in tertiary private hospitals. Methods: A descriptive cross-sectional survey was used to evaluate the burnout among healthcare providers. A total of 900 healthcare providers working in the clinical areas of six private hospitals in the Arabia Gulf Region were recruited for the study. A total of 892 healthcare providers were included in the study. A total of eight surveys were excluded due to major missing data. Results: A total of 892 healthcare providers were included in the study. The average age was 32 years ± 7 years for male and female healthcare providers. A high burnout level was found in the results. The participating female healthcare providers had a higher level of emotional exhaustion as compared with their male counterparts. Nurses had more emotional exhaustion as compared with physicians, respiratory therapists, and other colleagues. Conclusions: High burnout levels among healthcare providers can reflect negatively on the healthcare providers well-being, job satisfaction, and mental health. Burnout has been linked with medical errors and physician–patient relationships. We believe that it is important to deal with this issue of public health in Saudi Arabia and UAE. This study aimed to explore burnout levels among healthcare providers in Saudi Arabia and UAE. Results showed a high level of burnout among the healthcare.

Burnout among Moroccan Oncologists: A National Survey

Introduction: Burnout is an unwanted outcome of chronic occupational stressors. Oncology staff is expected to suffer from burnout more than other health-care professionals. The aim of this survey was to determine the prevalence of burnout among Moroccan oncologists and to determine potential causal factors. Methods: We conducted a cross-sectional analytical study using an online self-administered questionnaire to oncologists in Morocco. We used the Maslach Burnout Inventory and additional questions exploring work and lifestyle factors. The questionnaire was sent in January 2018. Results: A total of 100 oncologists answered the questionnaire with predominance of women (75%), young participants (74%), and medical oncologists (60%). Eighty-five percent of the oncologists showed evidence of burnout. The rates of high scores of emotional exhaustion, depersonalization, and low scores of personal accomplishment were, respectively, 57%, 44%, and 56%. In the univariate linear analysis, age younger than 35 years (p = 0.014), being in residency training (p = 0.004), not having extra professional activities (p = 0.009), having an experience less than 10 years (p = 0.02) and estimating vacation time as not adequate (p = 0.05) were all significantly associated with increased burnout scores. In the multivariate analysis, only age &lt;35 years (p = 0.028), being in residency training (p = 0.026), and having an experience less than 10 years (p = 0.01) were independent risk factors of burnout. Conclusion: These findings reveal that burnout in oncologists is higher than those reported internationally. Multidimensional interventions should be implemented to reduce burnout rates among Moroccan oncologists.

Systematic review of burnout among healthcare providers in sub-Saharan Africa

BACKGROUND

Burnout is characterized by physical and emotional exhaustion from long-term exposure to emotionally demanding work. Burnout affects interpersonal skills, job performance, career satisfaction, and psychological health. However, little is known about the burden of burnout among healthcare providers in sub-Saharan Africa.

METHODS

Relevant articles were identified through a systematic review of PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO). Studies were selected for inclusion if they examined a quantitative measure of burnout among healthcare providers in sub-Saharan Africa.

RESULTS

A total of 65 articles met our inclusion criteria for this systematic review. Previous studies have examined burnout in sub-Saharan Africa among physicians (N = 12 articles), nurses (N = 26), combined populations of healthcare providers (N = 18), midwives (N = 2), and medical or nursing students (N = 7). The majority of studies assessed burnout using the Maslach Burnout Inventory. The highest levels of burnout were reported among nurses, although all healthcare providers showed high burnout. Burnout among healthcare providers is associated with their work environments, interpersonal and professional conflicts, emotional distress, and low social support.

CONCLUSIONS

Available studies on this topic are limited by several methodological challenges. More rigorously designed epidemiologic studies of burnout among healthcare providers are warranted. Health infrastructure improvements will eventually be essential, though difficult to achieve, in under-resourced settings. Programs aimed at raising awareness and coping with burnout symptoms through stress management and resilience enhancement trainings are also needed.

Delivering and evaluating a scalable training model for strengthening family medicine in resource-limited environments: the Gaza experience. A mixed-methods evaluation

Background

Since 2007, Gaza Palestine has been subject to blockade affecting over 1.9 million people. This denies health professionals access to continuing professional development (CPD). In Gaza, family physicians are scarce, and their level of training does not meet the needs of United Nations Relief and Works Agency’s (UNRWA) Family Health Team (FHT) model for better population health.

Aim

This study sought to develop a postgraduate training programme for Gazan doctors via a Diploma in Family Medicine (FM PG), and evaluate its impact on physicians and patients.

Design & setting

A mixed-methods evaluation of a postgraduate diploma in Gaza Palestine.

Method

The programme was delivered over 1 year, to 15 primary care doctors. The impact was evaluated through focus group discussions and patient feedback questionnaire survey comparing FM PG graduate doctors and doctors without the FM PG Diploma.

Results

All participating doctors graduated successfully and found the experience extremely positive. Trainees felt that the Diploma helped them take more individualised approach to patients; have a better understanding of psychosocial elements affecting patient health; feel more inclined towards team-working and collaborative approaches to health care; and more insight into non-verbal communication such as active listening and tactile gestures. Statistical analysis of patients’ feedback showed significantly improved patient-reported outcomes and satisfaction when treated by course diplomates compared to non-diplomates.

Conclusion

Where there are limited training opportunities, investment in a structured postgraduate diploma training programme can improve quality of health service delivery. UNRWA’s experience in Gaza demonstrates the value of a scalable model in resource-limited settings.

Burnout and Its Relationships With Alexithymia, Stress, Self-Esteem, Depression, Alcohol Use Disorders, and Emotional Intelligence: Results From a Lebanese Cross-Sectional Study

Our aim was to assess the relationship between personality and psychological traits, and burnout among the Lebanese population. A questionnaire-based cross-sectional study was conducted with multiple validated scales used to measure burnout and other characteristics. A cluster analysis was then performed to split the population into mutually exclusive groups with different profiles according to the burnout scales using the K-mean method. A multivariate analysis of covariance was carried out to compare multiple measures between the cluster groups under comparison. The study, conducted between November 2017 and March 2018, enrolled 789 participants. The results showed that 100 (14.0%) had high emotional work fatigue, whereas 443 (62.5%) and 680 (95.4%) had high mental and physical work fatigue, respectively. People with high physical work fatigue (cluster 1) had lower alcohol dependence (β = -2.78), alexithymia (β = -3.16), depression (β = -7.20), anxiety (β = -6.99), perceived stress (β = -2.53), social phobia (β = -11.49), suicidal ideation (β = -0.35), emotional awareness (β = -4.54), emotional managament (β = -1.71), social emotional awareness (β = -9.27), and relationship management (β = -9.12). People with high emotional work fatigue (cluster 2) had higher alcohol dependence (β = 2.11), alexithymia (β = 6.51), depression (β = 2.48), anxiety (β = 4.11), perceived stress (β = 4.30), and lower emotional awareness (β = -6.68), emotional management (β = -7.80), social emotional awareness (β = -3.71), and relationship management (β = -3.05). Higher levels of burnout were found to be associated with multiple psychological factors. The results would help understand the burnout dimensions and their correlated factors in the Lebanese population.

Prevalence of Burnout among Primary Health Care Staff and Its Predictors: A Study in Iran

Burnout, which is an emerging challenge in health systems, is very common among primary health care (PHC) workers. The aim of this study was to investigate the level of burnout among PHC workers, and its predictive factors, in a region in the west of Iran. In this cross-sectional study, all the health network staff (n = 539) were enrolled. The data collection instrument was the Maslach Burnout Inventory (MBI), which consists of 22 items and the three subscales of emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). High scores in EE and DP and low scores in PA are indicative of high burnout. Logistic regression was used to determine the predictors of high burnout. The data were analyzed using SPSS version 16. The findings showed that 90.5% of the staff had high DP, 55.3% had high EE, and 98.9% had low PA scores. Also, 52.9% (277 people) of the staff suffered from high burnout. Single people (OR = 3.33), less experienced employees (OR = 9.09), people aged over 35 years (OR = 2.35), physicians (OR = 1.72), and staff with permanent employment (OR = 5.0) were more likely to suffer high levels of burnout. We conclude that burnout is a common problem in PHC workers. Less experienced, younger, single employees and physicians were more at risk of suffering from high burnout. Preventive measures, such as strengthening social skills, communication competencies, and coping strategies, and reduction of risk factors such as job stress, are suggested for reducing employees’ risk of burnout.

Association between transformational leadership and occupational burnout and the mediating effects of psychological empowerment in this relationship among CDC employees: a cross-sectional study

Purpose: Centers for Disease Control and Prevention (CDC) is playing a vital role in protecting public health and safety. However, few studies have researched on the occupational burnout of CDC employees in the world. Previous studies have reported that transformational leadership could improve the level of psychological empowerment and ameliorate burnout of the employees. In this study, we aimed to analyze the association between transformational leadership and burnout and to test the mediating role of psychological empowerment in this relationship among CDC employees in China.

Methods: Maslach Burnout Inventory-Human Service Survey, Transformational Leadership Questionnaire, and Psychological Empowerment Scale were used to measure burnout, transformational leadership, and psychological empowerment. A total of 385 CDC employees (effective response rate: 96.25%) were included in the study. We analyzed the association between transformational leadership and three subscales of burnout with hierarchical linear regression analyses. The mediating role of psychological empowerment was finally examined by asymptotic and resampling strategies.

Results: Transformational leadership was negatively associated with emotional exhaustion, depersonalization, and reduced personal accomplishment after controlling sociodemographic and working context characteristics. Transformational leadership and psychological empowerment, respectively, accounted for 9.3% and 12.3% of the variance in emotional exhaustion; 8.5% and 16.7% of the variance in depersonalization; and 6.7% and 10.0% of the variance in reduced personal accomplishment. We found that psychological empowerment played a partially mediating role on the relationship between transformational leadership and burnout. The proportion of psychological empowerment’s mediating effect was 41.56% for emotional exhaustion, 50.62% for depersonalization, and 44.32% for reduced personal accomplishment.

Conclusions: It was suggested that transformational leadership could decrease the risk of burnout by the pathway of promoting the employee’s psychological empowerment. Interventions focusing on transformational leadership and psychological empowerment should be of significance to cut burnout.

Provision and uptake of routine antenatal services: a qualitative evidence synthesis

BACKGROUND

Antenatal care (ANC) is a core component of maternity care. However, both quality of care provision and rates of attendance vary widely between and within countries. Qualitative research can assess factors underlying variation, including acceptability, feasibility, and the values and beliefs that frame provision and uptake of ANC programmes.This synthesis links to the Cochrane Reviews of the effectiveness of different antenatal models of care. It was designed to inform the World Health Organization guidelines for a positive pregnancy experience and to provide insights for the design and implementation of improved antenatal care in the future.

OBJECTIVES

To identify, appraise, and synthesise qualitative studies exploring:· Women's views and experiences of attending ANC; and factors influencing the uptake of ANC arising from women's accounts;· Healthcare providers' views and experiences of providing ANC; and factors influencing the provision of ANC arising from the accounts of healthcare providers.

SEARCH METHODS

To find primary studies we searched MEDLINE, Ovid; Embase, Ovid; CINAHL, EbscoHost; PsycINFO, EbscoHost; AMED, EbscoHost; LILACS, VHL; and African Journals Online (AJOL) from January 2000 to February 2019. We handsearched reference lists of included papers and checked the contents pages of 50 relevant journals through Zetoc alerts received during the searching phase.

SELECTION CRITERIA

We included studies that used qualitative methodology and that met our quality threshold; that explored the views and experiences of routine ANC among healthy, pregnant and postnatal women or among healthcare providers offering this care, including doctors, midwives, nurses, lay health workers and traditional birth attendants; and that took place in any setting where ANC was provided.We excluded studies of ANC programmes designed for women with specific complications. We also excluded studies of programmes that focused solely on antenatal education.

DATA COLLECTION AND ANALYSIS

Two authors undertook data extraction, logged study characteristics, and assessed study quality. We used meta-ethnographic and Framework techniques to code and categorise study data. We developed findings from the data and presented these in a 'Summary of Qualitative Findings' (SoQF) table. We assessed confidence in each finding using GRADE-CERQual. We used these findings to generate higher-level explanatory thematic domains. We then developed two lines of argument syntheses, one from service user data, and one from healthcare provider data. In addition, we mapped the findings to relevant Cochrane effectiveness reviews to assess how far review authors had taken account of behavioural and organisational factors in the design and implementation of the interventions they tested. We also translated the findings into logic models to explain full, partial and no uptake of ANC, using the theory of planned behaviour.

MAIN RESULTS

We include 85 studies in our synthesis. Forty-six studies explored the views and experiences of healthy pregnant or postnatal women, 17 studies explored the views and experiences of healthcare providers and 22 studies incorporated the views of both women and healthcare providers. The studies took place in 41 countries, including eight high-income countries, 18 middle-income countries and 15 low-income countries, in rural, urban and semi-urban locations. We developed 52 findings in total and organised these into three thematic domains: socio-cultural context (11 findings, five moderate- or high-confidence); service design and provision (24 findings, 15 moderate- or high-confidence); and what matters to women and staff (17 findings, 11 moderate- or high-confidence) The third domain was sub-divided into two conceptual areas; personalised supportive care, and information and safety. We also developed two lines of argument, using high- or moderate-confidence findings:For women, initial or continued use of ANC depends on a perception that doing so will be a positive experience. This is a result of the provision of good-quality local services that are not dependent on the payment of informal fees and that include continuity of care that is authentically personalised, kind, caring, supportive, culturally sensitive, flexible, and respectful of women's need for privacy, and that allow staff to take the time needed to provide relevant support, information and clinical safety for the woman and the baby, as and when they need it. Women's perceptions of the value of ANC depend on their general beliefs about pregnancy as a healthy or a risky state, and on their reaction to being pregnant, as well as on local socio-cultural norms relating to the advantages or otherwise of antenatal care for healthy pregnancies, and for those with complications. Whether they continue to use ANC or not depends on their experience of ANC design and provision when they access it for the first time.The capacity of healthcare providers to deliver the kind of high-quality, relationship-based, locally accessible ANC that is likely to facilitate access by women depends on the provision of sufficient resources and staffing as well as the time to provide flexible personalised, private appointments that are not overloaded with organisational tasks. Such provision also depends on organisational norms and values that overtly value kind, caring staff who make effective, culturally-appropriate links with local communities, who respect women's belief that pregnancy is usually a normal life event, but who can recognise and respond to complications when they arise. Healthcare providers also require sufficient training and education to do their job well, as well as an adequate salary, so that they do not need to demand extra informal funds from women and families, to supplement their income, or to fund essential supplies.

AUTHORS' CONCLUSIONS

This review has identified key barriers and facilitators to the uptake (or not) of ANC services by pregnant women, and in the provision (or not) of good-quality ANC by healthcare providers. It complements existing effectiveness reviews of models of ANC provision and adds essential insights into why a particular type of ANC provided in specific local contexts may or may not be acceptable, accessible, or valued by some pregnant women and their families/communities. Those providing and funding services should consider the three thematic domains identified by the review as a basis for service development and improvement. Such developments should include pregnant and postnatal women, community members and other relevant stakeholders.

Interactive effects of corticotropin-releasing hormone receptor 1 gene and work stress on burnout in medical professionals in a Chinese Han population

BACKGROUND

Burnout is a worked-related stress syndrome caused by long-term exposure to a stressful environment. Dysregulation of the hypothalamic- pituitary- adrenal (HPA) axis may be involved in both stress and burnout; an evaluation of genetic polymorphisms which alter activity in the HPA may be predictive of how likely an environment is to produce burnout.

METHODS

Using a cross-sectional design, this study examined whether corticotrophin-releasing hormone receptor 1 (CRHR1) gene polymorphism rs110402 is a risk factor for burnout; further, it explores whether the interaction of stress × CRHR1 gene predicts burnout in the healthcare workers in a Chinese Han population. House and Rizzo's work stress scale, Sources of Pressure Scale and Maslach Burnout Inventory-General Survey were administered to 712 participants from a large general hospital in Beijing. The CRHR1 rs110402 polymorphism was genotyped in 376 participants.

RESULTS

Our results showed significant positive inter-correlations between stressor, work stress and depressive scores (all p < 0.001) with only one exception. Males, younger age and higher educational level were associated with burnout (all p < 0.05). The presence of the CRHR1 rs110402 genotype was not correlated with the presence of job stress or burnout. However, we found statistically significant interaction between CRHR1 rs110402 and job stress on burnout (p < 0.05). Individuals homozygous for the A allele reported significantly higher emotional exhaustion than G allele carriers in the high stress group.

LIMITATIONS

The sample was only chosen from the medical professions, and the sample size was relatively small. Only one polymorphism in CRHR1 gene was analyzed, while only about half of the total individuals were genotyped.

CONCLUSIONS

Our results suggest a close relationship between work-related stress and burnout and that the A allele of the CRHR1 rs110402 polymorphism may enhance feelings of emotional exhaustion when experiencing work-related stress.

Emotional Intelligence and Burnout in Plastic Surgery Residents: Is There a Relationship?

Background:

The specific role of emotional intelligence (EI) in the field of plastic surgery has not been investigated. We aim to investigate the relationship between EI and the individual components of burnout among plastic surgery residents in Saudi Arabia.

Methods:

In this cross-sectional study, all plastic surgery residents (n = 37) in Riyadh, Saudi Arabia, were invited to participate in a questionnaire based study in March 2018. The survey contained a validated measure of burnout (Maslach Burnout Inventory-Human Services Survey), validated measure of EI (Trait Emotional Intelligence Questionnaire-Short Form), and evaluated residents’ demographics, professional and personal risk factors, and career satisfaction.

Results:

The overall rate of high burnout was 37.9%, with 72.4% residents reporting high level of emotional exhaustion (EE), 41% reporting high depersonalization (DP) and 41% reporting low sense of personal accomplishment (PA). EI has shown to have a significant negative relationship with EE (95% confidence interval CI, −9.061 to −1.374; P = 0.010), DP (95% CI, −5.747 to −1.974; P < 0.001), and a significant positive correlation with PA (95% CI, 1.398–5.439; P = 0.002). Significant risk factors for burnout included dissatisfaction with plastic surgery as a career choice, dissatisfaction with income, and dissatisfaction with the role in the operating room (P < 0.05).

Conclusions:

We found a positive correlation between higher levels of EI and sense of personal achievement, whereas a negative correlation was observed between higher level of EI and EE and DP among the residents in this study. Plastic surgery residents who are satisfied with their salary have lower EE and DP. Residents who are satisfied with their role in the operating room have a better sense of PA.

Addressing Burnout in Radiologists

Burnout is a global health problem affecting physicians across all medical specialties. Radiologists, in particular, experience high rates of burn out, and this trend has only continued to worsen. The "Promoting Health and Wellness for Radiologists Task Force of the Association of University Radiologists-Radiology Research Alliance" presents a review of the prevalence, causes, and impact of burnout among radiology faculty and trainees, and a discussion on strategies for overcoming burnout and promoting overall health and well-being among radiologists.

Perceived stress and coping strategies among ICU nurses in government tertiary hospitals in Saudi Arabia: a cross-sectional study

BACKGROUND

No study has examined the stress level and coping strategies among critical care nurses in Saudi Arabia.

OBJECTIVES

Examine perceived stress and coping behaviors among nurses in intensive care units in Saudi Arabia, and the influence of cop.ing mechanisms on stress.

DESIGN

Descriptive cross-sectional.

SETTING

Two tertiary training hospitals in Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

Nurses from cardiac, surgery and pediatric intensive care units responded to an online survey. Perceived Stress Scale-10 (PSS-10) and the Brief COPE Inventory were used as primary research tools. Multivariate methods were used to analyze the data.

MAIN OUTCOME MEASURES

Stress levels, coping strategies, and associated factors.

SAMPLE SIZE

154 nurses.

RESULTS

The majority of the respondents reported a moderate level of stress in the past month (87.0%). Mean (SD) scores for nurses working in the cardiac ICU indicated significantly higher levels of stress compared to surgical ICU (18.18 [3.88] vs 6.17 [3.21], P=.025). Belief in religion was the most common coping behavior while the use of substances was the lowest (mean scores [SD] 6.70 [ 1.72] vs 2.22 [0.81]). In the multivariate analysis, behavioral disengagement (P=.016) and self-blame (P less than .001) intensified the PSS-10 score, whereas acceptance (P=.048) reduced the PSS-10 score.

CONCLUSION

The additional knowledge that behavioral disengagement and blaming aggravate stress can serve as the basis in formulating work-related stress reduction strategies among nurses caring for critical patients.

LIMITATIONS

The use of self-reports, convenience sampling, and selected demographic factors may have limited the scope and generalizability of the findings and induced social desirability bias.

CONFLICT OF INTEREST

None.

New Burnout Evaluation Model Based on the Brief Burnout Questionnaire: Psychometric Properties for Nursing

Health care personnel are considered one of the worker sectors most exposed to heavier workloads and work stress. One of the consequences associated with the exposure to chronic stress is the development of burnout syndrome. Given that evaluating this syndrome requires addressing the context in which they are to be used, the purpose of this work was to analyze the psychometric properties and structure of the Burnout Brief Questionnaire (CBB), and to propose a more suitable version for its application to health professionals, and more specifically nurses. The final study sample was made up of 1236 working nursing professionals. An exploratory factorial analysis was carried out and a new model was proposed through a confirmatory factorial analysis. Thus, validation of the CBB questionnaire for nursing health care personnel showed an adequate discrimination of the items and a high internal consistency of the scale. With respect to the factorial analysis, four factors were extracted from the revised model. Specifically, these new factors, called job dissatisfaction, social climate, personal impact, and motivational abandonment, showed an adequate index of adjustment. Thus, the Brief Burnout Questionnaire Revised for nursing staff has favorable psychometric properties, and this model can be applied to all health care professionals.

Association between Depression and Factors Affecting Career Choice among Jordanian Nursing Students

Background

Although stress reaction is high among nursing staff and nursing students in the Middle East and its effect on life is known, there are scant studies reporting on these clinical and social features. In addition, there are no studies reporting on factors that influence career choice among this group.

Aim

This study aimed to investigate factors that influence career choice among nursing students and their possible association with depressive symptoms.

Method

Participants were 150 (84.7% response rate) nursing students randomly selected from each academic year at the Nursing College/Jordan University of Science and Technology. Participants consented and completed the socio-demographic data collection sheet. The Arabic version of the Beck Depression Inventory-II Scale was used to assess participants with respect to depressive symptoms. A modified list of factors influencing career choice and a Likert scale to assess the level of sadness and the degree of religiosity were used as well.

Results

Students ranked the most important three factors influencing their career selection as family decision, religious factors, and the desire to care for others. The prevalence of depression among the sample was 26%. Students who had a desire to care for others were less likely to suffer from depression and those who chose nursing as their career due to religious factors were significantly less depressed than those who did not. Meanwhile, students who chose nursing under family pressure or because of a lack of alternative opportunities were more depressed. The odds ratio for depressive symptoms was 0.24 when students chose nursing because of religious factors, whereas it was 4.92 when the family strongly influenced the student’s career decision and 3.61 when a nursing career was the only perceived opportunity available.

Conclusion

The main factors associated with depression among this sample of nursing students were pressure from their family to choose a nursing career and having no other career or employment opportunities. Religiosity was negatively associated with depression and may act as a protective factor; however, future studies using longitudinal designs will need to confirm this hypothesis.