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Wang D, Chen XY, Scherffius A, Yu Z, Wang X, Sun M, Fan F. Perceived school bullying and psychotic-like experiences in sexual minority adolescents: the mediating and moderating roles of resilience. Child Adolesc Psychiatry Ment Health 2024; 18:55. [PMID: 38755658 PMCID: PMC11100180 DOI: 10.1186/s13034-024-00747-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
AIMS This two-wave, longitudinal study aimed to examine the potential moderating and mediating effects of resilience on the association between perceived school bullying and psychotic-like experiences among Chinese sexual minority adolescents. METHODS A total of 4192 senior high students were included and 984 (23.5%) of them were identified as a sexual minority (mean age = 16.68 years, SD = 0.71). Participants completed two online surveys during April 21 to May 12, 2021 and December 17 to 26, 2021, respectively, as well as completed self-report measures of sample characteristics, perceived school bullying, resilience, and psychotic-like experiences (including two dimensions: delusional experiences and hallucinatory experiences). RESULTS Perceived school bullying and resilience were associated with psychotic-like experiences in sexual minority adolescents. Resilience mediated the relationship between perceived school bullying and subsequent psychotic-like experiences (b = 0.03, 95% CI = 0.01 ~ 0.04)/ delusional experiences (b = 0.03, 95% CI = 0.01 ~ 0.04)/ hallucinatory experiences (b = 0.02, 95% CI = 0.01 ~ 0.03). Additionally, resilience only moderated the associations of perceived school bullying with hallucinatory experiences (b = -0.06, 95% CI = -0.12 ~ -0.01). CONCLUSIONS These findings indicated that resilience plays a crucial role in mediating or moderating the relationship between perceived school bullying and psychotic-like experiences. Assessing and reducing school bullying, as well as promoting resilience, may have important clinical implications for reducing the risk of psychotic-like experiences in sexual minority adolescents.
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Affiliation(s)
- Dongfang Wang
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, Guangdong Emergency Response Technology Research Center for Psychological Assistance in Emergencies, South China Normal University, Guangzhou, China
| | - Xiao-Yan Chen
- School of Psychology, Fujian Normal University, Fuzhou, China
| | - Andrew Scherffius
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhijun Yu
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, Guangdong Emergency Response Technology Research Center for Psychological Assistance in Emergencies, South China Normal University, Guangzhou, China
| | - Xuan Wang
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, Guangdong Emergency Response Technology Research Center for Psychological Assistance in Emergencies, South China Normal University, Guangzhou, China
| | - Meng Sun
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fang Fan
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, Guangdong Emergency Response Technology Research Center for Psychological Assistance in Emergencies, South China Normal University, Guangzhou, China.
- School of Psychology, South China Normal University, Shipai Road, Guangzhou, China.
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2
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Scrimgeour G, Turner K. Hospital and departmental level strategies for managing the impact of adverse events on surgeons. Urol Oncol 2024:S1078-1439(24)00347-8. [PMID: 38514276 DOI: 10.1016/j.urolonc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
Adverse events have a profound impact on surgeons. This impact extends to physical and mental health, psychological wellbeing, and professional performance. Surgeons are ill prepared for these consequences of adverse events and are under-supported when they inevitably occur. Here we review the data on how adverse events affect surgeons. We explore the efforts made to date to both prepare surgeons before and support them after such events and we make recommendations regarding how this should and could be done better.
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Affiliation(s)
- Gemma Scrimgeour
- Department of Urology, Royal Bournemouth Hospital, University Hospitals Dorset, Castle Lane East, Bournemouth, UK
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3
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Fazekas C, Zieser M, Hanfstingl B, Saretzki J, Kunschitz E, Zieser-Stelzhammer L, Linder D, Matzer F. Physician resilience and perceived quality of care among medical doctors with training in psychosomatic medicine during the COVID-19 pandemic: a quantitative and qualitative analysis. BMC Health Serv Res 2024; 24:249. [PMID: 38413956 PMCID: PMC10900785 DOI: 10.1186/s12913-024-10681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND At an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic. METHODS This study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction. RESULTS The study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p <.05). Resilience and training background independently predicted perceived quality of care, even after controlling for variables such as own health concerns, involvement in the treatment of COVID-19 patients, financial strain, percentage of working hours spent on patient care, age, and gender (resilience: B = 0.33, SE = 0.12, p <.01; training background: B = 0.17, SE = 0.07, p <.05). Both resilience and training background predicted job satisfaction (resilience: B = 0.42, SE = 0.12, p <.001; training background: B = 0.18, SE = 0.07, p <.05), while resilience alone predicted professional autonomy (B = 0.27, SE = 0.12, p <.05). In response to an open question about their resources, resilient physicians more frequently reported applying conscious resilient skills/emotion regulation (p <.05) and personal coping strategies (p <.01) compared to less resilient medical doctors. CONCLUSION Physician resilience appears to play a significant role in the perceived quality of patient care, professional autonomy, and job satisfaction during healthcare crises.
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Affiliation(s)
- Christian Fazekas
- Department of Psychiatry, Psychosomatics and Psychotherapy, Division of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria.
| | | | | | | | - Evelyn Kunschitz
- II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Hanusch Hospital, Vienna, Austria
| | - Luise Zieser-Stelzhammer
- Department of Psychosocial, Psychosomatic and Psychotherapeutic Medicine, Austrian Medical Association, Vienna, Austria
| | - Dennis Linder
- Department of Psychiatry, Psychosomatics and Psychotherapy, Division of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Franziska Matzer
- Department of Psychiatry, Psychosomatics and Psychotherapy, Division of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
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4
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Aljuwaiser S, Brazzelli M, Arain I, Poobalan A. Common mental health problems in medical students and junior doctors - an overview of systematic reviews. J Ment Health 2023:1-37. [PMID: 37933550 DOI: 10.1080/09638237.2023.2278095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 09/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support. AIMS This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice. METHODS Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them. RESULTS Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP. CONCLUSIONS The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce. PRISMA/PROSPERO the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.
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Affiliation(s)
- Sameera Aljuwaiser
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Imran Arain
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Amudha Poobalan
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Foti TR, Watson C, Adams SR, Rios N, Staunton M, Wei J, Sterling SA, Ridout KK, Young-Wolff KC. Associations between Adverse Childhood Experiences (ACEs) and Prenatal Mental Health and Substance Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6289. [PMID: 37444136 PMCID: PMC10341286 DOI: 10.3390/ijerph20136289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Adverse childhood experiences (ACEs) are common and increase the risk of poor health outcomes. Resilience may offer protection against the impacts of ACEs. This study examined the association between maternal ACEs and mental/behavioral health outcomes during pregnancy overall and by resilience. The sample comprised pregnant patients in two pilot studies screened for eight ACEs and resilience during standard prenatal care in Kaiser Permanente Northern California from 1 March 2016 to 30 July 2016 (Study 1, medical centers A, B) and from 1 April 2018 to 31 March 2019 (Study 2, medical centers A, C). Early pregnancy outcomes included anxiety and depressive disorders, depression symptoms, intimate partner violence (IPV), and substance use. Multivariable logistic regression was used in this cross-sectional study to examine associations between maternal ACEs (0, 1-2, ≥3) and mental/behavioral health outcomes overall and among those with low and high resilience. Patients (n = 1084) averaged 30.8 years (SD 5.1); 41.7% were non-Hispanic White; 41.7% experienced ≥1 ACE, and 40.3% had low resilience. Patients with 1-2 ACEs or ≥3 ACEs (versus 0 ACEs) had higher odds of anxiety and depressive disorders, depressive symptoms, IPV, and any prenatal substance use (OR 1.44-4.40, p < 0.05). Each individual ACE was associated with ≥2 mental/behavioral health outcomes. In stratified analyses, having ≥1 ACE (vs. 0) was associated with a greater number of mental/behavioral health outcomes among patients with low versus high resilience. ACEs were associated with prenatal mental/behavioral health conditions, particularly in the context of low resilience, highlighting the importance of trauma-informed prenatal care and the need to study resilience-building interventions during pregnancy.
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Affiliation(s)
- Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Carey Watson
- Obstetrics and Gynecology, Kaiser Permanente, Antioch Medical Center, Antioch, CA 94531, USA
| | - Sara R. Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
| | - Normelena Rios
- Obstetrics and Gynecology, Kaiser Permanente, Dublin Medical Center, Dublin, CA 94568, USA
| | - Mary Staunton
- Department of Psychiatry, Kaiser Permanente, Walnut Creek Medical Center, Walnut Creek, CA 94596, USA
| | - Julia Wei
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Kathryn K. Ridout
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry, Kaiser Permanente, Santa Rosa Medical Center, Santa Rosa, CA 95403, USA
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA (K.C.Y.-W.)
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
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Gertler J, Dale L, Tracy N, Dorsett J, Sambuco N, Guastello A, Allen B, Cuffe SP, Mathews CA. Resilient, but for how long? The relationships between temperament, burnout, and mental health in healthcare workers during the Covid-19 pandemic. Front Psychiatry 2023; 14:1163579. [PMID: 37484670 PMCID: PMC10361786 DOI: 10.3389/fpsyt.2023.1163579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Dispositional traits of wellbeing and stress-reaction are strong predictors of mood symptoms following stressful life events, and the COVID-19 pandemic introduced many life stressors, especially for healthcare workers. Methods We longitudinally investigated the relationships among positive and negative temperament group status (created according to wellbeing and stress-reaction personality measures), burnout (exhaustion, interpersonal disengagement), COVID concern (e.g., health, money worries), and moral injury (personal acts, others' acts) as predictors of generalized anxiety, depression, and post-traumatic stress symptoms in 435 healthcare workers. Participants were employees in healthcare settings in North Central Florida who completed online surveys monthly for 8 months starting in October/November 2020. Multidimensional Personality Questionnaire subscale scores for stress-reaction and wellbeing were subjected to K-means cluster analyses that identified two groups of individuals, those with high stress-reaction and low wellbeing (negative temperament) and those with the opposite pattern defined as positive temperament (low stress-reaction and high wellbeing). Repeated measures ANOVAs assessed all time points and ANCOVAs assessed the biggest change at timepoint 2 while controlling for baseline symptoms. Results and Discussion The negative temperament group reported greater mood symptoms, burnout, and COVID concern, than positive temperament participants overall, and negative participants' scores decreased over time while positive participants' scores increased over time. Burnout appeared to most strongly mediate this group-by-time interaction, with the burnout exhaustion scale driving anxiety and depression symptoms. PTSD symptoms were also related to COVID-19 health worry and negative temperament. Overall, results suggest that individuals with higher stress-reactions and more negative outlooks on life were at risk for anxiety, depression, and PTSD early in the COVID-19 pandemic, whereas individuals with positive temperament traits became more exhausted and thus more symptomatic over time. Targeting interventions to reduce mood symptoms in negative temperament individuals and prevent burnout/exhaustion in positive temperament individuals early in an extended crisis may be an efficient and effective approach to reduce the mental health burden on essential workers.
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Affiliation(s)
- Joshua Gertler
- UF Center for OCD, Anxiety, and Related Disorders, University of Florida, Gainesville, Florida, United States
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, Florida, United States
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States
| | - Lourdes Dale
- Department of Psychiatry, College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida, United States
| | - Natasha Tracy
- UF Center for OCD, Anxiety, and Related Disorders, University of Florida, Gainesville, Florida, United States
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, Florida, United States
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Joelle Dorsett
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, Miami, Florida, United States
| | - Nicola Sambuco
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States
| | - Andrea Guastello
- UF Center for OCD, Anxiety, and Related Disorders, University of Florida, Gainesville, Florida, United States
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, Florida, United States
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Brandon Allen
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Steven P. Cuffe
- Department of Psychiatry, College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida, United States
| | - Carol A. Mathews
- UF Center for OCD, Anxiety, and Related Disorders, University of Florida, Gainesville, Florida, United States
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, Florida, United States
- Department of Psychiatry, College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida, United States
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Schwitz F, Torti J, Lingard L. What about Happiness? A Critical Narrative Review with Implications for Medical Education. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:208-217. [PMID: 37304335 PMCID: PMC10253238 DOI: 10.5334/pme.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/18/2023] [Indexed: 06/13/2023]
Abstract
Introduction Despite abundant scholarship and improvement initiatives, the problem of physician wellbeing persists. One reason might be conceptual: the idea of 'happiness' is rare in this work. To explore how it might influence the conversation about physician wellbeing in medical education, we conducted a critical narrative review asking: 'How does happiness feature in the medical education literature on physician wellbeing at work?' and 'How is happiness conceptualized outside medicine?' Methods Following current methodological standards for critical narrative review as well as the Scale for the Assessment of Narrative Review Articles, we conducted a structured search in health research, humanities and social sciences, a grey literature search, and consultation with experts. After screening and selection, content analysis was performed. Results Of 401 identified records, 23 were included. Concepts of happiness from the fields of psychology (flow, synthetic happiness, mindfulness, flourishing), organizational behaviour (job satisfaction, happy-productive worker thesis, engagement), economics (happiness industry, status treadmill), and sociology (contentment, tyranny of positivity, coercive happiness) were identified. The medical education records exclusively drew on psychological concepts of happiness. Discussion and Conclusion This critical narrative review introduces a variety of conceptualizations of happiness from diverse disciplinary origins. Only four medical education papers were identified, all drawing from positive psychology which orients us to treat happiness as individual, objective, and necessarily good. This may constrain both our understanding of the problem of physician wellbeing and our imagined solutions. Organizational, economical and sociological conceptualizations of happiness can usefully expand the conversation about physician wellbeing at work.
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Affiliation(s)
- Fabienne Schwitz
- Cardiologist and medical educator, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Suit 102A, London, Canada
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland
| | - Jacqueline Torti
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Suit 102A, London, Canada
| | - Lorelei Lingard
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Suit 102A, London, Canada
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Wadi MM, Yusoff MSB, Taha MH, Shorbagi S, Nik Lah NAZ, Abdul Rahim AF. The framework of Systematic Assessment for Resilience (SAR): development and validation. BMC MEDICAL EDUCATION 2023; 23:213. [PMID: 37016407 PMCID: PMC10073620 DOI: 10.1186/s12909-023-04177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Burnout and depression among health professions education (HPE) students continue to rise, leading to unwanted effects that ultimately jeopardise optimal medical care and patient health. Promoting the resilience of medical students is one solution to this issue. Several interventions have been implemented to foster resilience, but they focus on aspects other than the primary cause: the assessment system. The purpose of this study is to develop a framework to promote resilience in assessment planning and practice. METHODS We followed the guidelines suggested by Whetten for constructing a theoretical model for framework development. There were four phases in the model development. In the first phase, different literature review methods were used, and additional students' perspectives were collected through focus group discussions. Then, using the data, we constructed the theoretical model in the second phase. In the third phase, we validated the newly developed model and its related guidelines. Finally, we performed response process validation of the model with a group of medical teachers. RESULTS The developed systematic assessment resilience framework (SAR) promotes four constructs: self-control, management, engagement, and growth, through five phases of assessment: assessment experience, assessment direction, assessment preparation, examiner focus, and student reflection. Each phase contains a number of practical guidelines to promote resilience. We rigorously triangulated each approach with its theoretical foundations and evaluated it on the basis of its content and process. The model showed high levels of content and face validity. CONCLUSIONS The SAR model offers a novel guideline for fostering resilience through assessment planning and practice. It includes a number of attainable and practical guidelines for enhancing resilience. In addition, it opens a new horizon for HPE students' future use of this framework in the new normal condition (post COVID 19).
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Affiliation(s)
- Majed Mohammed Wadi
- Medical Education Department, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Muhamad Saiful Bahri Yusoff
- Medical Education Department, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan Malaysia
| | - Mohamed Hassan Taha
- College of Medicine and Center of Medical Education, University of Sharjah, Sharjah, United Arab Emirates
| | - Sarra Shorbagi
- Department of Family and Community Medicine and Behavioral Science, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Nik Ahmad Zuky Nik Lah
- Obstetrics and Gynecology Department, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan Malaysia
| | - Ahmad Fuad Abdul Rahim
- Medical Education Department, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan Malaysia
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9
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O’Connor M, Stapleton A, O'Reilly G, Murphy E, Connaughton L, Hoctor E, McHugh L. The efficacy of mindfulness-based interventions in promoting resilience: A systematic review and meta-analysis of randomised controlled trials. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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10
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Boland JW, Kabir M, Spilg EG, Webber C, Bush SH, Murtagh F, Lawlor PG. Over a third of palliative medicine physicians meet burnout criteria: Results from a survey study during the COVID-19 pandemic. Palliat Med 2023; 37:343-354. [PMID: 36789968 PMCID: PMC9936168 DOI: 10.1177/02692163231153067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Palliative medicine physicians may be at higher risk of burnout due to increased stressors and compromised resilience during the COVID-19 pandemic. Burnout prevalence and factors influencing this among UK and Irish palliative medicine physicians is unknown. AIM To determine the prevalence of burnout and the degree of resilience among UK and Irish palliative medicine physicians during the COVID-19 pandemic, and associated factors. DESIGN Online survey using validated assessment scales assessed burnout and resilience: The Maslach Burnout Inventory Human Services Survey for Medical Personnel [MBI-HSS (MP)] and the Connor-Davidson Resilience Scale (CD-RISC). Additional tools assessed depressive symptoms, alcohol use, and quality of life. SETTING/PARTICIPANTS Association of Palliative Medicine of UK and Ireland members actively practising in hospital, hospice or community settings. RESULTS There were 544 respondents from the 815 eligible participants (66.8%), 462 provided complete MBI-HSS (MP) data and were analysed. Of those 181/462 (39.2%) met burnout criteria, based on high emotional exhaustion or depersonalisation subscales of the MBI-HSS (MP). A reduced odds of burnout was observed among physicians who worked ⩽20 h/week (vs 31-40 h/week, adjusted odds ratio (aOR) 0.03, 95% confidence interval (CI) 0.002-0.56) and who had a greater perceived level of clinical support (aOR 0.70, 95% CI 0.62-0.80). Physicians with higher levels of depressive symptoms had higher odds of burnout (aOR 18.32, 95% CI 6.75-49.73). Resilience, mean (SD) CD-RISC score, was lower in physicians who met burnout criteria compared to those who did not (62.6 (11.1) vs 70.0 (11.3); p < 0.001). CONCLUSIONS Over one-third of palliative medicine physicians meet burnout criteria. The provision of enhanced organisational and colleague support is paramount in both the current and future pandemics.
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Affiliation(s)
- Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK.,Hull York Medical School, University of York, UK
| | | | - Edward G Spilg
- Division of Geriatric Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Shirley H Bush
- Bruyère Research Institute, Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Continuing Care, Ottawa, ON, Canada
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK
| | - Peter G Lawlor
- Bruyère Research Institute, Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Continuing Care, Ottawa, ON, Canada
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11
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Okamura M, Fujimori M, Goto S, Ohisa K, Boku N, Nakahara R, Uchitomi Y, Suzuki T, Matsuda T. Psychological distress among healthcare providers in oncology during the COVID-19 pandemic in Japan: The mediating role of moral distress and resilience. Front Psychol 2023; 14:1105800. [PMID: 36818071 PMCID: PMC9929353 DOI: 10.3389/fpsyg.2023.1105800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
Objective Even though vaccines have become widespread, there is an explosion of infection due to the emergence of new mutant strains, and support for healthcare providers' mental health is necessary. The aims of this study were to explore factors associated with the psychological distress, and to determine the degree of association between moral distress, resilience and psychological distress in order to consider intervention models for psychological distress of healthcare providers involved with cancer patients during the COVID-19 pandemic. Method We conducted a cross-sectional survey among healthcare providers at the National Cancer Center, Japan. Psychological distress was assessed by the Hospital Anxiety and Depression Scale. We also assessed moral distress using the Moral Distress Thermometer and resilience using the Connor-Davidson Resilience Scale 10 in April and May 2020 which was the first surge of the epidemic period. Results Five hundred sixty-six of 3,900 healthcare providers (14.5%) responded. Sixty-eight percent (385/566) responders were above the Hospital Anxiety and Depression Scale cutoff. Hierarchical regression analyses indicated that nurses, allied health professionals and office workers/engineers (odds ratio = 4.63; 95% confidence interval 1.90-11.29; p < 0.001, odds ratio = 3.88; 95% confidence interval 1.88-8.00; p < 0.001, odds ratio = 2.10; 95% confidence interval 1.06-4.18; p < 0.05) as well as healthcare providers with low resilience (odds ratio = 0.88; 95% confidence interval 0.85-0.91; p < 0.001) were at risk of psychological distress. Moral distress was not significantly associated with prevalence of psychological distress. Conclusion During the first surge of the pandemic, a high prevalence of psychological distress was demonstrated among cancer center healthcare providers. The study suggests that mental health care should be available to cancer care providers. Since the COVID-19 pandemic is still going on, in addition to the efforts by our facilities, we should consider interventions that promote resilience and a feasibility study of these interventions.
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Affiliation(s)
- Masako Okamura
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan,*Correspondence: Maiko Fujimori,
| | - Shinichi Goto
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Keiko Ohisa
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Rika Nakahara
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan,Strategic Planning Bureau, National Cancer Center, Tokyo, Japan
| | - Tomohiro Matsuda
- Division of International Health Policy Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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12
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Maragha T, Donnelly L, Schuetz C, von Bergmann H, Brondani M. Students' resilience and mental health in the dental curriculum. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:174-180. [PMID: 35178840 DOI: 10.1111/eje.12790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/29/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Dental education is perceived as a source of students' psychological and occupational stress. Resilience has been proposed as a protective factor that may support students' in managing that stress. The objectives of this study were twofold: to map the mental health and well-being content in the curriculum of the Faculty of Dentistry (FoD) at the University of British Columbia (UBC) and to investigate factors influencing resilience levels amongst dental students at UBC. METHODS The curricular database and website of UBC's FoD were used to gather information on mental health content. A survey with the Connor-Davidson 10-Item Resilience Scale was distributed to dental students at UBC (N = 289). Students' de-identified demographic data were also collected. RESULTS Two main mental health and well-being curricular components were identified: one didactic session on stress management and one interactive workshop on resilience. The response rate for the survey was 68.2%. Students who did not receive any mental health content (2020/21 year 1 students) had higher resilience scores (p = .043) when compared to students who received both components (2019/20 year 1 students and 2018/19 year 2 students). The multiple regression analysis highlighted North American/European ethnic origins as a predictor for higher resilience levels (p = .008). CONCLUSIONS The results of this study showed that ethnic origins and major life events, such as the pandemic, influenced resilience. Curricular activities promoting resilience seemed to not necessarily impact students' resilience. Further longitudinal studies are needed to assess the curricular and non-curricular activities influence over dental students' well-being.
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Affiliation(s)
- Tala Maragha
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leeann Donnelly
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Schuetz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - HsingChi von Bergmann
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mario Brondani
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Song C, Du XT, Hong YX, Mao JH, Zhang W. Association between social supports and negative emotions among pediatric residents in China: The chain-mediating role of psychological resilience and burnout. Front Public Health 2023; 10:962259. [PMID: 36755738 PMCID: PMC9899841 DOI: 10.3389/fpubh.2022.962259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 12/27/2022] [Indexed: 01/24/2023] Open
Abstract
Background Chinese pediatricians are facing challenges, and there is a need to examine the issue of negative emotions, namely, stress, anxiety and depression, among front-line pediatric residents in clinical settings. Understanding the current situation and influencing factors of negative emotions among pediatric residents in China and exploring the formation mechanism can lay a foundation for psychological interventions. Methods A total of 138 pediatric residents in the Children's Hospital, Zhejiang University School of Medicine, China, were surveyed using the Depression Anxiety Stress Scale-21 (DASS-21), Social Support Rating Scale (SSRS), Connor-Davidson Resilience Scale (CD-RISC), and Maslach Burnout Inventory-General Survey (MBI-GS). Results (1) The incidence of abnormal stress, anxiety, and depression among pediatric residents was 18.8%, 47.8%, and 47.8% respectively. (2) Negative emotions were significantly negatively correlated with social supports and psychological resilience, and positively correlated with burnout. (3) The chain-mediating effect of resilience and burnout between social supports and negative emotions was significant. Conclusion Psychological resilience and burnout played a chain-mediating role between social supports and negative emotions. Measures should be taken to improve the mental health of Chinese pediatric residents.
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Affiliation(s)
- Chao Song
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
| | - Xiao-Tian Du
- School of Public Health, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-Xia Hong
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China,*Correspondence: Yun-Xia Hong ✉
| | - Jian-Hua Mao
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China,Jian-Hua Mao ✉
| | - Wen Zhang
- Department of Philosophy, Beijing Normal University, Beijing, China
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14
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Walton M, McLachlan S, Nelson M, Skeffington P, Phillipson L, Christian MD. A Psychological Resilience Briefing Intervention for Helicopter Emergency Medical Service Observers. Air Med J 2022; 41:549-555. [PMID: 36494171 DOI: 10.1016/j.amj.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/15/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) observers may be at risk of negative psychological effects associated with exposure to traumatic events during shifts. This article describes a quality improvement project for HEMS observers at Essex & Herts Air Ambulance. METHODS A psychological resilience briefing intervention (PRBi) was developed and delivered during induction training with 60 HEMS observers. The PRBi aimed to raise awareness of traumatic events that observers may experience and provided basic education on 5 domains, including likely forms of trauma exposure, possible psychological reactions, advice on coping strategies and supporting colleagues, and resources that they could use if required. The intervention was intended to bolster resilience and reduce posttraumatic stress disorder symptoms, and to encourage adaptive coping styles in observers. RESULTS Observers learned from and valued the PRBi; statistically significant increases were observed in awareness of the 5 domains from pre- to post-delivery, and free-text responses cited a variety of benefits to the observers. There was no indication that the PRBi caused harm. CONCLUSION The PRBi has now been included in the routine induction of observers at Essex & Herts Air Ambulance and has the potential to be repurposed for use in other settings, including medical schools.
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Affiliation(s)
- Matthew Walton
- St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Sarah McLachlan
- Essex and Herts Air Ambulance, Essex, United Kingdom; Anglia Ruskin University, Essex, United Kingdom.
| | - Matthew Nelson
- School of Anaesthesia and Intensive Care, Health Education Yorkshire and Humber, Health Education England, Leeds, United Kingdom
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15
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Fischer A, Shapiro J, Nguyen T, Meckler G, Lam T, Mai U, Fenning R, De La Cruz JP, Haq C. Views from the trenches: California family physicians' challenges and resilience factors while providing patient care during the initial wave of COVID-19. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2022; 6:10296. [PMID: 37440773 PMCID: PMC10336883 DOI: 10.4081/qrmh.2022.10296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/11/2022] [Indexed: 07/15/2023] Open
Abstract
This study examined challenges and factors promoting resilience among 20 California family physicians (FPs) during the first six months of the COVID-19 pandemic. A subset of academic, community, and resident FPs who responded to an online survey also participated in a semi-structured interview that explored concerns, moral distress, burnout, resource needs, support systems, coping strategies, and motivation to continue caring for patients. Thematic analysis was used to identify common themes in participant interviews. Interviewees demonstrated adaptability, resilience, and grit (i.e., commitment to completing a valued goal in the face of setbacks and adversity) despite challenges disrupting patient care, fears for family and self, and frustration due to the politicization of the pandemic. Factors promoting well-being and perseverance included professional and personal support, strong coping skills, and focusing on the meaning derived from practicing medicine. A service orientation that permeates family medicine philosophy and values motivated practitioners to continue to provide patient care while dealing with overwhelming personal and structural challenges. FPs drew strength from their internal coping skills, core family medicine values, and external support, notwithstanding demoralizing effects of mixed messages and politicization of the pandemic. FPs demonstrated resilience and grit in the face of challenges created by the COVID-19 pandemic. Ensuring adequate resources to promote a physically and psychologically healthy workforce while increasing access to care for all patients is crucial to prepare for the next healthcare crisis.
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Affiliation(s)
| | | | - Tan Nguyen
- Department of Family Medicine, UC Irvine School of Medicine
| | | | - Tien Lam
- UC Irvine, California, United States
| | - Uyen Mai
- UC Irvine, California, United States
| | | | | | - Cynthia Haq
- Department of Family Medicine, UC Irvine School of Medicine
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16
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Adnan NBB, Dafny HA, Baldwin C, Jakimowitz S, Chalmers D, Aroury AMA, Chamberlain D. What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care. BMJ Open 2022; 12:e060973. [PMID: 36691206 PMCID: PMC9462087 DOI: 10.1136/bmjopen-2022-060973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals. DESIGN This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme. RESULTS A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience. CONCLUSIONS These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.
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Affiliation(s)
- Nurul Bahirah Binte Adnan
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Hila Ariela Dafny
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Claire Baldwin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Samantha Jakimowitz
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Ammar Moh'd Ahmad Aroury
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
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Srivastava S, Misra R, Tripathi PM. Coping Distress through Harvesting Resilience Among Indian Physicians: Role of Mediating–Moderating Variables. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221109307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study proposes to understand the dynamics of work stress and turnover relationship of physicians in Indian context. It also intends to understand the mediating and moderating roles of burnout and resilience on the relationship between work stress and turnover intentions. The article has taken the support of conservation of resources (COR) theory to develop the conceptual framework. The study uses the survey method for data collection which was analysed using quantitative statistical methods like confirmatory factor analysis and mediated and moderated regression. The result showed a significant moderating effect of resilience on burnout and turnover intentions relationship and a strong mediating effect of burnout on the relationship between stress and turnover intentions. Physicians who are regarded as ‘saviours’ should be treated with respect. Certain activities dealing with work–life balance, engaging in leisure activities, getting support from family and friends may help the physician in coping with the demands of stress and thereby reducing the burnout. Future research can take into account other states of India as well as other countries for generalisation of results. The demographic differences among the physicians can also be a new area of research. Although there is lot of available research on the study variables, but none of the studies have taken into context resilience as a moderator between burnout and turnover intention specially in reference to Indian context. The results can add value to the prevailing studies on stress, burnout, resilience and turnover intention.
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Affiliation(s)
| | - Richa Misra
- Jaipuria Institute of Management, Noida, Uttar Pradesh, India
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18
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Krishnan A, Odejimi O, Bertram I, Chukowry PS, Tadros G. A systematic review of interventions aiming to improve newly-qualified doctors' wellbeing in the United Kingdom. BMC Psychol 2022; 10:161. [PMID: 35754046 PMCID: PMC9235154 DOI: 10.1186/s40359-022-00868-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Newly-qualified doctors in the United Kingdom experience a great deal of stress and have poor wellbeing when compared to more senior counterparts. A number of interventions have been put in place to boost healthcare professionals’ wellbeing, but little is known about interventions aimed to improve the wellbeing of newly-qualified doctors in the United Kingdom. This study aims to systematically review current evidence of interventions which improved the wellbeing of newly-qualified junior doctors in the United Kingdom. Methods Five key electronic databases were searched. Subsequently, reference scanning and citation search was performed. Studies were included if they were conducted from the commencement of the Foundation Programme in 2004, until 2019. In addition, studies had to be performed on junior doctors: working in the United Kingdom and within their first five years post-qualification and have a quantitative outcome. Studies which did not meet these criteria were excluded. Quality was assessed using the modified Newcastle-Ottawa scale. Bias was not formally assessed using a standardised tool. Results Seven papers met the inclusion criteria and identified three main types of interventions: mentorship, mindfulness and clinical preparation interventions. The majority of included studies reported a positive result from the performed intervention, suggesting these to be beneficial in improving junior doctor wellbeing, and thereby reducing anxiety and stress levels. However, most of the studies used small sample sizes. Conclusions This review reveals that there is dearth of evidence on the effectiveness of intervention to improve the wellbeing of newly-qualified doctors in the United Kingdom. Most of the identified interventions focused on relieving stress and anxiety inherent within newly-qualified doctors’ training programmes. However, wellbeing interventions need to take into cognisance all the factors which impact on wellbeing, particularly job-related factors. We recommend that future researchers implement large-scale holistic interventions using appropriate research methods. Systematic review registration: PROSPERO CRD42019127341. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00868-8.
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Affiliation(s)
- Aditya Krishnan
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Opeyemi Odejimi
- Psychiatric Liaison Team, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | | | - Priyamvada Sneha Chukowry
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - George Tadros
- Aston Medical School, Aston University, Birmingham, UK
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McKenna M, Dempster M, Jarowslawska A, Shayegh J, Graham-Wisener L, McPherson A, White C. Moderating the work distress experience among inpatient hospice staff: a qualitative study. Int J Palliat Nurs 2022; 28:280-288. [PMID: 35727835 DOI: 10.12968/ijpn.2022.28.6.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Palliative and hospice care health professionals may be at risk of poorer psychological outcomes. It is unclear what specific stressors are experienced by staff and what impact they have on their psychological wellbeing. Aims: To identify stressors experienced when working in an adult hospice inpatient unit environment and how these are managed. Methods: Individual interviews were conducted with healthcare professionals working in a hospice adult inpatient unit. Findings: A total of 19 staff were interviewed. Six themes were constructed, with four related to stressors experienced: unrealistic workload, patient care, managing relationships, and work culture. Two themes concerned strategies for managing stressors were identified: peer support and time out. Conclusion: Changes within hospice care provision are placing demands on staff and reducing the amount of available resources. This may be alleviated by a move towards more compassionate workplaces. There is a need for further research to identify how distress can best be managed and how hospice organisations can best support healthcare staff.
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Affiliation(s)
- Morgan McKenna
- Trainee Clinical Psychologist, Queen's University Belfast, Northern Ireland
| | - Martin Dempster
- Professor, Centre for Improving Health-Related Quality of Life, Queen's University Belfast, Northern Ireland
| | | | - John Shayegh
- PhD Student, Queen's University Belfast, Northern Ireland
| | - Lisa Graham-Wisener
- Doctor, Centre for Improving Health-Related Quality of Life, Queen's University Belfast, Northern Ireland
| | | | - Clare White
- Doctor, Northern Ireland Hospice, Northern Ireland
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20
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Fosnot L, Jones CD, Keniston A, Burden M, Indovina KA, Patel H. Hospitalists' perspectives on challenging patient encounters and physician well-being: A qualitative study. PATIENT EDUCATION AND COUNSELING 2022; 105:1209-1215. [PMID: 34511284 DOI: 10.1016/j.pec.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/29/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Challenging patient encounters contribute to physician burnout, though little is known about how these impact hospitalists specifically. This study explores how hospitalists characterize challenging patient encounters and their impact on hospitalist well-being to inform organizational efforts. METHODS We conducted a qualitative, descriptive study with 15 physician hospitalist faculty at two locations, a tertiary academic and safety-net hospital, utilizing a conceptual framework based on the Stanford Wellness Framework for physician resilience around challenging patient encounters. RESULTS Two themes emerged: feelings of helplessness and time-consuming encounters. Helplessness was associated with systems issues, misaligned patient/provider goals, and violence. Time-consuming encounters were due to systems issues, misaligned goals requiring prolonged conversations, and patient factors. These factors were found to negatively impact hospitalist well-being. Resilience strategies included developing and teaching empathy and seeking expert/colleague opinion through debriefing, peer-to-peer interactions, and external resources. CONCLUSIONS Organizational strategies to support hospitalists in the context of challenging patient encounters require a multifaceted approach: improved system processes, fostering a local culture of empathy-building, and supporting peer-to-peer relationships and debriefing mechanisms. PRACTICE IMPLICATIONS Enhanced communication around system process improvements and culture of wellness, in addition to communication skills and mindfulness, could improve hospitalist well-being.
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Affiliation(s)
- Lisa Fosnot
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Kimberly A Indovina
- Division of Hospital Medicine, University of Colorado, Denver Health, Denver, CO, USA.
| | - Hemali Patel
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
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21
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Nutting R, Ofei-Dodoo S, Rose-Borcherding K, Strella G. Brief Mindfulness Intervention for Emotional Distress, Resilience, and Compassion in Family Physicians During COVID-19: A Pilot Study. PRIMER (LEAWOOD, KAN.) 2022; 6:3. [PMID: 35481235 DOI: 10.22454/primer.2022.746202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Objective There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program. Methods A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures. Results Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P<.004), stress (P<.001), perceived resilience (P<.001), and compassion (P<.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21. Conclusion This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.
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Affiliation(s)
- Ruth Nutting
- University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine, Wichita, KS
| | - Samuel Ofei-Dodoo
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Katherine Rose-Borcherding
- University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine, Wichita, KS
| | - Grace Strella
- University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine, Wichita, KS
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22
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Spilg EG, Kuk H, Ananny L, McNeill K, LeBlanc V, Bauer BA, Sood A, Wells PS. The impact of Stress Management and Resilience Training (SMART) on academic physicians during the implementation of a new Health Information System: An exploratory randomized controlled trial. PLoS One 2022; 17:e0267240. [PMID: 35452478 PMCID: PMC9032401 DOI: 10.1371/journal.pone.0267240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The Stress Management and Resilience Training (SMART) program is an evidence-based intervention designed to build resilience in physicians in clinical practice. The objective of the current study was to assess the impact of the SMART program on academic physicians' levels of resilience, subjective happiness, stress, and anxiety, and specifically during the implementation of a new hospital-wide Health Information System (HIS). METHODS A total of 40 physicians in a tertiary care academic hospital were randomized (allocation ratio 1:1) to either the SMART intervention or the control condition. The SMART intervention consisted of one mandatory two-hour in-person workshop and an optional 24-week online program, designed to support the materials delivered in the workshop. Outcome measures were assessed using validated scales administered online at baseline and at 3-months and 6-months follow-up. RESULTS After adjusting for baseline levels of each outcome, no statistically significant intervention effect was observed for resilience, subjective happiness, stress or anxiety at 3-months or 6-months follow-up. However, physicians in the intervention group demonstrated improvements in resilience, stress and anxiety at follow-up that were within the range of clinically relevant differences. CONCLUSIONS The findings of this exploratory study provide modest support that the SMART intervention may be beneficial for proactively addressing physician wellness during the implementation of a new HIS and that larger randomized trials are warranted. TRIAL REGISTRATION NCT04384861.
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Affiliation(s)
- Edward G. Spilg
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hanna Kuk
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lesley Ananny
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Kylie McNeill
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vicki LeBlanc
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Brent A. Bauer
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Amit Sood
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Philip S. Wells
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Khouri M, Lassri D, Cohen N. Job burnout among Israeli healthcare workers during the first months of COVID-19 pandemic: The role of emotion regulation strategies and psychological distress. PLoS One 2022; 17:e0265659. [PMID: 35324961 PMCID: PMC8947073 DOI: 10.1371/journal.pone.0265659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/06/2022] [Indexed: 01/11/2023] Open
Abstract
The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13–28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.
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Affiliation(s)
- Marlyn Khouri
- Faculty of Education, University of Haifa, Haifa, Israel
| | - Dana Lassri
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel.,Research Department of Clinical, Educational and Health Psychology, UCL (University College London), London, United Kingdom
| | - Noga Cohen
- Faculty of Education, University of Haifa, Haifa, Israel.,Edmond J. Safra Brain Research Center, University of Haifa, Haifa, Israel
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Karadaş A, Duran S. The effect of social support on work stress in health workers during the pandemic: The mediation role of resilience. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1640-1649. [PMID: 34735718 PMCID: PMC8657313 DOI: 10.1002/jcop.22742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/25/2021] [Indexed: 05/07/2023]
Abstract
Stressful experiences commonly increase among health workers during the coronavirus disease 2019 (COVID-19) pandemic. From this perspective, this study primarily aimed to examine the mediating role of resilience in the effect of perceived social support on work stress among health workers. The sample of the study consisted of 402 health workers. In the research, the "General Work Stress Scale," "Brief Resiliency Scale," and "Multidimensional Scale of Perceived Social Support" were used. There was a statistically significant negative correlation between work stress and social support (r = -0.223, p = 0.00) and resilience (r = -0.432, p = 0.00), and a statistically significant positive correlation between social support and resilience (r = 0.226, p = 0.00). Resilience mediates the relationship between perception of social support and work stress. When planning effective intervention strategies, it will be critical to reduce the risk of adverse mental health outcomes in health workers, who are fighting against the COVID-19 pandemic, by increasing social support and resilience and reducing work stress.
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Affiliation(s)
- Ayşe Karadaş
- Department of Nursing Management, Faculty of Health SciencesBalikesir UniversityBalıkesirTurkey
| | - Songül Duran
- Department of Elderly, Care ProgramDemokrasi UniversityİzmirTurkey
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25
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Dennis D, van Heerden PV, Knott C, Khanna R. Mitigating emotional responses to stressors: coping strategies, modifiers and support. Australas Psychiatry 2022; 30:247-253. [PMID: 34839741 DOI: 10.1177/10398562211047211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The stressful nature of the intensive care unit (ICU) environment is increasingly well characterised. The aim of this paper was to explore modifiers, coping strategies and support pathways identified by experienced Intensivists, in response to these stressors. METHOD Prospective qualitative study employing interviews with Intensivists in two countries. Participants were asked how they mitigated their emotional responses to the stressors of the ICU. Audio-recordings were transcribed and analysed by all researchers who agreed upon emerging themes and subthemes. RESULTS A wide range of strategies were reported. Although several participants had sought professional help and all supported its utility, few disclosed accessing such help to others indicating stigma. Many felt a sense of responsibility for the well-being of other staff but identified barriers that suggest alternate support pathways are required. Further implications of these findings to training considerations are described. CONCLUSIONS Several approaches were described as regularly employed by Intensivists to mitigate ICU environmental stressors. Intensivists perceive themselves to have limited training to provide support to others; they also perceive stigma in seeking professional help.
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Affiliation(s)
- D Dennis
- Intensive Care Unit, Sir Charles Gairdner Hospital; Curtin University, Perth, Western Australia
| | - P V van Heerden
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - C Knott
- Department of Intensive Care, Bendigo Health, Bendigo, Victoria, Australia; Monash Rural Health Bendigo, Monash University, Victoria, Australia; Rural Clinical School, University of Melbourne, Victoria, Australia; Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
| | - R Khanna
- Phoenix Australia, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia & Division of Mental Health, Austin Health, Heidelberg, Victoria, Australia
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LaDonna KA, Cowley L, Touchie C, LeBlanc VR, Spilg EG. Wrestling With the Invincibility Myth: Exploring Physicians' Resistance to Wellness and Resilience-Building Interventions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:436-443. [PMID: 34380930 DOI: 10.1097/acm.0000000000004354] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Physicians are expected to provide compassionate, error-free care while navigating systemic challenges and organizational demands. Many are burning out. While organizations are scrambling to address the burnout crisis, physicians often resist interventions aimed at enhancing their wellness and building their resilience. The purpose of this research was to empirically study this phenomenon. METHOD Constructivist grounded theory was used to inform the iterative data collection and analysis process. In spring 2018, 22 faculty physicians working in Canada participated in semistructured interviews to discuss their experiences of wellness and burnout, their perceptions of wellness initiatives, and how their experiences and perceptions influence their uptake of the rapidly proliferating strategies aimed at nurturing their resilience. Themes were identified using constant comparative analysis. RESULTS Participants suggested that the values of compassion espoused by health care organizations do not extend to physicians, and they described feeling dehumanized by professional values steeped in an invincibility myth in which physicians are expected to be "superhuman" and "sacrifice everything" for medicine. Participants described that professional values and organizational norms impeded work-life balance, hindered personal and professional fulfillment, and discouraged disclosure of struggles. In turn, participants seemed to resist wellness and resilience-building interventions focused on fixing individuals rather than broader systemic, organizational, and professional issues. Participants perceived that efforts aimed at building individual resilience are futile without changes in professional values and sustained organizational support. CONCLUSIONS Findings suggest that professional and organizational norms and expectations trigger feelings of dehumanization for some physicians. These feelings likely exacerbate burnout and may partly explain physicians' resistance to resilience-building strategies. Mitigating burnout and developing and sustaining a resilient physician workforce will require both individual resistance to problematic professional values and an institutional commitment to creating a culture of compassion for patients and physicians alike.
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Affiliation(s)
- Kori A LaDonna
- K.A. LaDonna is assistant professor, Department of Innovation in Medical Education and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-4738-0146
| | - Lindsay Cowley
- L. Cowley is a research assistant, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Claire Touchie
- C. Touchie is professor, Department of Medicine, Faculty of Medicine, University of Ottawa, and chief medical education officer, Medical Council of Canada, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7926-9720
| | - Vicki R LeBlanc
- V.R. LeBlanc is professor and chair, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, and director, University of Ottawa Skills and Simulation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Edward G Spilg
- E.G. Spilg is assistant professor and research chair in physician wellness, Department of Medicine, Faculty of Medicine, University of Ottawa, and senior clinician investigator (Clinical Epidemiology), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0002-6012-1571
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27
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Kong KYC, Ganapathy S. Are We in Control of Our Demons?: Understanding Compassion Satisfaction, Compassion Fatigue and Burnout in an Asian Pediatric Emergency Department in a Pandemic. Pediatr Emerg Care 2022; 38:e1058-e1062. [PMID: 35226631 DOI: 10.1097/pec.0000000000002656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The medical profession, with its remarkable physical and emotional demands, predisposes physicians to compassion fatigue (CF) and burnout (BO). Although these conditions have been studied individually, little attention has been paid to how pediatric emergency physicians experience these conditions in the context of an Asian emergency setting especially during a global pandemic In our study, we aim to understand the experiences of individual physicians and describe the potential triggers or protective factors of compassion satisfaction, BO, and compassion satisfaction among physicians in an Asian pediatric emergency department during a pandemic. METHODS A qualitative, individual interview methodology was used. From March to April 2020, we enrolled 20 physicians involved in frontline care during the coronavirus disease 2019 (COVID-19) pandemic in the pediatric emergency department to participate. Semistructured interviews were conducted, audiotaped, and transcribed in verbatim, with identifiers removed. Themes were identified, and data were analyzed using qualitative data analysis and iterative data analysis. RESULTS We recruited 20 physicians. Three themes emerged from data analysis. First, we showed how workplace conditions are protective, including work morale, leadership and management, and social support received. Second, workload affected participants emotionally and in terms of its heavier quantity and longer hours. Finally, intrinsic factors that were protective in developing CF or BO include having professional autonomy, experience, work-life balance, and having emotional resilience to develop self-care. Cultural influences affect emotional regulation and can lead to negative coping with negative peer pressure. In general, participants quantified their levels of satisfaction at work as average to above average. However, they highlighted experiencing greater stress during COVID-19 with the underlying fear of contagion and infection. CONCLUSIONS Being a pediatric emergency physician puts one at greater risk of experiencing CF and BO because of work and nonwork stressors, especially during a global pandemic, influenced by sociocultural factors. A positive and supportive work environment should be created while providing culturally adapted strategies to improve individual physician resilience to maintain their well-being.
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Affiliation(s)
- Kar Yee Catrin Kong
- From the Department of Emergency Medicine, KK Women's and Children's Hospital
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28
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Ting C, Chan AY, Chan LG, Hildon ZJL. "Well, I Signed Up to Be a Soldier; I Have Been Trained and Equipped Well": Exploring Healthcare Workers' Experiences during COVID-19 Organizational Changes in Singapore, from the First Wave to the Path towards Endemicity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042477. [PMID: 35206660 PMCID: PMC8878310 DOI: 10.3390/ijerph19042477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022]
Abstract
(1) Background: As COVID-19 transmission continues despite vaccination programs, healthcare workers (HCWs) face an ongoing pandemic response. We explore the effects of this on (1) Heartware, by which we refer to morale and commitment of HCWs; and identify how to improve (2) Hardware, or ways of enabling operational safety and functioning. (2) Methods: Qualitative e-diary entries were shared by HCWs during the early phases of the outbreak in Singapore from June to August 2020. Data were collected via an online survey of n = 3616 HCWs of all cadres. Nine institutions—restructured hospitals (n = 5), affiliated primary partners (n = 2) and hospices (n = 2)—participated. Applied thematic analysis was undertaken and organized according to Heartware and Hardware. Major themes are in italics (3) Results: n = 663 (18%) HCWs submitted a qualitative entry. Dominant themes undermining (1) Heartware consisted of burnout from being overworked and emotional exhaustion and at times feeling a lack of appreciation or support at work. The most common themes overriding morale breakers were a stoic acceptance to fight, adjust and hold the line, coupled with motivation from engaging leadership and supportive colleagues. The biggest barrier in (2) Hardware analysis related to sub-optimal segregation strategies within wards and designing better protocols for case detection, triage, and admissions criteria. Overall, the most cited enabler was the timely and well-planned provision of Personal Protective Equipment (PPE) for front-liners, though scope for scale-up was called for by those not considered frontline. Analysis maps internal organizational functioning to wider external public and policy-related narratives. (4) Conclusions: COVID-19 surges are becoming endemic rather than exceptional events. System elasticity needs to build on known pillars coupling improving safety and care delivery with improving HCW morale. Accordingly, a model capturing such facets of Adaptive Pandemic Response derived from our data analyses is described. HCW burnout must be urgently addressed, and health systems moved away from reactive “wartime” response configurations.
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Affiliation(s)
- Celene Ting
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Level 09-03J, Singapore 117549, Singapore; (C.T.); (A.Y.C.)
| | - Alyssa Yenyi Chan
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Level 09-03J, Singapore 117549, Singapore; (C.T.); (A.Y.C.)
| | - Lai Gwen Chan
- Department of Psychiatry, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Zoe Jane-Lara Hildon
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Level 09-03J, Singapore 117549, Singapore; (C.T.); (A.Y.C.)
- National Centre for Infectious Diseases (NCID), Ministry of Health of Singapore, 16 Jln Tan Tock Seng, Singapore 308442, Singapore
- Correspondence:
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Affiliation(s)
- Ankit Mehta
- Ankit Mehta, MD, FHM, FACP, is a Hospitalist, HealthPartners, and Assistant Professor, Department of Internal Medicine, University of Minnesota
| | - David Fessell
- David Fessell, MD, is a Retired Professor of Radiology, and Faculty Associate, Ross School of Business, University of Michigan
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30
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Kiss A. [Physician Resilience]. PRAXIS 2022; 111:769. [PMID: 36285407 DOI: 10.1024/1661-8157/a003919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Chura S, Saintila J, Mamani R, Ruiz Mamani PG, Morales-García WC. Predictors of Depression in Nurses During COVID-19 Health Emergency; the Mediating Role of Resilience: A Cross-Sectional Study. J Prim Care Community Health 2022; 13:21501319221097075. [PMID: 35549758 PMCID: PMC9109278 DOI: 10.1177/21501319221097075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Nurses are susceptible to several mental problems, such as fear, stress, and depression due to the COVID-19 pandemic, which affects their emotional well-being. However, resilience plays an important role in mitigating the effects of COVID-19. OBJECTIVE This study was to examine the mediating role of resilience in the relation between fear, stress, and depression of nurses during COVID-19 health emergencies. METHODS A cross-sectional-predictive study was carried out. The variables analyzed were fear, resilience, stress, and depression. A total of 286 nurses from 2 hospitals in the cities of Juliaca and Puno, Peru. Data analyses were performed using structural equation modeling (SEM). RESULTS Analyses showed that the variables were significantly related (P < .01). In addition, a confirmatory analysis of the hypothesized model using structural equation modeling shows that fear and stress are predictors of depression, and that resilience plays a role in mediating the effect of fear on stress (X2 = 534.69, gl = 372, P = .000; TLI = .902, CFI = .910, RMSEA = .039 [95% CI = 0.032-0.046], and SRMR = .065). CONCLUSION Nurses tend to develop fear, stress, and depression. Resilience reduces the impact of these psychological variables. Hospital management should provide psychological support and training for nurses in coping strategies.
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Roslan NS, Yusoff MSB, Morgan K, Ab Razak A, Ahmad Shauki NI. What Are the Common Themes of Physician Resilience? A Meta-Synthesis of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:469. [PMID: 35010729 PMCID: PMC8744634 DOI: 10.3390/ijerph19010469] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 01/27/2023]
Abstract
In the practice of medicine, resilience has gained attention as on of the ways to address burnout. Qualitative studies have explored the concept of physician resilience in several contexts. However, individual qualitative studies have limited generalizability, making it difficult to understand the resilience concept in a wider context. This study aims to develop a concept of resilience in the context of physicians' experience through a meta-synthesis of relevant qualitative studies. Using a predetermined search strategy, we identified nine qualitative studies among 450 participants that reported themes of resilience in developed and developing countries, various specialties, and stages of training. We utilized the meta-ethnography method to generate themes and a line-of-argument synthesis. We identified six key themes of resilience: tenacity, resources, reflective ability, coping skills, control, and growth. The line-of-argument synthesis identified resilient physicians as individuals who are determined in their undertakings, have control in their professional lives, reflect on adversity, utilize adaptive coping strategies, and believe that adversity provides an opportunity for growth. Resilient physicians are supported by individual and organizational resources that include nurturing work culture, teamwork, and support from the medical community and at home. Our findings suggest that resilience in physicians is dynamic and must be supported not only by physician-directed interventions but also by organization-directed interventions.
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Affiliation(s)
- Nurhanis Syazni Roslan
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Muhamad Saiful Bahri Yusoff
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur 50490, Malaysia
- Department of Health Psychology, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Asrenee Ab Razak
- Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia and Hospital USM, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Nor Izzah Ahmad Shauki
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
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Takhdat K, Lamtali S, El Adib AR. The effects of mindfulness on health profession students' simulation training outcomes: An integrative review. NURSE EDUCATION TODAY 2021; 106:105082. [PMID: 34391989 DOI: 10.1016/j.nedt.2021.105082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/27/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED Health profession students (HPSs) continuously experience psychological issues which can exacerbate cognitive errors and harm emotional well-being. The Healthcare simulation environment is stressful and overwhelming in nature and may impair learning outcomes. Therefore, integrating psychological interventions into simulation-based learning (SBL) instructional design may alleviate students' psychological distress and improve their learning outcomes. OBJECTIVES to examine the effects of mindfulness on health professions students' SBL outcomes. DESIGN a literature review, based on Whittemore and Knafl's (2005) updated methodology was used in this study. DATA SOURCES We investigated PubMed, ERIC, ScienceDirect, and Google Scholar to find papers addressing the effects of mindfulness on health professions students' SBL outcomes. We targeted Results: This integrative review suggests that although mindfulness improves SBL outcomes, HPSs still struggle to transfer mindfulness benefits to real clinical practice. CONCLUSION research on mindfulness in healthcare SBL is in its infancy, thus, further research is needed to prove mindfulness effects on HPSs' SBL outcomes.
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Affiliation(s)
- Kamal Takhdat
- Cadi Ayyad University, Faculty of Sciences Semlalia, Marrakesh, Morocco; Higher Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco.
| | - Saloua Lamtali
- Cadi Ayyad University, Faculty of Sciences Semlalia, Marrakesh, Morocco; Higher Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco
| | - Ahmed Rhassane El Adib
- Marrakesh Simulation and Innovation in Health Sciences Center, Faculty of Medicine and Pharmacy of Marrakesh, Cadi Ayyad University, Marrakesh, Morocco
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Vercio C, Loo LK, Green M, Kim DI, Beck Dallaghan GL. Shifting Focus from Burnout and Wellness toward Individual and Organizational Resilience. TEACHING AND LEARNING IN MEDICINE 2021; 33:568-576. [PMID: 33588654 DOI: 10.1080/10401334.2021.1879651] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Burnout is reported to be epidemic among physicians and medical trainees, and wellness has been the predominant target for intervention in academic medicine over the past several years. However, both burnout and wellness suffer from a lack of standardized definition, often making interventions difficult to generalize and extrapolate to different sites. Although well-meaning, current frameworks surrounding wellness and burnout have limitations in fully addressing the challenges of improving physician mental health. Wellness as a framework does not inherently acknowledge the adversity inevitably experienced in the practice of medicine and in the lives of medical trainees. During a crisis such as the current pandemic, wellness curricula often do not offer adequate frameworks to address the personal, organizational, or societal crises that may ensue. This leaves academic institutions and their leadership ill-equipped to appropriately address the factors that contribute to burnout. More recently, resilience has been explored as another framework to positively influence physician wellness and burnout. Resilience acknowledges the inevitable adversity individuals encounter in their life and work, allowing for a more open discussion on the tensions and flexibility between facets of life. However, emphasizing personal resiliency without addressing organizational resiliency may leave physicians feeling alienated or marginalized from critical support and resources that organizations can and should provide. Despite intense focus on wellness and burnout, there have not been significant positive changes in physicians' mental health. Many interventions have aimed at the individual level with mindfulness or other reflective exercises; unfortunately these have demonstrated only marginal benefit. Systems level approaches have demonstrated more benefit but the ability of organizations to carry out any specific intervention is likely to be limited by their own unique constraints and may limit the spread of innovation. We believe the current use of these conceptual lenses (wellness and burnout) has been clouded by lack of uniformity of definitions, an array of measurement tools with no agreed-upon standard, a lack of understanding of the complex interaction between the constructs involved, and an over-emphasis on personal rather than organizational interventions and solutions. If the frameworks of burnout and wellness are limited, and personal resilience by itself is inadequate, what framework would be helpful? We believe that focusing on organizational resilience and the connecting dimensions between organizations and their physicians could be an additional framework helpful in addressing physician mental health. An organization connects with its members along multiple dimensions, including communication, recognition of gifts, shared vision, and sense of belonging. By finding ways to positively affect these dimensions, organizations can create change in the culture and mental health of physicians and trainees. Educational institutions specifically would be well-served to consider organizational resilience and its relationship to individuals.
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Affiliation(s)
- Chad Vercio
- Pediatrics, Loma Linda University, Loma Linda, California, USA
| | - Lawrence K Loo
- Internal Medicine, Loma Linda University, Loma Linda, California, USA
| | - Morgan Green
- Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Daniel I Kim
- Internal Medicine, Loma Linda University, Loma Linda, California, USA
- Internal Medicine, Riverside University Health System, Moreno Valley, California, USA
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Ju G, Lee J, Ahn MH, Lee J, Kim EJ, Suh S, Chung S. Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic. J Korean Med Sci 2021; 36:e262. [PMID: 34519189 PMCID: PMC8438183 DOI: 10.3346/jkms.2021.36.e262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/06/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This study explored the clinical variables related to public workers' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic. METHODS A total of 938 public workers answered anonymous questionnaires in May 2020. The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields. RESULTS Married, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic. CONCLUSION It is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.
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Affiliation(s)
- Gawon Ju
- Department of Psychiatry, Chungbuk National University Hospital, Cheongju, Korea
- Chungcheongbuk-do Provincial Mental Health Center, Cheongju, Korea
| | - Jeonghwan Lee
- Department of Psychiatry, Chungbuk National University Hospital, Cheongju, Korea
| | - Myung Hee Ahn
- Division of Psychiatry, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Joohee Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jeong Kim
- Chungcheongbuk-do Provincial Mental Health Center, Cheongju, Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Resilience, Psychological Well-Being and Daily Functioning Following Hospitalization for Respiratory Distress Due to SARS-CoV-2 Infection. Healthcare (Basel) 2021; 9:healthcare9091161. [PMID: 34574935 PMCID: PMC8471260 DOI: 10.3390/healthcare9091161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
The ongoing COVID-19 pandemic has affected people's psychological well-being, and hospitalized patients could face an even greater risk of psychological distress. We aimed to study resilience in recovered COVID-19 patients after hospital discharge. We recruited 50 patients (38 males, aged 28-77) who were hospitalized for COVID-19 between March and April 2020. Participants underwent a psychological assessment 5 months after hospital discharge. We administered the Connor-Davidson Resilience Scale (CD-RISC-25), Beck's Depression inventory-II (BDI-II), and the State-Trait Anxiety Inventory Y-form (STAI). We also evaluated the impact of persisting physical, behavioral, and cognitive symptoms on resilience. Patients reported low resilience in the months following hospital discharge (CD-RISC-25 score [mean ± SD] = 55.82 ± 20.76), compared to data from studies on the general population. Lower resilience was associated with mood disturbances in the months following clinical recovery (p = 0.005), persisting fatigue (p = 0.015), sleep changes (p = 0.046), and subjective cognitive complaints (p < 0.05). Recovered COVID-19 patients exhibit low resilience following hospital discharge, which affects psychological well-being. The presence of persisting symptoms following hospital discharge affects psychological resilience. Interventions tailored to increase resilience should be considered to improve quality of life for recovered COVID-19 patients.
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Hirten RP, Danieletto M, Tomalin L, Choi KH, Zweig M, Golden E, Kaur S, Helmus D, Biello A, Pyzik R, Calcogna C, Freeman R, Sands BE, Charney D, Bottinger EP, Murrough JW, Keefer L, Suarez-Farinas M, Nadkarni GN, Fayad ZA. Factors Associated with Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data. J Med Internet Res 2021; 23:e31295. [PMID: 34379602 PMCID: PMC8439178 DOI: 10.2196/31295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/19/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. Objective This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. Methods HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. Results A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. Conclusions High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic.
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Affiliation(s)
- Robert P Hirten
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | | | - Lewis Tomalin
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | | | - Micol Zweig
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | - Eddye Golden
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | - Sparshdeep Kaur
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | - Drew Helmus
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | - Anthony Biello
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | - Renata Pyzik
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | | | - Robert Freeman
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | - Bruce E Sands
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | - Dennis Charney
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | | | | | - Laurie Keefer
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
| | | | | | - Zahi A Fayad
- Icahn School of Medicine, 1 Gustave L Levy Place, New York, US
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Klein CJ, Weinzimmer LG, Dalstrom M, Lizer S, Cooling M, Pierce L. Investigating practice-level and individual factors of advanced practice registered nurses and physician assistants and their relationship to resilience. J Am Assoc Nurse Pract 2021; 34:310-321. [PMID: 34334766 DOI: 10.1097/jxx.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience. PURPOSE The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience. METHODOLOGY An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables. SAMPLE A sample of 1,138 APRNs and PAs completed the survey questions. RESULTS Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p < .01 level, with the adjusted R2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p < .01). A negative association between the lack of autonomy and higher levels of resilience (b = -0.14, p < .01) was also demonstrated. CONCLUSIONS Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience. IMPLICATIONS FOR PRACTICE Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience.
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Affiliation(s)
- Colleen J Klein
- OSF HealthCare, Center for Advanced Practice, Peoria, Illinois
| | - Laurence G Weinzimmer
- Caterpillar, Inc. Endowed Professor of Management, Foster College of Business, Bradley University, Peoria, Illinois
| | | | - Shannon Lizer
- OSF HealthCare, Center for Advanced Practice, Peoria, Illinois
- Caterpillar, Inc. Endowed Professor of Management, Foster College of Business, Bradley University, Peoria, Illinois
- Saint Anthony College of Nursing, Rockford, Illinois
| | - Melinda Cooling
- OSF HealthCare, Center for Advanced Practice, Peoria, Illinois
| | - Lisa Pierce
- OSF HealthCare, Center for Advanced Practice, Peoria, Illinois
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Psychosocial Impact and Role of Resilience on Healthcare Workers during COVID-19 Pandemic. SUSTAINABILITY 2021. [DOI: 10.3390/su13137096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Italy was the first European country to be affected by the 2019 coronavirus epidemic (COVID-19). Several studies have shown the risk of developing depression, anxiety, and post-traumatic stress disorder in medical and paramedical staff. Causes included the high contagiousness of the virus, the fear of contracting it, the lack of adequate personal protective equipment, and physical and psychological fatigue. In this context, resilience represents a protective factor against adversity and stress burden. The aim of this research was to investigate if and how the resilience and personality profile is able to influence the response to stress and anxiety on a sample of Italian healthcare workers, during the COVID-19 outbreak. The sample consisted of 152 frontline healthcare workers, physicians, and paramedical professionals. Participants completed the online questionnaire measuring the Resilience Scale for Adults, the Big Five Inventory-10 Item, the State Anxiety Inventory, and the Perceived Stress Scale. Analyses of data aimed to show differences in the stress of healthcare workers due to gender and professional role, and at finding, by means of multidimensional scaling, the relations among anxiety, stress, resilience, and traits of personality. The findings gave some suggestions for implementing strategies useful to increase the resilience in healthcare workers and support them to cope with stressful events, typical of the pandemic emergency.
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Angelopoulou P, Panagopoulou E. Resilience interventions in physicians: A systematic review and meta-analysis. Appl Psychol Health Well Being 2021; 14:3-25. [PMID: 34019330 DOI: 10.1111/aphw.12287] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/29/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
The aim of this review was to evaluate the effectiveness of interventions in promoting resilience among physicians. Previous reviews concerning resilience did not assess effectiveness in a systematic way using meta-analytic methods. PubMed, PsycINFO, and Cochrane Register of Controlled Trials were searched from inception to January 31, 2020. Randomized clinical trials, non-randomized clinical trials, and repeated-measures studies of intervention designs targeting at resilience in physicians were included. Eleven studies were included in the review (n = 580 physicians). Research findings suggest that interventions for resilience in physicians were associated with small but significant benefits. Subgroup analyses suggested small but significantly improved effects for emotional-supportive-coping interventions (Hedges's g = 0.242; 95% CI, 0.082-0.402, p = .003) compared with mindfulness-meditation-relaxation interventions (Hedges's g = 0.208; 95% CI, 0.131-0.285, p = .000). Interventions that were delivered for more than a week indicated higher effect (Hedges's g = 0.262; 95% CI, 0.169-0.355, p = .000) compared with interventions delivered for up to a week (Hedges's g = 0.172; 95% CI, -0.010 to 0.355, p = .064). Results were not influenced by the risk of bias ratings. Findings suggest that physicians can benefit in their personal levels of resilience from attending an intervention specifically designed for that reason for more than a week. Moreover, policy-makers should view current results as a significant source of redesigning healthcare systems and promoting attendance of resilience interventions by physicians. Future research should address the need for more higher-quality studies and improved study designs.
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Affiliation(s)
| | - Efharis Panagopoulou
- Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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The Role of Burnout in the Association between Work-Related Factors and Perceived Errors in Clinical Practice among Spanish Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094931. [PMID: 34066327 PMCID: PMC8124853 DOI: 10.3390/ijerph18094931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to evaluate the prevalence of burnout syndrome in a sample of residents from different specialties, to determine the influence of work-related factors on the development of burnout, and to examine the mediating role of burnout in the relation between such work factors and perceived errors in clinical practice. A total of 237 Spanish residents participated (Mage = 28.87, SD = 3.84; 73.8% females). The Maslach Burnout Inventory and an ad hoc questionnaire were administered to assess burnout and work-related factors. Comparison analyses and mediational models were conducted. Half of the residents reported high levels of burnout (48.9%). Burnout was significantly associated with perceived errors in clinical practice. Significant differences were found between residents with lower and higher burnout levels, showing that those with higher burnout were less satisfied with the working conditions. Burnout mediated the associations between adjustment of responsibility, support among residents, satisfaction with teaching and rotations, general satisfaction, and perceived errors in the clinical practice. Adjusted levels of responsibility and workload, enhanced supervision, and more social support from colleagues predict lower levels of burnout, which may result in fewer errors in clinical practice. Consequently, such work-related factors should be taken into account as a preventive strategy for burnout and errors in the clinical practice so adequate patient care, good mental health of future specialists, and, therefore, higher quality of public health care can be ensured.
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Corgan S, Ford Winkel A, Sugarman R, Young JQ. From Burnout to Wholehearted Engagement: A Qualitative Exploration of Psychiatry Residents' Experience of Stress. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:709-717. [PMID: 33410608 DOI: 10.1097/acm.0000000000003912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Physician burnout is endemic across medical education and has numerous deleterious effects. Given the prevalence and negative effects of burnout, there is an urgent need to understand how residents experience and cope with stress and develop explanatory models that inform the development of more effective interventions. METHOD Using a qualitative, constructivist approach informed by grounded theory, the authors conducted semistructured interviews from March to April 2019, in which psychiatry residents were asked about their experiences of stress and how they coped. First- through fourth-year trainees at Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, were invited. Two authors independently and inductively coded deidentified transcripts. A constant comparative approach was used to analyze data and support construction of themes. Theoretic sufficiency was observed after 14 interviews. RESULTS The authors constructed an explanatory model for how residents cope with stress and whether they tended toward burnout or wholehearted engagement. The model included 3 themes: self-care, work relationships, and meaning making. Self-care, including time spent with others, provided connection and belonging that bolstered physicians' developing identities. Interpersonal relationships at work profoundly influenced the experience of residents. Positive peer and supervisor relationships enhanced confidence and perseverance. Negative role models and conflict engendered feelings of inadequacy. The ability to shift perspective and build meaning through examining moral values in the face of challenges was crucial for residents who reported success at coping with stress. Residents identified personal psychotherapy as an especially important strategy to facilitate meaning making. CONCLUSIONS These findings provide guidance for how residency programs may help residents cope with stress and move away from burnout toward wholehearted engagement. Strategies may include reducing barriers to self-care and to accessing help early in training, creating spaces that promote peer connection and providing training in addressing conflict, and facilitating engagement in meaning-making activities.
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Affiliation(s)
- Sondra Corgan
- S. Corgan is a fellow in child and adolescent psychiatry, Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Abigail Ford Winkel
- A. Ford Winkel is associate professor and vice chair for education, Department of Obstetrics and Gynecology, and assistant director, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Rebekah Sugarman
- R. Sugarman is a medical student, University of Michigan Medical School, Ann Arbor, Michigan
| | - John Q Young
- J.Q. Young is professor and vice chair for education, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York; ORCID: http://orcid.org/0000-0003-2219-5657
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Perret JL, Best CO, Coe JB, Greer AL, Khosa DK, Jones-Bitton A. Association of demographic, career, and lifestyle factors with resilience and association of resilience with mental health outcomes in veterinarians in Canada. J Am Vet Med Assoc 2021; 257:1057-1068. [PMID: 33135980 DOI: 10.2460/javma.2020.257.10.1057] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the association of demographic, career, and lifestyle factors with resilience and the association of resilience with mental health outcomes in Canadian veterinarians. SAMPLE 1,130 veterinarians in clinical practice across Canada. PROCEDURES An online questionnaire was used to collect participant data and included 5 validated psychometric scales to evaluate resilience (through the Connor-Davidson Resilience Scale [CD-RISC]), perceived stress (through the Perceived Stress Scale), emotional distress (through the Hospital Anxiety and Depression Scale), burnout (through the Maslach Burnout Inventory), and secondary traumatic stress (through the Professional Quality of Life Scale). A multivariable linear regression model was used to investigate associations between CD-RISC scores and demographic, career, and lifestyle characteristics. Univariable linear regression models were used to assess the relationship between resilience scores and other mental health outcomes. RESULTS The strongest positive association was between CD-RISC score and overall health. The level of satisfaction with support from friends and workplace resources had positive associations with the CD-RISC score. The presence of mental illness had the strongest negative association with the CD-RISC score. Being married, working in a small animal practice, or having an associate role were negatively associated with the CD-RISC score. The CD-RISC score had negative associations with scores for perceived stress, anxiety, depression, burnout, and secondary traumatic stress. CONCLUSIONS AND CLINICAL RELEVANCE Models provided evidence for the role of resilience in protecting against negative mental health outcomes in veterinarians. Both personal and workplace factors were associated with resilience, presenting opportunities for intervention at each of these levels.
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Hong Y, Lee J, Lee HJ, Kim K, Cho IK, Ahn MH, Shin YW, Park J, Chung S. Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era. Psychiatry Investig 2021; 18:357-363. [PMID: 33951781 PMCID: PMC8103016 DOI: 10.30773/pi.2021.0019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/14/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We aimed to investigate the effect of nursing professionals' resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. METHODS We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. RESULTS Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31-1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03-1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85-0.97) were expecting variables for the depression of healthcare workers. CONCLUSION Nursing professionals' level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.
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Affiliation(s)
- Youjin Hong
- Department of Psychiatry, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jukab Lee
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyuk Joo Lee
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kyumin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Inn-Kyu Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung Hee Ahn
- Division of Psychiatry, Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Wook Shin
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jangho Park
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Elliott M, Macedo A, Escaf M. Building Resilience within Institutions Together with Employees (BRITE): Preliminary experience with implementation in an academic cancer centre. Healthc Manage Forum 2021; 34:107-114. [PMID: 33478263 DOI: 10.1177/0840470420981595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Resilience is defined as the capacity to bounce back and respond to pressure, unpredictability, or adversity in an adaptive and effective manner that leads to learning and positive outcomes. BRITE, Building Resilience within Institutions Together with Employees, the focus of this article, is a program designed to equip healthcare workers with skills to foster their resilience as they work; herein, we describe the context, development, and preliminary implementation results.
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Affiliation(s)
- Mary Elliott
- Princess Margaret Cancer Centre, 7989University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Alyssa Macedo
- Princess Margaret Cancer Centre, 7989University Health Network, Toronto, Ontario, Canada
| | - Marnie Escaf
- Princess Margaret Cancer Centre, 7989University Health Network, Toronto, Ontario, Canada
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O'Connor P, Lydon S, O'Dowd E, Byrne D. The relationship between psychological resilience and burnout in Irish doctors. Ir J Med Sci 2020; 190:1219-1224. [PMID: 33118091 DOI: 10.1007/s11845-020-02424-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND There has been a considerable amount of research focused upon assessing doctor burnout. However, psychological resilience (PR) has been examined far less frequently. AIMS To examine the relationship between PR and burnout in Irish doctors in order to identify how PR can be improved-with a particular focus on how doctors can be empowered to strengthen their PR. METHOD The ResMed PR survey and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) were distributed to doctors from an Irish teaching hospital. RESULTS A total of 322 completed online and paper surveys were received. Response rate for the paper surveys was 42.0% (168/400). Depersonalisation and personal accomplishment were significant predicators of job gratification (taking satisfaction from the job of a physician). Emotional exhaustion and personal accomplishment were significant predicators of protective attitudes (attitudes that promote or sustain PR; e.g. not taking things personally). Being a man was more positively related to protective attitudes than being a woman. Emotional exhaustion and personal accomplishment were significant predicators of protective practices (approaches to building/maintaining resilience; e.g. good time management). CONCLUSIONS The research reported in this paper provides insights in to how healthcare leaders could empower frontline doctors to change how they work in order to allow them to improve their psychological resilience and help them to thrive, rather than just survive.
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Affiliation(s)
- Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, 1 Distillery Rd, Galway, Co., Galway, Ireland. .,Irish Centre for Applied Patient Safety and Simulation, University Road, Galway, Ireland.
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, University Road, Galway, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Emily O'Dowd
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, 1 Distillery Rd, Galway, Co., Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, University Road, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, University Road, Galway, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, Ireland
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Liu JJW, Ein N, Gervasio J, Battaion M, Reed M, Vickers K. Comprehensive meta-analysis of resilience interventions. Clin Psychol Rev 2020; 82:101919. [PMID: 33045528 DOI: 10.1016/j.cpr.2020.101919] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND/RATIONALE There is no current consensus on operational definitions of resilience. Instead, researchers often debate the optimal approach to understanding resilience, while continuing to explore ways to enhance and/or promote its qualities in various populations. The goal of the current meta-analysis is to substantiate existing evidence examining the promotion of resilience through various interventions. Particular emphasis was placed upon the factors that contribute to variability across interventions, such as age, gender, duration of intervention, intervention approaches and risk exposure of targeted population. METHOD The literature search was conducted on May 28, 2019. Search terms included "resilience intervention" OR "promoting resilience" OR "promoting resiliency" OR "resilience-based intervention". A total of 268 studies, with 1584 independent samples, were included in the meta-analysis. In addition to overall efficacy, outcome-based analyses were conducted for intervention outcomes based on action, biophysical, coping, emotion, resilience, symptoms, and well-being. Finally, moderators of age, gender, length of intervention, intervention approach, intervention target, and the level of risk exposure of the sampled population were examined as moderators. RESULTS The multi-level meta-analysis indicated that resilience-promoting interventions yielded a small, but statistically significant overall effect, Hedges's g = 0.48 (SE = 0.04, 95% CI = [0.40, 0.56]. The variability in study effect sizes within and between studies was significant, p < .001, with many falling short of the threshold for practical significance. DISCUSSION Findings lend some support for the overall efficacy of resilience interventions. However, empirical results should be cautiously interpreted in tandem with their theoretical relevance and potential advancements to the construct of resilience. Variabilities across findings reflect the current ambiguities surrounding the conceptualization and operationalization of resilience. Directions for future research on resilience as well as practical considerations are discussed.
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Affiliation(s)
- Jenny J W Liu
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Natalie Ein
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Julia Gervasio
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Mira Battaion
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Maureen Reed
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Kristin Vickers
- Department of Psychology, Ryerson University, Toronto, Canada.
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Conversano C, Ciacchini R, Orrù G, Di Giuseppe M, Gemignani A, Poli A. Mindfulness, Compassion, and Self-Compassion Among Health Care Professionals: What's New? A Systematic Review. Front Psychol 2020; 11:1683. [PMID: 32849021 PMCID: PMC7412718 DOI: 10.3389/fpsyg.2020.01683] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
Health care professionals (HCPs) are a population at risk for high levels of burnout and compassion fatigue. The aim of the present systematic review was to give an overview on recent literature about mindfulness and compassion characteristics of HCPs, while exploring the effectiveness of techniques, involving the two aspects, such as MBSR or mindfulness intervention and compassion fatigue-related programs. A search of databases, including PubMed and PsycINFO, was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and the methodological quality for this systematic review was appraised using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews-2). The number of articles that met the inclusion criteria was 58 (4 RCTs, 24 studies with pre-post measurements, 12 cross-sectional studies, 11 cohort studies and 7 qualitative studies). MBSR intervention was effective at improving, and maintaining, mindfulness and self-compassion levels and to improve burnout, depression, anxiety, stress. The most frequently employed interventional strategies were mindfulness-related trainings that were effective at improving mindfulness and self-compassion, but not compassion fatigue, levels. Compassion-related interventions have been shown to improve self-compassion, mindfulness and interpersonal conflict levels. Mindfulness was effective at improving negative affect and compassion fatigue, while compassion satisfaction may be related to cultivation of positive affect. This systematic review summarized the evidence regarding mindfulness- and compassion-related qualities of HCPs as well as potential effects of MBSR, mindfulness-related and compassion-related interventions on professionals' psychological variables like mindfulness, self-compassion and quality of life. Combining structured mindfulness and compassion cultivation trainings may enhance the effects of interventions, limit the variability of intervention protocols and improve data comparability of future research.
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Kunzler AM, Helmreich I, Chmitorz A, König J, Binder H, Wessa M, Lieb K. Psychological interventions to foster resilience in healthcare professionals. Cochrane Database Syst Rev 2020; 7:CD012527. [PMID: 32627860 PMCID: PMC8121081 DOI: 10.1002/14651858.cd012527.pub2] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes. OBJECTIVES To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists). SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results. SELECTION CRITERIA Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only). MAIN RESULTS We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence). AUTHORS' CONCLUSIONS For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.
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Affiliation(s)
| | | | - Andrea Chmitorz
- Faculty of Social Work, Health Care and Nursing, Esslingen University of Applied Sciences, Esslingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Harald Binder
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Michèle Wessa
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Clinical Psychology and Neuropsychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Klaus Lieb
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Heath C, Sommerfield A, von Ungern-Sternberg BS. Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review. Anaesthesia 2020; 75:1364-1371. [PMID: 32534465 PMCID: PMC7323405 DOI: 10.1111/anae.15180] [Citation(s) in RCA: 245] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. The longevity of the crisis and disruption to normality is unknown. With COVID-19 set to be a chronic health crisis, clinicians will be required to maintain a state of high alert for an extended period. The support received before and during an incident is likely to influence whether clinicians experience psychological growth or injury. An abundance of information is emerging on disease epidemiology, pathogenesis and infection control prevention. However, literature on interventions for supporting the psychological well-being of healthcare workers during disease outbreaks is limited. This article summarises the available management strategies to increase resilience in healthcare workers during the COVID-19 pandemic and beyond. It focuses on self-care and organisational justice. It highlights various individual as well as organisational strategies. With the success of slowing disease spread in many countries to date, and reduced work-load due to limitations on elective surgery in many institutions, there is more time and opportunity to be pro-active in implementing measures to mitigate or minimise potential adverse psychological effects and improve, restore and preserve the well-being of the workforce now and for years to come. The purpose of this review is to review available literature on strategies for minimising the psychological impact of the COVID-19 pandemic on clinicians and to identify pro-active holistic approaches which may be beneficial for healthcare workers both for the current crisis and into the future.
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Affiliation(s)
- C Heath
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Department of Peri-operative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - B S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
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