Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study

Demoralization Syndrome in End-Of-Life Cancer Patients: A Qualitative Study

ObjectivesIn our previous study we analyzed the prevalence of demoralization in a sample of 235 end-of-life cancer patients using the Demoralization Scale (DS). The findings revealed that 50.2% of the participants reported experiencing a moderate level of demoralization. The main sub-dimensions observed from the original DS were Helplessness, Disheartenment, and Sense of Failure, which we have categorized as "Emotional Distress and Inability to Cope". The aim of this study was to qualitatively investigate the subjective experience of this factor among a group of terminal cancer patients.MethodA sample of 30 patients was interviewed using seven open-ended questions, divided into 3 categories: helplessness, disheartenment and sense of failure. Content analysis was performed.ResultsFaith and prayer, social support and preserving autonomy were the principal coping strategies used by the sample and have been classed as sources of hope. Sadness, anger, death anxiety, fear, and sickness were the most commonly expressed emotions. Faith, social support, autonomy, and fighting spirit were identified as the primary coping strategies.ConclusionsThis study allowed a better understanding of the patient's subjective experience of the demoralization sub-dimension. The deepening of the topic can increase personalized clinical interventions, according to the patient's needs.

Translation and cultural adaptation of the DE-STRESS survey into Danish - Measuring stress, coping, and intention to leave among Emergency department Nurses, Nurse Assistants, and Physicians

AIM

This study aimed to translate and culturally adapt the DE-STRESS (Emergency Department Stress, Coping, and Intention to Leave Survey) to the Danish emergency context.

BACKGROUND

Clinicians (nurses, nurse assistants, and physicians) in an emergency department (ED) undertake psychologically demanding work, and the high-pressure environment combined with occupational stressors has made retention of ED clinicians a major issue. A suitable measure of stress and coping would contribute to the development of practices to support clinicians working in these high-stress environments.

METHOD

The translation process was undertaken using the ISPOR principles of good practice for the translation and cultural adaptation of patient-reported outcomes, including forward translation, back translation, and cognitive debriefing through individual interviews with ED clinicians (n = 5). The study took place in a large teaching hospital in Southern Denmark and involved three forward translators, two backward translators, a key in-country person from both Australia and Denmark, and a project lead.

RESULTS

The translation and cultural adaptation process was successfully conducted. Some concepts were difficult to translate, such as the terms ED and organization and the role of an ED supervisor. It was necessary to omit some demographic questions to ensure respondent anonymity, so the final Danish version has 123 questions versus the original 133 questions.

CONCLUSION

The ED clinicians found the survey relevant and comprehensive as it addressed key factors in their work. We concluded that the Danish version of DE-STRESS is appropriate for use; however, a future study employing confirmatory factor analysis and assessing internal reliability is necessary to further investigate its psychometric properties.

Key factors for sustainable working conditions in emergency departments: an EUSEM-initiated, Europe-wide consensus survey

BACKGROUND AND IMPORTANCE

Modern emergency medicine (EM) is a complex, demanding, and occasionally stressful field of work. Working conditions, provider well-being, and associated health and performance outcomes are key factors influencing the establishment of a sustainable emergency department (ED) working environment.

OBJECTIVES

This multinational European Delphi survey aimed to identify unequivocal major factors for good and poor ED working conditions and their possible effects on health care provider well-being.

DESIGN/SETTING AND PARTICIPANTS

A total of 18 experts from six European countries (Belgium, Finland, Germany, Italy, Romania, and the UK) covering three different hospital sizes (small, medium, and large) in their respective countries participated in the two-round Delphi survey. All panelists held leadership roles in EM.

OUTCOME MEASURES AND ANALYSIS

The first step involved conducting an extensive literature search on ED working conditions. The second step involved the first Delphi round, which consisted of structured interviews with the panelists. The survey was designed to obtain information concerning important working conditions, comments regarding work-life factors identified from the literature, and ratings of their importance. Interviews were transcribed and analyzed following a standardized protocol. In the second Delphi round, experts rated the relevance of items consolidated from the first Delphi round (classified into ED work system factors, provider health outcomes, and ED work-life intervention approaches).

RESULTS

A nearly unequivocal consensus was obtained in four ED work condition categories, including positive (e.g. job challenges, personal motivation, and case complexities) and negative (e.g. overcrowding, workflow interruptions/multitasking, medical errors) ED work conditions. The highly relevant adverse personal health events identified included physical fatigue, exhaustion, and burnout. Concerning intervention practices, the panelists offered a wide spectrum of opportunities with less consensus.

CONCLUSION

Work system conditions exert positive and negative effects on the work life of ED providers across Europe. Although most European countries have varying health care systems, the expert-based survey results presented herein strongly suggest that improvement strategies should focus on system-related external stressors common in various countries. Our findings lay the scientific groundwork for future intervention studies at the local and systemic levels to improve ED provider work life.

The mediator role of mindfulness in the relationship between the listening skills and anger management skills of emergency health care professionals

BACKGROUND

Effective communication plays a crucial role in establishing strong relationships and providing essential support in clinical situations. This study was conducted to investigate the mediator role of mindfulness in the relationship between the listening skills and anger management skills of healthcare professionals working in the emergency department (ED).

METHOD

This was a cross-sectional study, which was conducted with 230 emergency department healthcare professionals (EHCPs) working in adult EDs in Turkey. Sociodemographic Characteristics Data Collection Form, Mindful Attention Awareness Scale (MAAS), Listening Skills Assessment Scale (LSAS), and Anger Management Scale (AMS) were used for data collection. Descriptive statistics included frequency and percentage; t test and ANOVA test were used for statistical analyses, as was "Process Macro 3.5 Model 4", which was used to study the effect of mediator variables.

RESULTS

The participants had a mean MAAS score of 57.71 ± 12.38, a mean LSAS score of 45.36 ± 6.23, and a mean AMS score of 17.93 ± 3.39. There were significant positive correlations between LSAS and MAAS (r = 0.197, p < 0.001), between AMS and MAAS (r = 0.233p < 0.001), and between AMS and LSAS r = 0.24p < 0.001). In addition, the process model analysis results supported that MAAS had a partial mediator role in the correlation between LSAS and AMS, and that its indirect effects were predicted by LSAS and AMS. It was determined that 5.75 % of total change on AMS was predicted by LSAS (F = 13.918; p < 0.001).

CONCLUSION

The results of this study indicate that as the mindfulness level of EHCPs increases, their listening and anger management skills increased. Therefore, reinforcing mindfulness by integrating mindfulness interventions into in-service training and applying strategies that promote EHCPs' listening skills and anger management skills would make it possible to provide quality health care with employees who are more efficient in conflict management and enjoy a higher level of satisfaction.

Perceived Work Demands and Emergency Department Crowding as Predictors of Objective Stress Among Emergency Physicians: A Shift-Level Approach

OBJECTIVE

To understand shift-level determinants of emergency physician (EP) burnout, relationships were tested between EP shift demands, stress, and fatigue.

METHOD

EP ( n = 16) were assessed over 114 shifts that occurred before and during the COVID-19 pandemic. Salivary cortisol (an indicator of stress) and self-reported fatigue were collected prior to and following each shift. An objective crowding score (National Emergency Department Overcrowding Scale) per shift was calculated. Shift demands were assessed at the end of each shift.

RESULTS

Multilevel models revealed that shift demands, National Emergency Department Overcrowding Scale, and the pandemic were related to higher levels of end-of-shift cortisol, but not fatigue. Cortisol levels were higher for shifts with a higher number of demands, greater crowding, and during the pandemic.

CONCLUSIONS

Shift demands predicted objective indicators of stress, but not self-reported fatigue. Interventions are needed to decrease stress and shift demands to reduce EP burnout.

What can be done about workplace wellbeing in emergency departments? 'There's no petrol for this Ferrari'

Workplace wellbeing encompasses all aspects of working life. Peak health organisations recognise that poor workplace wellbeing is costly, both to individuals and to the organisation, and the value in promoting healthy workplaces. Workplace wellbeing improves when its barriers are acknowledged and addressed, and protective factors are promoted. The Emergency Department (ED) is a place of intense and challenging activity, exacerbated by high workloads and overcrowding. This impacts negatively on patient care, staff safety and wellbeing. We held focus groups across four EDs to discuss barriers and enablers to wellbeing and found four core themes: Workplace Satisfaction; Barriers to Wellbeing; Organisational Culture that Prioritises Staff Wellbeing; Self-care and Self Compassion. From this, and existing literature, we collaboratively developed a contextualised staff wellbeing framework titled: 'Staff Wellbeing Good Practice Framework: From Surviving to Thriving, How to Protect your Wellbeing in the Emergency Department' that emphasises their values of Competence, Connection and Control.

Exploring antecedents and outcomes of burnout among emergency department staff using the job demands-resources model: A scoping review protocol

INTRODUCTION

High levels of burnout are prevalent among Emergency Department staff due to chronic exposure to job stress. There is a lack of knowledge about anteceding factors and outcomes of burnout in this population.

AIMS

To provide a comprehensive overview of burnout and identify its workplace antecedents and outcomes among Emergency Department staff.

METHODS

The scoping study will follow the methodology outlined by the Joanna Briggs Institute. PubMed, Scopus, Web of Science, APA PsycInfo, and CINAHL databases will be searched using predefined strategies. Two reviewers will screen the title, abstract and full text separately based on the eligibility criteria. Data will be charted, coded, and narratively synthesized based on the job demands-resources model.

CONCLUSION

The results will provide insights into the underlying work-related factors contributing to burnout and its implications for individuals, healthcare organizations, and patient care.

Investigation of the selection and use of "other" personal protective equipment to prevent mucous membrane exposure in nurses: A cross-sectional study

BACKGROUND

Selection and use of personal protective equipment (PPE) to prevent non-percutaneous body fluid exposure (NP BFE) is determined by a clinical assessment of risk. The aim of this study was to explore the selection and use of PPE, particularly masks and eye protection to prevent NP BFE, by nurses.

METHODS

This quantitative single-site two-phased study was guided by the Health Belief Model (HBM). Phase 1 was a retrospective electronic database audit of body fluid exposure surveillance data. Phase 2 included a cross-sectional survey.

RESULTS

The highest incidence of reported NP BFE to non-intact skin and mucous membranes during the study period were identified in the emergency department (ED) at 51.3% (20/39), intensive care unit (ICU) at 30.8% (12/39), operating theatre (OT) with 12.9% (5/39), and inpatient renal ward with 5.1% (2/39). Reported PPE use during NP BFE was: 0% face shields or masks, 10% gown/apron, and 15% goggles. Survey results related to Prevention of mucocutaneous exposures were similar across all high-risk units, though ED nurses reported poorer compliance with the use of PPE to prevent exposure. Risk assessment for prevention of NP BFE was reported, yet there was a lack of compliance. The ICU results indicated a positive safety culture in contrast to the ED.

CONCLUSION

The findings are consistent with research identifying inadequate prevention of NP BFE, although nurses are aware of the importance of risk assessment. The HBM has the potential to increase understanding of the differences in nurses' perceptions of risk in safety culture.

Measuring occupational stress in emergency departments

OBJECTIVE

EDs are highly demanding workplaces generating considerable potential for occupational stress experiences. Previous research has been limited by a focus on specific aspects of the working environment and studies focussing on a range of variables are needed. The aim of the present study was to describe the perceptions of occupational stress and coping strategies of ED nurses and doctors and the differences between these two groups.

METHODS

This cross-sectional study was conducted at a public metropolitan hospital ED in Queensland, Australia. All ED nurses and doctors were invited to participate in an electronic survey containing 13 survey measures and one qualitative question assessing occupational stress and coping experiences. Descriptive statistics were employed to report stressors. Responses to open-ended questions were thematically analysed.

RESULTS

Overall, 104 nurses and 35 doctors responded (55.6% response rate). Nurses reported higher levels of both stress and burnout than doctors. They also reported lower work satisfaction, work engagement, and leadership support than doctors. Compared with doctors, nurses reported significantly higher stress from heavy workload/poor skill mix, high acuity patients, environmental concerns, and inability to provide optimal care. Thematic analysis identified high workload and limited leadership and management support as factors contributing to stress. Coping mechanisms, such as building personal resilience, were most frequently reported.

CONCLUSIONS

The present study found organisational stressors adversely impact the well-being of ED nurses and doctors. Organisational-focused interventions including leadership development, strategic recruitment, adequate staffing and resources may mitigate occupational stress and complement individual coping strategies. Expanding this research to understand broader perspectives and especially the impact of COVID-19 upon ED workers is recommended.

Factors of maladaptive coping in emergency healthcare professionals: A systematic review

BACKGROUND

Emergency healthcare professionals (EHPs) face significant occupational stressors requiring the skilled use of adaptive coping strategies. Some EHP resort to maladaptive coping (MC) strategies that negatively impact their mental health, yet MC strategies are not clearly defined in the literature. Examining factors that predispose EHP to MC can support interventions to improve coping and well-being.

OBJECTIVE

This systematic review examined MC among EHP working in pre-hospital and hospital-based settings. The primary aim was to identify factors associated with MC strategies used by EHP.

METHODS

Embase, Ovid, CINAHL Plus, PsychInfo, and the Cochrane Library were systematically searched for quantitative studies measuring MC use among EHP. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 checklist was used to guide the review. Studies were included if they: (a) targeted licensed healthcare professionals providing patient care, (b) occurred in emergency department or pre-hospital emergency setting, and (c) examined provider coping. Studies were excluded if they: (a) did not include EHPs, (b) did not differentiate results in mixed samples, (c) did not clearly measure coping strategies, (d) failed to include MC strategies in the results, or (e) were not available in full text. Risk of bias and study quality was appraised using Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Bandura's Social Cognitive Theory (SCT) guided the final synthesis, drawing conclusions from the evidence to identify factors associated with MC in EHP.

RESULTS

A total of 14 cross-sectional studies, published between 2003 and 2021, were included in the review. Included studies were conducted in either pre-hospital, hospital, or a combination of both settings. Most studies included mixed samples or emergency physicians. A variety of coping strategies were significantly correlated with poor mental health outcomes including venting, denial, disengagement, self-blame, and substance use. Among personal factors, EHPs who were female, older than 50, living alone, with personal trauma history were significantly more likely to use MC strategies. Additionally, EHP with children, work experience, higher life satisfaction, and resilience were negatively associated with MC. Environmental factors positively associated with MC included work stress, workload, and poor benefits. Trauma exposure had a positive, but non-significant relationship.

CONCLUSIONS

Emergency healthcare professionals use a variety of coping strategies, many of which are maladaptive and significantly related to poor mental health outcomes. Several personal and environmental factors contribute to behavior that reflect the use of MC strategies, but findings are sparse. Researchers should consider current limitations and challenges, particularly mental health stigma, when designing future studies.

CLINICAL RELEVANCE

The evidence in this review suggests that certain factors predispose EHP for use of MC strategies. This review highlights an important research gap necessitating more robust studies to identify MC risk factors among EHP in chronically high-stress environments.

Critical Clinical Events and Resilience Among Emergency Nurses in 3 Trauma Hospital-Based Emergency Departments: A Cross-Sectional Study

INTRODUCTION

Emergency nurses experience occupational stressors resulting from exposures to critical clinical events. The purpose of this study was to identify the critical clinical events for emergency nurses serving 3 patient populations (general, adult, pediatric) and whether the resilience of these nurses differed by the patient population served.

METHODS

This study used a cross-sectional survey design. A total of 48 emergency nurses were recruited from 3 trauma hospital-based emergency departments (general, adult, pediatric). Clinical Events Questionnaire, Connor-Davidson Resilience scale, and an investigator-developed demographic questionnaire were used to collect data from respondents.

RESULTS

All respondents were female (n = 48, 100%), and most were White (n = 46, 96%). The average age of participants was 39.6 years, the average number of years as a registered nurse was 12.7 years, and the average number of years as an emergency nurse was 8.8 years. Clinical events considered most critical were providing care to a sexually abused child, experiencing the death of a coworker, and lack of responsiveness by a colleague during a serious situation. The least stress-provoking event was incidents with excessive media coverage. Nurses were less affected by the critical events they experienced more frequently at work. Nurses in the 3 trauma settings had high level of resilience, with no statistically significant differences between groups.

DISCUSSION

The occupational stress from exposure to significant clinical events varied with the patient population served by emergency nurses. It is important that interventions be adopted to alleviate the effect of work-related stressors and promote the psychological health of emergency nurses.

Quantifying the impact of environment factors on the risk of medical responders' stress-related absenteeism

Medical emergency response staff are exposed to incidents which may involve high-acuity patients or some intractable or traumatic situations. Previous studies on emergency response staff stress-related absence have focused on perceived factors and their impacts on absence leave. To date, analytical models on absenteeism risk prediction use past absenteeism to predict risk of future absenteeism. We show that these approaches ignore environment data, such as stress factors. The increased use of digital systems in emergency services allows us to gather data that were not available in the past and to apply a data-driven approach to quantify the effect of environment variables on the risk of stress-related absenteeism. We propose a two-stage data-driven framework to identify the variables of importance and to quantify their impact on medical staff stress-related risk of absenteeism. First, machine learning techniques are applied to identify the importance of different stressors on staff stress-related risk of absenteeism. Second, the Cox proportional-hazards model is applied to estimate the relative risk of each stressor. Four significant stressors are identified, these are the average night shift, past stress leave, the squared term of death confirmed by the Emergency Services and completion of the safeguarding form. We discuss counterintuitive results and implications to policy.

Nurses' experiences, coping and support in the death of a child in the emergency department: A qualitative descriptive study

BACKGROUND

A child's death in the Emergency Department (ED) is usually unexpected and traumatic. Understanding nurses' experiences encountering such death is crucial in determining how they cope to provide quality nursing care to dying children and their families.

PURPOSE

To report ED nurses' experiences with children's death, coping strategies and support needs.

PROCEDURES

A qualitative descriptive design. Twenty-four registered nurses who had cared for a child who died in the ED took part in semi-structured interviews. Interviews were audiorecorded, and analyzed using thematic analysis.

FINDINGS

Three themes were generated: 'nature of emergency department work', 'working with families' and 'coping and support'. This paper reports on the theme 'coping and support'. Although children's deaths were traumatizing and affected nurses personally and professionally, constant time pressure allowed limited reflection time. Common individual coping mechanisms used by participants included external strategies through support from other staff members including peer-support and informal supervision, and internal strategies through personal coping strategies. Participants expressed need for greater support and education/training to effectively deal with pediatric death, children's families, and their own grief.

CONCLUSIONS

Children's deaths and nature of ED care affected nurses. Adequate support and deathrelated education were urged by participants to promote high-quality care provision.

Facilitators, barriers and opportunities in workplace wellbeing: A national survey of emergency department staff

INTRODUCTION

Emergency department (ED) staff face daily exposure to the illness, injury, intoxication, violence and distress of others. Rates of clinician burnout are high and associated with poor patient outcomes. This study sought to measure the prevalence of burnout in ED personnel as well as determine the important facilitators of and barriers to workplace wellbeing.

METHOD

An anonymous online survey including six open-ended questions on workplace wellbeing was completed by 1372 volunteer participants employed as nurses, doctors, allied health or nonclinical roles at 22 EDs in Aotearoa, New Zealand in 2020. Responses to the questions were analysed using a general inductive approach.

RESULTS

The three key themes that characterise what matters most to participants' workplace wellbeing are: (1) Supportive team culture (2) Delivering excellent patient-centred care and (3) Professional development opportunities. Opportunities to improve wellbeing also focused on enhancements in these three areas.

CONCLUSION

In order to optimise workplace wellbeing, emergency departments staff value adequate resourcing for high-quality patient care, supportive and cohesive teams and professional development opportunities. Initiatives in these areas may facilitate staff wellbeing as well as improving safety and quality of patient care.

Why are emergency medical technicians' coping strategies dysfunctional? Direct and indirect effects of resilience and perceived stress

BACKGROUND

Emergency Medical Technicians (EMTs) are at high risk for traumatic disorders, and these disorders are more likely if they resort to dysfunctional coping. However, few studies have examined how dysfunctional coping can be decreased, specifically by comparing the impact of personal characteristics, such as resilience, and of occupational factors, such as stress. This study examines the contribution of resilience and perceived stress on EMTs' dysfunctional coping.

METHODS

A total of 502 EMTs (66% men), with a job experience of approximately 8 years (SD = 3.84), answered the Resilience Scale (Self and Life Acceptance; Personal Competence; Total score), Brief Cope, and Anxiety Depression Stress Scales.

RESULTS

EMTs reported high resilience, low stress and dysfunctional coping. Resilience dimensions, specifically self and life acceptance, and stress contributed to dysfunctional coping. Stress displayed the highest regression coefficient. The effect of self and life acceptance on dysfunctional coping was no longer significant when accounting for stress, revealing a full mediation effect.

CONCLUSIONS

How EMTs perceive stress can mitigate the protective role of acceptance on the use of dysfunctional coping. These findings suggest EMTs' occupational training may benefit from focusing on how to manage stressful and critical incidents, as well as on how to cope with stress.

Core components of a staff wellness strategy in emergency departments: A clinician-informed nominal group study

OBJECTIVE

Busy, high-stress EDs prompt many work-based interventions to address staff wellness, with mixed success. The aim of the present study was to enable ED clinicians to systematically identify core components of a work-based strategy to improve their working environment and/or coping.

METHODS

Purposively sampled ED doctors and nurses from one health service were invited to participate in modified nominal group technique. Participants identified, from a pre-defined list, a key ED stressor and then discussed and ratified proposed core components of a work-based strategy to address or ameliorate this stressor.

RESULTS

Two nominal group technique sessions were held with a total of 10 participants (n = 7 nurses and n = 3 doctors). Participants proposed several strategies aimed at both individual and organisational levels to address occupational stress and coping, and support staff well-being in the workplace. These included mobile/web-based applications, group counselling sessions, yoga, social activities, team building activities and debriefing. Participants described three key components to promote staff wellness and hence enhance their ability to buffer negative aspects of occupational stress: (i) increased individual and team support; (ii) development of professional resilience; and (iii) maximising opportunities for social connection.

CONCLUSIONS

Ensuring appropriate systems, services and support for ED staff should be a priority at local departmental, wider organisational and governmental levels. ED clinicians are ideally placed to identify such systems, services and supports. Managers and policy makers can use these findings to inform the implementation of interventions in EDs.

A Multicenter Study into Burnout, Perceived Stress, Job Satisfaction, Coping Strategies, and General Health among Emergency Department Nursing Staff

Burnout is a major problem among nurses working in emergency departments and is closely related to a high turnover of personnel, nursing errors, and patient dissatisfaction. The aims of this study were to estimate burnout, perceived stress, job satisfaction, coping and general health levels experienced by nurses working in emergency departments in Spain and to analyze the relationships between sociodemographic, occupational, and psychological variables and the occurrence of burnout syndrome among these professionals. A cross-sectional study was conducted in four emergency departments in Andalusia (Spain) from March to December 2016. The study sample was composed of n = 171 nurses. An ad hoc questionnaire was prepared to collect sociodemographic and work data, and the Maslach Burnout Inventory, the Perceived Stress Scale, the Font–Roja Questionnaire, the Brief Cope Orientation to Problem Experience and the General Health Questionnaire were used. The prevalence of high burnout was 8.19%. The levels of perceived stress and job satisfaction were moderate. The most frequent clinical manifestations were social dysfunction and somatic symptoms, and problem-focused coping was the strategy most used by nurses. Lack of physical exercise, gender, years worked at an emergency department, anxiety, social dysfunction, and avoidance coping were significant predictors of the dimensions of burnout.

The demoralisation of nurses and medical doctors working in the emergency department: A qualitative descriptive study

AIM

To explore emergency department clinicians (nurses and medical doctors) perceptions of stressors and coping strategies in their work environment.

METHODS

A descriptive qualitative design was adopted. Twelve semi-structured interviews were conducted with medical and nursing personnel working in one Australian emergency department. A thematic inductive approach was used for analysis.

FINDINGS

Four key themes emerged regarding perceptions of and factors that influenced stressors around the emergency department working environment: i) workload and departmental activity, ii) lack of support; iii) inadequate resourcing; and iv) a mis-match between societal, organisational and staff expectations. The overlap between these themes is such that an overarching theme of 'demoralisation in the workforce' can be described. Staff reported both problem- and emotion-focussed coping strategies with varying levels of self-perceived effectiveness. The foci of solutions proposed by participants typically addressed the source of the stressors.

CONCLUSION

Exposure to occupational stressors remains problematic for emergency department clinicians. Continued exposure can, in some instances, result in demoralisation of the workforce. Immediate attention to causes and effects of occupational stress and demoralisation is warranted. Implementing tailored strategies has the potential to ameliorate effects of occupational stressors.

Development of a revised Jalowiec Coping Scale for use by emergency clinicians: a cross-sectional scale development study

OBJECTIVES

The aim of this study was to develop and validate a scale to measure the coping strategies used by emergency staff in response to workplace stress. To achieve this aim, we developed a refined Jalowiec Coping Scale (JCS), termed the Jalowiec Coping Scale-Emergency Department (JCS-ED) and validated this scale on a sample of emergency clinicians.

DESIGN

A cross-sectional survey incorporating the JCS, the working environment scale-10 and a measure of workplace stressors was administered between July 2016 and June 2017. The JCS-ED was developed in three stages: 1) item reduction through content matter experts, 2) exploratory factor analysis for further item reduction and to identify the factor structure of the revised scale and 3) confirmatory factor analyses to confirm the factors identified within the exploratory factor analysis.

SETTING

Six Emergency Departments (EDs) in Australia and four in Sweden. There were three tertiary hospitals, five large urban hospitals and two small urban hospitals.

PARTICIPANTS

Participants were eligible for inclusion if they worked full-time or part-time as medical or nursing staff in the study EDs. The median age of participants was 35 years (IQR: 28-45 years) and they had been working in the ED for a median of 5 years (IQR: 2-10 years). 79% were females and 76% were nurses.

RESULTS

A total of 875 ED staff completed the survey (response rate 51%). The content matter experts reduced the 60-item scale to 32 items. Exploratory factor analyses then further reduced the scale to 18 items assessing three categories of coping: problem-focussed coping, positive emotion-focussed coping and negative emotion-focussed coping. Confirmatory factor analysis supported this three-factor structure. Negative coping strategies were associated with poor perceptions of the work environment and higher ratings of stress.

CONCLUSIONS

The JCS-ED assesses maladaptive coping strategies along with problem-focussed and emotion-focussed coping styles. It is a short instrument that is likely to be useful in measuring the types of coping strategies employed by staff.

The Emergency Resiliency Initiative: A Pilot Mindfulness Intervention Program

Purpose: To assess the feasibility of a pilot mindfulness intervention program, the Emergency Resiliency Initiative (ERI), as well as to investigate changes in burnout scores and key drivers to burnout among registered nurses (RNs) and patient care technicians (PCTs) in a Level 1 trauma center emergency department (ED). Design: A mixed methods pre/post study with data collection points before and after the 3-month intervention. Method: Three mindfulness educational/experiential sessions were delivered once a month at staff meetings with topic themes of Introduction to Mindfulness, Practical Applications of Mindfulness, and Cultivating Compassion. Participants were asked to complete a minimum of two weekly 5-minute meditations. Burnout scores were assessed using the Maslach Burnout Inventory at preintervention (baseline) and postintervention. Findings: From the pre- (n = 35) to post- (n = 26) intervention period there was a significant increase in personal accomplishment scores (p = .01) and decrease in emotional exhaustion scores (p = .03) for RNs and PCTs combined. Qualitative interviews revealed five burnout-related themes: (a) prioritization distress, (b) change fatigue, (c) self-protection through superficiality, (d) intentional response, and (e) community amid chaos. Conclusion: The ERI was a feasible and acceptable program associated with improvements in burnout scores. Qualitative interviews revealed the positive impacts of mindfulness on ED clinician resiliency and identified future opportunities to address burnout from a holistic perspective.