Using a single item to measure burnout in primary care staff: a psychometric evaluation

Determinants of Patient Aligned Care Team (PACT) members' burnout and its relationship with patient-centered care

Burnout is a prevalent issue among healthcare providers affecting up to 54% of physicians and 35% of nurses. Patient Aligned Care Teams (PACT) is a team-based primary care delivery model designed to assure the delivery of high-quality care while improving clinicians' well-being. Limited studies evaluated the relationship between work environment variables and PACT members' burnout and the relationship between PACT members' burnout and patient-centered care. This cross-sectional study is based on the 2018 Veterans Health Administration (VHA) national web-based PACT survey. Burnout was measured using a single-item question that was validated in previous studies. Descriptive statistics and logistic regression were used to analyze the data. Fifty-one percent of primary care providers and 40.12% of nurses reported high burnout. PACT members with a work environment characterized by high-quality team interaction, leadership support, and psychological safety experienced lower levels of burnout. PACT members' burnout explained 6% of the variance in PACT members' ability to deliver patient-centered care. Burnout among PACT members is attributed to multiple personal and occupational variables. This study identified modifiable work environment variables that can be used to inform burnout interventions.

A study protocol for the modified interactive screening program plus MINDBODYSTRONG© RCT: A mental health resiliency intervention for nurses

BACKGROUND

Nurses, the largest workforce in healthcare, are at high risk of depression, anxiety, burnout, and suicidal ideation. Suicide among nurses is higher than the general population. This randomized controlled trial pairs the MINDBODYSTRONG© cognitive-behavioral skills building program with the American Foundation for Suicide Prevention's (AFSP) Modified Interactive Screening Program (mISP) to reduce depression, suicidal ideation, post-traumatic stress, anxiety, and burnout, and improve healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction in nurses with moderate to high risk of suicide.

AIMS

This study aims to determine the effects of the mISP combined with the digitized MINDBODYSTRONG© program versus the mISP alone on depression, suicidal ideation, burnout, anxiety, post-traumatic stress, healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction in 364 U.S. nurses.

METHODS

A digitized version of MINDBODYSTRONG© combined with the mISP screening and referral platform will be compared to the AFSP mISP alone through a two-arm randomized controlled trial. Follow-up post-intervention data will be collected at week eight and months three, six, and 12.

DISCUSSION

If successful, this study's findings could assist nurses who are hesitant to use conventional mental health resources by providing them with confidential aid and learning opportunities to reduce suicidality, depression, anxiety, post-traumatic stress, and burnout and improve healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction.

TRIAL/STUDY REGISTRATION

The Ohio State University Protocol Record 2021B0417, Modified Interactive Screening Program Plus MINDBODYSTRONG: A Mental Health Resiliency Intervention for Nurses, is registered and posted at ClinicalTrials.gov Identifier: NCT05582343. First posted date is October 17, 2022.

Modifiable work stress factors and psychological health risk among nurses working within 13 countries

INTRODUCTION

Nurses are identified as having higher work stress and poor mental health risk among health care workforce globally. It remains unclear which modifiable stress factors pose the greatest risk for poor psychological health among nursing workforce and needed to inform targeted practice and policy change. To determine which occupation-related or personal stress factors precipitate higher risk for burnout, depression, anxiety, job satisfaction or intention to leave one's position among nurses globally.

DESIGN

A cross-sectional anonymous survey was administered via email using a snowball recruitment strategy.

METHODS

Academic researchers and clinical industry leaders across 3 global regions collaborated to generate an email listserv of professional nursing contacts for survey distribution. The survey included valid and reliable measures to scale stress factors (Work Stress Questionnaire), and screen for burnout (single item), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2), resilience (Brief Resilience Scale) and intention to leave one's job (single item). We used logistic regression, first unadjusted and then adjusted for personal and professional characteristics, to determine associations between stress factors and psychological health risk.

RESULTS

The final sample consisted of responses from 2864 nurses working across 13 countries. Most respondents reported working as a clinical nurse in the Philippines (n = 2275), United States (n = 424) and Saudi Arabia (n = 104). One third of nursing respondents endorsed high burnout and intention to leave their job. Those reporting work conflict had significantly higher odds of burnout (odds ratio 3.18; 95% CI 2.22-4.54) and three times more likely to screen positive for depression (odds ratio 3.02; 95% CI 1.36-6.72) and anxiety (odds ratio 2.92; 95% CI 1.57-5.43). Those endorsing difficulty sleeping were 15 times more likely to screen positive for depression (odds ratio 15.63; 95% CI 2.09-117.06). Lack of social support was significantly associated to higher risk for burnout, job dissatisfaction, depression, anxiety, and intention to leave one's position.

CONCLUSIONS

Nurses remain at risk for burnout and poor psychological health stemming from work stress. Factors such as clear workplace goals and assignments, increased engagement, good sleep health and social support may serve as protective factors against suboptimal psychological health, and in-turn poor workforce retention.

CLINICAL RELEVANCE

Nurses reporting conflict in the workplace are three times more likely to screen positive for burnout, depression, and anxiety. Nurses reporting difficulty sleeping are 15 times more likely to screen positive for depression. Several modifiable factors can be targeted to reduce poor psychological health and high workforce turnover among nurses across countries.

Burnout, job satisfaction, and turnover intention among primary care nurse practitioners with their own patient panels

BACKGROUND

Nurse practitioners (NPs) can enhance NP care and improve access to care by autonomously managing their patient panels. Yet, its impact on workforce outcomes such as burnout, job satisfaction, and turnover intention remains unexplored.

PURPOSE

To estimate the impact of NP panel management on workforce outcomes.

METHODS

Structural equation modeling was conducted using survey data from 1,244 primary care NPs. NP panel management was categorized into co-managing patients with other providers, both co-managing and autonomously managing, and fully autonomous management.

DISCUSSION

Fully autonomous management led to more burnout than co-managing (B = 0.089, bias-corrected 95% bootstrap confidence interval [0.028, 0.151]). Work hours partially (27%) mediated this relationship. This findings indicate that greater autonomy in panel management among NPs may lead to increased burnout, partially due to longer work hours.

CONCLUSION

Interventions to reduce work hours could help NPs deliver quality care without burnout.

Global estimate of burnout among the public health workforce: a systematic review and meta-analysis

INTRODUCTION

Burnout is an occupational phenomenon resulting from chronic workplace stress. We conducted this review to estimate the pooled global prevalence of burnout among the public health workforce.

METHODS

We conducted this review as per the PRISMA 2020 guidelines. We included only cross-sectional studies reporting outcome estimates among the study population. We included articles published before December 2023. We used a search strategy to systematically select the articles from PubMed, Embase, and Google Scholar. We assessed the quality of the studies using an adapted version of NIH's study tool assessment for cross-sectional and observational cohort studies. We estimated the pooled proportion using the random-effects model.

RESULTS

We included eight studies in our review, covering a sample size of 215,787. The pooled proportion of burnout was 39% (95% CI: 25-53%; p-value: < 0.001). We also identified high heterogeneity among the included studies in our review (I2: 99.67%; p-value: < 0.001). Seven out of the eight studies were of good quality. The pooled proportion of the studies conducted during the COVID-19 pandemic was 42% (95% CI: 17-66%), whereas for the studies conducted during the non-pandemic period, it was 35% (95% CI: 10-60%).

CONCLUSION

In our review, more than one-third of public health workers suffer from burnout, which adversely affects individuals' mental and physical health. Burnout among the public health workforce requires attention to improve the well-being of this group. Multisite studies using standardized definitions are needed for appropriate comparisons and a better understanding of variations in burnout in various subgroups based on sociodemographic characteristics and type of work responsibilities. We must design and implement workplace interventions to cope with burnout and increase well-being.

LIMITATIONS

Due to the limited research on burnout among public health workers, we could not perform a subgroup analysis on various factors that could have contributed to burnout.

The association between population health management tools and clinician burnout in the United States VA primary care patient-centered medical home

BACKGROUND

Technological burden and medical complexity are significant drivers of clinician burnout. Electronic health record(EHR)-based population health management tools can be used to identify high-risk patient populations and implement prophylactic health practices. Their impact on clinician burnout, however, is not well understood. Our objective was to assess the relationship between ratings of EHR-based population health management tools and clinician burnout.

METHODS

We conducted cross-sectional analyses of 2018 national Veterans Health Administration(VA) primary care personnel survey, administered as an online survey to all VA primary care personnel (n = 4257, response rate = 17.7%), using bivariate and multivariate logistic regressions. Our analytical sample included providers (medical doctors, nurse practitioners, physicians' assistants) and nurses (registered nurses, licensed practical nurses). The outcomes included two items measuring high burnout. Primary predictors included importance ratings of 10 population health management tools (eg. VA risk prediction algorithm, recent hospitalizations and emergency department visits, etc.).

RESULTS

High ratings of 9 tools were associated with lower odds of high burnout, independent of covariates including VA tenure, team role, gender, ethnicity, staffing, and training. For example, clinicians who rated the risk prediction algorithm as important were less likely to report high burnout levels than those who did not use or did not know about the tool (OR 0.73; CI 0.61-0.87), and they were less likely to report frequent burnout (once per week or more) (OR 0.71; CI 0.60-0.84).

CONCLUSIONS

Burned-out clinicians may not consider the EHR-based tools important and may not be using them to perform care management. Tools that create additional technological burden may need adaptation to become more accessible, more intuitive, and less burdensome to use. Finding ways to improve the use of tools that streamline the work of population health management and/or result in less workload due to patients with poorly managed chronic conditions may alleviate burnout. More research is needed to understand the causal directional of the association between burnout and ratings of population health management tools.

The association between number of learners and pharmacist and technician levels of burnout

PURPOSE

Little is known about the relationship between learner load and pharmacist and pharmacy technician burnout. Therefore, the purpose of this study was to examine the association between burnout and the number of learners (residents, students, and new employees) assigned to pharmacists or pharmacy technicians.

METHODS

A validated survey to measure burnout and professional fulfillment was administered to employees of a university health system's pharmacy service in 2019. A threshold analysis determined the optimal cutoff for number of learners trained that maximized the ability to predict binary outcomes. Chi-square and Fisher's exact tests were used, and effect sizes between percentages were reported. Finally, the adjusted associations between number of learners and outcomes were assessed using logistic regression.

RESULTS

A total of 448 pharmacy staff members were included in the analysis. Of those, 57% (n = 254) worked in ambulatory care, 27.4% (n = 122) worked in an inpatient setting, and 15.7% (n = 70) worked in infrastructure. Pharmacists working in an inpatient setting who reported training 4 or more learners per year indicated significantly higher rates of burnout than those training fewer learners on both a single-item burnout assessment (64.3% vs 31.0%; P = 0.01; effect size, 0.68) and a 10-item burnout assessment (54.8% vs 13.8%; P = 0.01; effect size, 0.91). Similar results were not observed in pharmacists working in ambulatory care and infrastructure positions or in pharmacy technicians.

CONCLUSION

Added precepting and training responsibilities may be associated with higher levels of burnout among pharmacy team members, particularly inpatient pharmacists.

Evaluating Workforce Mental Health and Well-Being: A Review of Assessments

OBJECTIVE

Given the importance of mental health and well-being assessments to employers' efforts to optimize employee health and well-being, this paper reviews mental health assessments that have utility in the workplace.

DATA SOURCE

A review of publicly available mental health and well-being assessments was conducted with a primary focus on burnout, general mental health and well-being, loneliness, psychological safety, resilience, and stress.

INCLUSION CRITERIA

Assessments had to be validated for adult populations; available in English as a stand-alone tool; have utility in an employer setting; and not have a primary purpose of diagnosing a mental health condition.

DATA EXTRACTION

All assessments were reviewed by a minimum of two expert reviewers to document number of questions, subscales, fee structure, international use, translations available, scoring/reporting, respondent (ie, employee or organization), and the target of the assessment (ie, mental health domain and organizational or individual level assessments.

DATA SYNTHESIS & RESULTS

Sixty-six assessments across the six focus areas met inclusion criteria, enabling employers to select assessments that meet their self-identified measurement needs.

CONCLUSION

This review provides employers with resources that can help them understand their workforce's mental health and well-being status across multiple domains, which can serve as a needs assessment, facilitate strategic planning of mental health and well-being initiatives, and optimize evaluation efforts.

ALS Health care provider wellness

BACKGROUND

Interest in health care provider (HCP) wellness and burnout is increasing; however, minimal literature explores HCP wellness in the context of Amyotrophic Lateral Sclerosis (ALS) care.

OBJECTIVES

We sought to determine rates of burnout and resiliency, as well as challenges and rewards in the provision of ALS care.

METHODS

A survey link was sent to physicians at all Canadian ALS centers for distribution to ALS HCPs in their network. The survey included demographics questions, and validated measures for resiliency and burnout; the Brief Resilient Coping Scale (BRCS) and the Single Item Burnout Score (SIBS). Participants were asked to describe challenges and rewards of ALS care, impact of COVID-19 pandemic, and how their workplace could better support them.

RESULTS

There were 85 respondents across multiple disciplines. The rate of burnout was 47%. Burnout for female respondents was significantly higher (p = 0.007), but not for age, role, or years in ALS clinic. Most participants were medium resilient copers n = 48 (56.5%), but resiliency was not related to burnout. Challenges included feeling helpless while patients relentlessly progressed to death, and emotionally charged interactions. Participants found fulfillment in providing care, and through relationships with patients and colleagues. There was a strongly expressed desire for increased resources, team building/debriefing, and formal training in emotional exhaustion and burnout.

CONCLUSIONS

The high rate of burnout and challenges of ALS care highlight the need for additional resources, team-building, and formal education around wellness.

Positive Leadership within Breast Imaging: Impact on Burnout, Intent to Leave, and Engagement

Background High rates of provider burnout and turnover, as well as staffing shortages, are creating crises within radiology departments. Identifying ways to support health care workers, such as the Positively Energizing Leadership program, is important during these ongoing crises. Purpose To identify the relationship between leadership behaviors and workplace climate and health care worker outcomes (ie, burnout, intent to leave, and engagement) and to determine whether the positive leadership program could improve workplace climate and health care worker outcomes. Materials and Methods This prospective study involved two parts. First, a web-based survey was administered to faculty and staff in a breast imaging unit of a large academic medical center in February 2021 to identify relationships between leadership behaviors and workplace climate and health care worker outcomes. Second, a web-based survey was administered in February 2023, following the implementation of a positive leadership program, to determine improvement in engagement and reduction of burnout and intent to leave since 2021. Multiple regression, the Sobel test, Pearson correlation, and the t test were used, with a conservative significance level of P < .001. Results The sample consisted of 88 respondents (response rate, 95%) in 2021 and 85 respondents (response rate, 92%) in 2023. Leadership communication was associated with a positive workplace climate (β = 0.76, P < .001) and a positive workplace climate was associated with improved engagement (β = 0.53, P < .001), reduction in burnout (β = -0.42, P < .001), and reduction in intent to leave (β = -0.49, P < .001). Following a 2-year positive leadership program, improved perceptions were observed for leadership communication (pretest mean, 4.59 ± 1.51 [SD]; posttest mean, 5.80 ± 1.01; t = 5.97, P < .001), workplace climate (pretest mean, 5.09 ± 1.43; posttest mean, 5.77 ± 1.11; t = 3.35, P < .001), and engagement (pretest mean, 5.27 ± 1.20, posttest mean, 5.68 ± 0.96; t = 2.50, P < .01), with a reduction in burnout (pretest mean, 2.69 ± 0.94; posttest mean, 2.18 ± 0.74; t = 3.50, P < .001) and intent to leave (pretest mean, 3.12 ± 2.23; posttest mean, 2.56 ± 1.84; t = 1.78, P < .05). Conclusion After implementation of a positive leadership program in a radiology department breast imaging unit, burnout and intention to leave decreased among health care workers, while engagement increased. © RSNA, 2024 See also the editorial by Thrall in this issue.

The prevalence of impostor phenomenon and its association with burnout amongst urologists

OBJECTIVES

To characterise the prevalence of impostor phenomenon (IP; tendency for high-achieving individuals to perceive themselves as fraudulent in their successes) amongst attending staff in urology, to identify variables that predict more severe impostorism, and to study the association of IP with burnout.

SUBJECTS AND METHODS

A survey composed of the Clance Impostor Phenomenon Scale (CIPS), demographic information, practice details, and burnout levels was e-mailed to urologists via urological subspecialty societies. Survey results were analysed to identify associations between IP severity, survey respondent characteristics, and symptoms of professional burnout. This study was conducted in the United States of America.

RESULTS

A total of 614 survey responses were received (response rate 11.0%). In all, 40% (n = 213) of responders reported CIPS scores qualifying as either 'frequent' or 'intense' impostorism (i.e., scores of 61-100). On multivariable analysis, female gender, fewer years in practice (i.e., 0-2 years), and lower academic rank were all independently associated with higher CIPS scores (adjusted P < 0.05). Regarding burnout, 46% of responders reported burnout symptoms. On multivariable analysis, increase in CIPS score was independently associated with higher odds of burnout (odds ratio 1.06, 95% confidence interval 1.04-1.07; P < 0.001).

CONCLUSION

Impostor phenomenon is prevalent in the urological community and is experienced more severely in younger and female urologists. IP is also independently associated with burnout. Increased female representation may improve IP amongst our female colleagues. More work is needed to determine strategies that are effective in mitigating feelings of IP and professional burnout amongst urologists, particularly those earlier in their careers.

Nursing Home Workers' Experience During the COVID-19 Pandemic

PURPOSE

To understand nursing home workers' experience during the coronavirus disease 2019 (COVID-19) pandemic and investigate the prevalence of health-related quality of life, emotional distress, job satisfaction, and the impact of the pandemic.

METHOD

The Healthcare Worker Exposure Response and Outcomes (HERO) Registry served as the data source for this descriptive cross-sectional analysis. Recruitment was conducted nationally. Eligible nursing home workers (N = 1,409) enrolled in the study online, self-reported demographic and employment characteristics, and completed electronic surveys.

RESULTS

Nursing home workers reported overall good physical health, frequent depressive symptoms, burnout, and a high prevalence of feeling tired, stressed, having trouble sleeping, and feeling worried. Age and race were found to be positively associated with the impact of the pandemic.

CONCLUSION

Findings demonstrate the difficulties and challenges nursing home workers faced during the COVID-19 pandemic. Future research needs to evaluate the relationships among nursing home workers' roles, mental health, depressive symptoms, and prevalence of burnout with a larger, more diverse sample. [Research in Gerontological Nursing, 17(3), 131-140.].

Equity, diversity, and…exclusion? A national mixed methods study of "belonging" in Canadian undergraduate medical education

Equity, diversity, and inclusion remain a prominent focus in medical schools, yet the phenomenon of "belonging" has arguably been overlooked. Little is known regarding how belonging is experienced by medical students from groups that face systemic oppression and exclusion. We employed a sequential explanatory mixed methods design to explore how students from equity-deserving groups (EDGs) experience belonging during medical school, including those who are women, racialized, Indigenous, disabled, and 2SLGBTQIA+. First, we conducted a national cross-sectional survey of medical students (N = 480) measuring four constructs: belonging, imposter syndrome, burnout, and depression. Belonging scores were overall lower for students from EDGs and, more specifically, significantly lowest amongst racialized students. Structural equation models show that poor sense of belonging precedes imposter syndrome and further exacerbates burnout and depression. Next, we sampled and interviewed students (N = 16) from the EDG whose belonging scores were significantly lowest. Participants described the essence of belonging as being able to exist as one's "true self" while emphasizing feelings of acceptance, comfort, and safety as well as being valued and seen as an equal - yet described how routine experiences of "othering" inhibited a sense of belonging, often due to differences in social identity and structural privilege. Poor sense of belonging negatively affected learners' well-being and career trajectory. We illuminate the range of psychological and professional consequences associated with diminished sense of belonging and highlight the need to expand traditional notions of equity, diversity, and inclusion to consider structural barriers to belonging.

Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies

Importance

Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear.

Objective

To evaluate the association between clinician burnout and the outcomes of patients receiving of guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD).

Design, Setting, and Participants

This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023.

Exposures

Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more.

Main Outcomes and Measures

The primary outcome was patients' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix.

Results

In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement.

Conclusions and Relevance

In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.

Daily-level associations between posttraumatic stress disorder symptoms and reactions to retrieving positive autobiographical memories

Trauma survivors with posttraumatic stress disorder (PTSD) report difficulties accessing and describing positive memories. To understand these patterns, we examined daily-level relations of PTSD symptoms with affective, cognitive (dwelling/rumination; pushing memory out of one's mind; suppression; avoidance; distraction; thinking about something else; remembering negative or positive memories/events; negative or positive thoughts; accepting or disapproving memory; reinterpreting memory), and behavioral (using alcohol/drugs; smoking cigarettes; cravings for or seeking out cigarettes/alcohol/drugs; craving, seeking out, or consuming large amounts of food; dissociation; engaging in risky behaviors; sharing memories; interference with ongoing task; arousal) reactions to retrieving positive memories. Eighty-eight trauma survivors (Mage= 39.89 years; 59.1% female) completed 7 daily measures of PTSD and reactions to retrieving positive memories. Days with more PTSD severity were associated with higher odds of same-day suppression, avoidance, distraction, thinking about something else, smoking cigarettes, craving substances, craving, seeking out, or consuming large amounts of food, dissociation, remembering negative memories/events/thoughts, engaging in risky behaviors, interference with ongoing tasks, and arousal (ORs=1.10-1.22); and greater negative affect (β = 0.27). Supplemental lagged analyses indicated some associations between previous-day reactions to positive memory retrieval and next-day PTSD severity and vice versa. Trauma survivors with PTSD symptoms report negative and avoidance-oriented reactions to retrieving positive memories.

Small Patients but a Heavy Lift: Workload and Burnout of Advanced Practice Providers and Physicians in a Level IV Neonatal Intensive Care Unit

OBJECTIVE

This study explored the association between workload and the level of burnout reported by clinicians in our neonatal intensive care unit (NICU). A qualitative analysis was used to identify specific factors that contributed to workload and modulated clinician workload in the NICU.

STUDY DESIGN

We conducted a study utilizing postshift surveys to explore workload of 42 NICU advanced practice providers and physicians over a 6-month period. We used multinomial logistic regression models to determine associations between workload and burnout. We used a descriptive qualitative design with an inductive thematic analysis to analyze qualitative data.

RESULTS

Clinicians reported feelings of burnout on nearly half of their shifts (44%), and higher levels of workload during a shift were associated with report of a burnout symptom. Our study identified 7 themes related to workload in the NICU. Two themes focused on contributors to workload, 3 themes focused on modulators of workload, and the final 2 themes represented mixed experiences of clinicians' workload.

CONCLUSION

We found an association between burnout and increased workload. Clinicians in our study described common contributors to workload and actions to reduce workload. Decreasing workload and burnout along with improving clinician well-being requires a multifaceted approach on unit and systems levels.

Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

Testing an Intervention to Improve Health Care Worker Well-Being During the COVID-19 Pandemic: A Cluster Randomized Clinical Trial

Importance

Stress First Aid is an evidence-informed peer-to-peer support intervention to mitigate the effect of the COVID-19 pandemic on the well-being of health care workers (HCWs).

Objective

To evaluate the effectiveness of a tailored peer-to-peer support intervention compared with usual care to support HCWs' well-being at hospitals and federally qualified health centers (FQHCs) during the COVID-19 pandemic.

Design, Setting, and Participants

This cluster randomized clinical trial comprised 3 cohorts of HCWs who were enrolled from March 2021 through July 2022 at 28 hospitals and FQHCs in the US. Participating sites were matched as pairs by type, size, and COVID-19 burden and then randomized to the intervention arm or usual care arm (any programs already in place to support HCW well-being). The HCWs were surveyed before and after peer-to-peer support intervention implementation. Intention-to-treat (ITT) analysis was used to evaluate the intervention's effect on outcomes, including general psychological distress and posttraumatic stress disorder (PTSD).

Intervention

The peer-to-peer support intervention was delivered to HCWs by site champions who received training and subsequently trained the HCWs at their site. Recipients of the intervention were taught to respond to their own and their peers' stress reactions.

Main Outcomes and Measures

Primary outcomes were general psychological distress and PTSD. General psychological distress was measured with the Kessler 6 instrument, and PTSD was measured with the PTSD Checklist.

Results

A total of 28 hospitals and FQHCs with 2077 HCWs participated. Both preintervention and postintervention surveys were completed by 2077 HCWs, for an overall response rate of 28% (41% at FQHCs and 26% at hospitals). A total of 862 individuals (696 females [80.7%]) were from sites that were randomly assigned to the intervention arm; the baseline mean (SD) psychological distress score was 5.86 (5.70) and the baseline mean (SD) PTSD score was 16.11 (16.07). A total of 1215 individuals (947 females [78.2%]) were from sites assigned to the usual care arm; the baseline mean (SD) psychological distress score was 5.98 (5.62) and the baseline mean (SD) PTSD score was 16.40 (16.43). Adherence to the intervention was 70% for FQHCs and 32% for hospitals. The ITT analyses revealed no overall treatment effect for psychological distress score (0.238 [95% CI, -0.310 to 0.785] points) or PTSD symptom score (0.189 [95% CI, -1.068 to 1.446] points). Post hoc analyses examined the heterogeneity of treatment effect by age group with consistent age effects observed across primary outcomes (psychological distress and PTSD). Among HCWs in FQHCs, there were significant and clinically meaningful treatment effects for HCWs 30 years or younger: a more than 4-point reduction for psychological distress (-4.552 [95% CI, -8.067 to -1.037]) and a nearly 7-point reduction for PTSD symptom scores (-6.771 [95% CI, -13.224 to -0.318]).

Conclusions and Relevance

This trial found that this peer-to-peer support intervention did not improve well-being outcomes for HCWs overall but had a protective effect against general psychological distress and PTSD in HCWs aged 30 years or younger in FQHCs, which had higher intervention adherence. Incorporating this peer-to-peer support intervention into medical training, with ongoing support over time, may yield beneficial results in both standard care and during public health crises.

Trial Registration

ClinicalTrials.gov Identifier: NCT04723576.

A Systematic Review of the Single-Item Burnout Question: Its Reliability Depends on Your Purpose

BACKGROUND

Surveillance of burnout by the gold-standard Maslach Burnout Inventory (MBI) is hindered by cost and length. The validity and benchmarking of the commonly recommended and used single-item burnout question (SIBOQ) are unknown. We sought to (1) derive an equation for predicting the gold standard MBI from the SIBOQ and (2) measure the correlation of the SIBOQ with the full MBI and its subscales.

METHODS

We sought studies in PubMed along with citations by and to included studies. We included studies that either correlated the SIBOQ and the MBI or reported the rates of burnout measured by both instruments. Two reviewers extracted data and CLARITY risk of bias. We used generalized linear mixed regression to separately quantify the predictive (benchmarking) and explanatory (hot-spotting) capabilities of the SIBOQ. We created a regression equation for converting SIBOQ scores to MBI scores. We meta-analyzed correlation coefficients (r) for the SIBOQ and MBI subscales. For all analyses, we considered an r of 0.7 as acceptable reliability for group-level comparisons.

RESULTS

We included 17 studies reporting 6788 respondents. All studies had a high risk of bias, as no study had a response rate over 75% and no study was able to examine non-responders. The correlations (r) of the SIBOQ with the overall MBI were explanatory r = 0.82 and predictive r = 0.56. Regarding MBI subscales, the correlations of the SIBOQ with emotional exhaustion were adequate with r = 0.71 (95% CI 0.67-0.74; I2 = 89%), and depersonalization was r = 0.44 (95% CI 0.34-0.52; I2 = 90%). However, in 8 of 15 comparisons, the r was less than 0.70.

DISCUSSION

The SIBOQ's usually adequate explanatory abilities allow "hot-spotting" to identify subgroups with high or low burnout within a single, homogenous survey fielding. However, the predictive ability of the SIBOQ indicates insufficient reliability in comparing local results to external benchmarks.

Burnout assessment among pharmacist-academic detailers at the US Veterans Health Administration

BACKGROUND

Burnout among clinical pharmacist practitioners has been well established, but not among those who perform academic detailing.

OBJECTIVES

To measure burnout among clinical pharmacist practitioners who perform academic detailing (pharmacist-academic detailers) at the United States Veterans Health Administration and compare the findings using 2 validated burnout instruments for healthcare professionals.

METHODS

A cross-sectional study design was performed to measure burnout in VHA pharmacist-academic detailers across all VA regions between April 2023 and May 2023. Burnout was measured using the Oldenburg Burnout Inventory (OLBI) and a validated single-item burnout measure (SIMB). OLBI has 2 domains (exhaustion and disengagement) and categorizes burnout into Low, Moderate, and High based on scores above or below 1 standard deviation (SD) of the mean. The validated SIMB categorized burnout as having a score of 3 or greater (range: 1-5). Interrater reliability testing between the OLBI and the SIMB at detecting burnout among pharmacist-academic detailers was performed using the kappa test. Correlation between the 2 burnout instruments was assessed using the Spearman rho test.

RESULTS

A total of 50 pharmacist-academic detailers completed the burnout survey. A large proportion of respondents had Moderate levels of burnout for the total (72%) burnout score, disengagement (64%) domain, and exhaustion (74%) domain. In total, 86% of pharmacist-academic detailers reported having Moderate to High levels of burnout on the total OLBI score. On the SIMB, a total of 14 (28%) pharmacist-academic detailers reported having one or more symptoms of burnout. Interrater reliability was considered poor/slight agreement between the OLBI and SIMB. Correlation between the 2 burnout instruments was considered moderately correlated (rho = 0.67, P < 0.001).

CONCLUSION

This study provides an empirical analysis of burnout among pharmacist-academic detailers; however, the ability to detect burnout among pharmacist-academic detailers may be impacted by the selection of burnout instrument used.

Impact of the COVID-19 pandemic on pharmacists practicing in community pharmacies in the state of Nebraska

BACKGROUND

The rapid increase in COVID-19 combined with uncertainty surrounding transmission and treatment protocols resulted in unprecedented burnout amongst health care workers. As other health care workers scrambled to support patients, community pharmacists quickly responded to the pandemic by extending their services. This constantly changing environment amongst other factors created a high degree of psychological burden associated with COVID-19 for pharmacists. Although studies have examined the psychological impact of the pandemic on frontline health care workers, pharmacists are rarely included in these studies.

OBJECTIVE

To examine the impact of COVID-19 on work and personal well-being from the perspective of pharmacists practicing in community pharmacies in Nebraska.

METHODS

A cross-sectional online survey collected data from pharmacists with an active Nebraska Pharmacist license (N=2763) from November 2022 to January 2023. The survey was a hybrid of researcher-developed items and the validated abbreviated Maslach Burnout Inventory (aMBI). The aMBI is a 9-item Likert-scale scored instrument, which captures three domains of burnout: Personal Accomplishment; Emotional Exhaustion; and Depersonalization. Data was analyzed using IBM SPSS Statistics version 27.

RESULTS

The response rate to the survey was 12.3% (n=339). Mean age of the respondents was 44.8 years with an average of 18.7 years in practice. Most respondents (n = 113, 50.7%) practiced in a community pharmacy followed by hospital (n = 72, 32.3%). 55.8% of community pharmacists reported that they considered leaving their current employer. Chi-square analysis confirmed that community pharmacists are more burned out than noncommunity pharmacists.

CONCLUSIONS

Pharmacists realized they had not been recognized for their contributions as frontline health care workers, which motivated them to consider leaving their employer and even the profession of pharmacy. This study found community pharmacists are burned out more than non-community pharmacists. Within community pharmacies, it was found that pharmacists practicing at corporate-owned community pharmacies had increased burnout compared to those practicing in independent community pharmacies.

Association Between Physical Activity and the Risk of Burnout in Health Care Workers: Systematic Review

BACKGROUND

Burnout is a multidimensional psychological syndrome that arises from chronic workplace stress. Health care workers (HCWs), who operate in physically and emotionally exhausting work contexts, constitute a vulnerable group. This, coupled with its subsequent impact on patients and public economic resources, makes burnout a significant public health concern. Various self-care practices have been suggested to have a positive effect on burnout among HCWs. Of these, physical activity stands out for its ability to combine psychological, physiological, and biochemical mechanisms. In fact, it promotes psychological detachment from work and increases self-efficacy by inhibiting neurotransmitters and neuromodulators, increasing endorphin levels, enhancing mitochondrial function, and attenuating the hypothalamic pituitary-adrenal axis response to stress.

OBJECTIVE

Our objective was to conduct a systematic review of the evidence on the association between physical activity and burnout among HCWs.

METHODS

We considered HCWs, physical activity, and burnout, framing them as population, exposure, and outcome, respectively. We searched APA PsycArticles, MEDLINE, and Scopus until July 2022. We extracted relevant data on study design, methods to measure exposure and outcome, and statistical approaches.

RESULTS

Our analysis encompassed 21 independent studies. Although 10% (2/21) of the studies explicitly focused on physical activity, the remaining investigations were exploratory in nature and examined various predictors, including physical activity. The most commonly used questionnaire was the Maslach Burnout Inventory. Owing to the heterogeneity in definitions and cutoffs used, the reported prevalence of burnout varied widely, ranging from 7% to 83%. Heterogeneity was also observed in the measurement tools used to assess physical activity, with objective measures rarely used. In total, 14% (3/21) of the studies used structured questionnaires to assess different types of exercise, whereas most studies (18/21, 86%) only recorded the attainment of a benchmark or reported the frequency, intensity, or duration of exercise. The reported prevalence of physically active HCWs ranged from 44% to 87%. The analyses, through a variety of inferential approaches, indicated that physical activity is often associated with a reduced risk of burnout, particularly in the domains of emotional exhaustion and depersonalization. Furthermore, we compiled and classified a list of factors associated with burnout.

CONCLUSIONS

Our comprehensive overview of studies investigating the association between physical activity and burnout in HCWs revealed significant heterogeneity in definitions, measurements, and analyses adopted in the literature. To address this issue, it is crucial to adopt a clear definition of physical activity and make thoughtful choices regarding measurement tools and methodologies for data analysis. Our considerations regarding the measurement of burnout and the comprehensive list of associated factors have the potential to improve future studies aimed at informing decision-makers, thus laying the foundation for more effective management measures to address burnout.

"I realized I was not alone": A mixed-methods investigation of the implementation of Ubuntu groups to reduce burnout and social isolation in an allopathic medical School in the Southeastern United States

PURPOSE/BACKGROUND

Healthcare providers experience higher rates of workplace burnout, a reality highlighted by the COVID-19 pandemic. In response, small groups, inspired by South African philosophy, Ubuntu, were introduced to decrease burnout and social isolation and build community and belonging. This study examines how participation in these groups can impact these measures.

METHODS

In this mixed-methods study, trained facilitators led small groups that utilized story-sharing to foster connections within the group and broader community. Quantitative and qualitative data were analyzed separately and merged to identify convergence.

RESULTS

Three main qualitative themes emerged: 1) seeking and building connections and community, 2) curiosity, learning, and growing, and 3) open-hearted and thriving. These themes were linked to quantitative outcomes, showing a statistically significant decrease in social isolation among staff/faculty and students. Furthermore, faculty/staff exhibited reduced burnout compared to students, while students reported increased feelings of belonging.

CONCLUSION

Participation in Ubuntu groups positively influenced students' sense of belonging, reduced faculty/staff burnout, and alleviated social isolation for all participants. Future research should explore the potential of this intervention to further promote wellness on medical campuses. Programs emphasizing the well-being of individuals, including faculty, staff, and students, are crucial for supporting the overall health of medical communities and the wider society.

Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study

BACKGROUND

The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs.

OBJECTIVE

This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic.

METHODS

Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ≥1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave.

RESULTS

We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48%) attended >1 session. The study participants were predominantly female individuals (40/50, 80%) and comprised physicians (17/50, 34%), nurses (9/50, 18%), and other HCWs (24/50, 48%), who were largely from Ontario (41/50, 82%). Of 50 attendees, 26 (52%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92%). The most cited reasons for attending the program were to relax (38/48, 79%), manage stress or anxiety (36/48, 75%), wish for loving kindness or self-compassion (30/48, 64%), learn mindfulness (30/48, 64%), and seek help with emotional reactivity (25/48, 53%). Qualitative interviews with 15 out of 50 (30%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants' needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate.

CONCLUSIONS

The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs.

Advanced practice providers in hematology: actionable findings from national paired APP and physician surveys

ABSTRACT

Advanced practice providers (APPs) are critical to the hematology workforce. However, there is limited knowledge about APPs in hematology regarding specialty-specific training, scope of practice, challenges and opportunities in APP-physician interactions, and involvement with the American Society of Hematology (ASH). We conducted APP and physician focus groups to elucidate major themes in these areas and used results to inform development of 2 national surveys, 1 for APPs and 1 for physicians who work with APPs. The APP survey was distributed to members of the Advanced Practitioner Society of Hematology and Oncology, and the physician survey was distributed to physician members of ASH. A total of 841 APPs and 1334 physicians completed the surveys. APPs reported most hematology-specific knowledge was obtained via on-the-job training and felt additional APP-focused training would be helpful (as did physicians). Nearly all APPs and physicians agreed that APPs were an integral part of their organizations and that physician-APP collaborations were generally positive. A total of 42.1% of APPs and 29.3% of physicians reported burnout, and >50% of physicians felt that working with APPs had reduced their burnout. Both physicians and APPs reported interest in additional resources including "best practice" guidelines for APP-physician collaboration, APP access to hematology educational resources (both existing and newly developed resources for physicians and trainees), and greater APP integration into national specialty-specific professional organizations including APP-focused sessions at conferences. Professional organizations such as ASH are well positioned to address these areas.

Evaluation of Culture Conducive to Academic Success by Gender at a Comprehensive Cancer Center

INTRODUCTION

The primary objective of this study was to determine whether workplace culture in academic oncology differed by gender, during the COVID-19 pandemic.

MATERIALS AND METHODS

We used the Culture Conducive to Women's Academic Success (CCWAS), a validated survey tool, to investigate the academic climate at an NCI-designated Cancer Center. We adapted the CCWAS to be applicable to people of all genders. The full membership of the Cancer Center was surveyed (total faculty = 429). The questions in each of 4 CCWAS domains (equal access to opportunities, work-life balance, freedom from gender bias, and leadership support) were scored using a 5-point Likert scale. Median score and interquartile ranges for each domain were calculated.

RESULTS

A total of 168 respondents (men = 58, women = 106, n = 4 not disclosed) submitted survey responses. The response rate was 39% overall and 70% among women faculty. We found significant differences in perceptions of workplace culture by gender, both in responses to individual questions and in the overall score in the following domains: equal access to opportunities, work-life balance, and leader support, and in the total score for the CCWAS.

CONCLUSIONS

Our survey is the first of its kind completed during the COVID-19 pandemic at an NCI-designated Cancer Center, in which myriad factors contributed to burnout and workplace challenges. These results point to specific issues that detract from the success of women pursuing careers in academic oncology. Identifying these issues can be used to design and implement solutions to improve workforce culture, mitigate gender bias, and retain faculty.

Prevalence and Predictors of Burnout Among Resident Family Physicians

BACKGROUND AND OBJECTIVES

Resident burnout may affect career choices and empathy. We examined predictors of burnout among family medicine residents.

METHODS

We used data from the 2019-2021 American Board of Family Medicine Initial Certification Questionnaire, which is required of graduating residents. Burnout was a binary variable defined as reporting callousness or emotional exhaustion once a week or more. We evaluated associations using bivariate and multilevel multivariable regression analyses.

RESULTS

Among 11,570 residents, 36.4% (n=4,211) reported burnout. This prevalence did not significantly vary from 2019 to 2021 and was not significantly attributable to the residency program (ICC=0.07). Residents identifying as female reported higher rates of burnout (39.0% vs 33.4%, AOR=1.29 [95% CI 1.19-1.40]). Residents reporting Asian race (30.5%, AOR=0.78 [95% CI 0.70-0.86]) and Black race (32.3%, AOR=0.71 [95% CI 0.60-0.86]) reported lower odds of burnout than residents reporting White race (39.2%). We observed lower rates among international medical graduates (26.7% vs 40.3%, AOR=0.54 [95% CI 0.48-0.60]), those planning to provide outpatient continuity care (36.0% vs 38.7%, AOR=0.77 [95% CI 0.68-0.86]), and those at smaller programs (31.7% for <6 residents per class vs 36.3% for 6-10 per class vs 40.2% for >10 per class). Educational debt greater than $250,000 was associated with higher odds of burnout than no debt (AOR=1.29 [95% CI 1.15-1.45]).

CONCLUSIONS

More than one-third of recent family medicine residents reported burnout. Odds of burnout varied significantly with resident and program characteristics.

Radiology Resident Ownership Scale (RROS): Adapting a Validated Measure of Patient Care Ownership to the Radiology Context

RATIONALE AND OBJECTIVES

The aim of this study was to develop a validated instrument to measure radiology residents' sense of psychological ownership of patient care.

MATERIALS AND METHODS

A previously validated measure of patient care ownership was adapted through a two-step process of expert review and revision by six academic radiology faculty. An online, anonymous survey was distributed to 64 residents and fellows at the end of three consecutive four-week long rotations. We calculated Cronbach's α to determine the scale's internal consistency, performed exploratory factor analysis to identify possible subscales, and conducted bivariate and correlational analysis to establish construct validity.

RESULTS

The 11-item ownership scale demonstrated good internal consistency (Cronbach's α = 0.93), and three subscales were identified corresponding to assertiveness, conscientiousness, and confidence/perceived competence. Sense of ownership was significantly associated with training level, prior experience in the type of rotation, stress, sleep, burnout, peer support, relationships with clinical staff, and recognition by department. We found no significant association between ownership and age, gender, type of rotation, site of rotation, type of residency, perceived interruption frequency, or remote work frequency.

CONCLUSION

The radiology resident patient care ownership scale demonstrates good internal consistency and preliminary evidence of validity. After further validation, we expect the scale to be a valuable tool in evaluating interventions aimed at increasing radiology residents' sense of ownership.

The relationship between general practitioner movement behaviours with burnout and fatigue

BACKGROUND

Physical inactivity is associated with feelings of burnout and fatigue, which in turn are associated with reduced performance among healthcare practitioners. This study explored movement behaviours of general practitioners (GPs) and the association between these behaviours with burnout and fatigue.

METHODS

GPs in Northern Ireland were asked to wear a thigh-worn accelerometer for seven days and complete validated questionnaires to assess the association between daily number of steps, time spent sitting and standing with feelings of burnout and fatigue.

RESULTS

Valid accelerometer data were obtained from 47 (77.0%) participants. Average workday sitting time, standing time and number of steps were 10.6 h (SD 1.5), 3.8 h (SD 1.3), and 7796 steps (SD 3116) respectively. Participants were less sedentary (8.0 h (SD 1.6)) and more active (4.7 h (SD 1.4) standing time and 12,408 steps (SD 4496)) on non-workdays. Fourteen (30.4%) participants reported burnout and sixteen (34.8%) reported severe fatigue. There were no significant associations between sitting, standing and step counts with burnout or fatigue (p > 0.05).

CONCLUSION

GPs were less active on workdays compared to non-workdays and exhibited high levels of sitting. Feelings of burnout and fatigue were highly prevalent, however movement behaviours were not found to be associated with burnout and fatigue. Given the increased sedentariness among GPs on workdays compared to non-workdays, GPs should consider how they can improve their movement behaviours on workdays to help optimise their wellbeing.

The Underlying Structure of Preventive Behaviors and Related Factors During the COVID-19 Pandemic: A Comprehensive Network Analysis

BACKGROUND

Various strategies against COVID-19 have been adopted in different countries, with vaccination and mask-wearing being widely used as self-preventive interventions. However, the underlying structure of these behaviors and related factors remain unclear.

PURPOSE

In this study, we aimed to explore the network structure of preventive behaviors during the COVID-19 pandemic and their underlying factors, incorporating age and sex in the network.

METHODS

We used a multi-center sample of 20,863 adults who were vaccinated against COVID-19 in China between April 1, 2021, and June 1, 2021. Networks were estimated using unregularized partial correlation models. We also estimated the accuracy and stability of the network.

RESULTS

The preventive behaviors related to network factors revealed that self-initiated vaccination was more connected with cognition factors, and mask-wearing was more connected with personal profiles. The two clusters were linked through information-seeking and political beliefs. Moreover, self-initiated vaccination was negatively connected with vaccine hesitancy and concerns about COVID-19 vaccines and positively connected with trust in the vaccines, pandemic-related altruism, political beliefs, and being married. Mask-wearing was negatively connected with being a professional/white collar worker and higher education level and positively connected with regular physical examination, self-rated health, migration, being married, and better family relationships. Incorporation of age and sex into the network revealed relevant associations between age and mask-wearing and age and self-initiated vaccination. The network was highly accurately estimated. The subset bootstrap showed that the order of node strength centrality, betweenness, and closeness were all stable. The correlation stability coefficient (CS-coefficient) also showed the stability of this estimate, with 0.75 for node strength, 0.75 for betweenness, and 0.67 for closeness.

CONCLUSIONS

The internal structures of vaccination and mask-wearing behaviors were quite different, the latter of which were mainly affected by socioeconomic status and health-related behaviors and the former by knowledge about vaccines and political beliefs. Information-seeking and family relationships were the bridge factors connecting these two self-preventive behavior clusters, suggesting the direction of future efforts.

Sleep and mental health among unpaid caregivers of children, adults, and both: United States, 2022

OBJECTIVES

We sought to characterize sleep and mental health, and their relationship, among unpaid caregivers.

METHODS

During March through August 2022, four waves of cross-sectional surveys were administered to US adults using demographic quota sampling and weighting to improve representativeness of the US adult population.

RESULTS

Among 19,767 respondents, 6260 (31.7%) identified as serving one or more unpaid caregiving roles. Compared to people without caregiving roles, caregivers more commonly reported sleep duration outside the healthy range (7-9 hours), insomnia symptoms, diagnosed sleep disorders, and more commonly screened positive for anxiety, depression, and burnout symptoms. Multivariable analyses adjusted for demographics characteristics revealed unpaid caregivers had several-fold elevated odds of adverse mental health symptoms; associations were attenuated but remained significant after adjusting for impaired and nonoptimal sleep.

CONCLUSIONS

Both sleep and mental health challenges are disproportionately experienced by and commonly co-occur among unpaid caregivers, especially those who care for both children and adults. These populations, which serve critical societal roles, may benefit from enhanced support services to address sleep and mental health.

Newly Acquired Burnout During the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective Cohort Study on the Experiences of New York State Primary Care Clinicians

The well-being of primary care clinicians represents an area of increasing interest amid concerns that the COVID-19 pandemic may have exacerbated already high prevalence rates of clinician burnout. This retrospective cohort study was designed to identify demographic, clinical, and work-specific factors that may have contributed to newly acquired burnout after the onset of the COVID-19 pandemic. An anonymous web-based questionnaire distributed in August 2020 to New York State (NYS) primary care clinicians, via email outreach and newsletters, produced 1,499 NYS primary care clinician survey respondents. Burnout assessment was measured pre-pandemic and early in the pandemic using a validated single-item question with a 5-point scale ranging from (1) enjoy work to (5) completely burned out. Demographic and work factors were assessed via the self-reporting questionnaire. Thirty percent of 1,499 survey respondents reported newly acquired burnout during the early pandemic period. This was more often reported by clinicians who were women, were younger than 56 years old, had adult dependents, practiced in New York City, had dual roles (patient care and administration), and were employees. Lack of control in the workplace prior to the pandemic was predictive of burnout early in the pandemic, while work control changes experienced following the pandemic were associated with newly acquired burnout. Low response rate and potential recall bias represent limitations. These findings demonstrate that reporting of burnout increased among primary care clinicians during the pandemic, partially due to varied and numerous work environment and systemic factors.

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems.

METHODS

Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale.

RESULTS

A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder.

CONCLUSIONS

The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

Perceived and Received Support by Academic Medicine Faculty During the COVID-19 Pandemic: A Single Institution Study

OBJECTIVE

The COVID-19 pandemic negatively impacted healthcare worker well-being, leading to increased burnout and decreased workplace engagement. To combat expected stressors from the pandemic, our mid-sized academic health center implemented numerous institutional support, such as town halls, and virtual support groups. This study aimed to evaluate faculty utilization of institutional support, its association with perceived organizational support, received organizational support, and burnout.

METHODS

A retrospective, cross-sectional survey was distributed to 630 faculty employed at our institution in September 2020, assessing participant demographics, institutional support utilized, perceived organizational support, and burnout, through a combination of self-report measures and qualitative responses.

RESULTS

A total of 79 (12.5%) faculty provided complete responses and were included in the analysis. Qualitative analysis identified 4 primary themes: (1) flexibility and adjusted expectations, (2) direct communication, (3) sense of community, and (4) no support felt, with additional subthemes within each larger theme. Increased utilization of institutional support was associated with decreased odds of experiencing burnout.

CONCLUSION

Flexibility, communication, and sense of community emerged as important strategies for maintaining faculty well-being and engagement during the early stages of the COVID-19 pandemic. This study suggests that utilization of workplace support is protective against burnout. Perceived support was not beneficial.

How Does Sexual Subjectivity Vary on the Basis of Gender and Sexual Orientation? Validation of the Short Sexual Subjectivity Inventory (SSSI-11) in Cisgender, Heterosexual and Sexual and Gender Minority Adolescents

Through sexual exploration, adolescents learn that they are sexual beings with choices, desires, and are deserving of pleasure, which corresponds to sexual subjectivity. However, the two measures of this construct (i.e., Female Sexual Subjectivity Inventory and Male Sexual Subjectivity Inventory) have not been validated with younger adolescents and have different items for boys and girls (with no scale available for gender diverse individuals), limiting gender comparisons. This study examined (1) the factor structure of the adapted Short Sexual Subjectivity Inventory-11 items (SSSI-11) in a large sample of young cisgender, heterosexual and sexual and gender minority adolescents, (2) measurement invariance across language (English and French), gender, and sexual orientation, (3) validity with sexuality-related outcomes, and (4) one-year temporal stability. Results of a confirmatory factor analysis among 2001 adolescents (Mage = 15.5 years, SD = 0.60) revealed a multidimensional factor structure. The SSSI-11, in both English and French, showed adequate reliability and one-year temporal stability, and was invariant across genders, sexual orientations, and languages. Girls had lower scores on the entitlement to self-pleasure and self-efficacy in achieving pleasure factors, and higher scores on the entitlement to pleasure from a partner factor. No significant differences were observed on the basis of language or between heterosexual and sexual minority adolescents. The SSSI-11 correlated positively with sexuality-related variables. Findings support the strong psychometric properties of the SSSI-11, rendering it of considerable use in clinical, education, and research applications.

Beliefs, mental health, healthy lifestyle behaviors and coping strategies of college faculty and staff during the COVID-19 pandemic

Objective: To assess faculty and staff beliefs about returning to campus as well as their mental health and healthy lifestyle behaviors. Participants: Faculty and staff at a large Mid-west public land-grant university. Methods: A survey was emailed to a random sample of faculty and staff (N = 6,000 faculty; N = 6,000 staff). Results: Response rate was 35.6% for faculty (n = 2,138) and 37.8% (n = 2,226) for staff. Participants who were working from home (>60%) had less confidence about returning to campus safely than those who had been working on campus. Eighteen to 27% of faculty and 25%-31% of staff met the cutoff for clinical anxiety and the rates of depression were 4.4%-8.3% and 9.7%-10.0% respectively. Conclusion: Institutions of higher education must build wellness cultures and accelerate access to mental health services, which should be evidence-based and include a focus on promoting and maintaining overall wellness.

Hazardous, harmful, and dependent alcohol use in healthcare professionals: a systematic review and meta-analysis

Background

Healthcare professionals work in high-pressured and demanding environments, which has been linked to the use of alcohol as a coping strategy. This international review aimed (i) to determine the pooled prevalence of hazardous, harmful, dependent, and frequent binge drinking in healthcare professionals, and (ii) to explore factors associated with variation in these outcomes.

Methods

Scopus, MEDLINE, and PsycINFO were searched from 2003 to 17th November 2022, for studies reporting a prevalence estimate for any outcome among healthcare professionals. Random-effects meta-analyses determined pooled prevalence estimates. Sub-group analyses were conducted, stratifying the meta-analyses by pandemic period vs pre-pandemic period. Meta-regressions explored factors that were associated with variation in the outcomes. PROSPERO (CRD42020173119).

Results

After screening 9,108 records, 64 studies were identified as eligible. The pooled prevalence was 19.98% [95% Confidence Intervals [CI]: 16.05-24.23%] for hazardous alcohol use (K = 52), 3.17% [95% CI: 0.95-6.58%] for harmful drinking (K = 8), 14.59% [95% CI: 7.16-25.05%] for dependent drinking (K = 7), and 17.71% [95% CI: 8.34-29.63%] for frequent binge drinking (K = 11). The prevalence of hazardous drinking was greater during the pandemic (28.19%) compared with pre-pandemic estimates (17.95%), though this was not statistically significant (p = 0.049). Studies including all hospital staff (32.04%) showed higher prevalence estimates for hazardous drinking compared with studies of doctors (16.78%) and nurses (27.02%).

Conclusion

Approximately one fifth of healthcare professionals drink to hazardous levels, with higher prevalence estimates observed during the COVID-19 pandemic. It may be that healthcare professionals used alcohol to cope with the additional trauma and stressors. Further research is needed to investigate whether this is sustained in the post-pandemic period.

A study on measure of resilience and impact of demanding clinical training on young medical professional's burnout in a tertiary care hospital, Andhra Pradesh

BACKGROUND

The psychological state of medical students gaining concern on the part of medical institutions in several countries. Numerous studies are being conducted to study stress, burnout, and depression in medical students in India and globally. However, little is known about medical student resilience, particularly in India. The objectives of this study were to study the resilience, self-perceptions of stress coping skills, and burnout among medical students in clinical training in a tertiary care health center, to study factors associated with resilience among medical students in clinical training in a tertiary care health center and to study the relationship between resilience and self-perceptions of stress coping skills and symptoms of burnout.

MATERIALS AND METHODS

This cross-sectional study was conducted in a tertiary healthcare hospital in district Guntur, Andhra Pradesh from November 2020 to December 2020, among 186 adult male and female medical students, aged more than 20 years, enrolled in the regular degree course and part of patient care or at least last three months. Participants were randomly selected and a structured questionnaire with Connor Davidson Resilience Scale 10 was used for interviewing. Descriptive and inferential statistics were conducted to measure associations between outcome and explanatory variables. We used multiple linear regression to examine the association between dependent and independent variables. A P value less than. 05 was considered significant.

RESULTS

In the present study, 109 (58.0%) were females. The mean age of the study participants was 25.4 years (standard deviation 2.78). The mean score resilience score of the study participants using Connor Davidson Resilience Scale 10 was 25.1 (standard deviation 7.97). Of the total 44 (23.7%) of the study, participants reported the presence of burnout. A significant positive correlation was between resilience and self-perceptions of stress-coping skills with a Pearson Correlation coefficient of 0.393. Among the study participants, the mean resilience score was higher among those not having any symptoms of burnout. In the hierarchical stepwise multiple linear regression analysis, male gender (P value = .014), financial independence (P value = .044), and absence of burnout symptoms (P value = .004) were significantly associated with higher resilience scores. Psychiatric medicine usage was significantly associated with a lower resilience score with P < .05.

CONCLUSION

Our study samples had higher resilience and lower burnout prevalence compared to the West. The stressful clinical event experienced by medical students demands training and innovative strategies to foster communication and teamwork skills among medical teams.

An innovative programme to track and address burnout in physician trainees

BACKGROUND

There is a call to action for health care systems to assess and address burnout among physician trainees. To address this need for programmatic change, we developed a novel initiative to (1) proactively assess trainee burnout and identify drivers and (2) provide resources and recommendations for preventing and reducing burnout.

APPROACH

This pilot burnout tracking initiative began in 2020. A two-question burnout survey was disseminated to physician trainees at a hospital devoted exclusively to clinical research. The survey assessed burnout level and drivers of burnout. An algorithm was created to recommend action steps based on trainee responses. Participating training programmes completed a 23-question survey annually to provide information about their trainees and feedback.

EVALUATION

Seven of 10 (70%) programmes completed the annual survey in the first year, and 12 of the 15 (80%) programmes completed it the second year. Reported average burnout levels and drivers of burnout varied across programmes; all drivers of burnout were cited as key drivers by at least one programme. Most programmes had conversations with their trainees and found these conversations helpful. All responding programmes who administered the trainee survey felt the initiative improved their ability to track and reduce burnout.

IMPLICATIONS

An initiative to systematically track burnout levels and offer targeted interventions was feasible and useful. This project can be a model for institution-wide efforts to address trainee burnout and extend to other clinical health care settings and academic medicine faculty.

The effects of COVID-19 event strength on job burnout among primary medical staff

BACKGROUND

As a global pandemic, The Corona Virus Disease 2019 (COVID-19) has brought significant challenges to the primary health care (PHC) system. Health professionals are constantly affected by the pandemic's harmful impact on their mental health and are at significant risk of job burnout. Therefore, it is essential to gain a comprehensive understanding of how their burnout was affected. The study aimed to examine the relationship between COVID-19 event strength and job burnout among PHC providers and to explore the single mediating effect of job stress and work engagement and the chain mediating effect of these two variables on this relationship.

METHODS

Multilevel stratified convenience sampling method was used to recruit 1148 primary medical staff from 48 PHC institutions in Jilin Province, China. All participants completed questionnaires regarding sociodemographic characteristics, COVID-19 event strength, job stress, work engagement, and job burnout. The chain mediation model was analyzed using SPSS PROCESS 3.5 Macro Model 6.

RESULTS

COVID-19 event strength not only positively predicted job burnout, but also indirectly influenced job burnout through the mediation of job stress and work engagement, thereby influencing job burnout through the "job stress → work engagement" chain.

CONCLUSIONS

This study extends the application of event systems theory and enriches the literature about how the COVID-19 pandemic impacted PHC medical staff job burnout. The findings derived from our study have critical implications for current and future emergency response and public policy in the long-term COVID-19 disease management period.

The relationship between a single-item measure of burnout and the Copenhagen Burnout Inventory in family medicine residents

OBJECTIVE

Burnout during residency education is a phenomenon which requires careful study. A single item for measuring burnout shows promise for its brevity and concordance with the most commonly used measure of burnout, the Maslach Burnout Inventory, but has not been compared to the Copenhagen Burnout Inventory. We compared the single-item measure of burnout question to the Copenhagen Burnout Inventory to assess the convergence between these two measures of burnout.

METHOD

Family Medicine residents (n = 32) from three residency programs completed the single-item measure of burnout question and the Copenhagen Burnout Inventory. We compared the single-item measure of burnout measure to the three scales of the Copenhagen Burnout Inventory.

RESULTS

Our analyses indicated that the single item measure is highly correlated with personal burnout (r = .76), moderately correlated with patient burnout (r = .58), and not correlated with work burnout (r = .18).

CONCLUSIONS

Because the single-item measure of burnout is particularly useful for identifying personal burnout, it may help to identify early signs of burnout amount physicians in training.

Changes in anxiety and depression among public health workers during the COVID-19 pandemic response

OBJECTIVES

The COVID-19 pandemic has negatively impacted mental health indicators, leading to an increase in symptoms of anxiety and depression in both the general population of adults and children and many occupational groups. This study aims to examine changes in anxiety and depression among a cohort of public health workers in the U.S. during the first year of the COVID-19 pandemic and identify potential risk factors.

METHODS

Longitudinal data were collected from a sub-sample (N = 85) of public health workers in 23 U.S. states who completed two surveys in 2020 and 2021. Information on background characteristics, personal well-being, and work environment as well as validated scales to assess generalized anxiety disorder (GAD), depressive disorder, and burnout was collected. Data were analyzed using Stata Version 17, and significant differences were determined using Pearson's Chi2 and Fisher's Exact tests.

RESULTS

The proportion of those reporting GAD (46.3% to 23.2%) or depression (37.8% to 26.8%) improved from Survey 1 to Survey 2 overall; symptoms of anxiety saw the largest improvement. Persistent depression was associated with sustained burnout, changes in social support, and days worked per week.

CONCLUSION

Public health workers experienced elevated levels of anxiety and depression during the initial pandemic response, but a reduction in these symptoms was observed in the subsequent year after vaccines had become widely available. However, unmet needs remain for ongoing workplace mental health supports to address burnout, as well as for additional emotional supports outside of work for public health professionals.

Studying moral distress (MD) and moral injury (MI) among inpatient and outpatient healthcare professionals during the COVID-19 pandemic

BACKGROUND

COVID-19 increased moral distress (MD) and moral injury (MI) among healthcare professionals (HCPs). MD and MI were studied among inpatient and outpatient HCPs during March 2022.

OBJECTIVES

We sought to examine (1) the relationship between MD and MI; (2) the relationship between MD/MI and pandemic-related burnout and resilience; and (3) the degree to which HCPs experienced pandemic-related MD and MI based on their background.

METHODS

A survey was conducted to measure MD, MI, burnout, resilience, and intent to leave healthcare at 2 academic medical centers during a 4-week period. A convenience sample of 184 participants (physicians, nurses, residents, respiratory therapists, advanced practice providers) completed the survey. In this mixed-methods approach, researchers analyzed both quantitative and qualitative survey data and triangulated the findings.

RESULTS

There was a moderate association between MD and MI (r = .47, P < .001). Regression results indicated that burnout was significantly associated with both MD and MI (P = .02 and P < .001, respectively), while intent to leave was associated only with MD (P < .001). Qualitative results yielded 8 sources of MD and MI: workload, distrust, lack of teamwork/collaboration, loss of connection, lack of leadership, futile care, outside stressors, and vulnerability.

CONCLUSIONS

While interrelated conceptually, MD and MI should be viewed as distinct constructs. HCPs were significantly impacted by the COVID-19 pandemic, with MD and MI being experienced by all HCP categories. Understanding the sources of MD and MI among HCPs could help to improve well-being and work satisfaction.

Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study

BACKGROUND

Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations.

OBJECTIVE

This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages.

METHODS

We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups.

RESULTS

Few study participants resided in nonmetropolitan (25/255, 10%) or rural (3/255, 1%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39% (99/255) resided in an MUA and 55% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale≥10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA.

CONCLUSIONS

Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent-guided cognitive behavioral therapy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745.

When Illegitimate Tasks Threaten Patient Safety Culture: A Cross-Sectional Survey in a Tertiary Hospital

Objectives: The current study investigates the prevalence of illegitimate tasks in a hospital setting and their association with patient safety culture outcomes, which has not been previously investigated. Methods: We conducted a cross-sectional survey in a tertiary referral hospital. Patient safety culture outcomes were measured using the Hospital Survey on Patient Safety Culture questionnaire; the primary outcome measures were a low safety rating for the respondent's unit and whether the respondent had completed one or more safety event reports in the last 12 months. Analyses were adjusted for hospital department and staff member characteristics relating to work and health. Results: A total of 2,276 respondents answered the survey (participation rate: 35.0%). Overall, 26.2% of respondents perceived illegitimate tasks to occur frequently, 8.1% reported a low level of safety in their unit, and 60.3% reported having completed one or more safety event reports. In multivariable analyses, perception of a higher frequency of illegitimate tasks was associated with a higher risk of reporting a low safety rating and with a higher chance of having completed event reports. Conclusion: The prevalence of perceived illegitimate tasks was rather high. A programme aiming to reduce illegitimate tasks could provide support for a causal effect of these tasks on safety culture outcomes.

Workplace Discrimination and Burnout Among Asian Nurses in the US

This cross-sectional study analyzes the association of workplace discrimination with burnout among Asian nurses in the US.

Changes in stress, burnout, and resilience associated with an 8-week intervention with relational agent "Woebot"

Background

Research investigating the potential for digital mental health interventions with integrated relational agents to improve mental health outcomes is in its infancy. By delivering evidence-based mental health interventions through tailored, empathic conversations, relational agents have the potential to help individuals manage their stress and mood, and increase positive mental health.

Aims

The aims of this study were twofold: 1) to assess whether a smartphone app delivering mental health support through a relational agent, Woebot, is associated with changes in stress, burnout, and resilience over 8 weeks, and 2) to identify demographic and clinical factors associated with changes in these outcomes.

Method

This exploratory, non-randomized, single-armed, open-labeled trial was conducted from May to July 2022. A total of 256 adults (mean age 39 ± 13.35; 72 % females) recruited through social media advertising enrolled in the study. Participants completed an 8-week intervention period during which they were invited to use a smartphone app called Woebot-LIFE that delivers cognitive behavioral therapy through a relational agent called "Woebot". Participant-reported measures of stress, burnout, and resilience were collected at Baseline, and Week 8. Changes in these outcomes during the study period were assessed. Bivariate and stepwise multiple regression modeling was used to identify sociodemographic and clinical factors associated with observed changes over the 8-week study period.

Results

Exposure to Woebot-LIFE was associated with significant reductions in perceived stress and burnout and significantly increased resilience over the 8-week study period. A greater reduction in stress was observed among those with clinically elevated mood symptoms (i.e., Patient Health Questionnaire-8 or Generalized Anxiety Disorder 7-item scores ≥10) at baseline compared to those without; however, the differences in the improvements in resilience scores and burnout between the two groups were not statistically significant. Although a difference in the magnitude of change in stress was observed for participants with and without clinically elevated mood symptoms at baseline, significant improvements in stress, burnout, and resilience over the 8-week study period were observed for both groups. Bivariate analyses showed that race, insurance type, and baseline level of resilience were associated with changes in each of the outcomes, though baseline resilience was the only factor that remained significantly associated with changes in the outcomes in the stepwise multiple regression analyses.

Conclusion

Results of this single-arm, exploratory study suggest that conversational agent-guided mental health interventions such as Woebot-LIFE may be associated with reduced stress and burnout and increased resilience in both clinical and non-clinical populations.

Day to Day and Environmental Risk Factors for Psychological Distress Among Healthcare Workers: A Mixed Methods Analysis

OBJECTIVE

Despite a growing literature on mental health among clinical staff during COVID-19, factors shaping distress for nonclinical staff are understudied and may be driven by inequalities at work. We aimed to discuss the role of workplace factors in shaping psychological distress for a diverse group of clinical, nonclinical, and other health and hospital workers (HHWs).

METHODS

This convergent parallel mixed-methods study with HHWs in a US hospital system included an online survey ( n = 1127) and interviews ( n = 73) collected from August 2020 to January 2021. We thematically analyzed interviews; findings informed log binomial regression estimating risk factors for severe psychological distress (Patient Health Questionnaire - 4 item version [PHQ-4] scores of 9 or greater).

RESULTS

Qualitatively, day-to-day stressors fostered fear and anxiety, and concerns about work environments manifest as betrayal and frustration with leadership. Distress was associated with burnout, financial concerns, and feeling betrayed or unsupported by the institution and leadership. Staff in service versus clinical roles had higher risk for severe distress (adjusted prevalence ratio = 2.04, 95% confidence interval = 1.13-2.66); HHWs receiving workplace mental health support had lower risk (adjusted prevalence ratio = 0.52, 95% confidence interval = 0.29-0.92.

CONCLUSIONS

Our mixed-methods study underscores how the pandemic brought inequalities to the surface to increase distress for vulnerable HHWs. Workplace mental health activities can support HHWs now and during future crises.

Stress Impact and Care for COVID-19: Pilot Education and Support Course Decreases Burnout Among Nursing Students

BACKGROUND

Nurses and nursing students have been at the forefront of the fight against COVID-19, often working in conditions that produce stress injuries and burnout. Early recognition and mitigation of stress and emotional trauma help prevent burnout.

AIMS

To evaluate the effectiveness of an online 8-hour stress awareness course and associated 1-hour support group in reducing stress and burnout among nursing students.

METHODS

We conducted a program evaluation for an online stress awareness pilot course offered to nursing students. The course, and associated support groups led by trained psychiatric mental health nurse practitioner students, included a common language for talking about stress, screening tools for recognizing stress injuries, and strategies for improving self-care. Students completed pre- and post-course surveys. Outcome measures included changes on course learning objectives, level of burnout, health-related locus of control, and experiences of stress and coping.

RESULTS

Nursing students (n = 360) enrolled in the course, and 224 (62%) completed pre- and post-course surveys. Sixty percent rated the course excellent or very good. Depression Anxiety and Stress Scales and Impact of Event Scale Revised scores were within established normal ranges. There was a significant increase in all nine course learning objectives (p < .001) and decreased signs of stress (p < .001). Students' level of burnout decreased by odds ratio = 0.58 (95% CI: [0.4, 0.9], p < .006).

CONCLUSIONS

Nursing leaders can use psychoeducational strategies to mitigate the impact of stress, build confidence, and support nursing students entering the workforce during these unprecedented times.