Is this critical care clinician burned out?

HELLO: a protocol for a cluster randomized controlled trial to enhance interpersonal relationships and team cohesion among ICU healthcare professionals

BACKGROUND

Mental health symptoms among healthcare professionals (HCP) in intensive care units (ICUs) are a significant concern affecting both HCP well-being and patient care outcomes. Cross-sectional studies among members of the European Society of Intensive Care Medicine (ESICM) report up to 50% burnout rates. Determinants of burnout include communication, team cohesion, psychological support, and well-being promotion. We designed the 'Hello Bundle' intervention to mitigate burnout among ICU-HCPs by fostering positive social interactions and a supportive work environment. This justification synthesizes evidence from social psychology, positive psychology, and healthcare communication research to support the intervention. The 'Hello Bundle' aims to enhance interpersonal relationships, improve team cohesion, and reduce burnout rates. The six components include: Hello campaign posters, email reminders, integrating greetings in morning huddles, hello jars, lead-by-example initiatives, and a daily updated hello board in each ICU. This protocol describes a cluster randomized controlled trial to evaluate the effectiveness of the intervention.

METHODS

This protocol describes a cluster randomized controlled trial (RCT) conducted among ESICM-affiliated ICUs, consisting of at least 73 clusters with in average of 50 respondents per cluster, totaling approximately 7300 participants. Intervention clusters will implement the 6-component Hello Bundle between October 14 and November 10, 2024, while control clusters will be wait-listed to receive the intervention in January 2025 after the RCT concludes. Clusters will be matched based on ICU size (fewer or more than 20 beds), region, and average 2023 mortality. The primary outcome is the proportion of HCPs with burnout between intervention and control clusters at the end of the intervention. Secondary outcomes include comparing the following between clusters: (1) number of HCPs with high emotional exhaustion; (2) number with high depersonalization; (3) number with loss of accomplishment; (4) perception of ethical climate (5) satisfaction at work (VAS); (6) professional conflicts; (7) intention to leave the ICU (VAS); (8) patient-centered care rating; (9) family-centered care rating. The last secondary outcome is the comparison of burnout rates before and after the intervention in the intervention cluster. Outcomes will be based on HCP reports collected within four weeks before and after the intervention.

DISCUSSION

This is the first large trial of healthcare communication, social, and positive psychology intervention among ICU-HCPs. It holds the potential to provide valuable insights into effective strategies for addressing burnout in ICU settings, ultimately benefiting both HCPs and patients.

TRIAL REGISTRATION

This trial was registered on ClinicalTrials.Gov on June 18, 2024.

REGISTRATION

NCT06453616.

Implementation of a routine post-shift debriefing program in ICU aiming at quality-of-care improvement: A primary analysis of feasibility and impacts

OBJECTIVES

This report describes the implementation of a clinical debriefing (CD) program in intensive care units (ICU) and analyses its feasibility and its impact on staff well-being.

DESIGN

Observational study.

SETTING

From April to September 2023, post-shift CDs were run once a week in 2 out of 7 units in our department, using an adapted version of the DISCOVER-PHASE tool. CD sessions were performed face-to-face with volunteer members of the multidisciplinary ICU team.

MAIN OUTCOME MEASURES

After 6 months, a survey assessing the satisfaction of the debriefed teams was conducted. The impact of CD on staff well-being was assessed using three validated questionnaires (Maslach Burnout Inventory, Ways of Coping Checklist, Professional Quality of Life Scale) administered in the 7 units before and after the CD period.

RESULTS

A total of 44 CDs were performed, lasting 15 (4-35) min. There were 6 (1-9) attendees per CD, mainly nurses (64.6%). Discussions focused mainly on basic problems related to dysfunctional material, communication and organization inside the team. The two debriefed teams were satisfied of the program and gave 9, 8 and 8 out of 10 on a visual analogical scale for the climate of confidence of the DC, their organisation, and their ability to improve working conditions and quality of care, respectively. Subscores at the three questionnaires assessing staff well-being before and after the CD period were similar, whether teams experienced CD or not.

CONCLUSIONS

Implementing of post-shift debriefings in our ICU was feasible and well accepted. More prolonged programs are probably needed to demonstrate benefits on staff well-being.

IMPLICATIONS FOR CLINICAL PRACTICE

This report offers elements that other teams can use to successfully conduct post-shift debriefings and to plan future research on longer-term programs.

Burnout experience among healthcare workers post third COVID-19 wave in India; findings of a cross-sectional study

Background

The pandemic exacerbated burnout experienced by healthcare personnel, whose mental health had long been a public health concern before COVID-19. This study used the Copenhagen burnout inventory (CBI) tool to assess burnout and identify predictors among Indian healthcare workers managing COVID-19.

Methods

A cross-sectional study was conducted from June to December 2022, after the third pandemic wave. A web-based, fillable Google form was used to recruit COVID-19 management professionals from multiple Jaipur district hospitals. Healthcare professionals provided socio-demographic, work-related, and CBI scores. Multiple linear regression was used to control for model covariant independent variables.

Results

We evaluated the responses of a total of 578 participants with a mean age of 36.59 ± 9.1 years. Based on the CBI cut-off score of 50, 68.1% reported burnout. A total of 67.5%, 56.4%, and 48.6% of healthcare workers reported work-related, personal, and patient-related burnout, respectively. High burnout scores were significantly associated with the nursing profession (β = 7.89, 95% CI; 3.66, 12.11, p < 0.0001). The p-value indicates the probability of observing the data if the null hypothesis is true, and the confidence interval shows the range within which we can be 95% confident that the true effect lies. An independent relationship exists between male gender and higher personal-related burnout scores (β = 4.45, 95% CI 1.9-6.9).

Conclusion

This study identified key indicators that need further emphasis and the need for organizational and individual-level burnout monitoring in healthcare delivery sectors. Health workers continue to experience burnout due to a combination of personal, professional, and patient-related factors. This underscores the need for targeted organizational and individual interventions. The findings also suggest that the CBI tool could identify healthcare worker burnout risk groups.

The Recovering Together Initiative: Integrating Psychosocial Care into ICUs

More than 5 million patients are admitted to ICUs each year in the United States alone. ICUs are stressful environments given the patients' medical severity, family emotional experience, and staff burnout. However, psychosocial services are rarely offered and sustained in these settings. Multidisciplinary partnerships and innovative frameworks and services are needed to successfully integrate psychosocial care into these complex settings. To address this need, Massachusetts General Hospital developed the Recovering Together (RT) Initiative (2015-present) in its Neurosciences ICUs (Neuro-ICU). The hospital's aims were threefold: (1) to build a multidisciplinary collaboration to develop and sustain integrative care; (2) to implement a clinical, research, and training (CRT) framework to support patients, families, and staff; and (3) to develop an innovative, tailored evidence-based intervention for patient-caregiver dyads in the Neuro-ICU. The authors detail the process of developing the RT Initiative for the Neuro-ICU, including initial collaborations, psychosocial care implementation, and intervention development. This real-world approach to integrating psychosocial care in this setting was successful because of a strong multidisciplinary partnership, a feasible CRT framework, and funding to support the research and infrastructure. Physical proximity, consistent interactions and communication, mutual trust, and shared leadership priorities helped facilitate this integrated care approach. The findings provide practical guidance on how to integrate psychosocial care into medical settings. The authors hope that this approach is of value to clinicians, researchers, and health care systems working to develop and sustain integrated care models across complex medical settings.

Prevalence of burnout among intensivists in mainland China: a nationwide cross-sectional survey

BACKGROUND

Burnout has gained increasing attention worldwide; however, there is a lack of relevant research in China. This study investigated the prevalence and factors associated with burnout in physicians of the intensive care unit (ICU) in mainland China.

METHODS

This cross-sectional multicenter study included critical care physicians from all provinces in mainland China (except Tibet). A self-administered survey questionnaire was conducted. It included three parts: demographic information, lifestyle and work information, and the Maslach Burnout Inventory. The levels of burnout were calculated. The factors independently associated with burnout were analyzed by logistic regression.

RESULTS

Finally, 1813 intensivists participated in the survey. The participation rate was 90.7%. The prevalence of burnout and severe burnout was 82.1% (1489/1813) and 38.8% (704/1813), respectively. According to the logistic regression analysis, "difficulty in making treatment decisions" was independently associated with burnout [OR = 1.365, CI (1.060, 1.757)]. "Higher number of children" [OR = 0.714, CI (0.519, 0.981)] and higher "income satisfaction" [OR = 0.771, CI (0.619, 0.959)] were independent protective factors against severe burnout.

CONCLUSIONS

The burnout rate in ICU physicians in China is high. Difficult treatment decisions, the number of children, and income satisfaction are independently associated with burnout rates among ICU physicians in China.

TRIAL REGISTRATION

Burnout syndrome of the Chinese personnel working in intensive care units: a survey in China, ChiCTR-EOC-17013044, registered October 19, 2017. http://www.chictr.org.cn/showproj.aspx?proj=22329 .

Burnout signals are alarming worldwide: the active role of leadership

Introduction: The burnout phenomenon first came to clinical science 50 years ago. It is exponentially rising worldwide which prompted its discoverers to develop the most popular tool for its assessment, known as the Maslach burnout inventory (MBI)1 . Common symptoms of burnout include depression, irritability, and insomnia. It is known to hit professional areas where higher levels of stress are common. Intensive care unit (ICU) practitioners are particularly vulnerable to this condition. Bienvenu reported that up to 45% of ICU staff experienced burnout at a certain time in their career. The contributing factors include: age, gender, work schedule, involvement in decisions of withdrawing life support, policy of visiting hours, work quality, and care of dying patients. It is described as a growing crisis and is currently gaining a lot of interest aimed at addressing the issue and its consequences2 . We hypothesize that positive leadership with empowerment of staff may have an impact on burnout. Our objectives are to explore the prevalence of burnout in this area, to find the contributing factors, and determine the impact of the role of empowerment and leadership on burnout. Method: We conducted a cross-sectional descriptive study using a combined methodological quantitative and qualitative approach involving a convenience sample of 200 healthcare practitioners within surgical and medical ICUs of Hamad Medical Corporation (HMC), Qatar. We used two main instruments to develop an online questionnaire:– The MBI-human service survey (MBI-HSS)1 which is a standardized instrument to measure burnout. It utilizes 9 items related to emotional exhaustion and it is most frequently used in healthcare research. A score of 27 and more signals a high burnout level. – The Leadership scale, which assesses staff discernment of managers’ leadership attitude3 . It is based on a 7-point Likert scale 11-item questionnaire that considers resolving conflicts with others, autonomy in decision-making, and staff involvement in development. Results: Although none of the results are statistically significant, the findings (Table 1 ) show a high prevalence of burnout (25.5%) among ICU healthcare practitioners, where respiratory therapists are equally subjected as nurses and physicians. Younger staff were more subject to experiencing burnout. The mean leadership score of the study participants was 54.68 out of a maximum score of 77 (Figure 1 ). However, positive leadership and staff empowerment had a negative effect on burnout variance (12.4% and 3.8%, respectively) (Figure 2 ). Interestingly, we noted that certain nationalities were probably more prone to burnout although it did not reach statistical significance and may also be linked to their profession or level of responsibility (Table 1 ). Conclusions: Everyone is at risk of burnout in the ICU setting. Implementing the empowerment hypothesis among the ICUs in Qatar could enhance the managerial preferences in the hospitals dealing with a wide spectrum of healthcare practitioners.

Empowerment is symbolized by energizing the practitioners5 and as the awareness of burnout is increasing, proper interventions should be directed at adequate orientation, early recognition, and dealing with the predisposing factors to prevent future occurrences. The findings of this study could widen the scope of practitioners who could be involved through education in diagnosing and managing burnout.

"Sacred Pause" in the ICU: Evaluation of a Ritual and Intervention to Lower Distress and Burnout

BACKGROUND

Increased exposure to deaths in the intensive care unit (ICU) generate grief among ICU staff, which remains unresolved most of the time. Unresolved grief becomes cumulative and presents a risk factor for burnout. "sacred pause" is a ritual performed at patient's death to honor the lost life and recognize the efforts of the health-care team.

OBJECTIVE

To study the impact of the ritual of sacred pause on the attitudes and behaviors of the ICU physicians and nurses.

METHODS

Ten-question online anonymous survey was sent to ICU physicians and nurses in the medical ICU of a tertiary care hospital in July 2017.

RESULTS

Thirty-four ICU team members completed the survey including 12 physicians and 22 nurses. Seventy sacred pause rituals were performed from July 2016 to June 2017. Seventy-nine percent respondents believed that the ritual brought closure and helped them overcome the feelings of disappointment, grief, distress, and failure after the death of their patient in ICU. Seventy-three percent agreed that the ritual has instilled and encouraged a sense of team effort. Eighty-two percent responded that the ritual makes their efforts feel appreciated. Many felt that the ritual should be a universal phenomenon in all ICUs. Only 55% respondents felt that the practice has a potential to decrease ICU burnout, many of them (42%) were undecided.

CONCLUSION

Sacred pause brings closure, prevents cumulative grief and distress, builds resilience, promotes team effort, and improves professional satisfaction of ICU team. It may lower burnout syndrome in ICU, but further studies are warranted.

The association between spiritual well-being and burnout in intensive care unit nurses: A descriptive study

OBJECTIVES

To describe the spiritual well-being and burnout of intensive care unit nurses and examine the relationship between these factors.

RESEARCH METHODOLOGY

This was a cross-sectional descriptive study. The participants were 318 intensive care unit recruited from three university hospitals in South Korea. The survey questionnaire included demographic information, work-related characteristics and end-of-life care experience, along with the Spiritual Well-Being Scale and Burnout Questionnaire. The data were analysed using descriptive statistics, t-tests, ANOVA with Scheffé test and a multiple regression analysis.

RESULTS

The burnout level among intensive care unit nurses was 3.15 out of 5. A higher level of burnout was significantly associated with younger age, lower education level, single marital status, having no religion, less work experience and previous end-of-life care experience. Higher levels of spiritual well-being were associated with lower levels of burnout, even after controlling for the general characteristics in the regression model.

CONCLUSION

Intensive care unit nurses experience a high level of burnout in general. Increased spiritual well-being might reduce burnout among intensive care unit nurses. Younger and less experienced nurses should receive more attention as a vulnerable group with lower spirituality and greater burnout in intensive care unit settings.

Application of a mindfulness program among healthcare professionals in an intensive care unit: Effect on burnout, empathy and self-compassion

OBJECTIVE

To evaluate the effect of a mindfulness training program on the levels of burnout, mindfulness, empathy and self-compassion among healthcare professionals in an Intensive Care Unit of a tertiary hospital.

DESIGN

A longitudinal study with an intrasubject pre-post intervention design was carried out.

SETTING

Intensive Care Unit of a tertiary hospital.

PARTICIPANTS

A total of 32 subjects (physicians, nurses and nursing assistants) participated in the study.

INTERVENTION

A clinical session/workshop was held on the practice of mindfulness and its usefulness. The possibility of following an 8-week training program with specifically designed short guided practices supported by a virtual community based on a WhatsApp group was offered. A weekly proposal in audio and text format and daily reminders with stimulating messages of practice were sent.

MAIN MEASUREMENTS

Various psychometric measures were self-reported: burnout (MBI), mindfulness (FFMQ), empathy (Jefferson) and self-compassion (SCS), before and after the training program. Demographic and workplace variables were also compiled.

RESULTS

Among the factors affecting burnout, the level of emotional exhaustion decreased (-3.78 points; P=.012), mindfulness levels measured by the FFMQ were not globally modified, though "observation" and "non-reacting" factors increased. Empathy was not modified, and self-compassion levels increased (3.7 points; P=.001). Satisfaction and program adherence levels were very high.

CONCLUSIONS

In the population described, this program showed a decrease in emotional exhaustion and an increase in self-compassion -these being factors that can produce well-being and exert a positive impact upon burnout in this vulnerable group.