The Use of Yoga to Manage Stress and Burnout in Healthcare Workers: A Systematic Review

Capturing challenges and trade-offs in healthcare work using the pressures diagram: An ethnographic study

Healthcare workers must balance competing priorities to deliver high-quality patient care. Rasmussen's Dynamic Safety Model proposed three factors that organisations must balance to maintain acceptable performance, but there has been little empirical exploration of these ideas, and little is known about the risk trade-offs workers make in practice. The aim of this study was to investigate the different pressures that healthcare workers experience, what risk trade-off decisions they make in response to pressures, and to analyse the implications for quality and safety. The study involved 88.5 h of ethnographic observations at a large, teaching hospital in central London. The analysis revealed five distinct categories of hospital pressures faced by healthcare workers: efficiency, organisational, workload, personal, and quality and safety pressures. Workers most often traded-off workload, personal, and quality and safety pressures to accommodate system-level priorities. The Pressures Diagram was developed to visualise risk trade-offs and prioritising decisions and to facilitate communication about these aspects of healthcare work.

Yoga and mental health: what every psychiatrist needs to know

Yoga was developed primarily as a tool for self-mastery and spiritual progress. However, over the past few decades, the therapeutic applications of yoga in mental healthcare have been explored with promising results. This article aims to inform psychiatrists about the clinical usefulness of yoga for mental disorders. We discuss the rationale and latest evidence base for the use of yoga in psychiatric practice, including the neurobiological mechanisms and indications and contraindications for yoga therapy. We suggest practical yoga techniques that can be used as an add-on for managing common psychiatric conditions. Finally, we discuss the setting up and running of yoga clinical services in a tertiary psychiatric hospital in India and explore what can be learnt to facilitate yoga as a therapeutic approach in the Western world.

Yoga as an adjunct activity for medical students learning anatomy

BACKGROUND

Medical students experience high levels of stress during training due to demanding course loads which often leaves less time for self-care. This study combines the self-care technique of yoga with learning anatomical locations, innervations, actions, and functions of the muscles and organs to determine if anatomy tests scores are improved and whether students' stress levels attenuate from participating in yoga.

METHODS

In this randomized controlled study, 64 student volunteers were randomized into either a yoga intervention group or wait list control group throughout the M1 anatomy course. The yoga group (n = 32) participated in 8 yoga sessions synced with the anatomy topics they were learning in lecture. The wait list group (n = 32) went through their normal anatomy curriculum but had an option to participate in the same yoga sessions after the anatomy course. The primary research purpose was to determine whether yoga improved anatomy exam performance by comparing four anatomy exam scores between the two groups. The secondary research purposes included the following: to determine whether yoga classes including anatomy teaching still conferred acute and long-lasting stress relief by, respectively, comparing a students' own pre- and post-yoga stress level and self-perceived stress levels between the two groups; and to determine if a student's confidence in anatomy was improved after a yoga session.

RESULTS

There was no significant difference in anatomy exam performance between students who received yoga and those on the waitlist (all p > 0.05). For students who received yoga, their average self-reported stress levels decreased after each yoga session, their average DASS (Depression, Anxiety and Stress Scale) score decreased after a yoga session, but they were not significantly less stressed than their waitlist peers prior to an exam, and their self-reported confidence in anatomy material related to the back, upper extremity, head and neck, and abdomen/pelvis increased.

CONCLUSION

With this sample, there was no evidence that yoga sessions paired with anatomy lecture material improved overall anatomy exam performance, as opposed to only the musculoskeletal portion which other studies have looked at. However, yoga acutely reduced stress levels, and subjective feelings of knowledge improvement were noted by participants. Both of these can provide benefits to medical students.

Determining the effect of yoga on job satisfaction and burnout of nurse academicians

PURPOSE

This study was conducted to determine the effect of yoga on burnout and job satisfaction of nursing academicians.

DESIGN AND METHODS

The research is an experimental clinical trial conducted as pretest-posttest with control groups between March and August 2019 in a Nursing Faculty. Participants in the experimental group were given yoga practice (n = 33) twice a week for 8 weeks. Data were collected by using MBI and MSQ.

FINDINGS

The experimental group's mean posttest Personal Achievement, Extrinsic Satisfaction and General Satisfaction scores were higher than that of control group participants, and a highly significant difference was found between the groups.

PRACTICE IMPLICATIONS

Yoga practice is effective in reducing the burnout and increasing job satisfaction of nursing academicians.

Mindfulness as a tool for reducing stress in healthcare professionals: An umbrella review

BACKGROUND

Health care providers (HCPs) and health care students experience a huge amount of stress due to high workloads and pressure to perform and are likely to develop anxiety, depression and burnout.

OBJECTIVE

The objective was to carry out an umbrella review of systematic and narrative reviews on the effectiveness of mindfulness-based interventions in reducing stress and improving well-being in HCPs and health care students.

METHODS

Systematic and narrative reviews that examined the impact of mindfulness-based interventions on HCPs and healthcare students' perceived stress were identified through a systematic search of three electronic databases: PubMed, Scopus and Web of Science.

RESULTS

Fifteen articles were included in the analysis: eleven systematic and four narrative reviews. Studies' quality varied from critically low to high. The different interventions showed positive results in reducing stress in both HCPs and students, with mindfulness-based stress reduction (MBSR) course having the major impact.

CONCLUSIONS

MBSR techniques and other mindfulness based interventions resulted to be potentially effective in reducing stress. However, despite the vast amount of data collected by the studies and the promising results, several limitations affected the validity of the studies. Therefore, more research that considers the critical aspects of this field is required, in order to provide more reliable results.

Mindful self-compassion for nurses: a systematic review

This article details a systematic review that aimed to synthesise and analyse the published research on the effects of mindful self-compassion interventions on stress in nurses. Five studies were identified that met the inclusion criteria and were analysed in terms of sample characteristics, intervention, measurement of self-compassion, additional psychosocial outcome measures, intervention duration and adherence, intervention outcomes and effect size and follow-up. The review found that mindful self-compassion interventions had medium-to-large effect sizes for self-compassion, traumatic stress, burnout, stress and compassion satisfaction. There was also high intervention adherence (mean=86%) in the included studies. Since these interventions can improve self-compassion and compassion in nurses, they have the potential to enhance the quality of compassionate care provided by nurses who undergo training in mindful self-compassion.

Stress, psychological distress and support in a health care organization during Covid-19: A cross-sectional study

AIM

The main aim of this study was to understand what health and wellbeing initiatives are helpful for health care workers' stress and psychological distress during the Covid-19 pandemic.

BACKGROUND

Health care workers are at increased risk of poor mental health during health emergencies; understanding support required for health care workers is of paramount importance.

METHODS

Participants were health care workers at a health and social care organization (N = 159). The study included an online questionnaire including an evaluation of health and wellbeing initiatives and measures of perceived stress and psychological distress.

RESULTS

The highest rated resources were counselling, personal protective equipment (PPE) and Covid-19 testing. Those who accessed yoga reported significantly less stress and psychological distress than those who did not access yoga.

CONCLUSIONS

Health care workers with higher stress and psychological distress felt less supported by their organization, less listened to and less involved in organizational decisions.

IMPLICATIONS FOR NURSING MANAGEMENT

Practical implications are discussed such as forward planning for health emergencies (e.g., PPE supply), accessible Covid-19 testing as well as budgeting for counselling services and exercise classes. In addition, targeted support for those diagnosed with Covid-19 is recommended, alongside involvement of staff members in organizational decisions.

Therapeutic role of yoga in neuropsychological disorders

Yoga is considered a widely-used approach for health conservation and can be adopted as a treatment modality for a plethora of medical conditions, including neurological and psychological disorders. Hence, we reviewed relevant articles entailing various neurological and psychological disorders and gathered data on how yoga exerts positive impacts on patients with a diverse range of disorders, including its modulatory effects on brain bioelectrical activities, neurotransmitters, and synaptic plasticity. The role of yoga practice as an element of the treatment of several neuropsychological diseases was evaluated based on these findings.

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

Mindfulness-based interventions (MBIs) are reported by experimental studies as practical approaches to reduce burnout in primary healthcare professionals (PHCP). However, to date, no research has synthesized the evidence to determine the overall effects of MBIs for reducing burnout in PHCP. We conducted a systematic review and meta-analysis to analyze the effects of MBIs to reduce burnout in PHCP. We searched articles in the PubMed/MEDLINE, Web of Science, Cochrane, and Scopus databases from inception to September 2021 using MeSH terms: "mindfulness", "burnout", and "primary healthcare". Two reviewers extracted the data and assessed the risk of bias. We used a random-effects meta-analysis to calculate the standardized mean differences (SMD) and mean differences (MD) with 95% confidence intervals (CI) of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) domains of burnout. Of 61 records, ten were included (n = 417). Overall, the studies were rated as having a high risk of bias and limited quality evidence. MBIs significantly reduced EE (SMD = -0.54, 95%CI: -0.72 to -0.36; MD = -5.89, 95%CI: -7.72 to -4.05), DP (SMD = -0.34, 95%CI: -0.52 to -0.17; MD = -1.96, 95%CI: -2.96 to -0.95), and significantly increased PA (SMD = 0.34, 95%CI: 0.17 to 0.52; MD = 2.05, 95%CI: 1.04 to 3.06). Although further high-quality research is needed, our findings support the implementation of MBIs for reducing burnout in PHCP.

A Protocol for a Systematic Review and Meta-Analysis of Mind-Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era

The coronavirus disease 2019 (COVID-19) pandemic has become an unprecedented threat to humanity worldwide, including healthcare workers (HCWs). Mind–body modalities have been used to improve the mental health, well-being, quality of life, and physical health of clinical and general populations, and may also be used to improve the mental health of HCWs during COVID-19. The objective of this review is to analyze the effectiveness of mind–body modalities for the mental health of HCWs in the COVID-19 era. Six electronic bibliographic databases were comprehensively searched to find intervention studies using mind–body modalities, including meditation, mindfulness-based intervention, autogenic training, yoga, tai chi, qigong, breathing exercise, music therapy, guided imagery, biofeedback, prayer, and faith-based techniques for HCWs. All intervention studies conducted from December 2019 to August 2021 will be included. Quality assessment will be performed according to study type, and Cochrane Collaboration’s Risk of Bias tool will be used for randomized controlled clinical trials (RCTs). If sufficient homogeneous data from RCTs exist, a meta-analysis will be performed. Dichotomous data and continuous data are presented as risk ratios and mean differences with their 95% confidence intervals, respectively. The results of this systematic review will be disseminated through the publication of a manuscript in a peer-reviewed journal or by presentation at a conference.

The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being

CONTEXT.—

Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover.

OBJECTIVE.—

To describe the state of the science regarding HCW well-being, including how it is measured, what outcomes it predicts, and what institutional and individual interventions appear to reduce it.

DATA SOURCES.—

Peer review articles as well as multiple large data sets collected within our own research team are used to describe the nature of burnout, associations with institutional resources, and individual tools to improve well-being.

CONCLUSIONS.—

Rates of HCW burnout are alarmingly high, placing the health and safety of patients and HCWs at risk. To help address the urgent need to help HCWs, we summarize some of the most promising early interventions, and point toward future research that uses standardized metrics to evaluate interventions (with a focus on low-cost institutional and personal interventions).

Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions

Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.

Role of Ayurveda and Yoga-Based lifestyle in the COVID-19 Pandemic - A Narrative Review

The COVID-19 pandemic has posed an immense challenge to health care systems around the globe in terms of limited health care facilities and proven medical therapeutics to address the symptoms of the infection. The current health care strategies have primarily focused on either the pathogen on the environmental factors. However, efforts towards strengthening the host immunity are important from public health perspective to prevent the spread of infection and downregulate the potency of the agent. While a vaccine can induce specific immunity in the host, non-specific ways of improving overall host immunity are the need. This scenario has paved the way for the use of traditional Indian therapies such as Ayurveda and Yoga. This review aims at collating available evidence on Ayurveda, Yoga and COVID-19. Further, it draws inferences from recent studies on Yoga and Ayurveda on immunity, respiratory health and mental health respectively to approximate its probable role in prophylaxis and as an add-on management option for the current pandemic.

Yoga complemented cognitive behavioral therapy on job burnout among teachers of children with autism spectrum disorders

BACKGROUND/OBJECTIVE

Job burnout is a syndrome of reaction to chronic job-related stress which affects overall health, limits occupational efficacy, and personal accomplishments of employees thereby thwarting organizational outcomes. Burnout symptoms are common among teachers of children with autism spectrum disorders (ASD) and affect the academic progress of the children. This study investigated the effectiveness of Yoga-based cognitive behavioral therapy (Y-CBT) in reducing occupational burnout among teachers of children with autism in Lagos States, Nigeria.

METHODS

A group-randomized control-trial with immediate intervention and waitlist control groups was design was adopted. Participants included 58 teachers of children with autism in public and private special schools in the area. Participants were randomly assigned to Y-CBT (N = 29) and waitlist control (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments Demographic variable, Single Item Stress Questionnaire (SISQ), and Maslach Burnout Inventory-Educators' Survey (MBI-ES) were used to collect data. Data were collected at baseline; post-test and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts.

RESULTS

Results revealed that job-burnout reduced significantly at post-test assessment among the Y-CBT group compared to the waitlisted group. The reduction in the participant was sustained across 3months follow-up evaluation.

CONCLUSION

It was concluded that Y-CBT modalities could help to reduce the burnout symptoms among teachers of children with ASD.

Favorable Outcomes From an In-person and Online Feasibility Mindful Moment Pilot Study

Long hours, inadequate staff, and increasingly complicated patients make nurses more vulnerable to increased levels of stress and burnout. Nurses skilled in exercising self-care practices are better equipped to manage complex clinical situations. The purpose of this pilot study was to evaluate the feasibility of short mindfulness sessions (Mindful Moment) practiced prior to a shift, available in person and online, on nurse burnout and perceived levels of stress. The 8-week Mindful Moment study consisted of 20-minute sessions delivered either in person or online that included yoga, self-reflection, and meditation. Nurse burnout was assessed using the Maslach Burnout Inventory at weeks 0, 4, and 8. Perceived stress was assessed using a visual analog scale before and after each Mindful Moment session. Descriptive statistics, pre/postintervention differences, and percent change calculations were used to evaluate study outcomes. Forty-seven nurses agreed to participate, with 20 nurses completing the study (43%). Participants were all female, aged 36.8 ± 9.8 years, with 12 ± 8.6 years of nursing experience. With respect to nurse burnout, there was a -31% change in emotional exhaustion (P = .079), a -31% change in depersonalization (P = .057), and a +10% change in personal accomplishment (P = .331). There were consistent reductions in nurses' perceived stress pre/post-Mindful Moment session, with percent changes ranging from -35% to 40%. Findings from this study suggest that practicing a brief Mindful Moment prior to the start of a shift is feasible and self-care interventions provide lower levels of burnout and perceived stress among this sample of nurses.

A systematic review of yoga interventions for helping health professionals and students

Helping Health Professionals (HHP) and HHP students are among the highest risk occupational groups for compromised mental and physical health. There is a paucity of information regarding preventive interventions for mental and physical health in this group of healthcare providers.

OBJECTIVE

The objective of this review was to examine the effectiveness of yoga interventions for the prevention and reduction of mental and physical disorders among HHPs and HHP students.

DESIGN

An exhaustive systematic search was conducted in May 2020. Databases searched in the OVID interface included: MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Embase, and PsycINFO. EbscoHost databases searched included: CINAHL Plus with Full Text, SPORTDiscus with Full Text, Alt HealthWatch, Education Research Complete, SocINDEX with Full Text, ERIC, and Academic Search Complete. Scopus was also searched.

RESULTS

The search yielded 4,973 records, and after removal of duplicates 3197 records remained. Using inclusion and exclusion criteria, titles and abstracts were screened and full text articles (n = 82) were retrieved and screened. Twenty-five studies were identified for inclusion in this review. Most frequently reported findings of yoga interventions in this population included a reduction in stress, anxiety, depression, and musculoskeletal pain.

CONCLUSION

It is our conclusion that mental and physical benefits can be obtained through implementation of yoga interventions for HHPs and HHP students across a variety of settings and backgrounds. However, researchers would benefit from following recommended guidelines for the design and reporting of yoga interventions to improve study quality and rigour.

Impact of a Yogic Breathing Technique on the Well-Being of Healthcare Professionals During the COVID-19 Pandemic

Background

The COVID-19 pandemic has created unprecedented challenges for healthcare globally, the brunt of which has been borne by the health care providers (HCPs). These challenges are felt more keenly in India, as they stretch an insufficiently resourced healthcare system. The long hours, cross over of responsibilities, lack of resources to adequately care for patients, and concerns around safety of self and loves ones, have led to a spike in anxiety, depression, insomnia and other stress - related disorders in healthcare providers. Sudarshan Kriya Yoga (SKY) is a mind-body intervention that has been studied in multiple clinical populations. Prior to this study, there has been no exploration of the impact of SKY on healthcare providers, specifically the impact of a mind-body intervention like SKY on HCPs during a pandemic.

Objective

This study aims to investigate the impact of SKY on the well-being of HCPs during the COVID-19 pandemic.

Methods

We conducted a pilot feasibility study with a single arm pre-post design. SKY was taught to participants in a 4-day online breath and meditation workshop. We measured outcomes related to depression, anxiety, resilience, life satisfaction, and quality of sleep.

Results

Ninety-two subjects completed the study survey before and after the intervention. A significant reduction was observed in the levels of stress, anxiety and depression immediately after the program. In addition, the participants reported sig1nificant improvement in life satisfaction, resilience, and the quality of their sleep.

Conclusion

The results indicate that SKY breathing technique had a positive impact on the well-being of healthcare professionals during the pandemic. Participants experienced improved quality of sleep, enhanced satisfaction with life, and increased resilience after SKY. This pilot study provides important data for future multi-site randomized controlled trials to study the impact of yogic techniques on well-being of the HCPs.

Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review

BACKGROUND

A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME.

METHODS

We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool.

RESULTS

Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups.

CONCLUSIONS

Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

Experiences of nursing students as healthcare aid during the COVID-19 pandemic in Spain: A phemonenological research study

BACKGROUND

The coronavirus disease (COVID-19) pandemic has caused a worldwide health and social crisis directly impacting the healthcare system. Hospitals had to rearrange its structure to meet clinical needs. Spain has been experiencing a shortage of working nurses. Student nurses in their last year at university were employed to help the National Health System respond to the COVID-19 crisis.

AIM

The aim of this study was to explore and understand the experience of nursing students' roles as healthcare aid in responding to the COVID-19 crisis.

METHODS

A qualitative phenomenology design was used to explore undergraduate nursing students' perceptions of their experiences as HAs during the COVID-19 outbreak. Open face-to-face interviews were conducted to nursing students (n = 10) in May 2020. Data was analyzed using the hermeneutic interpretative approach.

RESULTS

All participants were women aged between 21 and 25 years. Seven main themes emerged: learning, ambivalent emotions and adaptation were classified at a personal level; teamwork, patient communication, and unclear care processes were categorized under hospital structure; and coping mechanisms were part of external factors.

CONCLUSIONS

Orientation, follow-up, and emotional support in crisis situations are key to unexperienced healthcare workers overcoming stressful emotions. Previous academic education and training may help novice future nurses feel more confident about their tasks and responsibilities as well as improve patient outcomes, resource management, and staff safety.

Predictors of Psychological Distress and Mental Health Resource Utilization among Employees in Malaysia

We sought to examine predictors of psychological distress among employees as well as the level of awareness and usage of available mental health resources by employees through their own organizations. The Malaysian Healthiest Workplace survey cross-sectional dataset was used to explore the association between psychological distress, a range of health conditions, as well as mental health resource awareness and usage in a sample of 11,356 working Malaysian adults. A multivariate logistic regression was conducted to determine predictors of high psychological distress. Comorbid illnesses that were associated with psychological distress were mental illness (OR 6.7, 95% CI 4.39-10.14, p = 0.001), heart conditions (OR 2.17, 95% CI 1.18-3.99, p = 0.012), migraines (OR 1.59, 95% CI 1.33-1.90, p = 0.001), bronchial asthma (OR 1.43, 95% CI 1.11-1.85, p = 0.006), and hypertension (OR 1.42, 95% CI 1.07-1.88, p = 0.016) compared to individuals with no comorbid conditions. A total of 14 out of 17 comorbid medical illnesses were associated with elevated levels of psychological distress among employees. Awareness and usage of support services and resources for mental health were associated with lower psychological distress. These findings extend the literature by providing further evidence on the link between chronic illness, occupational type, as well as awareness and use of mental health resources by psychological distress status.

Effect of four weeks of integrated yoga intervention on perceived stress and sleep quality among female nursing professionals working at a tertiary care hospital: A pilot study

BACKGROUND

Studies have reported that significant nursing professionals experience tremendous stress which often affects their sleep quality leading to poor well-being. Yoga being a mind body intervention reported to improve sleep quality and reduce stress.

AIM

The present pilot study was designed to assess the effect of yoga on perceived stress and sleep quality of the female nursing professionals working at tertiary care hospital.

MATERIALS AND METHODS

Thirty-three apparently healthy nursing staffs in the age range of 30-60 years (mean age 40.60 ± 10.26) were recruited as participants of the study, from a tertiary care hospital in Delhi. Participants were administered perceived stress scale (PSS) and Pittsburgh sleep quality index (PSQI) before and after the yoga intervention. Participants received 4 week of yoga intervention for 45 min/day for 5 days a week.

RESULTS

There was a significant reduction on the postscores of PSS (t = 5.86, P < 0.0001, paired t-test) and PSQI (z = -4.38, P < 0.0001, Wilcoxon signed-ranks test) in comparison to prescores. After the yoga intervention, perceived stress reduced by 27.01% and the sleep quality improved by 38.68%.

CONCLUSION

The finding of the study suggests effectiveness of yoga in reduction of the perceived stress and improvement of the quality of sleep of the nursing professional. However, the present findings need to be confirmed with further studies with larger sample size and robust research design.

Physical relaxation for occupational stress in healthcare workers: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

Work related stress is a major occupational health problem that is associated with adverse effects on physical and mental health. Healthcare workers are particularly vulnerable in the era of COVID-19. Physical methods of stress relief such as yoga and massage therapy may reduce occupational stress. The objective of this systematic review and network meta-analysis is to determine the effects of yoga, massage therapy, progressive muscle relaxation, and stretching on alleviating stress and improving physical and mental health in healthcare workers.

METHODS

Databases were searched for randomized controlled trials on the use of physical relaxation methods for occupational stress in healthcare workers with any duration of follow-up. Meta-analysis was performed for standard mean differences in stress measures from baseline between subjects undergoing relaxation vs non-intervention controls. Network meta-analysis was conducted to determine the best relaxation method.

RESULTS

Fifteen trials representing 688 healthcare workers were identified. Random-effects meta-analysis shows that physical relaxation methods overall reduced measures of occupational stress at the longest duration of follow-up vs baseline compared to non-intervention controls (SMD -0.53; 95% CI [-0.74 to -0.33]; p < .00001). On network meta-analysis, only yoga alone (SMD -0.71; 95% CI [-1.01 to -0.41]) and massage therapy alone (SMD -0.43; 95% CI [-0.72 to -0.14]) were more effective than control, with yoga identified as the best method (p-score = .89).

CONCLUSION

Physical relaxation may help reduce occupational stress in healthcare workers. Yoga is particularly effective and offers the convenience of online delivery. Employers should consider implementing these methods into workplace wellness programs.

Is It Me or You? A Team Approach to Mitigate Burnout in Critical Care

Burnout-a combination of emotional exhaustion, depersonalization, and a diminished sense of individual accomplishment-is a serious issue for critical care nurses. Burnout has been examined as an individual's emotional state, but burnout is also a social phenomenon that may spread among colleagues through emotional contagion. Current interventions to reduce burnout are either person directed or organization directed; few interventions focus on the critical care nursing team and their social support and interactions. This article reviews burnout in critical care nursing through the lens of emotional contagion. We offer suggestions for team-based interventions to address burnout in critical care nurses.

Burnout and its influencing factors between frontline nurses and nurses from other wards during the outbreak of Coronavirus Disease -COVID-19- in Iran

OBJECTIVES

To assess burnout level during an outbreak of COVID-19 and to identify influencing factors between frontline nurses and nurses from other wards.

METHODS

This cross-sectional study makes comparison between two groups of nurses including frontline (exposure group) and other nurses working in usual wards (non-exposure group) in Torbat Heydariyeh city, Iran. Oldenburg Burnout Inventory (OLBI), Job stress questionnaire (JSQ), and questionnaires of hospital resources, family support, and measuring the fear of COVID-19 were used as research instruments.

RESULTS

The scores of job stress and burnout in the exposure group with COVID-19 infection were significantly higher than in the non-exposure group (p=0.006 and p=0.002, respectively). Although, in univariate linear regression, employment status (p=0.047), experience in taking care of patient confirmed or suspected with COVID-19 infection (p=0.006), hospital resources (p=0.047), and job stress (p < 0.001) were considered as significant risk factors for COVID-19-related burnout. In multivariate regression analysis, job stress (p=0.031, β=0.308) was considered as an only factor that has a significant relationship with COVID-19-related burnout.

CONCLUSIONS

The burnout level in frontline nurses was higher than other nurses, the most important influencing factor was the job stress. Regarding to negative effects of burnout on both physical and mental health nurses, it is suggested that a strong strategy be considered to reduce nurses' burnout to be able to control ongoing and future outbreaks successfully.

Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses

OBJECTIVE

Numerous systematic reviews and meta-analyses on the interventions to reduce burnout of physicians and nurses have been published nowadays. This study aimed to summarize the evidence and clarify a bundled strategy to reduce burnout of physicians and nurses.

METHODS

Researches have been conducted within Cochrane Library, PubMed, Ovid, Scopus, EBSCO, and CINAHL published from inception to 2019. In addition, a manual search for relevant articles was also conducted using Google Scholar and ancestral searches through the reference lists from articles included in the final review. Two reviewers independently selected and assessed, and any disagreements were resolved through a larger team discussion. A data extraction spreadsheet was developed and initially piloted in 3 randomly selected studies. Data from each study were extracted independently using a pre-standardized data abstraction form. The the Risk of Bias in Systematic reviews and assessment of multiple systematic reviews (AMSTAR) 2 tool were used to evaluate risk of bias and quality of included articles.

RESULTS

A total of 22 studies published from 2014 to 2019 were eligible for analysis. Previous studies have examined burnout among physicians (n = 9), nurses (n = 6) and healthcare providers (n = 7). The MBI was used by majority of studies to assess burnout. The included studies evaluated a wide range of interventions, individual-focused (emotion regulation, self-care workshop, yoga, massage, mindfulness, meditation, stress management skills and communication skills training), structural or organizational (workload or schedule-rotation, stress management training program, group face-to-face delivery, teamwork/transitions, Balint training, debriefing sessions and a focus group) and combine interventions (snoezelen, stress management and resiliency training, stress management workshop and improving interaction with colleagues through personal training). Based on the Risk of Bias in Systematic reviews and AMSTAR 2 criteria, the risk of bias and methodological quality included studies was from moderate to high.

CONCLUSIONS

Burnout is a complicated problem and should be dealt with by using bundled strategy. The existing overview clarified evidence to reduce burnout of physicians and nurses, which provided a basis for health policy makers or clinical managers to design simple and feasible strategies to reduce the burnout of physicians and nurses, and to ensure clinical safety.

A Pragmatic Controlled Trial of a Brief Yoga and Mindfulness-Based Program for Psychological and Occupational Health in Education Professionals

OBJECTIVES

To examine changes in psychological and occupational wellbeing in education professionals that attended a brief yoga and mindfulness-based program.

DESIGN

Pragmatic controlled trial comparing education professionals that attended a yoga mindfulness-based program (n = 9) to a waitlist control group (n = 22).

SETTING

The 3-day program was delivered at the Kripalu Center for Yoga & Health in Massachusetts.

INTERVENTION

The 3-day yoga mindfulness program included 5 hours per day of yoga, mindfulness exercises, formal meditation, didactic, and experiential activities.

MAIN OUTCOME MEASURES

Measures of psychological and occupational wellbeing were completed before (baseline), immediately after (post-program), and two months after the program (follow-up).

RESULTS

Relative to controls (n = 21), the RISE group (n = 9) showed significant improvements in positive affect (p = .033), negative affect (p = .044), mindfulness (p = .001), empowerment (p = .022), self-compassion (p = .001), and work engagement from baseline to post-program. From baseline to follow-up, the RISE group showed significant improvements in stress (p = .008), negative affect (p = .013), mindfulness (p = .001), empowerment (p = .007), and self-compassion (p = .001) compared to the control group.

CONCLUSIONS

The yoga mindfulness program was associated with improvements in educators' psychological and occupational wellbeing immediately following and 2-months following the program. Future research with a larger sample size is needed to confirm these results.

Personalised yoga for burnout and traumatic stress in junior doctors

Objectives

Junior doctors are frequently exposed to occupational and traumatic stress, sometimes with tragic consequences. Mindfulness-based and fitness interventions are increasingly used to mitigate this, but have not been compared.

We conducted a randomised, controlled pilot trial to assess the feasibility, acceptability and effectiveness of these interventions in junior doctors.

Methods

We randomised participants (n=21) to weekly 1-hour sessions of personalised, trauma-informed yoga (n=10), with a 4-hour workshop, and eHealth homework; or group-format fitness (n=8) in an existing wellness programme, MDOK. Burnout, traumatic stress and suicidality were measured at baseline and 8 weeks.

Results

Both interventions reduced burnout, and yoga increased compassion satisfaction within group on the Professional Quality of Life scale, without difference between groups on this measure.

Personalised yoga significantly reduced depersonalisation (z=−1.99, p=0.05) compared with group fitness on the Maslach Burnout Inventory (MBI-HSS (MP)) and showed greater flexibility changes. Both interventions increased MBI Personal Accomplishment, with no changes in other self-report psychological or physiological metrics, including breath-counting.

Participants doing one-to-one yoga rated it more highly overall (p=0.02) than group fitness, and reported it comparatively more beneficial for mental (p=0.01) and physical health (p=0.05). Face-to-face weekly sessions were 100% attended in yoga, but only 45% in fitness.

Conclusion

In this pilot trial, both yoga and fitness improved burnout, but trauma-informed yoga reduced depersonalisation in junior doctors more than group-format fitness. One-to-one yoga was better adhered than fitness, but was more resource intensive. Junior doctors need larger-scale comparative research of the effectiveness and implementation of individual, organisational and systemic mental health interventions.

Trial registration number

ANZCTR 12618001467224.

Yoga and Mindfulness as a Tool for Influencing Affectivity, Anxiety, Mental Health, and Stress among Healthcare Workers: Results of a Single-Arm Clinical Trial

Mindfulness-based interventions have emerged as unique approaches for addressing a range of clinical and subclinical difficulties such as stress, chronic pain, anxiety, or recurrent depression. Moreover, there is strong evidence about the positive effects of yoga practice on stress management and prevention of burnout among healthcare workers. The aim of this study was to conduct a single-arm clinical trial to assess the effectiveness of an intervention based on mindfulness-based stress reduction and yoga in improving healthcare workers' quality of life. Healthcare workers of two hospitals in Rome were enrolled in a 4-week yoga and mindfulness course. Four questionnaires were administered at different times (Short Form-12 (SF-12), State-Trait Anxiety Inventory (STAI) Y1 and Y2, and Positive and Negative Affect Schedule (PANAS)) to evaluate the efficacy of the intervention. Forty participants took part to the study (83.3 %). The Mental Composite Score-12, that is part of the quality of life assessment, passed from a median of 43.5 preintervention to 48.1 postintervention (p = 0.041), and the negative affect passed from a score of 16 in the preintervention to 10 in the postintervention (p < 0.001). Both the forms of the STAI questionnaires showed a decrease after the intervention. Yoga and mindfulness administered together seem to be effective to reduce stress and anxiety in healthcare workers, providing them with more consciousness and ability to manage work stressful demands.

The precedence and viability of yoga in the lives of D3-dental students, dental practitioners, and dental patients

Dentistry as a profession is quite demanding and challenging and is also associated with occupational hazards like musculoskeletal disorders and stress-related problems. The practice of yoga has been proven to be efficacious in management of quite a lot of stress and lifestyle disorders. It strengthens one physically, mentally, and emotionally. Moreover, yoga can also be used in the management of dental patients for stress-related oral conditions like lichen planus, burning mouth syndrome, aphthous ulcers, etc., Yoga has also been found to have antiinflammatory, antianxiety effect, and also a lot of other beneficial effects. This review emphasizes on the relevance of yoga in the dental profession, from the practitioners, students, and patients viewpoint. Data pertaining to the subject was obtained after a thorough search of the PubMed literature and Google search engine.

Occupational Burnout and Its Related Factors Among Iranian Nurses: A Cross-Sectional Study in Shahroud, Northeast of Iran

BACKGROUND

Good physical and mental health of employees is one of the major characteristics of a healthy organisation.

AIM

Due to the importance of occupational burnout and its potentially negative consequences, the aim of this study was to assess occupational burnout and its related factors among Iranian nurses.

METHODS

In this cross-sectional study, 205 nurses who were working in two educational hospitals affiliated with Shahroud University of Medical Sciences were included. Forty-two of the nurses were male, and 163 were female (mean age: 31 years). Maslach Occupational Burnout Inventory, demographic and job characteristics questionnaires were completed for each nurse. Questionnaires were then collected, and data were analysed statistically by SPSS, version 22.

RESULTS

In the assessment of occupational burnout, the highest level was observed in emotional exhaustion and then in personal performance. There was a significant difference between the frequency of nurses' emotional exhaustion domain in terms of gender (P < 0.05), so that, women suffered more from emotional exhaustion. There was a significant difference between the frequencies of nurses' performance in terms of marital status (P < 0.05) so that married people had more personal performance disorder.

CONCLUSION

The results of this study showed that nurses suffered from low occupational burnout. Female gender, sleeping disorders, awakening at night and employment in stressful wards such as the emergency ward was associated with a higher level of occupational burnout in nurses.

A Cross Sectional Study Evaluating Psychosocial Job Stress and Health Risk in Emergency Department Nurses

Nurses experience psychosocial work stress that may negatively affect physical and mental health over time. In this cross-sectional study we investigated prevalence of job stress and oxidative stress in nurses, and determined if significant relationships exist between higher job stress scores and demographic factors and working conditions. Emergency department nurses (n = 42) were recruited from a University Hospital following Institutional Review Board approval. Job stress indicators, effort-reward ratio and overcommitment were evaluated from survey questionnaires using the effort-reward imbalance model, and associations with age, sex, body mass index, and working conditions were measured by logistic regression analysis. Oxidative stress biomarkers, 8-isoprostane, malondialdehyde, and antioxidant levels were measured from urine specimens. Job stress was prevalent with effort-reward ratio > 1 in 93% and overcommitment > 50 in 83% of the study participants. Age, body mass index, years of experience, weekend work, work hours per week, and shift work showed strong associations with effort-reward ratio and overcommitment scores. Malondialdehyde was higher in participants with high overcommitment. We report that psychosocial job stress is prevalent among nurses, as revealed by the high effort-reward and overcommitment scores. Job stress may be reduced through implementation of appropriate stress reduction interventions.

Prevalence, Related Factors, and Levels of Burnout Syndrome Among Nurses Working in Gynecology and Obstetrics Services: A Systematic Review and Meta-Analysis

BACKGROUND

Although burnout levels and the corresponding risk factors have been studied in many nursing services, to date no meta-analytical studies have been undertaken of obstetrics and gynecology units to examine the heterogeneity of burnout in this environment and the variables associated with it. In the present paper, we aim to determine the prevalence, levels, and related factors of burnout syndrome among nurses working in gynecology and obstetrics services.

METHODS

A systematic review and meta-analysis of the literature were carried out using the following sources: CINAHL (Cumulative Index of Nursing and Allied Health Literature), LILACS (Latin American and Caribbean Health Sciences Literature), Medline, ProQuest (Proquest Health and Medical Complete), SciELO (Scientific Electronic Library Online), and Scopus.

RESULTS

Fourteen relevant studies were identified, including, for this meta-analysis, n = 464 nurses. The following prevalence values were obtained: emotional exhaustion 29% (95% CI: 11-52%), depersonalization 19% (95% CI: 6-38%), and low personal accomplishment 44% (95% CI: 18-71%). The burnout variables considered were sociodemographic (age, marital status, number of children, gender), work-related (duration of the workday, nurse-patient ratio, experience or number of miscarriages/abortions), and psychological (anxiety, stress, and verbal violence).

CONCLUSION

Nurses working in obstetrics and gynecology units present high levels of burnout syndrome. In over 33% of the study sample, at least two of the burnout dimensions considered are apparent.

Burnout and Metabolic Syndrome in Female Nurses: An Observational Study

Nurses are at risk of having burnout due to workload and job stress-studies have reported that chronic stress is associated with metabolic syndrome. This study aimed to assess the association between burnout and metabolic syndrome in a sample of female nurses. Data were collected from a cross-sectional study from 2016 to 2018 in a tertiary hospital in Mexico City. All nurses that work in the hospital were invited to participate. Information pertaining to sociodemographic (age, education level), work (labor seniority, service area, shift work), anthropometric (weight, waist circumference, blood pressure) and biochemical (glucose, serum lipids) variables were collected. Burnout was assessed using the Maslach Burnout Inventory test, and metabolic syndrome was defined according to the International Diabetes Federation criteria. A total of 168 nurses participated with a median age of 44 years. The prevalence of burnout and metabolic syndrome was 19.6% and 38.7%, respectively. There was no association between burnout and metabolic syndrome (p = 0.373). However, associations of emotional exhaustion (aOR: 14.95; 95% CI: 1.5-148.7), personal accomplishment (aOR: 0.13; 95% CI: 0.01-0.99), and night shift (aOR: 12.39; 95% CI: 1.02-150.5) with increased waist circumference were found. Strategies are needed to prevent burnout and metabolic syndrome in nurses, especially in those who work at night shift.