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Billiau L, Bolliger L, Clays E, Eeckloo K, Ketels M. Flemish critical care nurses' experiences regarding the influence of work-related demands on their health: a descriptive interpretive qualitative study. BMC Nurs 2024; 23:387. [PMID: 38844928 PMCID: PMC11155134 DOI: 10.1186/s12912-024-02032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 05/21/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Critical care nurses (CCNs) around the globe face other health challenges compared to their peers in general hospital nursing. Moreover, the nursing workforce grapples with persistent staffing shortages. In light of these circumstances, developing a sustainable work environment is imperative to retain the current nursing workforce. Consequently, this study aimed to gain insight into the recalled experiences of CCNs in dealing with the physical and psychosocial influences of work-related demands on their health while examining the environments in which they operate. The second aim was to explore the complex social and psychological processes through which CCNs navigate these work-related demands across various CCN wards. METHODS A qualitative study following Thorne's interpretive descriptive approach was conducted. From October 2022 to April 2023, six focus groups were organised. Data from a diverse sample of 27 Flemish CCNs engaged in physically demanding roles from three CCN wards were collected. The Qualitative Analysis Guide of Leuven was applied to support the constant comparison process. RESULTS Participants reported being exposed to occupational physical activity, emotional, quantitative, and cognitive work-related demands, adverse patient behaviour, and poor working time quality. Exposure to these work-related demands was perceived as harmful, potentially resulting in physical, mental, and psychosomatic strain, as well as an increased turnover intention. In response to these demands, participants employed various strategies for mitigation, including seeking social support, exerting control over their work, utilising appropriate equipment, recognising rewards, and engaging in leisure-time physical activity. CONCLUSIONS CCNs' health is challenged by work-related demands that are not entirely covered by the traditional quantitative frameworks used in research on psychologically healthy work. Therefore, future studies should focus on improving such frameworks by exploring the role of psychosocial and organisational factors in more detail. This study has important implications for workplace health promotion with a view on preventing work absenteeism and drop-out in the long run, as it offers strong arguments to promote sufficient risk management strategies, schedule flexibility, uninterrupted off-job recovery time, and positive management, which can prolong the well-being and sustainable careers of the CCN workforce.
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Affiliation(s)
- Lukas Billiau
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000, Belgium.
| | - Larissa Bolliger
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium
| | - Els Clays
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium
| | - Margo Ketels
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium
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Azoulay É, Kentish-Barnes N, Boulanger C, Mistraletti G, van Mol M, Heras-La Calle G, Estenssoro E, van Heerden PV, Delgado MCM, Perner A, Arabi YM, Myatra SN, Laake JH, De Waele JJ, Darmon M, Cecconi M. Family centeredness of care: a cross-sectional study in intensive care units part of the European society of intensive care medicine. Ann Intensive Care 2024; 14:77. [PMID: 38771395 PMCID: PMC11109056 DOI: 10.1186/s13613-024-01307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/05/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE To identify key components and variations in family-centered care practices. METHODS A cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making. The primary outcome, self-rated family-centeredness, was assessed using a visual analog scale. Additionally, respondents completed the Maslach Burnout Inventory and the Ethical Decision Making Climate Questionnaire to capture burnout dimensions and assess the ethical decision-making climate. RESULTS The response rate was 53% (respondents from 359/683 invited ICUs who actually open the email); participating healthcare professionals (HCPs) were from Europe (62%), Asia (9%), South America (6%), North America (5%), Middle East (4%), and Australia/New Zealand (4%). The importance of family-centeredness was ranked high, median 7 (IQR 6-8) of 10 on VAS. Significant differences were observed across quartiles of family centeredness, including in visitation policies availability of a waiting rooms, family rooms, family information leaflet, visiting hours, night visits, sleep in the ICU, and in team-family interactions, including daily information, routine day-3 conference, and willingness to empower nurses and relatives. Higher family centeredness correlated with family involvement in rounds, participation in patient care and end-of-life practices. Burnout symptoms (41% of respondents) were negatively associated with family-centeredness. Ethical climate and willingness to empower nurses were independent predictors of family centeredness. CONCLUSIONS This study emphasizes the need to prioritize healthcare providers' mental health for enhanced family-centered care. Further research is warranted to assess the impact of improving the ethical climate on family-centeredness.
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Affiliation(s)
- Élie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France.
| | - Nancy Kentish-Barnes
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France
| | - Carole Boulanger
- Royal Devon University NHS Foundation Trust, Barrack Road, Exeter, UK
| | - Giovanni Mistraletti
- Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti. A.S.S.T. Ovest Milanese, Università degli Studi di Milano, Ospedale Civile di Legnano, Legnano, MI, Italy
| | | | - Gabriel Heras-La Calle
- International Research Project for the Humanisation of Intensive Care Units, Proyecto HU-CI, Madrid, Spain
- Humanizing Healthcare Foundation. Intensive Care Unit, Hospital Universitario de Jaén, Jaén, Spain
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos General San Martín, La Plata, Buenos Aires, Argentina
| | - Peter Vernon van Heerden
- Department of Anesthesiology, Critical Care and Pain medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maria-Cruz Martin Delgado
- Department Intensive Care Medicine Hospital 12 de Octubre, Madrid, Spain
- Research Institute "Hospital 12 de Octubre (imas12)", Universidad Complutense de Madrid, Madrid, Spain
| | - Anders Perner
- Department of Intensive Care, Department of Clinical Medicine, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Yaseen M Arabi
- Intensive Care Department, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Ministry of National Guard Health - Affairs, and College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Mumbai, India
| | - Jon Henrik Laake
- Department of Anaesthesiology and Intensive Care Medicine, Division of Critical Care and Emergencies, Rikshopitalet Medical Centre, Oslo University Hospital, Oslo, Norway
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Gent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Michael Darmon
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Levi Montalcini, Pieve Emanuele, MI, Italy
- 2IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
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Yslado Mendez RM, Sanchez-Broncano J, Mendoza Ramirez GD, Villarreal-Zegarra D. Prevalence and factors associated with burnout syndrome in Peruvian health professionals before the COVID-19 pandemic: A systematic review. Heliyon 2024; 10:e30125. [PMID: 38726126 PMCID: PMC11078627 DOI: 10.1016/j.heliyon.2024.e30125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Burnout syndrome (BS) is a prevalent occupational health problem in health professionals. To describe the prevalence and factors associated with BS in Peruvian health professionals. Method A systematic review and meta-analysis were performed. The key terms "burnout" and "professional exhaustion" were used with words related to Peru. The databases consulted were LILACS/Virtual Health Library, Medline/PubMed, Science Direct, EBSCO, Scopus, SciELO, and RENATI-SUNEDU; articles published between January 2000 to December 2020 were considered for inclusion. Methodological quality was evaluated using the Newcastle-Ottawa scale. Results Thirty studies were identified (8 scientific articles and 22 graduate theses). The median sample size was 78, with an interquartile range of 50-110. A meta-analysis was performed to calculate a dichotomic prevalence of burnout syndrome in health professionals of 25 % (95%CI: 9 %-45 %; I2 = 97.14 %; 5 studies). Also, our meta-analysis estimated the overall prevalence of mild burnout (27 %; 95%CI: 16%-41 %; I2 = 96.50 %), moderate burnout (48 %; 95%CI: 32%-65 %; I2 = 97.54 %), and severe burnout (17 %; 95%CI: 10%-24 %; I2 = 92.13 %; 18 studies). We present meta-analyses by region, profession, hospital area, and by dimension of the Maslach Burnout Inventory. Overall, the studies presented adequate levels of quality in 96.7 % of the included studies (n = 29). In addition, our narrative review of factors associated with BS and its three dimensions identified that different studies find associations with labor, socio-demographic, individual, and out-of-work factors. Conclusions There is a higher prevalence of moderate BS in Peruvian health professionals at MINSA and EsSalud hospitals in Peru, with severity differing by region of Peru, type of profession, work area, and dimensions of BS.
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Kramuschke M, Renner A, Kersting A. [Burnout : Symptoms, diagnostics and treatment approaches]. DER NERVENARZT 2024; 95:484-493. [PMID: 38625570 DOI: 10.1007/s00115-024-01649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
Burnout syndrome is characterized by the triad of symptoms exhaustion, mental distance from work activities and a feeling of ineffectiveness. The syndrome is not an independent mental disorder but can be coded in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a problem related to difficulties in coping with life (Z73) and in ICD-11 as a qualifying diagnosis (QD85). This article discusses the prevalence and comorbidities of burnout syndrome, taking the methodological difficulties in conceptualizing and operationalizing the construct into account. In addition, it provides an overview of available measurement instruments and their validation. Furthermore, it discusses work-related and individual factors in the development of burnout syndrome as well as analysis of the effectiveness of treatment options.
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Affiliation(s)
- M Kramuschke
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Renner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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Rodriguez-Ruiz E, van Mol MMC, Latour JM, Fuest K. Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety. Med Intensiva 2024:S2173-5727(24)00061-4. [PMID: 38594110 DOI: 10.1016/j.medine.2024.03.008] [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: 12/15/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.
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Affiliation(s)
- Emilio Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Joseph Maria Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK; Curtin School of Nursing, Curtin University, Perth, Australia; Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kristina Fuest
- Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ismaninger Str. 22, 81675 Munich, Germany
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Azoulay E, Pochard F, Argaud L, Cariou A, Clere-Jehl R, Guisset O, Labbé V, Tamion F, Bruneel F, Jourdain M, Reuter D, Klouche K, Kouatchet A, Souppart V, Lautrette A, Bohé J, Vieillard Baron A, Dellamonica J, Papazian L, Reignier J, Barbier F, Dumas G, Kentish-Barnes N. Resilience and Mental-Health Symptoms in ICU Healthcare Professionals Facing Repeated COVID-19 Waves. Am J Respir Crit Care Med 2024; 209:573-583. [PMID: 38163380 PMCID: PMC10919111 DOI: 10.1164/rccm.202305-0806oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
Rationale: Psychological resilience (the ability to thrive in adversity) may protect against mental-health symptoms in healthcare professionals during coronavirus disease (COVID-19) waves. Objectives: To identify determinants of resilience in ICU staff members. Methods: In this cross-sectional survey in 21 French ICUs, staff members completed the 10-item Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised (for post-traumatic stress disorder [PTSD]). Factors independently associated with resilience were identified. Measurements and Main Results: The response rate was 73.1% (950 of 1,300). The median 10-item Connor-Davidson Resilience Scale score was 29 (interquartile range, 25-32). Symptoms of anxiety, depression, and PTSD were present in 61%, 39%, and 36% of staff members, respectively. Distress associated with the COVID-19 infodemic was correlated with symptoms of depression and PTSD. More resilient respondents less often had symptoms of anxiety, depression, and PTSD. Greater resilience was independently associated with male sex, having provided intensive care during the early waves, having managed more than 50 patients with COVID-19, and, compared with earlier waves, working longer hours, having greater motivation, and more often involving families in end-of-life decisions. Independent risk factors for lower resilience were having managed more than 10 patients who died of COVID-19, having felt frightened or isolated, and greater distress from the COVID-19 infodemic. Conclusions: This study identifies modifiable determinants of resilience among ICU staff members. Longitudinal studies are needed to determine whether prior resilience decreases the risk of mental ill health during subsequent challenges. Hospital and ICU managers, for whom preserving mental well-being among staff members is a key duty, should pay careful attention to resilience.
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Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
| | - Frédéric Pochard
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France
| | | | - Olivier Guisset
- Medical Intensive Care Unit, Saint-André Hospital, Bordeaux, France
| | - Vincent Labbé
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Tenon University Hospital, Paris, France
| | - Fabienne Tamion
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Fabrice Bruneel
- Intensive Care Unit, André Mignot Hospital, Le Chesnay, France
| | - Mercé Jourdain
- Intensive Care Unit, Lille University Hospital-Roger Salengro Site, INSERM, Lille, France
| | - Danielle Reuter
- Medical-Surgical Intensive Care Unit, Sud Francilien Hospital, Corbeil, France
| | - Kada Klouche
- Medical Intensive Care Unit, Lapeyronie University Hospital, Montpellier, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers University Hospital, Angers, France
| | - Virginie Souppart
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
| | | | - Julien Bohé
- Medical Intensive Care Unit, Hôpital Lyon Sud, Lyon, France
| | - Antoine Vieillard Baron
- Intensive Care Unit, Ambroise-Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Jean Dellamonica
- Medical Intensive Care Unit, UR2CA Clinical Research Unit, Côte d'Azur University, Nice, France
- Nice University Hospital, Nice, France
| | - Laurent Papazian
- Respiratory and Infectious Diseases Intensive Care Unit, Marseille-Nord University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jean Reignier
- Medical Intensive Care Unit, UR 4334 Movement-Interactions-Performance Research Unit, Nantes University Hospital, Nantes, France; and
| | - Francois Barbier
- Medical Intensive Care Unit, La Source Hospital, Orléans Regional Hospital, Orléans, France
| | - Guillaume Dumas
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
| | - Nancy Kentish-Barnes
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
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7
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Orieux A, Prevel R, Dumery M, Lascarrou JB, Zucman N, Reizine F, Fillatre P, Detollenaere C, Darreau C, Antier N, Saint-Léger M, Schnell G, La Combe B, Guesdon C, Bruna F, Guillon A, Varillon C, Lesieur O, Grand H, Bertrand B, Siami S, Oudeville P, Besnard C, Persichini R, Bauduin P, Thyrault M, Evrard M, Schnell D, Auchabie J, Auvet A, Rigaud JP, Beuret P, Leclerc M, Berger A, Ben Hadj Salem O, Lorber J, Stoclin A, Guisset O, Bientz L, Khan P, Guillotin V, Lacherade JC, Boyer A, Orieux A, Prevel R, Dumery M, Lascarrou JB, Zucman N, Reizine F, Fillatre P, Detollenaere C, Darreau C, Antier N, Saint-Léger M, Schnell G, La Combe B, Guesdon C, Bruna F, Guillon A, Varillon C, Lesieur O, Grand H, Bertrand B, Siami S, Oudeville P, Besnard C, Persichini R, Bauduin P, Thyrault M, Evrard M, Schnell D, Auchabie J, Auvet A, Rigaud JP, Beuret P, Leclerc M, Berger A, Ben Hadj Salem O, Lorber J, Stoclin A, Guisset O, Bientz L, Khan P, Guillotin V, Lacherade JC, Boyer A. Invasive group A streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study). Crit Care 2024; 28:4. [PMID: 38167516 PMCID: PMC10759709 DOI: 10.1186/s13054-023-04774-2] [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: 10/21/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Group A Streptococcus is responsible for severe and potentially lethal invasive conditions requiring intensive care unit (ICU) admission, such as streptococcal toxic shock-like syndrome (STSS). A rebound of invasive group A streptococcal (iGAS) infection after COVID-19-associated barrier measures has been observed in children. Several intensivists of French adult ICUs have reported similar bedside impressions without objective data. We aimed to compare the incidence of iGAS infection before and after the COVID-19 pandemic, describe iGAS patients' characteristics, and determine ICU mortality associated factors. METHODS We performed a retrospective multicenter cohort study in 37 French ICUs, including all patients admitted for iGAS infections for two periods: two years before period (October 2018 to March 2019 and October 2019 to March 2020) and a one-year after period (October 2022 to March 2023) COVID-19 pandemic. iGAS infection was defined by Group A Streptococcus isolation from a normally sterile site. iGAS infections were identified using the International Classification of Diseases and confirmed with each center's microbiology laboratory databases. The incidence of iGAS infections was expressed in case rate. RESULTS Two hundred and twenty-two patients were admitted to ICU for iGAS infections: 73 before and 149 after COVID-19 pandemic. Their case rate during the period before and after COVID-19 pandemic was 205 and 949/100,000 ICU admissions, respectively (p < 0.001), with more frequent STSS after the COVID-19 pandemic (61% vs. 45%, p = 0.015). iGAS patients (n = 222) had a median SOFA score of 8 (5-13), invasive mechanical ventilation and norepinephrine in 61% and 74% of patients. ICU mortality in iGAS patients was 19% (14% before and 22% after COVID-19 pandemic; p = 0.135). In multivariate analysis, invasive mechanical ventilation (OR = 6.08 (1.71-21.60), p = 0.005), STSS (OR = 5.75 (1.71-19.22), p = 0.005), acute kidney injury (OR = 4.85 (1.05-22.42), p = 0.043), immunosuppression (OR = 4.02 (1.03-15.59), p = 0.044), and diabetes (OR = 3.92 (1.42-10.79), p = 0.008) were significantly associated with ICU mortality. CONCLUSION The incidence of iGAS infections requiring ICU admission increased by 4 to 5 after the COVID-19 pandemic. After the COVID-19 pandemic, the rate of STSS was higher, with no significant increase in ICU mortality rate.
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Affiliation(s)
- Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
| | - Margot Dumery
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | | | - Noémie Zucman
- Service de Réanimation Médico-Chirurgicale, CH Annecy Genevois, Epagny Metz-Tessy, France
| | - Florian Reizine
- Service de Réanimation Polyvalente, CH de Vannes, Vannes, France
| | - Pierre Fillatre
- Service de Réanimation Polyvalente, CH de Saint Brieuc, Saint Brieuc, France
| | - Charles Detollenaere
- Service de Réanimation - Unité de Soins Continus, CH de Boulogne Sur Mer, Boulogne, France
| | - Cédric Darreau
- Service de Réanimation Médico-Chirurgicale, CH Le Mans, Le Mans, France
| | | | | | - Guillaume Schnell
- Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier du Havre, Le Havre, France
| | - Béatrice La Combe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Charlotte Guesdon
- Service de Réanimation Polyvalente, Centre Hospitalier de Pau, Pau, France
| | - Franklin Bruna
- Service de Réanimation, CH Alpes Leman, Contamine Sur Arve, France
| | - Antoine Guillon
- Service de Médecine Intensive Réanimation, INSERM, Centre d'Étude des Pathologies Respiratoires (CEPR), UMR 1100, CHRU de Tours, Université de Tours, Tours, France
| | - Caroline Varillon
- Service de Médecine Intensive Réanimation, CH Dunkirk, Dunkirk, France
| | - Olivier Lesieur
- Service de Réanimation Médico-Chirurgical, CH La Rochelle, La Rochelle, France
| | - Hubert Grand
- Service de Réanimation Polyvalente, Hôpital Robert Boulin, Libourne, France
| | - Benjamin Bertrand
- Service de Réanimation Polyvalente, CH Intercommunal Toulon, La Seyne sur Mer (CHITS), Toulon, France
| | - Shidasp Siami
- Service de Réanimation Polyvalente, CH Sud Essonne, Étampes, France
| | - Pierre Oudeville
- Service de Réanimation Médicale, Groupe Hospitalier Régional Mulhouse Sud Alsace (GHRMSA), Mulhouse, France
| | - Céline Besnard
- Service de Médecine Intensive Réanimation, CH Régional de Orléans, Orléans, France
| | - Romain Persichini
- Service de Réanimation Et Soins Continus, CH de Saintonge, Saintes, France
| | - Pierrick Bauduin
- Service de Médecine Intensive Réanimation, CHU de Caen, Caen, France
| | - Martial Thyrault
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord Essonne - site Longjumeau, Longjumeau, France
| | - Mathieu Evrard
- Service Réanimation Polyvalente et Surveillance Continue, CH de Lens, Lens, France
| | - David Schnell
- Service de Réanimation Polyvalente, CH d'Angoulême, Angoulême, France
| | - Johann Auchabie
- Service de Réanimation Polyvalente, CH de Cholet, Cholet, France
| | - Adrien Auvet
- Service de Réanimation Polyvalente, CH de Dax, Dax, France
| | | | - Pascal Beuret
- Service de Réanimation et Soins Continus, CH de Roanne, Roanne, France
| | - Maxime Leclerc
- Service de Réanimation et Soins Intensifs Polyvalents, CH Mémorial Saint-Lô, Saint-Lô, France
| | - Asaël Berger
- Service de Réanimation, CH de Haguenau, Haguenau, France
| | - Omar Ben Hadj Salem
- Service de Réanimation Médico-Chirurgicale, CHI Meulan - les Mureaux, Meulan en Yvelines, France
| | - Julien Lorber
- Service de Médecine Intensive Réanimation, CH de Saint Nazaire, Saint Nazaire, France
| | - Annabelle Stoclin
- Département Interdisciplinaire d'Organisation des Parcours Patients (DIOPP), Service de Réanimation, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olivier Guisset
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Léa Bientz
- Laboratoire de Bactériologie, CHU de Bordeaux; Microbiologie Fondamentale et Pathogénicité UMR5234, Université de Bordeaux, Bordeaux, France
| | - Pierre Khan
- Département d'Anesthésie Réanimation Sud, Centre Médico-Chirurgical Magellan, Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France
| | - Vivien Guillotin
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, CH Départemental de la Vendée, La Roche-sur-Yon, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
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8
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Burt L, Clark L, Park C. Stronger together: learner reactions on a team-based, interprofessional first death simulation experience. J Interprof Care 2024; 38:95-103. [PMID: 37422861 DOI: 10.1080/13561820.2023.2232408] [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: 09/27/2022] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
Patient death is a common experience that may be traumatic for health care providers. Although current rates of burnout are high, evidence supports that interprofessional coping can improve clinician mental health. While health care simulation affords learners freedom of safety to participate in a variety of educational experiences, current application of simulation during patient death is limited to professional duties, without explicitly addressing learner emotional well-being. We designed a patient death simulation scenario within a supportive and reflective interprofessional environment to teach foundational coping and well-being strategies to preclinical nursing, medical, and pharmacy students. Sixty-one students participated in this team-based, First Death simulation experience. Debriefings were analyzed using qualitative inductive content analysis methodology. Students reacted to being part of an interprofessional team after having participated in simulation about the death of a patient as described by five categories: emotional awareness, communication insight, feeling stronger together, with role curiosity, and through reflections on support. Findings suggested that simulation is an effective teaching modality for mentoring interprofessional students on humanistic well-being strategies. Furthermore, the experience fostered reactions transcending interprofessional competencies, which are transferrable to future clinical practice.
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Affiliation(s)
- Leah Burt
- College of Nursing Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lou Clark
- M Simulation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christine Park
- College of Medicine, Simulation and Integrative Learning (SAIL) Institute, University of Illinois, Chicago, Illinois, USA
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9
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Dorneles AJA, Dalmolin GDL, Barlem ELD, Silveira RSD, Andolhe R, Camponogara S, Magnago TSBDS, Costa VZD. Burnout, ethical climate and work organization in covid-19 intensive care units: mixed method study. Rev Bras Enferm 2023; 76Suppl 3:e20220684. [PMID: 38055526 DOI: 10.1590/0034-7167-2022-0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/14/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES to analyze the association between burnout and the perception of the ethical climate in nursing professionals in the covid-19 Intensive Care Unit and the relationship with the organization of work from the perspective of managers of these units. METHODS mixed method study conducted in three university hospitals in southern Brazil from December 2021 to March 2022. A cross-sectional study was developed with 110 nursing professionals, followed by an exploratory-descriptive study through semi-structured interviews with six managers. Descriptive and analytical statistics and discursive textual analysis were used. RESULTS the prevalence of burnout was 10% and the perception of negative ethical climate was 24.5%. The association between burnout and ethical climate revealed overload and fatigue during working hours, related to tension, fear, and stress that emerged from the consequences of the organization and relations of work in the covid-19 Intensive Care Unit. CONCLUSIONS there was an association between burnout and ethical climate and elements of the work organization.
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Affiliation(s)
| | | | | | | | - Rafaela Andolhe
- Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil
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10
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Apaydin EA, Rose DE, McClean MR, Mohr DC, Yano EM, Shekelle PG, Nelson KM, Guo R, Yoo CK, Stockdale SE. Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic. BMC Health Serv Res 2023; 23:1306. [PMID: 38012726 PMCID: PMC10683139 DOI: 10.1186/s12913-023-10270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017-2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic. METHODS We analyzed individual- and healthcare system-level data from 19,894 primary care HCWs in 139 healthcare systems in 2020. We modeled potential relationships between individual-level burnout and turnover intent as outcomes, and individual-level employee engagement, perceptions of workload, leadership, and workgroups. At healthcare system-level, we assessed prior-year levels of burnout and turnover intent, COVID-19 burden (number of tests and deaths), and the extent of virtual care use as potential determinants. We conducted multivariable analyses using logistic regression with standard errors clustered by healthcare system controlled for individual-level demographics and healthcare system complexity. RESULTS In 2020, 37% of primary care HCWs reported burnout, and 31% reported turnover intent. Highly engaged employees were less burned out (OR = 0.57; 95% CI 0.52-0.63) and had lower turnover intent (OR = 0.62; 95% CI 0.57-0.68). Pre-pandemic healthcare system-level burnout was a major predictor of individual-level pandemic burnout (p = 0.014). Perceptions of reasonable workload, trustworthy leadership, and strong workgroups were also related to lower burnout and turnover intent (p < 0.05 for all). COVID-19 burden, virtual care use, and prior year turnover were not associated with either outcome. CONCLUSIONS Employee engagement was associated with a lower likelihood of primary care HCW burnout and turnover intent during the pandemic, suggesting it may have a protective effect during stressful times. COVID-19 burden and virtual care use were not related to either outcome. Future research should focus on understanding the relationship between engagement and burnout and improving well-being in primary care.
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Affiliation(s)
- Eric A Apaydin
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Danielle E Rose
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - Michael R McClean
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - David C Mohr
- National Center for Organization Development, Veterans Health Administration, Cincinnati, OH, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Paul G Shekelle
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Karin M Nelson
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, University of Washington, Seattle, WA, USA
| | - Rong Guo
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - Caroline K Yoo
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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11
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Rodriquez J. Becoming futile: the emotional pain of treating COVID-19 patients. FRONTIERS IN SOCIOLOGY 2023; 8:1231638. [PMID: 38024788 PMCID: PMC10663339 DOI: 10.3389/fsoc.2023.1231638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Introduction The COVID-19 pandemic has had a profoundly detrimental impact on the emotional wellbeing of health care workers. Numerous studies have shown that their rates of the various forms of work-related distress, which were already high before the pandemic, have worsened as the demands on health care workers intensified. Yet much less is known about the specific social processes that have generated these outcomes. This study adds to our collective knowledge by focusing on how one specific social process, the act of treating critically ill COVID-19 patients, contributed to emotional pain among health care workers. Methods This article draws from 40 interviews conducted with intensive care unit (ICU) staff in units that were overwhelmed with COVID-19 patients. The study participants were recruited from two suburban community hospitals in Massachusetts and the interviews were conducted between January and May 2021. Results The results show that the uncertainty over how to treat critically ill COVID-19 patients, given the absence of standard protocols combined with ineffective treatments that led to an unprecedented number of deaths caused significant emotional pain, characterized by a visceral, embodied experience that signaled moral distress, emotional exhaustion, depersonalization, and burnout. Furthermore, ICU workers' occupational identities were undermined as they confronted the limits of their own abilities and the limits of medicine more generally. Discussion The inability to save incurable COVID-19 patients while giving maximal care to such individuals caused health care workers in the ICU an immense amount of emotional pain, contributing to our understanding of the social processes that generated the well-documented increase in moral distress and related measures of work-related psychological distress. While recent studies of emotional socialization among health care workers have portrayed clinical empathy as a performed interactional strategy, the results here show empathy to be more than dramaturgical and, in this context, entailed considerable risk to workers' emotional wellbeing.
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Affiliation(s)
- Jason Rodriquez
- Department of Sociology, University of Massachusetts Boston, Boston, MA, United States
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12
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Liu HH, Petrone P, Akerman M, Howell RS, Morel AH, Sohail AH, Alsamarraie C, Brathwaite B, Kinzler W, Maurer J, Brathwaite CEM. The First COVID-19 Pandemic Wave and the Effect on Health Care Trainees: A National Survey Study. Am Surg 2023; 89:4654-4661. [PMID: 36121024 PMCID: PMC9483660 DOI: 10.1177/00031348221117028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study observes the trends and patterns among trainees during the coronavirus disease 2019 (COVID-19) pandemic and their response to resident education and hospital/program support. METHODS An anonymous online 31-question survey was distributed to medical students and postgraduate year residents. Topics included were demographics, clinical responsibilities, educational/curricula changes, and trainee wellness. Descriptive analysis was performed for each set of demographic groupings as well as 2 and 3 group comparisons. RESULTS Total 1051 surveys collected, 930 used for analysis: 373 (40.1%) male, 434 (46.6%) aged 30-34 years, 588 (63.2%) white, 417 (44.8%) married, 168 (18%) with children, and 323 (34.7%) from the Northeast region. The Northeast experienced difficulty sleeping, feelings of guilt, hopelessness, and changes in appetite (P = .0077). The pandemic interfered significantly with relationships and living situations (P < .0001). Trainees 18-34 years believed the pandemic affected residency training (P < .0001). Surgical residents were concerned about reaching numbers of operative procedures to graduate (P < .0001). Residency programs adhered to ACGME work restrictions (P < .0001). CONCLUSION We aim to provide continued educational support for our trainees' clinical development and well-being during the COVID-19 pandemic.
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Affiliation(s)
- Helen H. Liu
- Department of Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - Patrizio Petrone
- Department of Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - Meredith Akerman
- Biostatistics Core, Division of
Health Services Research, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - Raelina S. Howell
- Department of Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - Andrew H. Morel
- Department of Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - Amir H. Sohail
- Department of Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - Cindy Alsamarraie
- Department of Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - Barbara Brathwaite
- Department of Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - Wendy Kinzler
- Department of Obstetrics and
Gynecology, NYU Langone Hospital—Long
Island, Mineola, NY, USA
| | - James Maurer
- Department of Surgery, NYU Langone Hospital—Long
Island, Mineola, NY, USA
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13
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Bódi B, Szvath P, Mátay G, Takács S, Hermann C, Zana Á. [The impact of the coronavirus pandemic on the mental health of critical care workers]. Orv Hetil 2023; 164:1646-1655. [PMID: 37865948 DOI: 10.1556/650.2023.32888] [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: 07/15/2023] [Accepted: 08/18/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION The coronavirus pandemic has focused attention on the importance of critical care and highlighted the shortage of critical care specialists. Due to increasing workloads and high mortality rates, healthcare professionals were exposed to higher levels of physical and psychological stress during the pandemic than before. OBJECTIVE Our study investigated the effects of the coronavirus outbreak on the emotional, mental and moral stress of intensive care professionals. METHOD Our workgroup performed paper-based surveys among caregivers in the Department of Anaesthesiology and Intensive Therapy at Semmelweis University. The first survey was conducted at the start of the pandemic in 2020, the second survey was conducted after the third wave in 2021. We applied validated questionnaires (Professional Quality of Life, Demoralization Scale, Perceived Stress Scale, Impact of Event Scale, and Posttraumatic Growth Inventory), collected demographic data and information on lifestyle, recreation, dietary habits, and accepting psychological support. RESULTS The number and demographic characteristics of the participants in the two studies are different, reflecting the changes in the workforce during the pandemic. Our results revealed no differences between the working and socio-demographic groups before the outbreak, however, one year later, nurses scored significantly higher on all negative psychological scales compared to other groups. Only a minority of the respondents had sought psychological support (9.5-12.7%), although more than a third of respondents reported the need for psychological support. Employees in new work positions showed significantly increased posttraumatic growth (2.91 ± 0.82 vs. 2.20 ± 1.06, p = 0.016). DISCUSSION These findings demonstrate that nurses are the most strained workgroup during an uncertain and stressful period. The available mental support alone is not enough to help caregivers. CONCLUSION Further steps are needed to improve the mental health of critical care workers. Orv Hetil. 2023; 164(42): 1646-1655.
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Affiliation(s)
- Bernadett Bódi
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Klinika Budapest, Üllői út 78/a, 1082 Magyarország
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Magatartástudományi Intézet Budapest Magyarország
| | - Petra Szvath
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Klinika Budapest, Üllői út 78/a, 1082 Magyarország
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Magatartástudományi Intézet Budapest Magyarország
| | - Gábor Mátay
- 3 Károli Gáspár Református Egyetem Budapest Magyarország
| | | | - Csaba Hermann
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Klinika Budapest, Üllői út 78/a, 1082 Magyarország
- 4 Széchenyi István Egyetem Győr Magyarország
| | - Ágnes Zana
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Magatartástudományi Intézet Budapest Magyarország
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14
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Cecconi M. Reflections of an intensivist in 2050: three decades of clinical practice, research, and human connection. Crit Care 2023; 27:391. [PMID: 37814338 PMCID: PMC10563297 DOI: 10.1186/s13054-023-04674-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023] Open
Affiliation(s)
- Maurizio Cecconi
- Biomedical Sciences Department, Humanitas University, Milan, Italy.
- Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
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15
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Salas-Bergües V, Lizarazu-Armendáriz E, Eraso-Pérez de Urabayen M, Mateo-Manrique P, Mendívil-Pérez M, Goñi-Viguria R. Levels of burnout and exposure to ethical conflict and assessment of the practice environment in nursing professionals of intensive care. ENFERMERIA INTENSIVA 2023; 34:195-204. [PMID: 37455225 DOI: 10.1016/j.enfie.2023.02.003] [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: 08/05/2022] [Accepted: 02/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Nursing professionals working in Intensive Care Units (ICU) are at high risk of developing negative emotional responses as well as emotional and spiritual problems related to ethical issues. The design of effective strategies that improve these aspects is determined by knowing the levels of burnout and ethical conflict of these professionals, as well as the influence that the practice environment might have on them. OBJECTIVES To analyze the relationship between levels of burnout, the exposure to ethical conflicts and the perception of the practice environment among themselves and with sociodemographic variables of the different intensive care nursing professionals. METHODS Descriptive, correlational, cross-sectional, observational study in an ICU of a tertiary level university hospital. The level of burnout was evaluated with the Maslach Burnout Inventory Human Services Survey scale; the level of ethical conflict with the Ethical Conflict Questionnaire for Nurses and the perception of the environment with the Practice Environment Scale of the Nursing Work Index. Descriptive and inferential statistics were performed. The association between categorical variables was analyzed using Fisher's exact chi-square test (χ2) RESULTS: 31 nurses and 8 nursing assistants were evaluated, which meant a participation rate of 82,93%. 31,10% of the nursing professionals presented signs of burnout, 14,89% considered that they work in an unfavorable environment and 87,23% presented a medium-high index of exposure to ethical conflict. The educational level (χ2=11.084, p=0.011) and the professional category (χ2=5.007, p=0.025) influenced the level of burnout: nursing assistants presented higher levels of this. When comparing the level of burnout with the environment and the index of ethical conflict, there were no statistically significant differences. CONCLUSIONS The absence of association found in the study between Burnout and ethical conflict with the perception of the practice environment suggests that personal factors may influence its development.
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Affiliation(s)
- V Salas-Bergües
- Enfermería, Área de Investigación, Clínica Universidad de Navarra, Pamplona, Spain
| | - E Lizarazu-Armendáriz
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - P Mateo-Manrique
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain.
| | - M Mendívil-Pérez
- Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Goñi-Viguria
- Enfermería, Práctica Avanzada del Área de Críticos, Clínica Universidad de Navarra, Spain
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16
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Uhlenbrock G, Schulze S, Sappl I, Rapp MA, Tallarek M, Spallek J, Holmberg C. [Concern about Covid-19 Infection and the Risk of Burnout Symptoms: a Study of Caregiver Stress in Brandenburg Nursing Homes During the Covid-19 Pandemic]. PSYCHIATRISCHE PRAXIS 2023; 50:353-360. [PMID: 37072030 DOI: 10.1055/a-2019-6495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Investigation of the association of concern about own infection or infection of friends, family and care recipients with Covid-19 and burnout symptoms of caregivers in Brandenburg full inpatient geriatric care facilities. METHODS Cross-sectional survey of nursing staff (n=195) in Brandenburg nursing homes between August and December 2020 regarding their psychosocial stress at work. RESULTS Concern about having infected oneself, family and/or friends, or care recipients with Covid-19 is associated with increased expression of burnout symptoms (b=0,200, t(155)=2,777, p=0,006). CONCLUSION Increased experience of burnout symptoms due to concerns of risk of infection with Covid-19 in the workplace indicates a need for comprehensive support measures as well as sustainable approaches to managing psychosocial stress for geriatric caregivers.
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Affiliation(s)
- Greta Uhlenbrock
- Institut für Sozialmedizin und Epidemiologie Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg
| | - Susanne Schulze
- Institut für Sozialmedizin und Epidemiologie Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg
- Fakultät für Gesundheitswissenschaften, Gemeinsame Fakultät der Universität Potsdam, der Brandenburgischen Technischen Universität Cottbus-Senftenberg und der Medizinischen Hochschule Brandenburg Theodor Fontane, Potsdam
- Sozial- und Präventivmedizin, Universität Potsdam
| | - Isabella Sappl
- Institut für Sozialmedizin und Epidemiologie Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg
| | - Michael A Rapp
- Fakultät für Gesundheitswissenschaften, Gemeinsame Fakultät der Universität Potsdam, der Brandenburgischen Technischen Universität Cottbus-Senftenberg und der Medizinischen Hochschule Brandenburg Theodor Fontane, Potsdam
- Sozial- und Präventivmedizin, Universität Potsdam
| | - Marie Tallarek
- Fakultät für Soziale Arbeit, Gesundheit und Musik, Brandenburgische Technische Universität Cottbus-Senftenberg
| | - Jacob Spallek
- Fakultät für Gesundheitswissenschaften, Gemeinsame Fakultät der Universität Potsdam, der Brandenburgischen Technischen Universität Cottbus-Senftenberg und der Medizinischen Hochschule Brandenburg Theodor Fontane, Potsdam
- Fakultät für Soziale Arbeit, Gesundheit und Musik, Brandenburgische Technische Universität Cottbus-Senftenberg
| | - Christine Holmberg
- Institut für Sozialmedizin und Epidemiologie Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg
- Fakultät für Gesundheitswissenschaften, Gemeinsame Fakultät der Universität Potsdam, der Brandenburgischen Technischen Universität Cottbus-Senftenberg und der Medizinischen Hochschule Brandenburg Theodor Fontane, Potsdam
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17
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Kok N, Zegers M, Teerenstra S, Fuchs M, van der Hoeven JG, van Gurp JLP, Hoedemaekers CWE. Effect of Structural Moral Case Deliberation on Burnout Symptoms, Moral Distress, and Team Climate in ICU Professionals: A Parallel Cluster Randomized Trial. Crit Care Med 2023; 51:1294-1305. [PMID: 37272981 DOI: 10.1097/ccm.0000000000005940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Moral case deliberation (MCD) is a team-based and facilitator-led, structured moral dialogue about ethical difficulties encountered in practice. This study assessed whether offering structural MCD in ICUs reduces burnout symptoms and moral distress and strengthens the team climate among ICU professionals. DESIGN This is a parallel cluster randomized trial. SETTING Six ICUs in two hospitals located in Nijmegen, between January 2020 and September 2021. SUBJECTS Four hundred thirty-five ICU professionals. INTERVENTIONS Three of the ICUs organized structural MCD. In three other units, there was no structural MCD or other structural discussions of moral problems. MEASUREMENTS AND MAIN RESULTS The primary outcomes investigated were the three burnout symptoms-emotional exhaustion, depersonalization, and a low sense of personal accomplishment-among ICU professionals measured using the Maslach Burnout Inventory on a 0-6 scale. Secondary outcomes were moral distress (Moral Distress Scale) on a 0-336 scale and team climate (Safety Attitude Questionnaire) on a 0-4 scale. Organizational culture was an explorative outcome (culture of care barometer) and was measured on a 0-4 scale. Outcomes were measured at baseline and in 6-, 12-, and 21-month follow-ups. Intention-to-treat analyses were conducted using linear mixed models for longitudinal nested data. Structural MCD did not affect emotional exhaustion or depersonalization, or the team climate. It reduced professionals' personal accomplishment (-0.15; p < 0.05) but also reduced moral distress (-5.48; p < 0.01). Perceptions of organizational support (0.15; p < 0.01), leadership (0.19; p < 0.001), and participation opportunities (0.13; p < 0.05) improved. CONCLUSIONS Although structural MCD did not mitigate emotional exhaustion or depersonalization, and reduced personal accomplishment in ICU professionals, it did reduce moral distress. Moreover, it did not improve team climate, but improved the organizational culture.
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Affiliation(s)
- Niek Kok
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Malaika Fuchs
- Department of Intensive Care, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Johannes G van der Hoeven
- Department Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle L P van Gurp
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Cornelia W E Hoedemaekers
- Department Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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18
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Ching SM, Cheong AT, Yee A, Thurasamy R, Lim PY, Ismail IZ, Mohammad NM, Ho BK, Ng JY, Tan SF, Zainol Rashid ZZ, Jogulu SR, Lee KW, Taher SW. Level of fear towards COVID-19 and its determinants among healthcare providers in Malaysia: A cross-sectional study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:56. [PMID: 37814673 PMCID: PMC10560469 DOI: 10.51866/oa.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Introduction Malaysia is one of the hardest-hit countries by COVID-19 in Asia. The rapidly rising number of cases had sparked fear among healthcare providers. This study aimed to assess the determinants of fear towards COVID-19 among healthcare providers in primary care settings. Method This online-based cross-sectional study was conducted among 1280 healthcare providers aged ≥18 years from 30 primary care clinics in the state of Selangor, Malaysia. The Fear of COVID-19 Scale was used to assess the level of fear, and the results were analysed using multiple linear regression. Results The mean age of the respondents was 36 years, and the mean working experience was 11 years. The majority of the respondents were women (82.4%) and Malays (82.3%). The factors that were significantly correlated with higher levels of fear were underlying chronic disease (ß=1.12, P=0.002, 95% confidence interval [CI]=0.08, 3.15), concern about mortality from COVID-19 (ß=3.3, P<0.001, 95% CI=0.19, 7.22), higher risk of exposure (ß=0.8, P<0.001, 95% CI=0.14, 5.91), concern for self at work (ß=2.8, P=0.002, 95% CI=0.08, 3.10) and work as a nurse (ß=3.6, P<0.001, 95% CI=0.30, 7.52), medical laboratory worker (ß=3.0, P<0.001, 95% CI=0.12, 4.27) and healthcare assistant (ß=3.9, P<0.001, 95% CI=0.17, 5.73). The level of fear was inversely correlated with a higher work-related stress management score (ß=-0.9, P<0.001, 95% CI=-0.14, -5.07) and a higher sleep quality score (ß=-1.8, P<0.001, 95% CI=-0.28, -10.41). Conclusion Family physicians should be vigilant and identify healthcare providers at risk of developing COVID-19-related fear to initiate early mental health intervention.
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Affiliation(s)
- Siew Mooi Ching
- MD (Unimas), MMed (Family Medicine), PhD, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia Serdang, Selangor, Malaysia.
| | - Ai Theng Cheong
- MBBS (UM), MFamMed (UMl), PhD (UM), Department of Family Medicine Universiti Putra Malaysia Serdang, Selangor, Malaysia
| | - Anne Yee
- MB Bch BAO (Ireland), MPM (Malaya), PhD (Malaya), Department of Psychological Medicine, Faculty of Medicine University of Malaya, Kuala Lumpur, Malaysia
| | - Ramayah Thurasamy
- MBA (USM), School of Management, Universiti Sains Malaysia, Penang, Malaysia
- Department of Management, Sunway University Business School (SUBS)
- Faculty of Economics and Business Universitas Indonesia (UI)
- University Center for Research & Development (UCRD), Chandigarh University (CU), India
- Department of Information Technology & Management, Daffodil International University, Bangladesh (DIU)
- Faculty Of Business, Economics and Social Development, Universiti Malaysia Terengganu (UMT), Kuala Terengganu, Malaysia
- Azman Hashim International Business School, Universiti Teknologi Malaysia (UTM), Kuala Lumpur, Malaysia
| | - Poh Ying Lim
- Bioinformatics (UKM), Master of Sciences (Statistics) (USM), PhD (Biostatistics) (University of Nottingham), Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia Serdang, Selangor, Malaysia
| | - Irmi Zarina Ismail
- MD (USM), MMed (Family Medicine) (UM), Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nik Mazlina Mohammad
- MBBS (UM), MMed (Family Medicine)(UKM), Klinik Kesihatan Kelana Jaya, Ministry of Health Malaysia, Petaling Jaya, Malaysia
| | - Bee Kiau Ho
- MBBS (UM), MMed (Family Medicine)(UM), Klinik Kesihatan Bandar Botanic, Ministry of Health Malaysia, Klang, Malaysia
| | - Jun Ying Ng
- MBBS (UM), Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siow Foon Tan
- MBBS (UM),MEDFAM (UM), Klinik Kesihatan Pelabuhan Klang, Ministry of Health Malaysia, Klang, Malaysia
| | - Zienna Zufida Zainol Rashid
- MBBCh BAO (Queen's University of Belfast, UK), MMed (Family Medicine) (UM), Klinik Kesihatan Pandamaran, Ministry of Health Malaysia, Klang, Malaysia
| | - Sathya Rao Jogulu
- MBBS (IMU), MMed (Family Medicine)(UKM), Klinik Kesihatan Ampang, Ministry of Health Malaysia, Hulu Langat, Malaysia
| | - Kai Wei Lee
- BAgriSci (UMS), MSc (UPM), PhD (UPM). Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul, Rahman, Kajang, Selangor, Malaysia
| | - Sri Wahyu Taher
- BSC. MED. SC.(UK), MBCHB(GLASG), MMed (Family Medicine)(UKM), Klinik Kesihatan Simpang Kuala, Ministry of Health Malaysia, Alor, Setar, Kedah, Malaysia
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19
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Sikioti T, Zartaloudi A, Pappa D, Mangoulia P, Fradelos EC, Kourti FE, Koutelekos I, Dousis E, Margari N, Stavropoulou A, Evangelou E, Dafogianni C. Stress and burnout among Greek critical care nurses during the COVID-19 pandemic. AIMS Public Health 2023; 10:755-774. [PMID: 38187893 PMCID: PMC10764964 DOI: 10.3934/publichealth.2023051] [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: 05/08/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 01/09/2024] Open
Abstract
Occupational stress and burnout of health personnel during the COVID-19 pandemic, especially of the nursing population in intensive care units (ICUs), were quite frequent along with negative effects and a direct correlation with the manifestation of many physical, behavioral and psychological symptoms. For the purposes of this research, a quantitative survey was carried out, in which 153 ICU nurses of secondary and tertiary public hospitals in Greece participated. Nurses completed anonymously and voluntarily a special electronic questionnaire about stress, burnout, personal concerns about the pandemic, the consequences of the outbreak and their resilience toward COVID-19 patients' care. Specific validated scales were used in this study. Female nurses felt, to a greater extent than males, work-related burnout, especially patient-related burnout and total burnout. There was a statistically significant negative relationship between the existence of a psychological support group within a hospital and personal burnout. Participants who had experience in caring for SARS-CoV-2 patients had higher mental resilience than those without experience. As the consequences experienced by the health professionals of the reference COVID-19 hospitals were increased, so did mental resilience and stress coping strategies during the pandemic. The COVID-19 outbreak and the conditions configurated in the health system had negative effects on the psycho-emotional state of ICU nurses. The manifestation of anxiety, stress and burnout had a direct correlation with both the work and personal functionality of the nurses and the whole of the healthcare services provided. The early recognition of symptoms and their individualized management are imperative for the protection of the psycho-emotional well-being of nurses.
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Affiliation(s)
| | | | - Despoina Pappa
- Faculty of Nursing, University of West Attica, Athens, Greece
| | - Polyxeni Mangoulia
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | | | - Eleni Evangelou
- Faculty of Nursing, University of West Attica, Athens, Greece
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20
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Short A, McPeake J, Andonovic M, McFee S, Quasim T, Leyland A, Shaw M, Iwashyna T, MacTavish P. Medication-related problems in critical care survivors: a systematic review. Eur J Hosp Pharm 2023; 30:250-256. [PMID: 37142386 PMCID: PMC10447966 DOI: 10.1136/ejhpharm-2023-003715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES There are numerous, often single centre discussions of assorted medication-related problems after hospital discharge in patients who survive critical illness. However, there has been little synthesis of the incidence of medication-related problems, the classes of medications most often studied, the factors that are associated with greater patient risk of such problems or interventions that can prevent them. METHODS We undertook a systematic review to understand medication management and medication problems in critical care survivors in the hospital discharge period. We searched OVID Medline, Embase, PsychINFO, CINAHL and the Cochrane database (2001-2022). Two reviewers independently screened publications to identify studies that examined medication management at hospital discharge or thereafter in critical care survivors. We included randomised and non-randomised studies. We extracted data independently and in duplicate. Data extracted included medication type, medication-related problems and frequency of medication issues, alongside demographics such as study setting. Cohort study quality was assessed using the Newcastle Ottowa Score checklist. Data were analysed across medication categories. RESULTS The database search initially retrieved 1180 studies; following the removal of duplicates and studies which did not fit the inclusion criteria, 47 papers were included. The quality of studies included varied. The outcomes measured and the timepoints at which data were captured also varied, which impacted the quality of data synthesis. Across the studies included, we found that as many as 80% of critically ill patients experienced medication-related problems in the posthospital discharge period. These issues included inappropriate continuation of newly prescribed drugs such as antipsychotics, gastrointestinal prophylaxis and analgesic medications, as well as inappropriate discontinuation of chronic disease medications, such as secondary prevention cardiac drugs. CONCLUSIONS Following critical illness, a high proportion of patients experience problems with their medications. These changes were present across multiple health systems. Further research is required to understand optimal medicine management across the full recovery trajectory of critical illness. PROSPERO REGISTRATION NUMBER CRD42021255975.
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Affiliation(s)
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Mark Andonovic
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Tara Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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21
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Whitehead IO, Moffatt S, Warwick S, Spiers GF, Kunonga TP, Tang E, Hanratty B. Systematic review of the relationship between burn-out and spiritual health in doctors. BMJ Open 2023; 13:e068402. [PMID: 37553194 PMCID: PMC10414094 DOI: 10.1136/bmjopen-2022-068402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To investigate the relationship between burn-out and spiritual health among medical doctors. DESIGN Systematic literature review and narrative synthesis of cross-sectional studies. SETTING Any setting, worldwide. DATA SOURCES Five databases were searched from inception to March 2022, including Medline, Embase, PsycINFO, Scopus and Web of Science. ELIGIBILITY CRITERIA Any study design that involved medical doctors (and other healthcare staff if assessed alongside medical doctors), that measured (in any way) both burn-out (or similar) and spiritual health (or similar) medical doctors. DATA EXTRACTION AND SYNTHESIS All records were double screened. Data extraction was performed by one reviewer and a proportion (10%) checked by a second reviewer. Quality was assessed using the Appraisal of Cross-sectional Studies tool. Due to the heterogeneity of the included studies, a narrative review was undertaken without a meta-analysis. RESULTS Searches yielded 1049 studies. 40 studies met eligibility criteria and were included in this review. Low reported levels of spirituality were associated with high burn-out scores and vice versa. Religion was not significantly associated with lower levels of burn-out. Few studies reported statistically significant findings, few used validated spiritual scores and most were vulnerable to sampling bias. CONCLUSIONS Published research suggests that burn-out is linked to spiritual health in medical doctors but not to religion. Robust research is needed to confirm these findings and develop effective interventions. PROSPERO REGISTRATION NUMBER CRD42020200145.
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Affiliation(s)
| | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie Warwick
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma F Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Eugene Tang
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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22
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Shah N, Goodwin AJ, Verdin R, Clark JT, Rheingold AA, Ruggiero KJ, Simpson AN, Ford DW. Evaluation of a Telehealth-Enabled Pilot Program to Address Intensive Care Unit Health Care Worker Mental Health Distress. TELEMEDICINE REPORTS 2023; 4:249-258. [PMID: 37637378 PMCID: PMC10457649 DOI: 10.1089/tmr.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/29/2023]
Abstract
Introduction Health care workers (HCWs) are at heightened risk of adverse mental health events (AMHEs) and burnout with resultant impact on health care staffing, outcomes, and costs. We piloted a telehealth-enabled mental health screening and support platform among HCWs in the intensive care unit (ICU) setting at a tertiary care center. Methods A survey consisting of validated screening tools was electronically disseminated to a potential cohort of 178 ICU HCWs. Participants were given real-time feedback on their results and those at risk were provided invitations to meet with resiliency clinicians. Participants were further invited to engage in a 3-month longitudinal assessment of their well-being through repeat surveys and a weekly text-based check-in coupled with self-help tips. Programmatic engagement was evaluated and associations between at-risk scores and engagement were assessed. Qualitative input regarding programmatic uptake and acceptance was gathered through key informant interviews. Results Fifty (28%) HCWs participated in the program. Half of the participants identified as female, and most participants were white (74%) and under the age of 50 years (93%). Nurses (38%), physicians-in-training (24%), and faculty-level physicians (20%) engaged most frequently. There were 19 (38%) requests for an appointment with a resiliency clinician. The incidence of clinically significant symptoms of AMHEs and burnout was high but not clearly associated with engagement. Additional programmatic tailoring was encouraged by key informants while time was identified as a barrier to program engagement. Discussion A telehealth-enabled platform is a feasible approach to screening at-risk HCWs for AMHEs and can facilitate engagement with support services.
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Affiliation(s)
- Nihar Shah
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew J. Goodwin
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca Verdin
- Telehealth Center of Excellence; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - John T. Clark
- Biomedical Informatics Center; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alyssa A. Rheingold
- Department of Psychiatry and Behavioral Sciences; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kenneth J. Ruggiero
- College of Nursing, Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Annie N. Simpson
- Department of Healthcare, Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee W. Ford
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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23
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Siddiqui S, Warner MA, Kelly L, Novack V, Monteith E, Douin DJ, Mladinov D, Shaefi S, Stevens RD, Tung A, Sladen RN. Determinants of Professional Fulfillment and Burnout Among Intensivists: A National Survey by the Society of Critical Care Anesthesiologists in 2022. Anesth Analg 2023; 137:375-382. [PMID: 36791019 PMCID: PMC10363231 DOI: 10.1213/ane.0000000000006384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Increased burnout and decreased professional fulfillment among intensive care physicians is partly due to intensive care unit (ICU) workload. Although the SARS-CoV-2 (COVID-19) pandemic increased ICU workload, it also may have increased feelings of personal fulfillment due to positive public perceptions of physicians caring for COVID patients. We surveyed critical care anesthesiologists to identify the effect of provider demographics, ICU workload, and COVID-19-related workload, on professional fulfillment and burnout. METHODS We performed an exploratory survey of 606 members of the Society of Critical Care Anesthesiologists (SOCCA) in January and February 2022. We used the Stanford Professional Fulfillment Index (PFI) to grade levels of professional fulfillment and markers of burnout (ie, work exhaustion and disengagement). Univariable and multivariable models were used to identify associations between provider demographics and practice characteristics and professional fulfillment and work exhaustion. RESULTS One hundred and seventy-five intensivists (29%) responded. A total of 65% were male and 49% were between 36 and 45 years old. The overall median PFI score-0 (none) to 24 (most professional fulfillment)-was 17 (IQR, 1-24), with a wide distribution of responses. In multivariable analysis, factors associated with higher professional fulfillment included age >45 years ( P =.004), ≤15 weeks full-time ICU coverage in 2020 ( P =.02), role as medical director ( P =.01), and nighttime home call with supervision of in-house ICU fellows ( P =.01). CONCLUSIONS Professional fulfillment and work exhaustion in this cross-sectional survey were associated with several demographic and practice characteristics but not COVID-19-related workload, suggesting that COVID-19 workload may not have either positive or negative perceptions on professional fulfillment.
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Affiliation(s)
- Shahla Siddiqui
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Matthew A. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, MN, USA
| | - Lauren Kelly
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Victor Novack
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Erika Monteith
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - David J. Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Domagoj Mladinov
- Department of Anesthesiology and Perioperative Medicine, University of Alabama, Birmingham, AL, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago, IL, USA
| | - Robert N. Sladen
- Division of Critical Care Medicine, Department of Anesthesiology, Columbia University Irvine Medical Center, NY, USA
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24
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Bureau C, Van Hollebeke M, Dres M. Managing respiratory muscle weakness during weaning from invasive ventilation. Eur Respir Rev 2023; 32:32/168/220205. [PMID: 37019456 PMCID: PMC10074167 DOI: 10.1183/16000617.0205-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/08/2022] [Indexed: 04/07/2023] Open
Abstract
Weaning is a critical stage of an intensive care unit (ICU) stay, in which the respiratory muscles play a major role. Weakness of the respiratory muscles, which is associated with significant morbidity in the ICU, is not limited to atrophy and subsequent dysfunction of the diaphragm; the extradiaphragmatic inspiratory and expiratory muscles also play important parts. In addition to the well-established deleterious effect of mechanical ventilation on the respiratory muscles, other risk factors such as sepsis may be involved. Weakness of the respiratory muscles can be suspected visually in a patient with paradoxical movement of the abdominal compartment. Measurement of maximal inspiratory pressure is the simplest way to assess respiratory muscle function, but it does not specifically take the diaphragm into account. A cut-off value of -30 cmH2O could identify patients at risk for prolonged ventilatory weaning; however, ultrasound may be better for assessing respiratory muscle function in the ICU. Although diaphragm dysfunction has been associated with weaning failure, this diagnosis should not discourage clinicians from performing spontaneous breathing trials and considering extubation. Recent therapeutic developments aimed at preserving or restoring respiratory muscle function are promising.
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Affiliation(s)
- Côme Bureau
- Sorbonne Université, INSERM, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation, Département R3S, Paris, France
| | - Marine Van Hollebeke
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Martin Dres
- Sorbonne Université, INSERM, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation, Département R3S, Paris, France
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25
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Doucet J, Shatz DV, Kaplan LJ, Bulger EM, Capella J, Kuhls DA, Fallat M, Remick KN, Newton C, Fox A, Jawa R, Harvin JA, Blake DP, Bukur M, Gates J, Ficke J, Gestring ML. Are trauma surgeons prepared? A survey of trauma surgeons' disaster preparedness before and during the COVID-19 pandemic. Trauma Surg Acute Care Open 2023; 8:e001073. [PMID: 37564125 PMCID: PMC10410846 DOI: 10.1136/tsaco-2022-001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/26/2023] [Indexed: 08/12/2023] Open
Abstract
Objective US trauma centers (TCs) must remain prepared for mass casualty incidents (MCIs). However, trauma surgeons may lack formal MCI training. The recent COVID-19 pandemic drove multiple patient surges, overloaded Emergency Medical Services (EMS) agencies, and stressed TCs. This survey assessed trauma surgeons' MCI training, experience, and system and personal preparedness before the pandemic compared with the pandemic's third year. Methods Survey invitations were emailed to all 1544 members of the American Association for the Surgery of Trauma in 2019, and then resent in 2022 to 1575 members with additional questions regarding the pandemic. Questions assessed practice type, TC characteristics, training, experience, beliefs about personal and hospital preparedness, likelihood of MCI scenarios, interventions desired from membership organizations, and pandemic experiences. Results The response rate was 16.7% in 2019 and 12% in 2022. In 2022, surgeons felt better prepared than their hospitals for pandemic care, mass shootings, and active shooters, but remained feeling less well prepared for cyberattack and hazardous material events, compared with 2019. Only 35% of the respondents had unintentional MCI response experience in 2019 or 2022, and even fewer had experience with intentional MCI. 78% had completed a Stop the Bleed (STB) course and 63% own an STB kit. 57% had engaged in family preparedness activities; less than 40% had a family action plan if they could not come home during an MCI. 100% of the respondents witnessed pandemic-related adverse events, including colleague and coworker illness, patient surges, and resource limitations, and 17% faced colleague or coworker death. Conclusions Trauma surgeons thought that they became better at pandemic care and rated themselves as better prepared than their hospitals for MCI care, which is an opportunity for them to take greater leadership roles. Opportunities remain to improve surgeons' family and personal MCI preparedness. Surgeons' most desired professional organization interventions include advocacy, national standards for TC preparedness, and online training. Level of evidence VII, survey of expert opinion.
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Affiliation(s)
- Jay Doucet
- Department of Surgery, University of California San Diego Health System, San Diego, California, USA
| | - David V Shatz
- Department of General Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Lewis J Kaplan
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | | | - Deborah A Kuhls
- Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Mary Fallat
- Department of Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Kyle N. Remick
- Department of Surgery, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
| | | | - Adam Fox
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Randeep Jawa
- Department of Surgery, Stony Brook University, Stony Brook, New York, USA
| | - John A Harvin
- Department of Surgery, UT Health, Houston, Texas, USA
| | - David P Blake
- Division of Acute Care Surgery, Inova Health System, Falls Church, Virginia, USA
| | - Marko Bukur
- Bellevue Hospital Center, New York, New York, USA
| | - Jonathan Gates
- Department of Surgery, Hartford Hospital, Hartford, Connecticut, USA
| | - James Ficke
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark L Gestring
- Department of Surgery, University of Rochester, Rochester, New York, USA
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26
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Gambaro E, Gramaglia C, Marangon D, Probo M, Rudoni M, Zeppegno P. Health Workers' Burnout and COVID-19 Pandemic: 1-Year after-Results from a Repeated Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6087. [PMID: 37372674 DOI: 10.3390/ijerph20126087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/07/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: This study evaluates, one year later, the levels of burnout, anxious-depressive, and post-traumatic symptoms and the general health status in the Health Workers (HWs) involved in the SARS-COVID-19 pandemic in the Novara area. (2) Methods: The survey was sent via a link in an email to doctors, nurses, and other operators during the period between June and August 2021. The survey collected socio-demographic data and contained some self-administered questionnaires. (3) Results: A total of 688 HWs completed the survey, 53% were aged 30-49 years, 68% were female, 76% were cohabiting, 55% had children, 86% reported family habit changes, and 20% had non-COVID related health problems. Only a few of the respondents had a follow-up by a specialist (12%), of which there were even less in recent times (6%). It was observed that the respondents had undergone burnout; a poor state of general mental health (62%); depressive symptoms (70%); post-traumatic symptoms (29%); and less frequently, anxious symptoms (16%). The data of this study are in line with other studies in the literature. (4) Conclusions: The data indicate that psychological-based suffering was no longer markedly concentrated in some specific bands of HWs. In conclusion, it would be essential to enhance HW support strategies.
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Affiliation(s)
- Eleonora Gambaro
- Department of Translational Medicine, Università del Piemonte Orientale, 13100 Vercelli, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Università del Piemonte Orientale, 13100 Vercelli, Italy
- Psychiatry Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Debora Marangon
- Department of Translational Medicine, Università del Piemonte Orientale, 13100 Vercelli, Italy
| | - Manuela Probo
- Department of Mental Health, ASL NOVARA, 28100 Novara, Italy
| | - Marco Rudoni
- Department of Mental Health, ASL NOVARA, 28100 Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Università del Piemonte Orientale, 13100 Vercelli, Italy
- Psychiatry Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
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Hrynyk N, Peel JK, Grace D, Lajoie J, Ng-Kamstra J, Kuper A, Carter M, Lorello GR. Queer(ing) medical spaces: queer theory as a framework for transformative social change in anesthesiology and critical care medicine. Can J Anaesth 2023; 70:950-962. [PMID: 37217735 DOI: 10.1007/s12630-023-02449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/02/2022] [Accepted: 09/15/2022] [Indexed: 05/24/2023] Open
Abstract
Queer theory is a disruptive lens that can be adopted by researchers, educators, clinicians, and administrators to effect transformative social change. It offers opportunities for anesthesiologists, critical care physicians, and medical practitioners to more broadly understand what it means to think queerly and how queering anesthesiology and critical care medicine spaces improves workplace culture and patient outcomes. This article grapples with the cis-heteronormative medical gaze and queer people's apprehensions of violence in medical settings to offer new ways of thinking about structural changes needed in medicine, medical language, and the dehumanizing application of medical modes of care. Using a series of clinical vignettes, this article outlines the historical context underlying queer peoples' distrust of medicine, a primer in queer theory, and an understanding of how to begin to "queer" medical spaces using this critical framework.
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Affiliation(s)
- Nicholas Hrynyk
- Department of Philosophy, History, and Politics, Thompson Rivers University, Kamloops, BC, Canada
| | - John K Peel
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jason Lajoie
- Department of English, University of Waterloo, Waterloo, ON, Canada
| | - Joshua Ng-Kamstra
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Department of Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Ayelet Kuper
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Mic Carter
- The Creative School, Toronto Metropolitan University, Toronto, ON, Canada
| | - Gianni R Lorello
- The Wilson Centre, University Health Network - University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada.
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- University Health Network-Toronto Western Hospital, 399 Bathurst Avenue, McL 2-405, Toronto, ON, M5T 2S8, Canada.
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Baillat L, Vayre E, Préau M, Guérin C. Burnout and Brownout in Intensive Care Physicians in the Era of COVID-19: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6029. [PMID: 37297633 PMCID: PMC10253172 DOI: 10.3390/ijerph20116029] [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: 02/23/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
The health crisis has had a strong impact on intensive care units. The objective of this study was to investigate the experience of resuscitation physicians during the COVID-19 health crisis to understand the associated determinants of quality of life, burnout, and brownout. This qualitative, longitudinal study covered two periods (T1, February 2021, and T2, May 2021). The data were collected in individual semi-directed interviews with 17 intensive care physicians (ICPs) (T1). Nine of the latter also participated in a second interview (T2). The data were examined using grounded theory analysis. We identified a multiplication of burnout and brownout indicators and factors already known in intensive care. In addition, burnout and brownout indicators and factors specific to the COVID-19 crisis were added. The evolution of professional practices has disrupted the professional identity, the meaning of work, and the boundaries between private and professional life, leading to a brownout and blur-out syndrome. The added value of our study lies in identifying the positive effects of the crisis in the professional domain. Our study revealed indicators and factors of burnout and brownout associated with the crisis among ICPs. Finally, it highlights the beneficial effects of the COVID-19 crisis on work.
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Affiliation(s)
- Léa Baillat
- Unité INSERM U1296—Radiations: Défense, Santé, Environnement, Université Lumière-Lyon 2, 69500 Bron, France
| | - Emilie Vayre
- Unité INSERM U1296—Radiations: Défense, Santé, Environnement, Université Lumière-Lyon 2, 69500 Bron, France
| | - Marie Préau
- Unité INSERM U1296—Radiations: Défense, Santé, Environnement, Université Lumière-Lyon 2, 69500 Bron, France
| | - Claude Guérin
- CHU de Lyon, Groupement Hospitalier Centre, Hospices Civils de Lyon, 69002 Lyon, France
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Savu C, Armaș I, Burcea M, Dobre D. Behind the scenes of the healthcare COVID-19 pandemic crisis: potential affecting factors of healthcare work sustainability in Romania during 2020-2022. Front Psychiatry 2023; 14:1179803. [PMID: 37324811 PMCID: PMC10267456 DOI: 10.3389/fpsyt.2023.1179803] [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: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Aim The COVID-19 pandemic represented a great disturbance for medical systems around the world, putting medical personnel on the front lines of the fight against the SARS-Cov2 virus. This fight was particularly impactful in countries with medical systems already facing various challenges, including Romania; where the pandemic unfolded in five waves that severely affected the psychological and physical well-being of medical professionals in terms of overload and continuous exposure to health threats. Against this background, our research aims to identify the mediating role of potential affecting factors of healthcare work sustainability during the change-related uncertainty conditions generated by the COVID 19 crisis. Dynamics and relations of nine carefully selected constructs were tracked along all five pandemic waves in Romania, which span from March 2020 to April 2022. The tested variables and constructs are perception of healthcare workers of their own state of health, their workplace safety, the work-family conflict, the satisfaction of basic needs, the work meaningfulness and work engagement, patient care, pandemic stress and burnout. Methods This cross-sectional study is based on an online snowball sampling of 738 health workers from 27 hospitals. Panel research is limited to a maximum of 61 respondents for two successive waves. The analytical part is built on means comparison of analysed variables between all five pandemic waves and an in-depth model to explain the relationships between the variables. Results The results indicate statistically significant correlations between the perception of health risks and all selected factors excluding patient care, which seems to be above the own health perception. The factors' dynamics was followed along all five pandemic waves. The developed model identified that one's health status satisfaction is a mediator of the family-work conflict and, together, of work engagement. In turn, work engagement plays a significant role in satisfying basic psychological needs and supporting work meaningfulness. Also, work meaningfulness influences the satisfaction of basic psychological needs. Discussion Health workers with higher levels of positive perceived health are better at managing pandemic stress, burnout effects and work-family imbalances. Adaptive behaviors and attitudes towards COVID-19 pandemic threats could be identified in later pandemic waves due to the progress in terms of medical protocols and procedures.
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Affiliation(s)
- Cristina Savu
- Faculty of Geography, University of Bucharest, Bucharest, Romania
| | - Iuliana Armaș
- Faculty of Geography, University of Bucharest, Bucharest, Romania
| | - Marin Burcea
- Faculty of Administration and Business, University of Bucharest, Bucharest, Romania
| | - Daniela Dobre
- Faculty of Geography, University of Bucharest, Bucharest, Romania
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Garner O, Velamuri K, Staggers K, Braun AB. Impact of the COVID-19 pandemic on the education and procedural volume of fellows in critical care medicine - a cross-sectional survey. BMC MEDICAL EDUCATION 2023; 23:371. [PMID: 37226108 DOI: 10.1186/s12909-023-04358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/12/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic has changed the way medical education is delivered. The purpose of this study was to assess the impact of the COVID-19 pandemic on the education and procedural volume of critical care and pulmonary critical care fellows. METHODS We conducted a cross-sectional, internet-based, voluntary, anonymous, national survey of adult critical care fellows and academic attending physicians in critical care and pulmonary critical care fellowship programs in the United States between December 2020 and February 2021. Survey questions covered both didactic and non-didactic aspects of education and procedural volumes. Answers were ranked on a 5-point Likert scale. Survey responses were summarized by frequency with percentage. Differences between the responses of fellows and attendings were assessed with the Fisher's exact or Chi-Square test, using Stata 16 software (StataCorp LLC, College Station, TX). RESULTS Seventy four individuals responded to the survey; the majority (70.3%) were male; less than one-third (28.4%) female. Respondents were evenly split among fellows (52.7%) and attendings (47.3%). 41.9% of survey respondents were from the authors' home institution, with a response rate of 32.6%. Almost two-thirds (62.2%) reported that fellows spend more time in the ICU since the onset of the pandemic. The majority noted that fellows insert more central venous catheters (52.7%) and arterial lines (58.1%), but perform fewer bronchoscopies (59.5%). The impact on endotracheal intubations was mixed: almost half of respondents (45.9%) reported fewer intubations, about one-third (35.1%) more intubations. Almost all respondents (93.0%) described fewer workshops; and one-third (36.1%) fewer didactic lectures. The majority (71.2%) noted less time available for research and quality improvement projects; half (50.7%) noted less bedside teaching by faculty and more than one-third (37.0%) less fellow interaction with faculty. Almost one-half of respondents (45.2%) reported an increase in fellows' weekly work hours. CONCLUSION The pandemic has caused a decrease in scholarly and didactic activities of critical care and pulmonary critical care fellows. Fellows spend more time in ICU rotations, insert more central and arterial lines, but perform fewer intubations and bronchoscopies. This survey provides insights into changes that have occurred in the training of critical care and pulmonary critical care fellows since the onset of the COVID-19 pandemic.
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Affiliation(s)
- Orlando Garner
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kanta Velamuri
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kristen Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Andrea Barbara Braun
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
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Weber C, Golding SE, Yarker J, Teoh K, Lewis R, Ratcliffe E, Munir F, Wheele T, Windlinger L. Work fatigue during COVID-19 lockdown teleworking: the role of psychosocial, environmental, and social working conditions. Front Psychol 2023; 14:1155118. [PMID: 37260958 PMCID: PMC10228694 DOI: 10.3389/fpsyg.2023.1155118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/21/2023] [Indexed: 06/02/2023] Open
Abstract
Background During national lockdowns in response to the COVID-19 pandemic, previously office-based workers who transitioned to home-based teleworking faced additional demands (e.g., childcare, inadequate homeworking spaces) likely resulting in poor work privacy fit. Previous office research suggests poor work privacy fit is associated with lower wellbeing and higher work fatigue. Emerging evidence suggests a relationship between childcare duties during pandemic teleworking and work fatigue. In addition to psychosocial working conditions (job demand, job control, and job change management), which are acknowledged predictors of work fatigue, this poses a significant threat to occupational health during pandemic teleworking. However, the relative effects of aspects of the psychosocial environment (job demands and resources), the home office environment (including privacy fit), and the social environment (childcare) on work fatigue as well as their interactions are under-explored. Objective This study examined the relationships between the psychosocial, environmental, and social working conditions of teleworking during the first COVID-19 lockdown and work fatigue. Specifically, the study examined teleworkers' physical work environment (e.g., if and how home office space is shared, crowding, and noise perceptions) as predictors of privacy fit and the relationship between privacy fit, childcare, psychosocial working conditions (job demand, job control, and job change management), and work fatigue. Work privacy fit was hypothesized to mediate the relationship between childcare and work fatigue. Methods An online cross-sectional survey was conducted with teleworkers (n = 300) during the first COVID-19 lockdown in April and May 2020; most participants were in Germany, Switzerland, and the United Kingdom. Results Path analysis was used to examine the hypothesized relationships. Privacy fit was lower for those reporting greater levels of noise in home-working spaces and those feeling crowded at home. Work fatigue was lower amongst those with greater privacy fit and higher amongst those with high levels of job demand. An indirect relationship was observed between childcare and work fatigue with privacy fit mediating this relationship. Conclusion The influence of privacy fit has so far been largely neglected in research on teleworking, especially during the pandemic. However, its contribution to workers' wellbeing should be acknowledged in occupational health strategies.
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Affiliation(s)
- Clara Weber
- Institute of Facility Management, School of Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Sarah E. Golding
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Joanna Yarker
- Department of Organisational Psychology, Birkbeck University of London, London, United Kingdom
| | - Kevin Teoh
- Department of Organisational Psychology, Birkbeck University of London, London, United Kingdom
| | - Rachel Lewis
- Department of Organisational Psychology, Birkbeck University of London, London, United Kingdom
| | - Eleanor Ratcliffe
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Theresa Wheele
- Institute of Facility Management, School of Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Lukas Windlinger
- Institute of Facility Management, School of Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
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Kok N, Van Gurp J, van der Hoeven JG, Fuchs M, Hoedemaekers C, Zegers M. Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study. BMJ Qual Saf 2023; 32:225-234. [PMID: 34187883 PMCID: PMC10086276 DOI: 10.1136/bmjqs-2020-012239] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Burnout threatens intensive care unit (ICU) professionals' capacity to provide high-quality care. Moral distress is previously considered a root cause of burnout, but there are other risk factors of burnout such as personality, work-life balance and culture. This study aimed to disentangle the associations of ICU professionals' moral distress and other risk factors with the components of burnout-emotional exhaustion, depersonalisation and personal accomplishment-suggesting informed burnout prevention strategies. METHODS Cross-sectional survey completed in 2019 of ICU professionals in two Dutch hospitals. The survey included validated measure for burnout (the Dutch Maslach Burnout Inventory), moral distress (Moral Distress Scale), personality (short Big Five Inventory), work-home balance (Survey Work-Home Interaction Nijmegen) and organisational culture (Culture of Care Barometer). Each of the three components of burnout was analysed as a separate outcome, and for each of the components, a separate regression analysis was carried out. RESULTS 251 ICU professionals responded to the survey (response rate: 53.3%). Burnout prevalence was 22.7%. Findings showed that moral distress was associated with emotional exhaustion (β=0.18, 95% CI 0.9 to 0.26) and depersonalisation (β=0.19, 95% CI 0.10 to 0.28) and with increased emotional exhaustion mediated by negative work-to-home spillover (β=0.09, 95% CI 0.04 to 0.13). Support from direct supervisors mitigates the association between moral distress and emotional exhaustion (β=0.16, 95% CI 0.04 to 0.27). CONCLUSIONS Understanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work-home imbalance. Interventions that support individual coping with moral distress and a work-home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses.
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Affiliation(s)
- Niek Kok
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Malaika Fuchs
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cornelia Hoedemaekers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Lima-Setta F, de Moraes CL, Silami PHNC, Reichenheim ME, de Mello E Silva JF, Stochero L, de Oliveira MBG, Robaina JR, Rodrigues-Santos G, de Almeida CG, Amoretti CF, Bellinat APN, Brandão IB, de Carvalho PB, Falcão RV, Gregory SC, de Lorena Jacques M, Sapolnik R, Jae CML, Koliski A, Krauzer JRM, de Lima LFP, Lorenzo VB, Cobas Macedo JHG, Zaponi Melek SL, Fonseca da Mota IC, Neves CC, Castro MA, Rascão FL, Massaud-Ribeiro L, Riveiro PM, Rodrigues KA, Scarlato ACCP, Peres da Silva T, Souza ACMCFF, de Araújo Torreão L, de Seixas Zeitel R, Alves da Cunha AJL, Prata-Barbosa A, de Magalhães-Barbosa MC. Mental Health and Emotional Disorders During the COVID-19 Pandemics: Prevalence and Extent in PICU Staff. Pediatr Crit Care Med 2023; 24:277-288. [PMID: 36534761 PMCID: PMC10072053 DOI: 10.1097/pcc.0000000000003119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the prevalence of burnout, anxiety and depression symptoms, and posttraumatic stress disorder (PTSD) in PICU workers in Brazil during the first peak of the COVID-19 pandemic. To compare the results of subgroups stratified by age, gender, professional category, health system, and previous mental health disorders. DESIGN Multicenter, cross-sectional study using an electronic survey. SETTING Twenty-nine public and private Brazilian PICUs. SUBJECTS Multidisciplinary PICU workers. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Self-reported questionnaires were used to measure burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), and PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) in 1,084 respondents. Subjects were mainly young (37.1 ± 8.4 yr old) and females (85%), with a median workload of 50 hours per week. The prevalence of anxiety and depression was 33% and 19%, respectively, whereas PTSD was 13%. The overall median burnout scores were high in the emotional exhaustion and personal accomplishment dimensions (16 [interquartile range (IQR), 8-24] and 40 [IQR, 33-44], respectively) whereas low in the depersonalization one (2 [IQR, 0-5]), suggesting a profile of overextended professionals, with a burnout prevalence of 24%. Professionals reporting prior mental health disorders had higher prevalence of burnout (30% vs 22%; p = 0.02), anxiety (51% vs 29%; p < 0.001), and depression symptoms (32.5% vs 15%; p < 0.001), with superior PCL-5 scores for PTSD ( p < 0.001). Public hospital workers presented more burnout (29% vs 18.6%, p < 0.001) and more PTSD levels (14.8% vs 10%, p = 0.03). Younger professionals were also more burned out ( p < 0.05 in all three dimensions). CONCLUSIONS The prevalence of mental health disorders in Brazilian PICU workers during the first 2020 peak of COVID-19 was as high as those described in adult ICU workers. Some subgroups, particularly those reporting previous mental disorders and younger professionals, should receive special attention to prevent future crises.
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Affiliation(s)
- Fernanda Lima-Setta
- Department of Pediatrics, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
- Pediatric Intensive Care Unit, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, RJ, Brazil
| | - Claudia Leite de Moraes
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, RJ, Brazil
- Postgraduate Program in Family Health, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil
| | - Pedro Henrique Nunes Costa Silami
- Pediatric Intensive Care Unit, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
- Pediatric Intensive Care Unit, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brazil
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Luciane Stochero
- Sergio Arouca National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | - Ricardo Viana Falcão
- Pediatric Intensive Care Unit, Hospital Geral Dr. Waldemar Alcântara, Fortaleza, CE, Brazil
| | - Simone Camera Gregory
- Pediatric Intensive Care Unit, Hospital Estadual da Criança, Rio de Janeiro, RJ, Brazil
| | | | - Roberto Sapolnik
- Pediatric Intensive Care Unit, Hospital São Rafael, Salvador, BA, Brazil
| | - Claudia Mei Lan Jae
- Pediatric Intensive Care Unit, Hospital Santo Antonio/Obras Sociais Irmã Dulce, Salvador, BA, Brazil
| | - Adriana Koliski
- Pediatric Intensive Care Unit, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | | | | | | | | | - Cinara Carneiro Neves
- Pediatric Intensive Care Unit, Hospital Infantil Albert Sabin, Fortaleza, CE, Brazil
| | - Mirela Alves Castro
- Pediatric Intensive Care Unit, Hospital Alvorada Moema, São Paulo, SP, Brazil
| | - Fernanda Lobo Rascão
- Pediatric Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | - Letícia Massaud-Ribeiro
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paula Marins Riveiro
- Pediatric Intensive Care Unit, Hospital Caxias D'Or, Duque de Caxias, RJ, Brazil
| | | | | | | | | | | | - Raquel de Seixas Zeitel
- Pediatric Intensive Care Unit, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Antonio José Ledo Alves da Cunha
- Department of Pediatrics, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Department of Pediatrics, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
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Papazian L, Hraiech S, Loundou A, Herridge MS, Boyer L. High-level burnout in physicians and nurses working in adult ICUs: a systematic review and meta-analysis. Intensive Care Med 2023; 49:387-400. [PMID: 36971792 PMCID: PMC10041519 DOI: 10.1007/s00134-023-07025-8] [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: 01/03/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The prevalence of burnout in intensive care unit (ICU) professionals is difficult to establish due to the variety of survey instruments used, the heterogeneity of the targeted population, the design of the studies, and the differences among countries regarding ICU organization. METHODS We performed a systematic review and meta-analysis examining the prevalence of high-level burnout in physicians and nurses working in adult ICUs, including only studies that use the Maslach Burnout Inventory (MBI) as a tool to evaluate burnout and involving at least 3 different ICUs. RESULTS Twenty-five studies with a combined population of 20,723 healthcare workers from adult ICUs satisfied the inclusion criteria. Combining 18 studies including 8187 ICU physicians, 3660 of them reported a high level of burnout (prevalence 0.41, range 0.15-0.71, 95% CI [0.33; 0.5], I2 97.6%, 95% CI [96.9%; 98.1%]). The heterogeneity can be at least in part explained by the definition of burnout used and the response rate as confirmed by the multivariable metaregression done. In contrast, there was no significant difference regarding other factors such as the study period (before or during the coronavirus disease 2019 (COVID-19) pandemic), the income of the countries, or the Healthcare Access and Quality (HAQ) index. Combining 20 studies including 12,536 ICU nurses, 6232 of nurses were reporting burnout (prevalence 0.44, range 0.14-0.74, [95% CI 0.34; 0.55], I2 98.6% 95% CI [98.4%; 98.9%]). The prevalence of high-level burnout in ICU nurses for studies performed during the COVID-19 pandemic was higher than that reported for studies performed before the COVID-19 pandemic (0.61 [95% CI, 0.46; 0.75] and 0.37 [95% CI, 0.26; 0.49] respectively, p = 0.003). As for physicians, the heterogeneity is at least in part explained by the definition used for burnout using the MBI but not by the number of participants. When compared, the prevalence of high-level burnout was not different between ICU physicians and ICU nurses. However, the proportion of ICU nurses with a high level of emotional exhaustion was higher than for ICU physicians (0.42 [95% CI, 0.37; 0.48] and 0.28 [0.2; 0.39], respectively, p = 0.022). CONCLUSION According to this meta-analysis, the prevalence of high-level burnout is higher than 40% in all ICU professionals. However, there is a great heterogeneity in the results. To evaluate and to compare preventive and therapeutic strategies, there is the need to use a consensual definition of burnout when using the MBI instrument.
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Affiliation(s)
- Laurent Papazian
- Centre Hospitalier de Bastia, 20600, Bastia, Corsica, France.
- Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France.
- Intensive Care Unit, Bastia General Hospital, Chemin de Falconaja, 20600, Bastia, Corsica, France.
| | - Sami Hraiech
- Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France
| | - Anderson Loundou
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Margaret S Herridge
- Critical Care and Respiratory Medicine, 22 Toronto General Research Institute, Institute of Medical Sciences, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
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Carter B. Unsettling the fluidity of practice and dealing with threat: the experiences of paediatric pharmacists in response to the admission of adult COVID-19 patients requiring intensive care in a paediatric tertiary hospital. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:86-94. [PMID: 36305688 PMCID: PMC9620377 DOI: 10.1093/ijpp/riac074] [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: 05/16/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The COVID-19 pandemic impacted the lives of pharmacists, resulting in new ways of working. Little literature focuses on the experiences and well-being of hospital pharmacists, particularly on paediatric pharmacists. The setting - a paediatric stand-alone tertiary hospital - opened to adult ICU COVID-19 patients for two time periods. Paediatric pharmacists had to shift their roles; this impacted their well-being. Paediatric ICU clinical psychologists provided support using a compassion-focused therapy (CFT) model to guide thinking, reflection and promoting behaviour change. This study aimed to explore the experiences and perceptions of the paediatric pharmacists working in a paediatric stand-alone tertiary hospital before, during and after the admission of adult COVID-19 patients into ICU and their experiences of support offered by clinical psychologists. METHODS A qualitative interpretative design using remote photo-elicitation interviews was adopted. Data analysis was undertaken using the six stages of reflexive thematic analysis. KEY FINDINGS Five paediatric pharmacists participated; four deployed to work in the A-ICU (from PICU) and one deployed to work in the PICU (from ward-based work). An overarching theme, 'Unsettling the fluidity of practice and dealing with threat', is supported by four key themes 'Context and preparation', 'Dread and challenges', 'Keeping it together' and 'Lessons learned'. The fluidity of the pharmacists' practice was unsettled as they dealt with the threats and sought resources (drive) to enable optimal care delivery. Soothe techniques helped compensate for threats, and promote resilience and well-being. CONCLUSION The CFT model has been useful in the longer term with the adoption of a more open, compassionate approach to their work and colleagues.
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Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Alkhamees AA, Aljohani MS, Kalani S, Ali AM, Almatham F, Alwabili A, Alsughier NA, Rutledge T. Physician's Burnout during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054598. [PMID: 36901612 PMCID: PMC10001574 DOI: 10.3390/ijerph20054598] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 05/09/2023]
Abstract
The burnout rate among physicians is expected to be higher during COVID-19 period due to the additional sources of physical and emotional stressors. Throughout the current COVID-19 pandemic, numerous studies have evaluated the impacts of COVID-19 on physicians' burnout, but the reported results have been inconsistent. This current systematic review and meta-analysis aims to assess and estimate the epidemiology of burnout and the associated risk factors during the COVID-19 pandemic among physicians. A systematic search for studies targeting physicians' burnout was conducted using PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, and pre-print services (PsyArXiv and medRχiv) for English language studies published within the time period of 1 January 2020 to 1 September 2021. Search strategies resulted in 446 possible eligible studies. The titles and abstracts of these studies were screened, which resulted in 34 probable studies for inclusion, while 412 studies were excluded based on the predetermined inclusion criteria. These 34 studies went through a full-text screening for eligibility, which resulted in 30 studies being included in the final reviews and subsequent analyses. Among them, the prevalence of physicians' burnout rate ranged from 6.0-99.8%. This wide variation could be due to the heterogeneity among burnout definitions, different applied assessment tools, and even cultural factors. Further studies may consider other factors when assessing burnout (e.g., the presence of a psychiatric disorders, other work-related and cultural factors). In conclusion, a consistent diagnostic indices for the assessment of burnout is required to enable consistent methods of scoring and interpretation.
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Affiliation(s)
- Abdulmajeed A. Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
- Correspondence:
| | - Moath S. Aljohani
- Department of Family and Community Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
| | - Simindokht Kalani
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan 8174673441, Iran
| | - Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 5424041, Egypt
| | - Fahad Almatham
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
| | - Afnan Alwabili
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
| | - Naif Abdullah Alsughier
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah 52571, Saudi Arabia
| | - Thomas Rutledge
- VA San Diego Healthcare System, Department of Psychiatry, Psychology Service, University of California San Diego, San Diego, CA 92093, USA
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Parsons Leigh J, Mizen SJ, Moss SJ, Brundin-Mather R, de Grood C, Dodds A, Honarmand K, Shah S, Mehta S. A qualitative descriptive study of the impact of the COVID-19 pandemic on staff in a Canadian intensive care unit. Can J Anaesth 2023; 70:384-394. [PMID: 36627462 PMCID: PMC9831684 DOI: 10.1007/s12630-022-02377-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/19/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE We sought to explore the lived experiences of a professionally diverse sample of healthcare workers (HCWs) in a single intensive care unit (ICU) serving a large and generalizable Canadian population. We aimed to understand how working during the COVID-19 pandemic affected their professional and personal lives, including their perceptions of institutional support, to inform interventions to ameliorate impacts of the COVID-19 and future pandemics. METHODS In this qualitative descriptive study, 23 ICU HCWs, identified using convenience purposive sampling, took part in individual semistructured interviews between July and November 2020, shortly after the first wave of the pandemic in Ontario. We used inductive thematic analysis to identify major themes. RESULTS We identified five major themes related to the COVID-19 pandemic: 1) communication and informational needs (e.g., challenges communicating policy changes); 2) adjusting to restricted visitation (e.g., spending less time interacting with patients); 3) staffing and workplace supports (e.g., importance of positive team dynamics); 4) permeability of professional and personal lives (e.g., balancing shift work and childcare); and 5) a dynamic COVID-19 landscape (e.g., coping with constant change). The COVID-19 pandemic contributed to HCWs in the ICU experiencing varied negative repercussions on their work environment, including staffing and institutional support, which carried into their personal lives. CONCLUSION Healthcare workers in the ICU perceived that the COVID-19 pandemic had negative repercussions on their work environment, including staffing and institutional support, as well as their professional and personal lives. Understanding both the negative and positive experiences of all ICU HCWs working during the COVID-19 pandemic is critical to future pandemic preparedness. Their perspectives will help to inform the development of mental health and wellbeing interventions to support staff during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, Second Floor, 2A01, Office 2A08, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| | - Sara J Mizen
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Stephana Julia Moss
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, USA
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Chloe de Grood
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Alexandra Dodds
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Sumesh Shah
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Klick JC, Syed M, Leong R, Miranda H, Cotter EK. Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the Longevity of a Critical Specialty. Anesthesiol Clin 2023; 41:303-316. [PMID: 36872006 PMCID: PMC9985495 DOI: 10.1016/j.anclin.2022.10.009] [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] [Indexed: 03/07/2023]
Abstract
A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical care physicians are especially affected. This article reviews the history of burnout in health care workers, presents the signs and symptoms, discusses the specific impact of the COVID-19 pandemic on intensive care unit caregivers, and attempts to identify potential strategies to combat the Great Resignation disproportionately affecting health care workers. The article also focuses on how the specialty can amplify the voices and highlight the leadership potential of underrepresented minorities, physicians with disabilities, and the aging physician population.
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Affiliation(s)
- John C Klick
- Department of Anesthesiology, University of Vermont Medical Center, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Madiha Syed
- Department of Intensive Care & Resuscitation, Anesthesiology Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code G58, Cleveland, OH 44195, USA
| | - Ron Leong
- Thomas Jefferson University Hospital, Sidney Kimmel Medial College, 111 South 11th Street, Gibbon Building, Suite 8130, Philadelphia, PA 19107, USA
| | - Haley Miranda
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA
| | - Elizabeth K Cotter
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA.
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Pan CX, Crupi R, August P, Sundaram V, Norful AA, Schwartz JE, Miele AS, Simons RR, Mikrut EE, Brondolo E. An Intensive Longitudinal Assessment Approach to Surveilling Trajectories of Burnout over the First Year of the COVID Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2930. [PMID: 36833628 PMCID: PMC9956892 DOI: 10.3390/ijerph20042930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Frontline clinicians responding to the COVID-19 pandemic are at increased risk of burnout, but less is known about the trajectory of clinician burnout as caseloads increase and decrease. Personal and professional resources, including self-efficacy and hospital support, can attenuate the risk of burnout. Yet, empirical data documenting how burnout and resources changed as the pandemic waxed and waned are limited. This intensive longitudinal prospective study employed ecological momentary assessment methods to examine trajectories of burnout and resources over the pandemic's first year in a New York City hospital. A 10-item survey was emailed every 5 days to frontline clinicians (physicians, nurses, and physician assistants). The primary outcome was a single-item validated measure of burnout; predictors included daily hospital COVID-19-related caseloads and personal and professional resources. Clinicians (n = 398) completed the initial survey and an average of 12 surveys over the year. Initially, 45.3% of staff reported burnout; over the year, 58.7% reported burnout. Following the initial COVID peak, caseloads declined, and burnout levels declined. During the second wave of COVID, as caseloads increased and remained elevated and personal and professional resource levels decreased, burnout increased. This novel application of intensive longitudinal assessment enabled ongoing surveillance of burnout and permitted us to evaluate how fluctuations in caseload intensity and personal and professional resources related to burnout over time. The surveillance data support the need for intensified resource allocation during prolonged pandemics.
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Affiliation(s)
- Cynthia X. Pan
- NewYork-Presbyterian Queens Hospital, Flushing, NY 11355, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Robert Crupi
- NewYork-Presbyterian Queens Hospital, Flushing, NY 11355, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Phyllis August
- NewYork-Presbyterian Queens Hospital, Flushing, NY 11355, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Varuna Sundaram
- NewYork-Presbyterian Queens Hospital, Flushing, NY 11355, USA
- Department of Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Joseph E. Schwartz
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Andrew S. Miele
- Department of Psychology, St. John’s University, New York, NY 11439, USA
| | - R. Rhiannon Simons
- Department of Psychology, St. John’s University, New York, NY 11439, USA
| | - Emilia E. Mikrut
- Department of Psychology, St. John’s University, New York, NY 11439, USA
| | - Elizabeth Brondolo
- Department of Psychology, St. John’s University, New York, NY 11439, USA
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Ishimaru T, Yoshikawa T, Okawara M, Kido M, Nakashima Y, Nakayasu A, Kimori K, Imamura S, Matsumoto K. Presenteeism in front-line physicians involved in COVID-19-related clinical practice: a national survey of employed physician members of the Japan Medical Association. Environ Health Prev Med 2023; 28:13. [PMID: 36740269 PMCID: PMC9922563 DOI: 10.1265/ehpm.22-00194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic may have increased the rate of presenteeism among front-line physicians. Presenteeism is the term used to describe attendance at work despite ill health that would normally prompt rest or absence from work. This study aimed to examine the associations between COVID-19 clinical practice and presenteeism among physicians. METHODS A cross-sectional study was conducted from December 2021 to January 2022. The questionnaires were distributed to 21,737 employed physicians who were members of the Japan Medical Association. Presenteeism was measured by the Work Functioning Impairment Scale. Multiple logistic regression analysis was used to evaluate the association between COVID-19 clinical practice and presenteeism. RESULTS Overall, 3,968 participants were included in the analysis, and presenteeism was observed in 13.9% of them. The rate of presenteeism significantly increased with both the number of COVID-19 patients treated and the percentage of work time spent treating these patients (both P values for trend < 0.001). In comparison to those not currently engaged in the treatment of COVID-19 patients, presenteeism was significantly higher among front-line (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.16-2.53) and second-line physicians supporting those in the front-line (aOR = 1.45, 95% CI: 1.17-1.78). There was no association between involvement in COVID-19 vaccination services and presenteeism. CONCLUSIONS The burden on front-line and second-line physicians in COVID-19 clinical practice must be minimized. Employed physicians also need to recognize the importance of communicating with their workplaces about presenteeism.
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Affiliation(s)
- Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Toru Yoshikawa
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Japan, Kawasaki, Japan
| | - Makoto Okawara
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Michiko Kido
- Department of Obstetrics & Gynecology, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | - Anna Nakayasu
- Department of Obstetrics & Gynecology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kokuto Kimori
- Exective Boards, Japan Medical Association, Tokyo, Japan
| | - Satoshi Imamura
- Exective Boards, Japan Medical Association, Tokyo, Japan,Imamura Clinic, Tokyo, Japan
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Brucki BM, Bagade T, Majeed T. A health impact assessment of gender inequities associated with psychological distress during COVID19 in Australia's most locked down state-Victoria. BMC Public Health 2023; 23:233. [PMID: 36732738 PMCID: PMC9894749 DOI: 10.1186/s12889-022-14356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/29/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Since March 2020, when the COVID19 pandemic hit Australia, Victoria has been in lockdown six times for 264 days, making it the world's longest cumulative locked-down city. This Health Impact Assessment evaluated gender disparities, especially women's mental health, represented by increased levels of psychological distress during the lockdowns. METHODS A desk-based, retrospective Health Impact Assessment was undertaken to explore the health impacts of the lockdown public health directive with an equity focus, on the Victorian population, through reviewing available qualitative and quantitative published studies and grey literature. RESULTS Findings from the assessment suggest the lockdown policies generated and perpetuated avoidable inequities harming mental health demonstrated through increased psychological distress, particularly for women, through psychosocial determinants. CONCLUSION Ongoing research is needed to elucidate these inequities further. Governments implementing policies to suppress and mitigate COVID19 need to consider how to reduce harmful consequences of these strategies to avoid further generating inequities towards vulnerable groups within the population and increasing inequalities in the broader society.
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Affiliation(s)
- Belinda M Brucki
- School of Medicine & Public Health, College of Health Medicine & Wellbeing, University of Newcastle, Callaghan, NSW, Australia.
| | - Tanmay Bagade
- School of Medicine & Public Health, College of Health Medicine & Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Public Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Tazeen Majeed
- School of Medicine & Public Health, College of Health Medicine & Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Public Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Burnout and Turnover Intention in Critical Care Professionals During the COVID-19 Pandemic in Japan: A Cross-sectional Survey. Ann Am Thorac Soc 2023; 20:262-268. [PMID: 36122173 PMCID: PMC9989855 DOI: 10.1513/annalsats.202201-029oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Rationale: The prevalence of burnout among critical care professionals during the coronavirus disease (COVID-19) pandemic varies in different countries. Objectives: To investigate the prevalence of burnout and turnover intention in Japanese critical care professionals in March 2021. Methods: This cross-sectional study used a web-based survey of Japanese critical care professionals working in 15 intensive care units in 15 prefectures. Burnout was measured using the Mini Z 2.0 Survey. Intention to leave (turnover intention) was assessed by survey. Resilience was measured using the Brief Resilience Scale (Japanese version). Demographics and personal and workplace characteristics were also collected. Results: Of 1,205 critical care professionals approached, 936 (77.6%) completed the survey. Among these, 24.3%, 20.6%, and 14.2% reported symptoms of burnout, depression, and anxiety, respectively. A total of 157 respondents (16.8%) reported turnover intention. On multivariate analysis, higher resilience scores (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.84-0.95; and OR, 0.94; 95% CI, 0.91-0.96) and perceived support from the hospital (OR, 0.64; 95% CI, 0.44-0.93; and OR, 0.54; 95% CI, 0.40-0.73) were associated with a lower odds of burnout and turnover intention, respectively. Conclusions: Approximately 24% and 17% of the Japanese critical care professionals surveyed had symptoms of burnout and turnover intention from critical care, respectively, during the COVID-19 pandemic. Such professionals require organizational support to cultivate both individual and organizational resilience to reduce burnout and turnover intention.
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McPeake J, Kentish-Barnes N, Banse E, Anderson L, Cuzco C, Azoulay E, Quasim T, Castro P, Puxty K. Clinician perceptions of the impact of ICU family visiting restrictions during the COVID-19 pandemic: an international investigation. Crit Care 2023; 27:33. [PMID: 36681838 PMCID: PMC9862209 DOI: 10.1186/s13054-023-04318-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To guarantee the safety of the public, clinicians and patients during the COVID-19 pandemic, hospital visits were severely restricted internationally. There are limited data on the precise impact of these visiting restrictions on Intensive Care Unit clinicians. Our objectives therefore were to explore the impact of family visitation restrictions on clinicians and care delivery and describe innovation alongside areas for potential improvement. METHODS A qualitative approach using focus groups was employed. We recruited members of the multi-disciplinary team from Spain, France and the UK. Framework analysis was used to synthesize and interpret data. RESULTS In total, 28 staff from multiple international sites contributed to data across six focus groups: 12 from the UK, 9 from France and 7 from Spain. In relation to the key aims, we derived four themes: the emergence of new technologies, relationships and rapport establishment, communication challenges and end-of-life care provision. Across each theme, the overarching concepts of clinician emotional exhaustion and emotional distress emerged alongside the negative impact on job satisfaction. CONCLUSION The impact of COVID-19 family visitation restrictions is far reaching. Future research should examine the wider impact of family presence in the ICU.
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Affiliation(s)
- Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Nancy Kentish-Barnes
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Emilie Banse
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Lynne Anderson
- Department of Anaesthetics, Golden Jubilee National Hospital, Glasgow, UK
| | - Cecilia Cuzco
- Medical Lntensive Care Unit, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Elie Azoulay
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Tara Quasim
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Pedro Castro
- Medical Lntensive Care Unit, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Kathryn Puxty
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Alhenaidi A, Al-Haqan A, Kelendar H, Al-Bader B, Alkandari O, Al-Zuabi H. The Association of Professional Burnout and Turnover Intentions Among Intensive Care Units Physicians: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231206253. [PMID: 37877580 PMCID: PMC10605698 DOI: 10.1177/00469580231206253] [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: 06/06/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023]
Abstract
Intensive Care Units (ICU) workers work in highly stressful conditions that make them prone to professional burnout, which can lead to high turnover rates. This study explores professional burnout levels among ICU workers in Kuwait general governmental hospitals (GGHs), their turnover intentions, and the correlation factors. A cross-sectional self-administered survey study was conducted. Professional burnout level was measured using the Copenhagen Burnout Inventory (CBI), while turnover intention was measured using the Turnover Intention Scale (TIS-6). Data were analyzed using STATA software, and descriptive, correlative, and comparative analyses were performed. Eighty-nine ICU physicians filled out the questionnaire. Most of the participants were males, married, non-Kuwaiti nationals, with 10 to 20 years of experience, and the mean age of respondents was 39.2. The total professional burnout score was high was 54.7 (17.6). There were high total average scores for the personal and work-related domains. Participants who were younger than 35 years of age and graduated before 5 to 10 years had higher levels of professional burnout compared to other groups. More than half of the sample expressed their intention to leave their current job as an ICU physician. However, no association was found between turnover intentions and levels of burnout. High levels of professional burnout of turnover intentions were seen among ICU physicians in Kuwait. Policies should be adopted to reduce and mitigate professional burnout among ICU physicians and increase their retention. Future research should further investigate professional burnout among ICU staff, the associated factors, and its relation to their turnover intention.
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Affiliation(s)
- Abdulaziz Alhenaidi
- Directorate of Planning and Monitoring, Ministry of Health, Kuwait
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Scotland
| | - Asmaa Al-Haqan
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait
| | - Hisham Kelendar
- Directorate of Planning and Monitoring, Ministry of Health, Kuwait
| | | | | | - Homoud Al-Zuabi
- Directorate of Non-Communicable Diseases Control and Prevention, Ministry of Health, Kuwait
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Rodriquez J. Reconfiguring the social organization of work in the intensive care unit: Changed relationships and new roles during COVID-19. Soc Sci Med 2023; 317:115600. [PMID: 36538836 PMCID: PMC9721201 DOI: 10.1016/j.socscimed.2022.115600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic caused hospitals to make changes to workflow that exacerbated emotional exhaustion and burnout among health care workers. This article examines one of those changes, restricted visitation, showing how it changed the social organization of work by upending established interactional patterns and relationships between health care workers, patients, and patients' families. Based on 40 interviews with intensive care unit (ICU) workers in units that were full of COVID-19 patients and had fully restricted visitation, study findings show that staff took on emotional support roles with patients that had typically been done by families at the bedside. They also faced increased anger, distrust, and misunderstandings from families who were not allowed to see their dying loved one. With each other, staff bonded together with dark humor and candid talk about the scale of deaths, constructing a shared understanding and solidarity amidst the tragedy of the pandemic.
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Affiliation(s)
- Jason Rodriquez
- Department of Sociology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA, 02115, USA.
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Müller MM, Baillès E, Blanch J, Torres X, Rousaud A, Cañizares S, Cervera Teruel M, Conti C, Dunne PJ, Stanculete MF, Farré JM, Font E, Gayán E, Guagnano MT, König S, Kundinger N, Lanzara R, Lobo A, Nejatisafa AA, Obach A, Offiah G, Peri JM, Rosa I, Schuster SK, Waller C, Stein B. Burnout among hospital staff during the COVID-19 pandemic: Longitudinal results from the international Cope-Corona survey study. J Psychosom Res 2023; 164:111102. [PMID: 36508846 PMCID: PMC9677553 DOI: 10.1016/j.jpsychores.2022.111102] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study. METHODS Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age. RESULTS A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients. CONCLUSION Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions. REGISTRATION Müller, M. M. (2020, August 30). Cope-Corona: Identifying and strengthening personal resources of hospital staff to cope with the Corona pandemic. Open Science Foundation.
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Affiliation(s)
- Markus M. Müller
- Corresponding author at: Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Prof-Ernst-Nathan-Str. 1, 90418 Nuremberg, Germany
| | - Eva Baillès
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Jordi Blanch
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Xavier Torres
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Araceli Rousaud
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Silvia Cañizares
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Marta Cervera Teruel
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Chiara Conti
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | | | - Mihaela Fadgyas Stanculete
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Josep Maria Farré
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Elena Font
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Elena Gayán
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Maria Teresa Guagnano
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Sarah König
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Nina Kundinger
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Roberta Lanzara
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Antonio Lobo
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Ali-Akbar Nejatisafa
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Amadeu Obach
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Gozie Offiah
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Josep Maria Peri
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Ilenia Rosa
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Sara Katharina Schuster
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Christiane Waller
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
| | - Barbara Stein
- Paracelsus Medical University, General Hospital Nuremberg, Department for Psychosomatic Medicine and Psychotherapy, Nuremberg, Germany.
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Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic has posed great challenges to intensive care units (ICUs) across the globe. The objective of this review is to provide an overview on how ICU surging was managed during COVID-19 pandemic, with a special focus on papers published in the last 18 months. RECENT FINDINGS From the onset of the COVID-19 pandemic, it was apparent that the biggest challenge was the inequity of access to an adequately equipped and staffed ICU bed. The first wave was overwhelming; large surge of patients required critical care, resources were limited and non-COVID-19 care processes were severely compromised. Various approaches were used to address ICU staffing shortage and to expand the physical ICU space capacity. Because of restrictions to family visitations in most ICUs, the pandemic posed a threat to communication and family-centered ICU care. The pandemic, especially during the first wave, was accompanied by a high level of apprehension in the community, many uncertainties about clinical course and therapy and an influx of speculations and misinformation. SUMMARY Although healthcare systems learned how to face some of the challenges with subsequent waves, the pandemic had persistent effects on healthcare systems.
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Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers. Curr Opin Crit Care 2022; 28:686-694. [PMID: 36302198 DOI: 10.1097/mcc.0000000000000994] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW. RECENT FINDINGS The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14-47%), burnout (45-85%), anxiety (31-60%), and depression (16-65%) have been reported, and these mental health symptoms are often interrelated. Most studies suggest that nurses and female HCW are at highest risk for developing mental health symptoms. The main personal concerns associated with reporting mental health symptoms among ICU HCW were worries about transmitting COVID-19 to their families, worries about their own health, witnessing colleagues contract the disease, and experiencing stigma from their communities. Major modifiable work-related risk factors were experiencing poor communication from supervisors, perceived lack of support from administrative leadership, and concerns about insufficient access to personal protective equipment, inability to rest, witnessing hasty end-of-life decisions, and restriction of family visitation policies. SUMMARY The COVID-19 pandemic has severely impacted ICU HCW worldwide. The psychological trauma, manifesting as posttraumatic stress disorder, burnout, anxiety, and depression, is substantial and concerning. Urgent action by lawmakers and healthcare administrators is required to protect ICU HCW and sustain a healthy workforce.
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Burnout Syndrome During COVID-19 Second Wave on ICU Caregivers. J Crit Care Med (Targu Mures) 2022; 8:266-272. [DOI: 10.2478/jccm-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
The main objective of this article is to evaluate the prevalence of burnout syndrome (BOS) among the Intensive Care Unit (ICU) healthcare workers.
Methods
The COVID-impact study is a study conducted in 6 French intensive care units. Five units admitting COVID patient and one that doesn’t admit COVID patients. The survey was conducted between October 20th and November 20th, 2020, during the second wave in France. A total of 208 professionals responded (90% response rate). The Maslach Burnout Inventory scale, the Hospital Anxiety and Depression Scale and the Impact of Event Revisited Scale were used to study the psychological impact of the COVID-19 Every intensive care unit worker.
Results
The cohort includes 208 professionals, 52.4% are caregivers. Almost 20% of the respondents suffered from severe BOS. The professionals who are particularly affected by BOS are women, engaged people, nurses or reinforcement, not coming willingly to the intensive care unit and professionals with psychological disorders since COVID-19, those who are afraid of being infected, and people with anxiety, depression or post-traumatic stress disorder. Independent risk factors isolated were being engaged and being a reinforcement. Being a volunteer to come to work in ICU is protective. 19.7% of the team suffered from severe BOS during the COVID-19 pandemic in our ICU. The independent risk factors for BOS are: being engaged (OR = 3.61 (95% CI, 1.44; 9.09), don’t working in ICU when it’s not COVID-19 pandemic (reinforcement) (OR = 37.71 (95% CI, 3.13; 454.35), being a volunteer (OR = 0.10 (95% CI, 0.02; 0.46).
Conclusion
Our study demonstrates the value of assessing burnout in health care teams. Prevention could be achieved by training personnel to form a health reserve in the event of a pandemic.
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Lluch-Sanz C, Galiana L, Tomás JM, Oliver A, Vidal-Blanco G, Sansó N. Using latent profile analysis to understand palliative care professionals' quality of life during the COVID-19 pandemic. CURRENT PSYCHOLOGY 2022; 42:1-13. [PMID: 36406840 PMCID: PMC9649396 DOI: 10.1007/s12144-022-03958-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/12/2022]
Abstract
Healthcare workers' professional quality of life has been increasingly under the spotlight, even more so during the COVID-19 pandemic, which has posed a genuine challenge for them. This study aims to describe the professional quality of life profiles of a sample of Spanish palliative care professionals during the COVID-19 pandemic, encompassing aspects such as work satisfaction, burnout, compassion fatigue, and compassion satisfaction; while studying the relationships between these profiles and sociodemographic variables, clinical situations experienced during the pandemic, protectors of professional quality of life, the quality of care delivered, and the professionals' wellbeing. Data from a survey of Spanish palliative care professionals were used. The variables measured were professional quality of life, sociodemographic characteristics, COVID-19-related experiences, protectors of professional quality of life, wellbeing, and quality of care. Our research included latent profile analyses, along with chi-squared and t-tests. The results suggested two profiles of professional quality of life, namely low (32.78%) and high (67.22%). The following profile displayed a higher likelihood of having a low professional quality of life: younger professionals, registered nurses, with a decrease in their teamwork, without specific training in palliative care, in coping with death and stress or emotional training and with lower levels of self-care and self-compassion, whose patients were unable to die a dignified death. Similarly, a low professional quality of life profile was associated with reduced wellbeing and poorer quality of care offered. In conclusion, providing professionals with education and training to improve their ability to handle end-of-life care and stress, maintaining cohesive teams and promoting self-care and self-compassion are pivotal to maintaining the quality of life and wellbeing of palliative care professionals and the quality of care that they provide.
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Affiliation(s)
- Cristina Lluch-Sanz
- Department of Methodology for the Behavioral Sciences, University of Valencia, Av. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Laura Galiana
- Department of Methodology for the Behavioral Sciences, University of Valencia, Av. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - José M. Tomás
- Department of Methodology for the Behavioral Sciences, University of Valencia, Av. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Amparo Oliver
- Department of Methodology for the Behavioral Sciences, University of Valencia, Av. Blasco Ibañez, 21, 46010 Valencia, Spain
| | | | - Noemí Sansó
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Cra. de Valldemossa, Km 7.5, 07120 Palma, Spain
- Balearic Islands Health Research Institute (IDISBA), Palma, Spain
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