Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review

Person-directed burnout intervention for nurses: A systematic review of psychoeducational approaches

BACKGROUND

Nurse burnout is a pervasive issue impacting their well-being and patient care quality. Recognized by the World Health Organization as an "occupational phenomenon," burnout results from inadequately managed chronic workplace stress and manifests as emotional exhaustion, depersonalization, and reduced personal accomplishment. This can lower the quality of life and increase turnover. Effective interventions are vital to overcome nurse burnout and its consequences.

OBJECTIVE

This systematic review explored and analyzed the effectiveness of person-directed psychoeducational interventions in reducing nurse burnout.

MATERIALS AND METHODS

A comprehensive search of five databases was conducted for studies published between 2014 and 2023, following PRISMA guidelines. Eligible studies that reported outcomes of psychoeducational interventions using validated evaluation tools were included. Data were extracted using standardized forms, and quality was assessed with Joanna Briggs Institute critical appraisal tools. A thematic narrative synthesis was performed.

RESULTS

27 studies met the inclusion criteria. Interventions including mindfulness-based interventions and cognitive-behavioral therapy, delivered either in combination or on their own, were shown to be effective in reducing nurses' burnout in 24 studies. However, the sustainability of these effects varied, with limited long-term follow-up data. Additionally, delivery formats (physical, digital, or combined), also influenced effectiveness, suggesting the importance of tailored interventions to specific contexts and needs of the target population.

CONCLUSIONS

Psychoeducational interventions effectively reduce nurse burnout but need further investigation to ensure long-term sustainability. Future research should target diverse settings, incorporate objective and subjective outcome measures, and explore a broader range of interventions to strengthen evidence of burnout management strategies.

What is the State of Organisational Compassion-Based Interventions Targeting to Improve Health Professionals' Well-Being? Results of a Systematic Review

AIM

To identify and assess the state of knowledge regarding compassion-based interventions and outcomes, targeted to the organisational level, that aim to improve health professionals' well-being.

DESIGN

Systematic review.

DATA SOURCES

Using the PICO model, the clinical question and search strategy were structured. The searches were performed on 20 September 2022 and 26 December 2023 in the Scopus, CINAHL, EMBASE, PsycINFO and ProQuest Dissertations & Theses Global databases. Content analysis was applied to analyse data, and the PRISMA and SWiM guidelines were followed for reporting.

RESULTS

Thirty-eight studies, mostly from the United Kingdom and the United States, met the inclusion criteria and were quality assessed and analysed. Compassion-based interventions that target the organisational level are quite new, thus representing a burgeoning initiative. In this review, many included quantitative studies revealed significant methodological challenges in effectively measuring organisational compassion (interpersonal relationships, organisational culture and retention/turnover). However, the review findings overall indicate that interpersonal connections between colleagues that foster a sense of community, through shared experiences, mindfulness and (self-)compassion practices and social activities, may be a protective factor for well-being. Further, the review emphasises the crucial role of management support in catalysing organisational changes to improve health professionals' well-being.

CONCLUSION

Evidence strongly suggests that fostering human interconnectedness among health professionals is associated with enhanced well-being. Further rigorous studies are needed to validate these findings, clarify the organisational cultural aspects of compassion and develop an effective outcome measurement tool for organisational compassion.

PRACTICE IMPLICATIONS

Organisational compassion-based interventions may help foster a culture of compassion within organisations, enhance health professionals' capacity for compassion and benefit both their well-being and the quality of care provided to patients and relatives.

PATIENT CONTRIBUTIONS

This review is part of a larger project about compassion and includes two patient representatives (mothers of children with cancer) in the research team.

Spousal Support and Physician Work-Life Integration and Burnout

Importance

Few studies have assessed whether factors outside the workplace, such as support from a spouse or partner, are associated with work-life integration (WLI) satisfaction and burnout among physicians. Evaluating such an association may help with developing novel strategies to address burnout and improve WLI satisfaction among this group.

Objectives

To compare spousal support among female and male physicians and explore associations of spousal support with WLI satisfaction and burnout.

Design, Setting, and Participants

This cross-sectional, multispecialty survey study was conducted among 661 faculty physicians employed at an academic medical center from March 26 to May 22, 2024.

Main Outcomes and Measures

Survey items measured spousal support (5 items), WLI satisfaction (1 item), and burnout (2 Maslach Burnout Inventory items). Associations of spousal support and gender with WLI and burnout were assessed using logistic regression analyses adjusting for age, race and ethnicity, weekly work hours, and weekly hours spent on household or childcare duties.

Results

Overall, 739 of 2103 faculty physicians (response rate, 35.1%) completed the survey, of whom 661 (89.4%) were currently married or partnered (359 of 661 men [54.3%]). In this subset, 322 of 351 male physicians (91.7%) and 276 of 298 of female physicians (92.6%) reported frequent career support (defined as often, most of the time, or always) over the last year from their spouse or partner. Physicians reporting high levels of career support from their spouse or partner had higher odds of WLI satisfaction (odds ratio [OR], 1.50 [95% CI, 1.22-1.86]; P < .001) and lower odds of burnout (OR, 0.73 [95% CI, 0.61-0.87]; P < .001), independent of gender and adjusted for age, race and ethnicity, weekly work hours, and weekly hours spent on household or childcare duties. Male physicians had higher odds of WLI satisfaction than female physicians (OR, 1.95 [95% CI, 1.32-2.90]; P < .001), even after adjusting for spousal career support and other covariates listed, whereas odds of burnout did not significantly differ by gender (OR, 0.84 [95% CI, 0.57-1.23]; P = .37).

Conclusions and Relevance

This study suggests that the level of career support from a spouse or partner is associated with WLI satisfaction and burnout among physicians, independent of gender. Future studies should explore whether interventions designed to enhance career support can improve WLI and well-being among physicians.

Preventing healthcare worker burnout in primary care settings through the trauma-informed CARES Leadership Competency Model

Staff burnout, a pervasive and persistent issue in the Canadian primary care environment, demands urgent and immediate attention. The managerial response to this problem has been largely reactive, especially in the post-COVID era. The need for proactive approaches to equip health leaders to detect early signs of burnout in healthcare workers and intervene effectively is more pressing than ever. Health leaders are beginning to acknowledge the significant role that trauma plays in impacting workers' propensity to experience burnout, leading to the growing recognition of trauma-informed best practices in healthcare management. This article will introduce the CARES Model, a leadership competency framework that underscores the connections between leadership competencies and employee-leader engagement to detect early signs of burnout in primary care workers. The model, along with the proposed CARES toolkit, strongly emphasizes trauma-informed best practices and will enable health leaders to better proactively prevent burnout through appropriate, empathetic, and efficient interventions.

Employer-provided wellbeing support for nurses working in intensive care units: A national cross-sectional study

BACKGROUND

Intensive care units are characterised as high-stress work environments that may negatively affect nurses' wellbeing. Employer-provided support has a crucial role in reducing burnout and improving wellbeing.

OBJECTIVE

The aim of this study was to examine wellbeing supports routinely offered by employers of nurses working in intensive care units and examine the relationships amongst perceived organisational support, wellbeing, and burnout.

METHODS

A cross-sectional study of nurses working in Australian intensive care units was conducted from 4 to 19 September 2023. A web-based survey was distributed via the Australian College of Critical Care Nurses and social media, with snowball sampling. Validated tools for perceived organisational support, subjective wellbeing, and burnout were used.

RESULTS

Of 668 responses, 632 met inclusion criteria for analysis (94.6%). Education and training were the most common supports recognised by nurses (63.4%, n = 401). The most helpful support was childcare assistance (M = 3.17, standard deviation [SD] = 1.38). Higher levels of perceived organisational support were associated with better subjective wellbeing (r = 0.20; p < 0.001). Perceived organisational support was higher for nurses without burnout (M = 4.15, SD = 0.89) than for those with burnout (M = 3.64, SD = 0.85; t [625] = 7.43, p < 0.001, two-tailed). For every one-point increase in the mean value of perceived organisational support, nurses were 56% less likely to report experiencing burnout than those who perceived lower organisational support (B = -0.81, p < 0.001, odds ratio = 0.44, 95% confidence interval: 0.35-0.56). The strongest predictor of reporting burnout was engaging in an education/clinical support job role (B = 0.88, p = 0.04, odds ratio = 2.41, 95% confidence interval: 1.04-5.60).

CONCLUSIONS

Nurses working in Australian intensive care units perceived employer-provided wellbeing support to be inadequate. Perceived organisational support is a modifiable independent predictor of burnout, suggesting that employers need to work with nurses to improve wellbeing supports.

REGISTRATION

Not registered.

Perceptions of participants and organisers of a social prescribing programme for hospital staff through horticulture (SP4S-H) in the community hospitals in Singapore: a qualitative study

OBJECTIVES

Hospital workers face multiple biopsychosocial stressors in the course of their work, which could potentially be addressed by social prescribing of horticultural activities. However, the effectiveness of such interventions has not been evaluated. We conducted a qualitative study to understand the perceptions of participants and organisers of a horticulture-based social prescribing intervention for staff (SP4S-H) in three community hospitals in Singapore.

DESIGN

The RE-AIM Planning and Evaluation Framework was used to develop our semistructured interview guides and guided our thematic analysis. Indepth interviews were conducted with subsequent transcribing, coding and iterative analysis until thematic saturation was reached.

SETTING

Three community hospitals in Singapore, between May 2022 and June 2024.

PARTICIPANTS

26 hospital staff.

RESULTS

SP4S-H was perceived to have a positive impact on staff, including increasing their knowledge on horticulture, team bonding, positive emotions and self-help skills. Barriers to participation included participants preferring not to spend time outside working hours (ie, lunch hours) for SP4S-H or attending physical meetings. Appealing to the interest of staff, overcoming barriers in their attendance, organising the events and improving the working culture of participants were found to influence the reach, implementation and sustainability of SP4S-H.

CONCLUSION

SP4S-H was perceived to be beneficial by hospital workers in improving social connectedness and their ability to cope with stress. The importance of having the support of senior management, adequacy of resources and deliberate staff engagement in rolling out this initiative cannot be underestimated.

Predictors of Burnout and Well-Being Among Veterinarians in Slovenia

Burnout is a major challenge for the veterinary profession and is closely linked to negative effects on mental health, reduced job satisfaction and impaired professional sustainability. The aim of this study was to investigate the extent of burnout symptoms among Slovenian veterinarians and their association with factors such as work-life balance, ethical dilemmas and overall job satisfaction. A cross-sectional survey was conducted in 2024, to which all registered Slovenian veterinarians (N = 1250) were invited. The response rate was 38% (N = 473). Burnout was assessed using the Mayo Clinic Physicians Wellbeing Index, which captures both the traditional burnout dimensions and broader indicators of psychological distress such as anxiety and depression. Results showed that 45.5% of veterinarians reported low burnout, 26.4% reported moderate burnout, and 28.3% reported high burnout. A multivariate regression analysis revealed that work-life imbalance, ethical conflicts and long working hours were significant predictors of burnout symptoms, with younger veterinarians and women being disproportionately affected. The findings highlight the importance of addressing the systemic and individual factors that contribute to burnout in veterinary practice. Tailored interventions that focus on improving work-life balance, enhancing ethical decision-making and promoting mental health awareness are recommended to mitigate the risks of burnout. These findings contribute to the growing literature on veterinarian well-being and provide valuable insight into the development of targeted strategies to promote veterinarians' mental health and career sustainability.

Psychological capital appreciation as a mediator between resilience and burnout among ICU nurses

Objective

This study investigated the mediating effects of psychological capital appreciation in the relationship between psychological resilience and burnout among ICU nurses. The findings aim to provide an objective reference for hospitals to enhance the occupational health of ICU nurses.

Methods

A cross-sectional questionnaire survey was administered to 150 ICU nurses employed at 20 tertiary hospitals across Hebei Province. Stratified random sampling was employed in the sampling methodology, with strata defined by hospital size and ranking. Subsequently, ICU nurses were randomly selected within each stratum to enhance the representativeness of the sample.

Results

(i) Among the 150 nurses, the psychological resilience score was (68.701 ± 14.549), resilience was (63.547 ± 14.020), and burnout score was (65.095 ± 18.461). (ii) The analysis revealed that psychological capital appreciation mediated the relationship between psychological resilience and burnout, with a mediation effect size of 0.597, accounting for 79% of the total effect. (iii) Psychological resilience did not directly affect job burnout (direct effect = 0.148, 95% CI includes 0, t = 0.864, p = 0.389), but indirectly reduced burnout by enhancing PCA. The indirect effect was significant (indirect effect = 0.601, 95% CI excludes 0, z = 6.073, p = 0.000), with a total effect size of 0.748 (95% CI excludes 0, z = 8.486, p = 0.000).

Conclusion

(i) Psychological capital appreciation (PCA) plays a complete mediating role between resilience and job burnout of ICU nurses. (ii) The overall incidence of job burnout among nurses is high, while the levels of resilience and psychological capital appreciation are at a low to medium level, which need to be improved urgently.

Sustainable development goals: a call for future internal medicine

2030 Agenda Sustainable Development Goals (SDGs) achievement is the main challenge in order to design a sustainable future society. SDG 3 ensure healthy lives and promote well-being for all at all ages, focusing on prevention and treatment of communicable diseases (CDs) and non-communicable diseases (NCDs). Moreover, access to care, affordable drugs, and vaccines is crucial to improve quality of life leaving no one behind. Internal medicine can answer to the United Nations (UN) universal call by taking action both on infectious disease burden and on NCDs challenge, enabling prevention strategies and treatments, providing new drugs and ensuring accessible care for all. Furthermore, thanks to internist holistic and patient-centered approach, together with a multidisciplinary strategy, misallocation of economic and human resources, and medical errors due to healthcare fragmentation could be avoided. Nonetheless, a syndemic approach taking into account economic, social, and environmental dimensions of health will become fundamental for healthcare systems design. In this framework, internal medicine will be crucial giving a comprehensive patient-centered perspective, coordinating multidisciplinary team interventions, and contributing to sustainable healthcare systems.

Graphical abstract

Prevalence of major global causes of death by groups in 2021 according to Wolrd Health Organization World Health Statistics 2024 [12]; Internal Medicine characteristics; Internal Medicine-related SDGs summary; Future challenges for Internal Medicine

Examining the link between intensive care unit nurses' burnout and perceived quality of life: a multicenter cross-sectional study

BACKGROUND

Intensive care unit (ICU) nurses are pivotal in ensuring high-quality care to patients with life-threatening conditions in the healthcare sector. These nurses operate in high-pressure environments that demand constant vigilance, technical proficiency, and emotional resilience. The challenging nature of their work can predispose them to burnout, a syndrome marked by emotional exhaustion, cynicism, and a low sense of personal accomplishment. Therefore, we investigated the relationship between burnout and perceived quality of life (QoL) among ICU nurses.

METHODS

A cross-sectional design was employed, with 265 ICU nurses in the Hail Region, Saudi Arabia, participating in this study. Two self-report scales (23-item Burnout Assessment Tool and 15-item Quality of Life Scale) were used to collect data from March to June 2024. Statistical analysis included descriptive statistics and Pearson correlation coefficients to explore the relationship between burnout levels and QoL dimensions.

RESULTS

The findings indicated a high prevalence of burnout, with 73.2% of nurses reporting high to very high levels of burnout. The overall QoL score was moderate, averaging 64.46 out of 105. Significant negative correlations were observed between burnout and all measured dimensions of QoL (p = 0.01). These dimensions include material and physical well-being (-0.303, p = 0.01), relationships with other people (-0.337, p = 0.01), and personal development (-0.381, p = 0.01).

CONCLUSION

The study underscores a significant inverse relationship between burnout and QoL among ICU nurses. The data highlight the urgent need for targeted interventions to reduce burnout and improve the personal well-being of nurses. This will not only enhance the quality of patient care but also ensure the sustainability of the healthcare system.

CLINICAL TRIAL NUMBER

Not applicable.

The mediating role of psychological well-being in the relationship between mindfulness and patient education implementation among oncology nurses: A cross-sectional study

PURPOSE

This research investigates the relationships between mindfulness, psychological well-being, patient education implementation among oncology nurses. Additionally, it examines the determinants influencing patient education implementation and investigated the mediating function of psychological well-being in the association between mindfulness and patient education implementation.

METHODS

A cross-sectional study was conducted with oncology nurses between 2023 and 2024 at an oncology hospital. The study utilized validated instruments, including the Nurse Information Form, Mindful Attention Awareness Scale, Psychological Well-Being Scale, Patient Education Implementation Scale. The data were analysed using descriptive and correlational statistics and structural equation modelling. Independent variables were mindfulness and psychological well-being; the dependent variable was patient education implementation in this hypothesized model.

RESULTS

A total of 218 nurses participated in the study. Patient education implementation scores varied significantly by professional roles and were higher among charge nurses (F = 4.076, p = .008). The structural equation modeling analysis demonstrated that mindfulness exerted a significant direct influence on patient education implementation (β = 0.180, p < .001), while also having an indirect effect (β = 0.117, p < .001) mediated by psychological well-being. These results indicate that psychological well-being serves as a partial mediator in the mindfulness and patient education implementation relationship.

CONCLUSION

This study highlights that higher mindfulness are associated with improved patient education implementation, both directly and indirectly through enhanced psychological well-being. Nursing managers should recognize the impact of mindfulness and psychological well-being on nurses' ability to provide high-quality patient education and consider strategies to enhance these attributes.

The Effects of Grit, Emergency Nursing Competency, and Positive Nursing Organisational Culture on Burnout Among Nurses in the Emergency Department

This descriptive cross-sectional study investigated the relationship between grit, emergency nursing competency, positive nursing organisational culture, and burnout among emergency department nurses and identified the factors influencing burnout. The study participants were 176 nurses from one tertiary and six general hospitals in Chungcheong-do, South Korea. Data were collected from 18 July to 10 August 2024 and analysed using hierarchical multiple regression. Burnout was negatively correlated with grit (r = -0.57, p < 0.001), emergency nursing competency (r = -0.41, p < 0.001), and positive nursing organisational culture (r = -0.60, p < 0.001). It was also negatively correlated with the subdomains of positive nursing organisational culture: active leadership of nurse managers (r = -0.46, p < 0.001), pursuit of shared values (r = -0.55, p < 0.001), trust-based organisational relationship formation (r = -0.62, p < 0.001), and fair management systems (r = -0.55, p < 0.001). The regression analysis showed two variables that significantly affected burnout-trust-based organisational relationship formation in positive nursing organisational culture (β = -0.31, p = 0.012) and grit (β = -0.29, p < 0.001); their explanatory power was 44.0% (F = 18.19, p < 0.001). Thus, positive nursing organisational culture and grit were major factors affecting burnout. Therefore, to prevent and effectively manage burnout among emergency department nurses, nursing organisations must create a positive organisational atmosphere based on mutual respect and trust, promoting active participation in work, decision-making, and collaboration.

Analysing the effect of social jetlag on burnout among shift nurse using a chained mediation model

The purpose of the present research is to explore the relationship between social jetlag and burnout among Chinese shift nurses. Furthermore, we seek to demonstrate how perceived stress and sleep quality play as chain mediators in this relationship. A cross-sectional study. There are 429 Chinese shift nurses data records included through one-on-one format using the subjects' sociodemographic information, the Munich Chronotype Questionnaire for shift workers (MCTQshift), the Chinese version of the 14-item Perceived Stress Scale (CPSS-14), the Pittsburgh Sleep Quality Index (PSQI), and the Chinese version of Maslach Burnout Inventory-General Survey. The positive correlations are found between social jetlag and burnout among Chinese shift nurses; perceived stress and sleep quality, respectively, play a partial mediating role in this relationship. Furthermore, perceived stress and sleep quality play a chain mediating role between social jetlag and burnout. These findings contribute to understanding the impact mechanism of social jetlag on shift nurses' burnout and provide a theoretical foundation for nurses managers to develop programs designed for reducing the burnout that affects shift nurses.

Sources of Distress for Secure Mental Healthcare Staff: A Cross-Sectional Study of the Impact of Personal and Occupational Problems on Psychological Wellbeing and Functioning

Despite a global drive to improve staff well-being in healthcare, distress and absenteeism continue to persist, posing consequences for patient care and organisational functioning. Current research and subsequent strategies implemented to remediate such problems have primarily focused on occupational experiences, disregarding the contribution of problems occurring outside of the workplace. The current study sought to establish the prevalence of work and non-work problems, and their respective impacts on several well-being outcomes, in this occupational group. Secondary analysis of data from a cross-sectional survey of 323 staff in a secure UK mental healthcare organisation was conducted. Exposure to non-work problems was pervasive across the sample (79.3%). Demographic discrepancies in exposure to types of problems were apparent, though number of problems reported was comparable across the sample. Number of non-work problems was a significant predictor of depression, anxiety, functional impairment, and complex post-traumatic stress disorder symptoms, when controlling for exposure to work problems. The findings implicate the need for a broader conceptualisation of distress in secure mental healthcare staff, who typically report exposure to several non-work problems, in the context of occupational challenges. Policy, practice and service implications are discussed, with consideration for the availability and modality of support offered to staff.

Auricular acupuncture for compassion fatigue in nursing professionals: a randomized clinical trial protocol

OBJECTIVE

To present a study protocol to evaluate the efficacy of auricular acupuncture on compassion fatigue scores in nursing professionals, compared to the placebo group and control group.

METHOD

Randomized, controlled, double-blind, three-arm parallel clinical trial protocol, conducted with nursing professionals from a teaching hospital who present compassion fatigue. Volunteers will be randomly assigned to three groups to receive eight sessions of auricular acupuncture or follow-up. The primary outcome will be the compassion fatigue score, and the secondary outcome will be compassion satisfaction, measured by the Brazilian version of the Professional Quality of Life scale, and the depression, anxiety, and stress scores, measured by the Depression, Anxiety, and Stress scale, Brazilian version.

EXPECTED RESULTS

The results may strengthen the validity of auricular acupuncture to mitigate compassion fatigue, enabling its incorporation as a mental health care strategy for the nursing team in the workplace.

FINAL CONSIDERATIONS

This protocol aims to test the efficacy of auricular acupuncture for compassion fatigue in hospital nursing professionals. In addition, it may contribute to the management of these professionals' quality of life and support future research on the application of this therapy by nurses. Record identifier RBR-28xttdt.

"We really need to surround people with care:" a qualitative examination of service providers' perspectives on barriers to HIV care in Manitoba, Canada

OBJECTIVE

To identify barriers to HIV care from the perspectives of HIV service providers in Manitoba (MB), Canada during the 2020-2022 period of the COVID-19 pandemic.

METHODS

In this qualitative study, we conducted semi-structured interviews with HIV service providers between October 2022 and January 2023. Purposive sampling was used to include a cross-section of 27 providers (clinicians, nurses, social workers, pharmacists, program managers, and health education facilitators). The main themes explored in the interviews included: (1) provider roles and organization; (2) facilitators and barriers to HIV care; (3) harm reduction and sexually transmitted and blood-borne infections prevention practices; (4) impacts of the COVID-19 pandemic on HIV care and providers and (5) policies related to HIV care in Manitoba.

RESULTS

Using a Social Ecological Model of Health framework, our analysis of service provider interviews identified barriers at four different levels: (1) structural level barriers, including limitations to public health and social support systems, geographic barriers, and policy inefficiencies; (2) socio-cultural/community level barriers, such as experiences of racism, stigma and discrimination leading to people living with HIV's (PLHIV) reduced trust in the health care system; (3) institutional level barriers, which describe how lack of primary care for PLHIV, limitations to the HIV care delivery model in Manitoba, and system capacity limitations have created missed opportunities for linkage to HIV care; and (4) intrapersonal barriers that reflect how the interaction of structural, socio-cultural, and institutional level barriers challenge providers' role performance and exacerbate risk of burnout and moral distress.

CONCLUSIONS

Our findings demonstrate how multi-level barriers intersect to create challenges for both PLHIV and providers, limiting where and how people receive HIV care and impeding providers' ability to perform their roles and provide effective, consistent HIV care. Given the key role of HIV providers in facilitating care, structural, social/community, and institutional changes are needed, as is further research to examine structural causes of burnout to develop meaningful interventions that support service providers' mental health and well-being.

Physician and Medical Student Burnout, a Narrative Literature Review: Challenges, Strategies, and a Call to Action

Background: Burnout is a state of emotional, physical, and mental exhaustion produced by excessive and prolonged professional stress. Its prevalence is unclear, and figures from 2 to 81% have been reported, although studies focused on this issue are scarce and inconsistent definitions and the absence of validated measurement tools make comparisons difficult. Methods: Our narrative review's purpose was to explore physician and medical student burnout across medical specialties and in specific subgroups, including young doctors, researchers, and female physicians. We also assess burnout effects in medical students and patients and the possible strategies to prevent and reverse it. Results: Burnout affects doctors, medical students, and patients. It impacts significantly on physicians mental health and can be the trigger for depression, substance abuse, and suicide attempts. Moreover, this psychological and physical exhaustion can also increase the risk of systemic conditions such as cardiovascular disease. Physician burnout increases the risk of medical errors, reduces professional efficacy, and might compromise patients' safety. Strategies focusing on mental, physical, social, and occupational well-being can help to prevent and treat burnout. These include resilience training, self-care, exercise, work-life balance, and institutional changes, such as reducing administrative burdens and improving electronic health record systems. Medical students' burnout might be triggered by specific problems related to their young age, economic situation, exam stress and workload, high academic expectations, lack of support, and others. Conclusions: Burnout is common in physicians and medical students, negatively affecting mental health, professional/academic efficacy, and patient outcomes. Addressing burnout requires a multifaceted approach, including individual strategies and systemic changes within institutions.

A scoping review of interprofessional education in healthcare: evaluating competency development, educational outcomes and challenges

BACKGROUND

Interprofessional education (IPE) is essential in healthcare to enhance collaboration, communication and teamwork among health professions education students. This review aimed to map out the core competencies health professions education students develop during IPE and identify the positive and negative educational outcomes.

METHODS

A comprehensive search strategy was developed and reported in accordance with the PRISMA ScR guidelines. The search was conducted across five electronic databases (Medline, Scopus, Web of Science, PsycINFO and EBSCO) for peer-reviewed articles published in English within the last 20 years. Data was extracted and core competencies were categorised into four defined areas-roles and responsibilities; interprofessional communication; values for interprofessional practice; teams and teamwork. The frequency of occurrence of each core competency, along with the positive and negative outcomes of IPE were analysed. Mixed methods analysis was used to integrate both qualitative and quantitative data.

RESULTS

Team and teamwork emerged as the most frequently attained core competency in IPE. The positive impacts of IPE include significant improvements in role clarity, communication skills, and teamwork dynamics. However, negative impacts were also noted, such as logistical challenges and interpersonal issues like power dynamics and communication barriers, which impeded the personal professional growth and professional interactional skill-related benefits of IPE. Additionally, some participants reported feeling overwhelmed by the extra workload required for IPE activities.

CONCLUSION

IPE is a valuable component of health professions education, significantly contributing to the development of core competencies necessary for interprofessional collaborative practice. Addressing the challenges and implementing best practices can further enhance the effectiveness of IPE programs, ultimately improving healthcare outcomes. The implications for practice, training of healthcare students and future research are discussed.

Toward better prevention of physician burnout: insights from individual participant data using the MD-specific Occupational Stressor Index and organizational interventions

Background

Physician burnout has become a public-health crisis. The need is dire for robust organizational solutions, focusing on reduction of specific stressors. The physician-specific Occupational Stressor Index (OSI) based on cognitive ergonomics can help. Individual-participant data (IPD) from different studies addressing physician burnout are lacking.

Aims

To perform IPD analysis regarding job stressors and their relation to physician burnout and to utilize the IPD results to inform a systematic review of the stressors that show an association with physician burnout, focusing on intervention studies.

Methods

PRISMA guidelines are followed for the IPD analysis and systematic review of intervention studies on the implicated stressors, taking the COVID-19 pandemic into consideration. The IPD analysis is performed on studies using the physician-specific OSI vis-à-vis burnout assessed by the Copenhagen Burnout Inventory (CBI). Odds ratios (OR) ± 95% confidence-intervals (CI) are reported, adjusting for age, gender and caring for patients with suspected COVID-19 infection.

Results

Three studies fulfilled the inclusion criteria, providing complete IPD data for 95 physicians. Thirty-two (33.7%) physicians had total OSI scores >88, for which intervention is urgently needed. Unit-change in the total stressor burden assessed via OSI yielded OR = 1.11 (95%CI: 1.03-1.18) (p = 0.003) for personal burnout, OR = 1.17 (95%CI: 1.08-1.26) (p = 0.0001) for work-related burnout and OR = 1.07 (95%CI: 1.01-1.15) (p = 0.03) for patient-related burnout. Caring for patients with suspected COVID-19 infection showed significant multivariable results (p = 0.04) only for personal burnout. Twenty distinct work stressors revealed multivariable associations with CBI. Systematic examination via PUBMED, CINAHL and OVID Medline yielded 33 publications mitigating those stressors among physicians. Adequate staffing was pivotal. Clerical staff off-loaded administrative burden. Information-technology staff helped diminish interruptions, enhancing workflow. Cross-coverage reduced time constraints, ensured separate periods for non-clinical tasks, and ≥1 work-free day/week. Several interventions impacted physician burnout, as did recognition of physicians' efforts/achievements. Other OSI-identified stressors were insufficiently examined in intervention studies: e.g. vacation; appropriately-timed, cross-covered restbreaks; and counter-measures for emotionally-disturbing aspects of MD's work, particularly during the pandemic.

Conclusions

Further participatory-action research is needed in well-controlled intervention trials to alleviate physician burnout.

COVID-19 related complications

The COVID-19 pandemic has significantly impacted global healthcare systems, revealed vulnerabilities and prompted a re-evaluation of medical practices. Acute complications from the virus, including cardiovascular and neurological issues, have underscored the necessity for timely medical interventions. Advances in diagnostic methods and personalized therapies have been pivotal in mitigating severe outcomes. Additionally, Long COVID has emerged as a complex challenge, affecting various body systems and leading to respiratory, cardiovascular, neurological, psychological, and musculoskeletal problems. This broad spectrum of complications highlights the importance of multidisciplinary management approaches that prioritize therapy, rehabilitation, and patient-centered care. Vulnerable populations such as paediatric patients, pregnant women, and immunocompromised individuals face unique risks and complications, necessitating continuous monitoring and tailored management strategies to reduce morbidity and mortality associated with COVID-19.

Supports for Mental Well-Being Valued by Healthcare Workers: Qualitative Analysis of Data From a Canadian Cohort of Healthcare Workers During the COVID-19 Pandemic

A prospective cohort of 4964 HCWs from four Canadian provinces was established early in the COVID-19 pandemic. Participants were invited to comment about workplace mental health supports at three time points. We performed a thematic content analysis of responses from 1738 participants using the Social Support Behaviour Code framework to categorize barriers to support as informational, tangible, emotional, social, or expressing esteem. Themes were synthesized into suggestions for healthcare organizations to prepare for future crises. Formal and informal peer support, workplace mental health supports, and one-on-one counseling were most often mentioned as valued. Analysis suggested that workplace social networks as a source of support and mental health supports would have been appreciated. HCWs perceived that a lack of tangible workplace supports, such as staffing, compensation, and time off, were barriers to well-being. Medical workplaces could consider the availability of tangible supports in addition to developing formal mental health supports for healthcare workers.

Relationship between work productivity and patient safety attitudes among intensive and critical care nurses: A structural equation modelling approach

BACKGROUND

Intensive care units present various challenges that can affect the productivity of nurses who play a critical role in ensuring patient safety; however, the relationship between these nurses' work productivity and patient safety attitudes has not been sufficiently explored.

AIM

To investigate the relationship between work productivity and patient safety attitudes among intensive and critical care nurses (ICCNs) using structural equation modelling (SEM).

STUDY DESIGN

This cross-sectional study involved 372 ICCNs who were members of the Turkish Society of Critical Care Nurses. Data were collected via an online survey using the Nurse Information Form, the Attitudes Toward Productivity Scale (ATPS) and the Patient Safety Attitude Questionnaire (PSAQ).

RESULTS

A significant positive correlation was found between the total ATPS and the PSAQ score (r = .704, p < .01). The SEM analysis revealed that teamwork climate (β = .192, p = .001), perceptions of management (β = .141, p = .001) and job satisfaction (β = .482, p = .001) positively predicted attitudes towards productivity, while stress recognition had a negative impact (β = -.219, p = .001). The model accounted for 62.2% of the variance in attitudes towards productivity and demonstrated good fit indices (χ2/df = 3.566; GFI = 0.989; CFI = 0.991; RMSEA = 0.078).

CONCLUSIONS

Teamwork climate, perceptions of management, job satisfaction and stress recognition significantly influence work productivity among ICCNs. Enhancing these factors can improve ICCNs' productivity and foster positive patient safety attitudes, ultimately leading to better patient care outcomes in intensive care settings.

RELEVANCE TO CLINICAL PRACTICE

Health care institutions need to adopt strategies to increase ICCNs' work productivity and patient safety attitudes, such as teamwork support initiatives, leadership development programmes for managers, professional development opportunities and stress reduction interventions. Positive working environment and favourable working conditions can improve ICCNs' well-being and performance, leading to better patient care outcomes in intensive care settings.

Guidance for Creating Morally Healthy Organizations That Remediate the Experience of Moral Injury in Health Care: Findings From an International e-Delphi Study

OBJECTIVE

To date, research and policy directives have focused on identifying individual risk factors for moral injury, with less attention to solutions for establishing nonmorally injurious cultures and practices.

METHODS

Experts with academic or clinical knowledge of moral injury were recruited to a three-round e-Delphi survey exploring descriptors and characteristics of nonmorally injurious organizations.

RESULTS

Forty-nine, 41, and 39 experts responded at each round. Morally "healthy," "congruent," and "centered" were endorsed as descriptors for nonmorally injurious organizations. Consensus was also obtained on 111 characteristics and behaviors relating to organizational identity (eg, just culture), behaviors and practices (eg, transparency in decision-making), and self-awareness (eg, monitoring of moral injury in workforce).

CONCLUSIONS

The findings implicate the need for a strengths-oriented, solution-focused approach to addressing moral injury. The recommendations proposed warrant evaluation and operationalization within formal guidance.

Mediating Role of Resilience in the Relationships Between Objective Physical Activity With Depression and Stress Among Nurses in Türkiye

OBJECTIVE

Nurses belong to a professional cohort that frequently experiences depression and stress. The objective of this research was to examine the correlation between objective physical activity (PA) with depression and stress among nurses, with a specific focus on the mediating role of resilience.

METHODS

This study employed the descriptive-correlation method. One-hundred twenty-seven nurses (76 women) working in hospitals in Bitlis province, Türkiye in 2023 were selected using a convenience sampling. To measure PA, depression, stress, and resilience, ActiGraph GT3X-BT accelerometer, Beck Depression Inventory, Perceived Stress Scale, and Connor-Davidson Resilience Scale were utilized, respectively. Data analysis was conducted using Pearson correlation test and structural equation modeling.

RESULTS

Nurses, particularly women, experienced a moderate level of depression and stress. Moreover, the number of step counts was significantly higher in day vs. night shift. Overall, the nurses in this study, especially women, engaged in PA levels that were significantly below the international guidelines for adults (p<0.001). Additionally, higher intensity levels of PA (i.e., moderate PA [MPA] and vigorous PA [VPA]) were found to be linked with reduced levels of depression (β=-0.528, β=-0.410, respectively) and stress (β=-0.605, β=-0.531, respectively). Lastly, resilience was identified as a significant mediator in the correlation between MPA and VPA with depression and stress (p<0.05).

CONCLUSION

These findings hold great significance as they demonstrate the positive impact of both resilience and PA on the mental well-being of nurses. It is advisable for healthcare authorities to formulate policies and strategies aimed at enhancing the overall stability and performance of the healthcare sector.

Ethical and legal considerations in the care of children and young people with high consequence infectious diseases (HCIDs): an approach to decision making

High consequence infectious diseases (such as Ebola virus or avian influenza) require specialist management with strict isolation to avoid spread to health-care staff and the wider community. These infections present various ethical and legal issues for children and young people. Specific challenges include the impact of isolation on the child and family (potentially without a child's consent), limitations to care due to staff safety considerations, and reduction of resources for other children (due to potential closure of paediatric intensive care unit beds). The complex decision making required in these scenarios needs timely ethical support. As planning for future pandemics accelerates, we suggest that the ethical and legal considerations involved in delivering care to affected children and their families need urgent consideration, and we have highlighted the important areas for focus to provide a route map for this important undertaking.

Validation of the Russian version of the Copenhagen Burnout Inventory among nurses in Kazakhstan and Kyrgyzstan

Objectives

This study aimed to validate the Russian version of the Copenhagen Burnout Inventory (R-CBI) among nurses in Kazakhstan and Kyrgyzstan and explored factors contributing to burnout.

Methods

The original Copenhagen Burnout Inventory (CBI) was translated into the R-CBI using a rigorous forward-backward method and reviewed by experts. Between July and November 2022, 1,530 nurses were recruited through convenience sampling method from various nursing settings in Kazakhstan and Kyrgyzstan to test the scale's reliability and validity, including confirmatory factor analysis (CFA), internal consistency reliability, and concurrent validity. A linear regression analysis was conducted to identify influencing factors of burnout.

Results

The content of the R-CBI is consistent with the original CBI, consisting of 19 items with three dimensions. The Cronbach's α coefficient is 0.926 in Kazakhstan and 0.922 in Kyrgyzstan, ranging from 0.830 to 0.898 for three dimensions. The CFA results among nurses in Kazakhstan and Kyrgyzstan supported the three-factor structure of R-CBI with good fit indices. Concurrent validity was established through significant correlations (P < 0.001) with job satisfaction questionnaire (r = -0.457), Depression Anxiety Stress Scales (r = 0.506 in depression, r = 0.485 in anxiety, r = 0.564 in stress), and WHO-5 Well-Being Index (r = -0.528). The overall burnout level was 36.1 ± 17.6 and 37.5 ± 17.4 in Kazakhstani and Kyrgyzstani nurses, respectively. Significant influencing factors of burnout included gender, age, educational level, and COVID-19 infection history.

Conclusions

The R-CBI was proved to be a reliable and valid tool for assessing nurses' burnout in Kazakhstan and Kyrgyzstan.

A systematic review of psychological distress reduction programs among nurses in emergency departments

BACKGROUND

Emergency department (ED) nurses experience high levels of psychological distress. Practical programs that alleviate psychological distress are essential for enhancing the mental well-being of nurses, which in turn can mitigate the potential adverse effects on the quality of emergency care. However, no systematic review has been conducted.

AIM

This study aims to systematically summarize the evidence-based psychological distress reduction programs for ED nurses.

METHODS

A systematic search of Web of Science, Scopus, PubMed, and China National Knowledge Infrastructure (CNKI) was conducted for randomized controlled trials published until April 10, 2023. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and the quality of the qualified studies was assessed using the Cochrane RoB 2 tool.

RESULTS

A total of 29 studies were eligible with 2058 participants. Three primary kinds of interventions have been identified: psychological interventions targeting the reduction of psychological distress symptoms, educational programs designed to enhance the coping skills of ED nurses, and organization-directed interventions aimed at alleviating stressors. Collectively, these interventions have contributed significantly to the reduction of stress, depression, anxiety, burnout, and post-traumatic stress disorder while also improving life satisfaction and overall quality of life.

CONCLUSION

Three types of interventions have provided pathways to alleviate the psychological stress of ED nurses at various levels. Future efforts should refine interventions for ED nurses' psychological distress, evaluate their long-term benefits, and explore organizational strategies to promote healthier workplaces. Policymakers and administrators must support these initiatives, focusing on prevention and empowerment.

Workplace Wellness Support Enhances Health and Mental Well-Being in Optometrists

Purpose

To (1) assess rates of burnout in Fellows of the American Academy of Optometry and (2) assess associations among perceptions of workplace wellness support with lifestyle behaviors and health and wellness indicators (ie, anxiety, depression, stress, burnout, mattering to the workplace, and workplace is not stressful).

Methods

A survey collected sample characteristics and outcomes of interest from 321 Fellows.

Results

Thirty-two percent reported burnout. Females and those working in academia were significantly more likely to report being burned out at work. Compared to Fellows with low perceptions of workplace wellness support, Fellows with high perceptions of support were significantly more likely to report mattering to their workplace, a non-stressful workplace environment, and no burnout.

Conclusion

Promoting workplace wellness support may improve perceptions of mattering, stressful workplace environments, and rates of self-reported burnout in optometrists.

Leveling of triggers: a comprehensive summative content analysis of factors contributing to physical violence in emergency medical services

BACKGROUND

The literature has identified numerous factors that contribute to workplace violence, ranging from environmental stressors to interpersonal conflict. However, a gap remains in our understanding of the specific factors associated with physical violence, particularly concerning its frequency and perceived significance.

METHODS

A summative content analysis was conducted via the electronic survey platform Porsline in Iran for data collection. In April 2024, EMTs working in urban, road, and air bases in western Iran participated in the study. In total, 358 EMTs were selected via convenience sampling. They provided open-ended responses to the following question: "What do you believe are the most significant factors contributing to physical violence in your workplace?"

RESULTS

The analysis resulted in a comprehensive list of 1,407 descriptions, organized into 20 subcategories and further consolidated into ten main categories. The category with the highest frequency was "legal and policy deficiencies," with a frequency of 3103, and the category with the lowest frequency was "workplace culture and professional satisfaction," with 579. The categories based on frequency and significance included "legal and policy deficiencies," "cultural and societal barriers," "insufficient training and practical skills," "shortcomings in organizational safety and support," "interpersonal and operational pressures," "organizational culture and workforce dynamics," "barriers to effective prehospital care," "resource and infrastructure limitation," "challenges in interagency coordination and support," and "workplace culture and professional satisfaction."

CONCLUSION

Legal reforms addressing legal inadequacies, enhancing organizational support systems, and implementing targeted training programs to mitigate conflicts are essential for fostering a safer working environment. By addressing these pressing issues, healthcare facilities can enhance emergency care, safeguard the well-being of emergency responders, and increase the quality of emergency medical services for communities.

Evolution of burnout syndrome in Spanish healthcare professionals during and after the COVID-19 pandemic: psychosocial variables involved

Introduction

Evidence shows that throughout the COVID-19 pandemic, healthcare workers have experienced high levels of burnout. The preceding literature also points to the need to consider the three elements of burnout independently, as they appear to have different evolutionary trends and possibly different buffering and amplifying variables, although these aspects have hardly been explored.

Methods

The aim of the present investigation is precisely to shed light on these latter issues. It is a prospective study, carried out in 256 healthcare workers in Spain during three time points in relation to the COVID-19 pandemic: (1) (T1) between 5 May and 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March), (2) (T2) 6 months after the end of the state of alarm (January-April 2021), and (3) (T3) 1 year after this second evaluation (April-July 2022). The different components of burnout syndrome (emotional exhaustion, depersonalization and self-fulfillment) were assessed at the second and third time points. Together with sociodemographic and occupational data (age, gender, professional category, years of experience, hours of work), anxiety, depression, stress, family support, friends' support, and self-efficacy were assessed at the first time point. At the second time point, cognitive fusion and resilience were assessed. At the third time point, optimism and hopelessness were assessed.

Results

The results show significant decreases in burnout syndrome (p < 0.001). However, when observing the evolution of each of the dimensions, it can be seen that emotional exhaustion has significantly decreased (p < 0.001), while an increase in depersonalization (p < 0.001) and a decrease in self-fulfillment (all p < 0.001) are observed. The results of the repeated measures General Linear Models, after controlling for the effect of the covariates show that the evolution of emotional exhaustion is associated with the levels of depression at T1 (p = 0.031), of cognitive fusion at T2 (p < 0.001) and of resilience at T2 (p = 0.039). The evolution of depersonalization is associated with levels of hopelessness at T2 (p = 0.042). Finally, the evolution of self- fulfillment is associated with levels of optimism at T3 (p = 0.043) and hopelessness at T3 (p = 0.019).

Discussion

The results highlight the need to attend to the three components of burnout in a differentiated manner. Our results indicate that, during the COVID-19 pandemic, although overall burnout levels tend to decrease, it is actually emotional exhaustion that decreases, but levels of depersonalization increase and self- fulfillment decreases. In addition, the data point to the different personality factors involved in each of the dimensions. While the evolution of emotional exhaustion seems to be more affected by the levels of symptomatology (i.e., depression) at the onset of the pandemic, and of the inability to handle intrusive thoughts (i.e., cognitive fusion), the evolution of depersonalization and self- fulfillment are more related to long-term cognitive-emotional personality variables such as optimism and hopelessness.

Practical implications

The results found have important practical implications for the prevention of each of the implicated components of the syndrome. Although further research is needed, emotional exhaustion is shown to be one of the dimensions affected in the short term and intervention programs aimed at reducing anxiety and depression at times of acute stress (onset of the COVID-19 pandemic), including thought management, seem fundamental. Depersonalization and decreased self-fulfillment do not seem to respond to the same pattern. They are shown as results of a chronification of a poor management of emotional exhaustion, and in the case of their appearance, given the variables associated with their evolution (i.e., optimism and hopelessness), therapies more focused on the meaning of existence, such as Acceptance and Commitment Therapy, could be useful.

Functional connectivity in burnout syndrome: a resting-state EEG study

Chronic occupational stress is associated with a pronounced decline in emotional and cognitive functioning. Studies on neural mechanisms indicate significant changes in brain activity and changed patterns of event-related potentials in burnout subjects. This study presents an analysis of brain functional connectivity in a resting state, thus providing a deeper understanding of the mechanisms accompanying burnout syndrome. The sample consists of 49 burnout employees and 49 controls, matched by age, gender and occupation (Mage = 36.15, SD = 8.10; 59 women, 39 men). Continuous dense-array EEG data were collected from a 256-channel EEG system. The difference in functional connectivity between burnout and control subjects was tested in the eyes-closed (EC) and eyes-open (EO) conditions using the resting-state paradigm. The results indicate significant differences in brain activity between the burnout and the control groups. The resting-state network of the burnout group is characterized by decreased functional connectivity in frontal and midline areas in the alpha3 sub-band (11-13 Hz) in an eyes-open condition. The most significant effect of decreased connectivity was observed in the right frontal brain area. For the first time, these analyses point to distinctive aspects of functional connectivity within the alpha3 sub-band in burnout syndrome. These findings provide insights into the neurobiological underpinnings of burnout syndrome and its associations with changed resting-state networks. The data on neural characteristics in burnout subjects may help to understand the mechanisms of decline in cognitive function and emotion regulation and to search for adequate methods of treatment.

Allied health professionals cognitive workload scale in Malacca, Malaysia: A psychometric properties evaluation

BackgroundCognitive workload has emerged as one of the most important topics that must be understood and addressed because of its impact on errors and work performance that will compromise patient safety. With increasing patient health demands, Allied Health Professionals (AHPs) tend to have heavier cognitive workloads and impact on personal well-being.ObjectiveOur study aims to determine the validity and reliability of a cognitive workload scale for AHP in Malacca, Malaysia and examine its effect on personal well-being.MethodThe instrument comprises items related to human reliability, human-computer interaction, decision-making, skilled performance, training, work stress and cognitive ergonomic effect. The content validation was conducted using the Content Validity Questionnaire with eight expert panels' responses. 120 AHP working in Malacca were recruited using purposive sampling and took part in the study, completing the online questionnaires. To evaluate the validity based on relationships with other measures, the SMEQ scale was also administered. AMOS Version 24 and IBM SPSS Version 26 were used in data analysis.ResultsThe instrument showed good content validity (CVI > 0.74). After the deletion of six items, the instrument has good convergent validity (AVE > 0.5), discriminant validity (HTMT Ratio < 0.85), composite reliability (CR > 0.7), internal consistency (alpha > 0.7), construct validity the ratio (1.865), CFI (0.900), PCFI (0.821), PNFI (0.738), RMSEA (0.085), IFI (0.90) and test-retest reliability (ICC > 0.6). The study found a positive correlation with the Malay version of SMEQ. This study also found that the AHP in the laboratory group have higher work stress and experiences more cognitive load effects, leading to lower personal well-being.ConclusionOverall, the final version of a scale measuring the cognitive workload is valid and reliable in assessing cognitive ergonomics among AHP. Testing cognitive workload on different work populations, including manual and non-manual workers, is recommended for future studies.

Our Unrealized Imperative: Integrating Mental Health Care into Hospice and Palliative Care

The field of Hospice and Palliative Medicine (HPM) has its roots in the principles, promulgated by Dame Cicely Saunders, that patient and family are the unit of care and that comprehensive integration of physical, psychological, social, and spiritual care is necessary to address suffering in all its dimensions. Although we aspire to provide comprehensive care for our patients, most hospice and palliative care (HPM) physicians lack basic competencies for identifying and managing patients with psychological distress and mental health distress and disorders, a growing segment of our clinical population. In this article, I argue that we are not living up to the founding values of our field in how we practice, how we educate our trainees, our research, and in how we pursue our own professional development as faculty. The history of our field, the nature of our clinical workforce, the culture of PC, and our educational programs all contribute to our current practice model, which is not adequate to meet the mental health needs of our patients. I propose strategies to address these challenges focused on enhancing integration between psychiatry/psychology and HPM, changes in fellowship education and faculty development, addressing the stigma against people with mental health diagnoses, and addressing system and cultural challenges that limit our ability to provide the kind of comprehensive, integrative care that our field aspires to.

Organisational factors associated with burnout among emergency and internal medicine physicians: a qualitative study

OBJECTIVE

To identify physician perspectives on factors associated with physician burnout, protective factors against burnout, and to seek potential solutions for this pervasive problem.

DESIGN

A qualitative study with semistructured focus group interviews using a systematic framework analysis.

SETTING AND PARTICIPANTS

Physicians from general internal medicine (GIM) and the emergency department (ED) at two urban tertiary care hospitals in Vancouver, Canada, were recruited. Separate GIM and ED physician focus groups were conducted virtually from July 2021 to December 2022, led by an independent facilitator. Audio recordings from focus group sessions were then transcribed for analysis.

RESULTS

41 physicians (29 GIM and 12 ED) participated in the focus groups. The dominant themes for organisational factors attributed to burnout that were highlighted by both groups included heavy workload and scheduling, frequent interruptions, interdepartmental conflict and feeling undervalued by leadership. Other contributing factors that were only emphasised by GIM physicians were pressure to work out-of-scope of their practice, pressure to admit and discharge patients quickly, as well as sexism in the workplace. Factors unique to ED physicians included experiencing violence in the workplace and having to assess patients in waiting rooms. Protective organisational factors included time to build rapport with patients, staff collegiality, working within their scope of practice, and feeling rewarded and valued by leadership. Interventions suggested by physicians included improving channels of communication between staff, increasing flexibility in scheduling and strengthening hospitalists' services.

CONCLUSIONS

Most organisational factors driving burnout were common to both GIM and ED physicians, including heavy workload and scheduling, frequent interruptions, interdepartmental conflict and feeling undervalued by leadership. Leveraging protective factors and intervening on organisational factors attributed to burnout such as improving communication and enhancing support services may be effective in addressing the physician burnout epidemic.

Shift Work, Psychological Health Disorders, and Job Security Among Nurses: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Shift work is prevalent among nurses, often leading to adverse psychological effects, such as fatigue, depression, anxiety, and stress. Understanding how shift work contributes to psychological health disorders can help healthcare organizations identify critical areas where support should be offered. This study aimed to determine the relationships between shift work, psychological health disorders, and job security among nurses in Saudi Arabia.

METHODS

This cross-sectional study included 163 nurses, recruited via convenience sampling. The participants completed an online questionnaire that assessed demographic variables, psychological disorders, fatigue, and job security. The data were analyzed using descriptive statistics as well as bivariate analyses to explore relationships between variables.

RESULTS

Most participants (73%) worked 12 h shifts, and 67.5% reported fair sleep quality. We found significant correlations among shift work, fatigue, and common psychological disorders. Significant differences were also observed for fatigue (p = 0.007) and depression (p = 0.008). Both nationality (p < 0.001) and shift work (p = 0.015) were correlated with anxiety. Similarly, significant differences were found for nationality (p = 0.001) and shift work (p = 0.002) regarding stress.

CONCLUSIONS

These findings underscore the psychological challenges faced by nurses related to shift work, emphasizing the importance of addressing fatigue and mental health. Healthcare organizations should implement strategies to enhance job security and support nurses' well-being to ultimately improve both nurse satisfaction and patient care outcomes. Further research is warranted to explore effective interventions and the long-term effects of shiftwork on nursing professionals.

Network of job demands-resources and depressive symptoms in critical care nurses: a nationwide cross-sectional study

BACKGROUND

Critical care nurses are vulnerable to depression, which not only lead to poor well-being and increased turnover intention, but also affect their working performances and organizational productivity as well. Work related factors are important drivers of depressive symptoms. However, the non-liner and multi-directional relationships between job demands-resources and depressive symptoms in critical care nurses has not been adequately analyzed. Understanding these relationships would be helpful for reducing depression, increasing nurses' well-being and retain healthcare forces.

METHODS

This was a cross-sectional study using baseline data from the Nurses' mental health study (NMHS), a prospective cohort study on nurses from 67 tertiary hospitals in 31 province-level administrative regions in China. Only clinical nurses working in the ICU were included (n = 13,745). Data were collected using online questionnaires, and analyzed using network analysis and structural equation model. Job demands (average working hours per week, average number of night shifts per month, paperwork burden and work-life balance), job resources (supervisor support, co-worker support, leader justice, organizational climate satisfaction, work meaning, and career prospect), personal resource (resilience) and depressive symptoms were main variables in the networks, while demographic data and social health (social-emotional support and loneliness) were covariates.

RESULTS

The prevalence of severe, moderately severe, moderate, mild, and none or minimum depressive symptoms in critical care nurses of this study were 1.21, 3.42, 9.76, 42.88, and 42.07% respectively. In the final network, 132 of 210 possible edges (62.8%) were not zero. "Fatigue" had the highest expected influence, followed by "Motor", and "Appetite". Meanwhile, in terms of job demands-resources and personal resources, the node with the highest expected influence was "Supervisor support", followed by "Work meaning" and "Co-worker support". Three bridge variables were identified: "Resilience-adaptation", "Average working hours per week", and "Co-worker support". The final structural equation model basically supported the results of network analysis with an acceptable model-fit (GFI = 0.918, AGFI = 0.896, PCFI = 0.789, PNFI = 0.788, NFI = 0.909, IFI = 0.911, CFI = 0.911, SRMR = 0.040, and RMSEA = 0.064).

CONCLUSIONS

There was a rather strong interconnectedness between depressive symptoms and job demands-resources. Fatigue, motor, and appetite were core depressive symptoms of critical care nurses. Close attention to those symptoms could help recognize depression in critical care nurses. Supervisor support, work meaning, and co-worker support played vital roles as job resources in reducing depression, while negative impact of long average working hours per week were more contagious. Resilience, as personal resources, could help mediate the associations between job demands-resources and depression. In clinical practice, it's recommended for nursing managers to (1) encourage critical care nurses to find their "meaning in work", (2) implement resilience enhancing programs for nurse, (3) build and maintain meaningful relationships with nurses and support them in daily work, and (4) create a harmonious and dedicated working environment where co-workers are willing to help and support each other. Improvements in those modifiable aspects could help reduce risk and prevent exacerbations of depressive symptoms in critical care nurses.

The intermediary effect of work stress on the relationship between off-duty professional growth and reflective ability among mid- and senior-level nurses

BACKGROUND

Mid- to senior-level nurses play a pivotal role in healthcare. Their reflective ability is crucial for clinical decision-making and the continuous improvement of nursing practices. Although numerous studies have emphasized the importance of enhancing reflective ability among mid- to senior-level nurses, the specific relationship between off-duty professional growth, dual work stress, and reflective ability remains unclear.

OBJECTIVE

This study aims to investigate the relationship between reflective ability, work stress, and off-duty professional growth among mid- to senior-level nurses in China, and to determine the mediating role of work stress.

METHODS

A convenience sampling method was used to recruit 534 mid- to senior-level nurses from three tertiary hospitals in Jiaxing, Zhejiang Province. Data were collected and analyzed using a general information questionnaire, the Leisure Crafting Scale, the Challenge-Hindrance Work Stress Scale, and the Clinical Nurse Reflective Ability Scale.

RESULTS

The mean scores for leisure crafting, challenge stress, hindrance stress, and reflective ability among mid- to senior-level nurses were 23.82 ± 9.17, 16.97 ± 6.49, 16.65 ± 5.44, and 56.26 ± 19.09, respectively. Leisure crafting was positively correlated with reflective ability (r = 0.389, P < 0.001), challenge stress (r = 0.399, P < 0.001), and negatively correlated with hindrance stress (r = -0.367, P < 0.001). Reflective ability was positively correlated with challenge stress (r = 0.350, P < 0.001) and negatively correlated with hindrance stress (r = -0.417, P < 0.001). Both challenge-and hindrance stress partially mediated the relationship between leisure crafting and reflective ability, with mediation effects of 19.7% and 30.8%, respectively.

CONCLUSION

This study demonstrates that the reflective ability of mid- to senior-level nurses in China is currently at a moderately low level. Enhancing Off-duty professional growth, leveraging the beneficial aspects of challenge stress, and reducing the negative effects of hindrance stress can notably improve reflective ability. These efforts can lay a strong foundation for the continuous enhancement of nursing quality.

Perspectives and Practices of Healthcare Leaders in Supporting Healthcare Worker Well-Being: A Reality Check

Introduction

The well-being of healthcare workers (HCWs) is a critical concern. While healthcare leaders can play a crucial role in influencing employees' well-being, it remains unclear how leaders are leveraging this influence. This study aims to unravel the current perspectives and practices of healthcare leaders in supporting HCW well-being.

Methods

Semi-structured interviews were conducted with healthcare leaders at various levels within a university medical center. The interviews focused on exploring three key topics: factors influencing HCW well-being, data sources utilized for information gathering, and strategies leaders employ to influence HCW well-being. Our study design was grounded in constructionist epistemology and adopted a phenomenological approach. The methodology primarily involved a data driven, inductive thematic analysis to discern patterns and themes from the collected data.

Results

Fifteen interviews with healthcare leaders revealed a multitude of factors influencing HCW well-being, categorized into three domains: personal, socioeconomic, and work-related factors. Leaders reported a variety of data sources, including "contact data", data derived from regular and sporadic interpersonal interactions, and "investigation data", entailing formal inquiries conducted within the healthcare organization. Interestingly, while leaders acknowledge their potential to positively influence well-being, particularly in work-related aspects, there was a notable trend of deflecting responsibility, often redirecting it towards other leaders or placing it back on the individual employee.

Conclusion

Healthcare leaders show a comprehensive understanding of factors affecting employee well-being. However, healthcare leaders have a predominantly reactive approach to managing employees' well-being. Data collection is often sporadic, lacking consistency, and there is a tendency to redirect responsibility for well-being, revealing a discrepancy between acknowledgement of influence and its actual implementation. We argue that it is essential for leaders at all hierarchical levels to assume responsibility actively and collectively for employee well-being, transitioning to a proactive approach in promoting and safeguarding the well-being of HCWs.

Exploring Compassion Fatigue in Pediatric Nursing: A Cross-Sectional Study

BACKGROUND

Compassion fatigue is a state of emotional and physical exhaustion that arises from frequent contact with people who have experienced trauma or stress, which may affect particularly those working in health care. This study aimed to elucidate the prevalence and determinants of compassion fatigue among pediatric nurses.

METHODS

A survey was administered to pediatric nurses at a tertiary hospital in Jiangsu province, China. Chinese compassion fatigue scale was used to investigate the compassion fatigue.

RESULTS

The study enrolled 364 pediatric nurses, with a compassion fatigue prevalence of 59.89%. Age (odds ratio [OR] = 2.094, 95% confidence interval [CI] = 1.833-2.418), education level (OR = 2.118, 95% CI = 1.852-2.669), monthly income (OR = 3.976, 95% CI = 2.904-4.412), and having children at home (OR = 2.314, 95% CI = 1.851-3.025) were independent predictors of compassion fatigue.

CONCLUSIONS

These findings demonstrate the need for targeted interventions to mitigate compassion fatigue in pediatric nurses.

Impact of the COVID-19 pandemic on health emergency and disaster risk management systems: a scoping review of mental health support provided to health care workers

OBJECTIVES

This systematic scoping review examined the strategies used by different countries and institutions to support the mental health of health care workers (HCWs) during the COVID-19 pandemic, to identify effective practices and the lessons learned in dealing with the associated challenges.

METHODS

Of 1330 retrieved articles from PubMed, Scopus, and the Web of Science, 34 articles were ultimately included in the final analysis.

RESULTS

The analysis revealed that mental health consultation services, especially telephone support lines, online interventions, and apps, played a critical role in addressing the psychological burden experienced by HCWs. Group activities and peer support strategies offered personalized support, and educational programs offered crucial information regarding stress management. Improvements in the work environment, such as the addition of dedicated rest areas, enhanced the well-being of HCWs. However, many interventions suffered from low participation and a lack of tailored content, despite their apparent effectiveness.

CONCLUSIONS

Many interventions have focused on psychological support and resilience-building for HCWs, but they often overlook systemic issues. Comprehensive mental health support must address these systemic factors, such as adequate staffing, training, and resource allocation. Future strategies should emphasize leadership commitment to tackling root causes and actively involve HCWs in program design to ensure relevance and effectiveness. Educational resources and wellness interventions, although reported as effective, need to be tailored and adapted to specific emergencies. Additionally, research gaps, especially in low-resource settings, highlight the need for further studies to enhance preparedness for future crises.

Nursing Wellness in Academic and Clinical Cardiovascular and Stroke Nursing: A Scientific Statement From the American Heart Association

Nursing is an essential part of our health care system workforce. Cardiovascular and stroke nursing represents one of the largest specialty areas requiring expert knowledge and clinical proficiency to ensure safety and quality patient outcomes. To support the growth and sustainability of the various nursing roles in clinical practice, academia, and research, it is vital to attract, engage, mentor, and retain nurses. However, as the health care needs of the nation rise, staff nurses, advanced practice registered nurses, nursing educators, and nurse scientists are experiencing unprecedented demands, and individual wellness and burnout are being more closely examined at both the university and health care system levels. The goal of this scientific statement is to outline the drivers of burnout or intent to leave the profession that impact wellness specific to academic and clinical cardiovascular and stroke nursing and propose system-level interventions to mitigate and support future and current nurse clinicians, nurse educators, and nurse scientists.

Exploring the personal and professional outcomes of pursuing fellowship training in orthopedic manual physical therapy: a mixed-methods analysis

OBJECTIVE

Post-professional education in orthopedic manual physical therapy (OMPT) provides a unique pathway for clinicians to refine clinical skills and reasoning in pursuit of professional excellence. Despite these benefits, fellowship training demands significant personal and financial investment. Therefore, understanding whether fellowship education promotes professional growth, job satisfaction, and return on investment is essential. The aim of this study was to explore fellowship-trained OMPTs' self-reported perceptions of pursuing fellowship education in the United States (US), while identifying predictors that may be associated with career success following fellowship education.

METHODS

A convergent parallel mixed-methods design via online survey and one-on-one semi-structured interviews was used. A thematic coding process was implemented for qualitative analysis. Descriptive statistics were calculated for demographic data. Binary logistic regression models assessed relationships between demographic variables and the personal and professional impact of fellowship training.

RESULTS

One hundred and nine participants completed the survey, and 23 underwent focused interviews, meeting data saturation. Merging of analyses revealed five themes related to personal and professional impacts of fellowship including clinical outcomes, job satisfaction, barriers, clinical excellence, and professional opportunities. Board-certified clinicians had greater odds (OR = 4.47, 95% CI 1.17-15.93, p = .03) of reporting fellowship training enhancing their application of current research. Those with a doctorate degree reported greater odds (OR = 9.18, 95% CI 2.31-36.56, p = .002) of establishing impactful mentors through fellowship. PTs with < 10 years of practice were more likely to report fellowship training positively affecting their salary (OR = 4.28, 95% CI 1.50-12.24, p = .01) and self-perception as expert clinicians (OR = 7.29, 95% CI 1.65-32.22, p = .01).

DISCUSSION/CONCLUSION

This study is the first to examine personal and professional outcomes among US fellowship-trained clinicians, highlighting the positive impact on clinical reasoning, mentorship, and compensation - especially among novice clinicians. Fellowship enhances job satisfaction, career growth, and clinical excellence, offering insights for prospective fellows and future research directions.

The Representation of Wellness Programs in Plastic Surgery Residency

Background

Plastic surgery residency comprises a significant portion of early adulthood. The difficulties of residency are well documented, particularly with the impact on wellness and risk of burnout. Structured wellness programs, mentorship, social support, and autonomy can decrease residency burnout. This study looked at how plastic surgery program websites and GME websites represent wellness and support programs between both integrated and independent plastic surgery residencies.

Methods

A cross-sectional analysis of US plastic surgery residency programs was performed during the month of April 2024. The authors conducted a systematic content analysis on the available websites of these residency websites, GME websites, and associated programs' Instagram and X (formally Twitter) pages. Data points included (1) mention of wellness on the program website, (2) vacation time mentioned on the website, (3) protected time available, (4) spouse support options, (5) day care options, (6) connections with mentors, (7) images of social events on the website, and (8) images of social events on Instagram. Data were compiled and analyzed in JASP (JASP Team [2024]. JASP [version 0.18.3; computer software]) as well as Microsoft Excel. Categorical variables were compared using binomial tests and chi-squared tests. Statistical significance was defined a P value less than or equal to 0.05.

Results

The majority of plastic surgery residencies did not discuss or describe their wellness programs on their official website, regardless of program size. Similar results were displayed when searching for spousal support and daycare. GME websites were more comprehensive than the program websites but still showed significant discrepancies with vacation policies and day care. Mentorship was mentioned in under half of all plastic surgery residencies. Integrated programs were more likely to display social events on Instagram when compared with independent programs.

Conclusions

Plastic surgery residencies do not provide evidence of existing wellness programs on their program websites. Although a lack of public information on wellness programs does not mean they do not exist, this could easily be mitigated by providing more comprehensive information on both GME and program websites.

Misaligned Supports: Differences in Reported Health Care Worker Well-being Supports Provided and Needed During the COVID-19 Pandemic

PURPOSE

To describe the well-being supports provided to health care workers (HCWs) during the COVID-19 pandemic in health centers and hospitals.

DESIGN

Cross-sectional qualitative interviews before and after implementation of a peer-based support intervention.

SETTING

Purposively sampled hospitals and health centers across the US.

PARTICIPANTS

28 site leaders and 56 HCWs sampled from 16 hospitals and 12 health centers.

METHOD

Site leaders and HCWs were asked to describe supports available to HCWs during the COVID-19 pandemic. Thematic and content coding and analysis of interview responses were conducted using Dedoose.

RESULTS

Both site leaders and HCWs identified a range of support resources available. Communication resources were the most frequently cited in both groups. Health care workers reported bi-directional communication, while one-way communication was emphasized by site leaders. Hospitals highlighted counseling support, particularly Employee Assistance Programs (EAP), while health centers prioritized community support. Wellness activities were more prevalent in hospital settings, while health centers offered specific workplace-provided training for HCWs. Health care workers encountered barriers when accessing support, including limited time, fear of stigma, and disruptions to their existing support networks attributable to the pandemic.

CONCLUSION

While there are resources for HCWs, the available supports may not align with their needs and barriers to access may limit the effectiveness of these supports. Continued engagement between leaders and HCWs could help better align resources with needs.

Towards a Thriving Workplace: A Feasibility Study on Mindfulness and the Mediterranean Lifestyle for Corporate Wellness

Background/Objectives: This study explores the potential of integrating mindfulness and the Mediterranean lifestyle into corporate wellness programs to enhance workplace well-being. Methods: A survey of 485 employees from Greece and Cyprus examined how mindfulness, resilience, adherence to the Mediterranean lifestyle, and work ability are connected. Results: Pearson correlation analysis showed statistically significant positive relationships between mindfulness, resilience, and work ability (p < 0.001 and p < 0.001, respectively). Mindfulness was associated with higher job satisfaction (p < 0.001) and was a significant predictor of good (OR = 1.112, 95% CI: 1.043-1.186, p = 0.001) and excellent (OR = 1.163, 95% CI: 1.087-1.245, p < 0.001) work ability, while adherence to the Mediterranean lifestyle had a lower yet significant positive correlation with resilience (p < 0.01) and work ability (p < 0.05). Differences in wellness across job sectors were observed: employees in health and retail sectors had lower resilience, work ability, and mindfulness compared to those in manufacturing, technology, education, and services. Notably, 78% of participants expressed interest in future wellness programs, favoring a combination of online and onsite formats. Conclusions: These findings suggest that mindfulness and the Mediterranean lifestyle can enhance employee well-being and productivity, but sector-specific strategies may be necessary to address unique challenges. Practical applications include tailoring interventions to meet the needs of employees in sectors with lower wellness scores. Future research should investigate the long-term benefits of such programs across diverse industries and employee groups.

Prevalence and factors associated with burnout among healthcare providers at Kasulu district in Kigoma region, 2024: an analytical cross-sectional study in a primary healthcare setting

BACKGROUND

Burnout among healthcare providers affects their well-being and quality of care. Despite its importance, limited data exist on burnout among primary healthcare providers in Tanzania.

OBJECTIVES

To determine the prevalence of burnout and associated factors among healthcare providers in Kasulu district, Kigoma region, 2024.

STUDY DESIGN

Analytical cross-sectional study conducted from January to June 2024.

STUDY SETTING

Primary health facilities at Kasulu district in Kigoma region.

PARTICIPANTS

Healthcare providers working in Kasulu district for more than 6 months before study.

PRIMARY OUTCOME

Burnout.

RESULTS

Among 266 healthcare providers with a response rate of 99%, 59.4% were male. The median age was 32 years (IQR 27-37). Burnout prevalence was 54.5% (95% CI 48.5% to 60.4%), higher among nurses (61.3%), those living off-site (69.6%) and those considering leaving their careers (86.2%). Significant factors included age 21-30 years (adjusted prevalence ratio (aPR) 1.55, 95% CI 1.06 to 2.27), nursing profession (aPR 2.19, 95% CI 1.07 to 4.48), off-site residence (aPR 1.23, 95% CI 1.02 to 1.49), 6 months to 2 years of experience (aPR 1.44, 95% CI 1.12 to 1.86), dissatisfaction with salary (aPR 1.77, 95% CI 1.02 to 3.07), poor colleague relationships (aPR 1.25, 95% CI 1.03 to 1.51), ≥4 night shifts/week (aPR 2.54, 95% CI 1.33 to 4.86), attending ≥41 patients per day (aPR 1.52, 95% CI 1.06 to 2.19) and lack of academic growth opportunities (aPR 1.62, 95% CI 1.15 to 2.29).

CONCLUSION

Rural settings like Kasulu face unique challenges, including limited resources and heavy workloads, exacerbating burnout among healthcare providers. Over half of healthcare providers experienced burnout, with younger providers, nurses, those living off-site, less experienced staff, poor colleague relationships and high patient loads at higher risk. To mitigate burnout, authorities should provide career counselling, onsite housing, mental health support and increased staffing.

Anxiety and depression in healthcare workers are associated with work stress and poor work ability

Background

Symptoms of anxiety and depression are very common among healthcare workers (HCWs) and could impact the quality of care.

Objective

This study aimed to evaluate the prevalence of these disorders in a public health company and their association with work ability and work-related stress.

Methods

A cross-sectional study involved 80 HCWs being treated for mental disorders (MD), 55 HCWs who said they suffered from MD but were not being treated, and 824 healthy colleagues. All workers completed the Work Ability Index (WAI), the Siegrist's Effort/Reward Imbalance questionnaire (ERI), the Goldberg's scales of anxiety and depression (GADS), and the Warr's scale of job satisfaction.

Results

Three-quarters of workers with MD suffered from anxiety and/or depression. Workers who declared at the periodic medical examination in the workplace that they were being treated for MD had significantly lower levels of work ability than those of their colleagues who declared good mental health. They also reported greater work stress (high effort, low rewards, high overcommitment) and lower job satisfaction than their healthy colleagues. Symptomatic but untreated workers reported significantly lower work ability, lower satisfaction, and greater occupational stress than their healthy colleagues. In the entire sample, there were many workers with symptoms of anxiety or depression who did not declare these disorders during the examination. Overall, there were 328 suspected cases of anxiety (34.2%) and 334 cases of depression (34.8%). Anxious workers [OR = 8.11, 95% confidence interval (CI) = 3.74-17.58] and depressed workers (OR = 4.49, 95% CI = 2.22-9.10) had an increased risk of being classified as having "poor work ability".

Conclusion

The negative association between psychological symptoms and work ability even in undiagnosed/untreated workers demonstrates the usefulness of screening for these symptoms in work environments.

Understanding Cardiovascular Health and Lifestyle Choices Among Healthcare Professionals in Medically Underserved Regions in Illinois

This study assesses the prevalence of cardiovascular risk factors, such as diabetes, obesity, high blood pressure, and stress, as related to healthy lifestyle behaviors among healthcare professionals (HCPs), including medical doctors, nurses, pharmacists, laboratory scientists, and radiologists, in medically underserved regions (MURs). Using a cross-sectional study design, an online survey was administered to HCPs in MURs of West Central Illinois. A total of 316 HCPs completed the survey. The study population was predominantly White, female, and aged 55 or older. The findings of this research imply that HCPs in medically underserved regions (MURs) with high cholesterol generally do not engage in physical activity. The study showed a correlation between HCP age, high blood pressure, Type 2 diabetes, and high cholesterol, implying that as HCPs age like every other individual, the likelihood of developing these conditions increases. This study emphasizes the role of time constraints and a lack of motivation in limiting HCPs' participation in physical activity in rural areas. Additionally, the study suggests that inadequate access to nutritious food and exercise facilities in rural regions contributes to lower rates of healthy eating and physical activity. Findings demonstrate how essential it is for healthcare professionals to remain vigilant about cardiovascular disease risk factors.