Burnout among primary health-care professionals in low- and middle-income countries: systematic review and meta-analysis

Burnout syndrome and psychological workplace violence among Peruvian physicians: a cross-sectional study

BACKGROUND

Physicians face increased emotional weariness as a result of the inherent stress and responsibility of their roles. In addition, they are vulnerable to abuse, coercion, and aggressiveness in their workplace settings. The link between burnout syndrome and psychological workplace violence (WPV) is complex and must be viewed as bidirectional. We assessed the association between the levels of burnout and psychological WPV among their colleagues among Peruvian physicians.

METHODS

We performed a cross-sectional study that surveyed licensed Peruvian physicians actively practicing clinical medicine from April to December 2023. A non-probability convenience sampling via hospital interviews and diffusion through online platforms was carried out. The SPV-Health scale, validated for the Peruvian context, assessed psychological violence, while the MBI-HSS evaluated burnout dimensions. Descriptive statistics and Poisson regression models, adjusting for covariates, were employed for analysis.

RESULTS

We included 384 medical doctors; most participants worked in urban areas, with nearly half being specialists or subspecialists, predominantly in medicine services. Physicians experiencing burnout were 4.04 times more likely to encounter psychological violence compared to those without burnout (95% CI: 2.45-6.57), even after adjusting for age, sex, medical positions and years of medical practice (PR: 3.93; 95% CI: 2.35-6.57). Among the risk factors for psychological violence, being a resident practitioner was the only significant one (PR: 1.79; 95% CI: 1.18-2.73).

CONCLUSION

Our study underscores a significant association between Burnout Syndrome among Peruvian doctors and their experience of psychological WPV from colleagues. Tailored interventions addressing these challenges are imperative, with organizational strategies offering potential while interventions for WPV require further investigation.

Mitigating Burnout: The Role of Healthcare Organizations

Even before the coronavirus disease (COVID-19) pandemic, burnout in healthcare providers had reached crisis levels, with up to 50% of nurses and 40% of physicians experiencing symptoms of burnout. Because of the immense work-related stress during the pandemic, healthcare providers' burnout dramatically escalated, with percentages reaching as high as 70-90%, and many healthcare providers started to leave their profession. As a result, patients are beginning to experience the deleterious impact of extreme staffing shortages in healthcare facilities. Burnout interventions are defined as either organizational or individually focused. Organizational interventions address problems such as electronic medical records, documentation, or billing systems. Individual interventions provide the necessary skills to address specific job-related stressors. Ideally, the most effective interventions would combine these two categories by teaching healthcare providers to cope with job-related stressors in a safe community that is supported by the healthcare organization. The adoption of combined organizational and individual programs will improve healthcare providers' job satisfaction, decrease burnout and other forms of psychological distress, enhance job retention, and return joy to health care. The resulting decreased turnover rates would also reduce some of the skyrocketing healthcare costs, as turnover is expensive for healthcare organizations. Ultimately, enhancing healthcare providers' well-being would improve the care we deliver to our patients. In this article, I explain why it is a critical time in health care and highlight four general principles that frame the development of specific well-being interventions. Finally, I discuss several interventions that could enhance the well-being of healthcare providers and ultimately transform the culture of health care.

Occupational burnout among healthcare workers in Central Asia during the COVID-19 pandemic

Occupational burnout (OB) among healthcare workers (HCWs) has significant implications for workforce sustainability and patient care. The COVID-19 pandemic exacerbated existing stressors, highlighting the urgent need to investigate burnout prevalence and associated factors among HCWs in Central Asia (CA). This study aimed to assess burnout levels, explore contributing factors, and evaluate the impact of job satisfaction and pandemic-related stressors. A cross-sectional online survey was conducted between July and November 2022 among physicians and nurses in Kazakhstan, Kyrgyzstan, and Uzbekistan. The survey included the Copenhagen Burnout Inventory (CBI), a validated job satisfaction scale, and a measure assessing the impact of COVID-19 on work and personal life. Burnout prevalence and associated factors were analyzed using regression modeling and mediation analysis. Among 2685 HCWs (Kazakhstan: 67.7%, Kyrgyzstan: 19.9%, Uzbekistan: 12.4%), the overall prevalence of OB was 28.3%. Physicians had higher burnout levels than nurses, with job satisfaction playing a mediating role in this disparity in Kazakhstan and Kyrgyzstan. A poor work environment and high job demands were strongly linked to OB (p < 0.001). HCWs with severe COVID-19 histories experienced significantly greater burnout (OR 1.346-2.270, p < 0.05). Pandemic-related stressors, including social stigma, excessive workload, and lack of appreciation, were significant predictors of burnout. OB remains a critical issue among HCWs in CA, with job satisfaction, workplace conditions, and pandemic-related stressors playing key roles. Targeted interventions, such as workload optimization, institutional support, and mental health resources, are essential to mitigate OB and improve HCW well-being.

Creative Arts Therapy Reduces Psychological Distress in Nonpatient-Facing Healthcare Workers

BACKGROUND

Our aim was to assess the feasibility, acceptability, and efficacy of a 12-week in-person Creative Arts Therapy intervention in reducing psychological distress and burnout symptoms in nonpatient-facing healthcare workers. Burnout and psychological distress among nonpatient-facing healthcare workers are significant and understudied problems in healthcare systems.

METHODS

Nonpatient-facing healthcare workers with burnout symptoms were randomly assigned to one of 4 Creative Arts Therapy modalities (art, music, creative writing, or dance/movement) or a control group. The intervention consisted of 12 weekly 90-minute sessions. All participants completed baseline and follow-up assessments postintervention and at 4-, 8-, and 12-months. Primary outcomes were feasibility (session attendance) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Secondary outcomes included changes in psychological distress; symptoms of burnout, anxiety, and depression; and turnover intention.

RESULTS

Of 168 active participants, 164 (98%) completed postintervention surveys, with 90% follow-up at 12 months. Participants attended a mean of 10.7 sessions (SD = 3.2). The median CSQ-8 score for the program was 31 (17-32). Intervention group participants demonstrated significant improvements in symptoms of anxiety (-40.6%), depression (-29.0%), emotional exhaustion (-15.0%), and depersonalization (-14.3%), and reduced turnover intention (-6.1%) compared to the control group. At 12-months, improvements in depressive and anxiety symptoms persisted.

CONCLUSIONS

The Creative Arts Therapy intervention was feasible, acceptable, and effective in reducing psychological distress and burnout symptoms among nonpatient-facing healthcare workers.

Development and validation of a nomogram for predicting high-burnout risk in nurses

AIM

To develop a predictive model for high-burnout of nurses.

DESIGN

A cross-sectional study.

METHODS

This study was conducted using an online survey. Data were collected by the Chinese Maslach Burnout Inventory-General Survey (CMBI-GS) and self-administered questionnaires that included demographic, behavioural, health-related, and occupational variables. Participants were randomly divided into a development set and a validation set. In the development set, multivariate logistic regression analysis was conducted to identify factors associated with high-burnout risk, and a nomogram was constructed based on significant contributing factors. The discrimination, calibration, and clinical practicability of the nomogram were evaluated in both the development and validation sets using receiver operating characteristic (ROC) curve analysis, Hosmer-Lemeshow test, and decision curve analysis, respectively. Data analysis was performed using Stata 16.0 software.

RESULTS

A total of 2750 nurses from 23 provinces of mainland China responded, with 1925 participants (70%) in a development set and 825 participants (30%) in a validation set. Workplace violence, shift work, working time per week, depression, stress, self-reported health, and drinking were significant contributors to high-burnout risk and a nomogram was developed using these factors. The ROC curve analysis demonstrated that the area under the curve of the model was 0.808 in the development set and 0.790 in the validation set. The nomogram demonstrated a high net benefit in the clinical decision curve in both sets.

CONCLUSION

This study has developed and validated a predictive nomogram for identifying high-burnout in nurses.

RELEVANCE TO CLINICAL PRACTICE

The nomogram conducted by our study will assist nursing managers in identifying at-high-risk nurses and understanding related factors, helping them implement interventions early and purposefully.

REPORTING METHOD

The study adhered to the relevant EQUATOR reporting guidelines: TRIPOD Checklist for Prediction Model Development and Validation.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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

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

Burnout Among Primary Healthcare Nurses: A Study of Association With Depression, Anxiety and Self-Efficacy

Burnout is a significant issue among healthcare professionals, particularly nurses, due to high workloads and emotional demands. However, limited research has explored burnout among primary healthcare nurses in Saudi Arabia, who play a vital role in healthcare delivery. This study aims to address this gap by investigating burnout levels and their association with anxiety, depression and self-efficacy among primary healthcare nurses. A cross-sectional survey design was employed, with 161 primary healthcare nurses from the Qassim region, Saudi Arabia. Data were collected using the Maslach Burnout Inventory, the Patient Health Questionnaire-4 and the General Self-Efficacy Scale. Pearson correlation and logistic regression were used to analyse the associations between study variables. A high prevalence of burnout risk (78.9%) was observed. Emotional exhaustion was detected in 35.4%, depersonalisation in 44.7% and low personal accomplishment in 57.8%. Anxiety (r = 0.707, p < 0.01) and depression (r = 0.564, p < 0.01) were positively correlated with emotional exhaustion, while self-efficacy was negatively correlated (r = -0.260, p < 0.05). Logistic regression analysis revealed that anxiety (OR = 5.784, 95% CI: 2.056-16.269) and low self-efficacy (OR = 6.625, 95% CI: 2.979-14.737) were significant predictors of burnout. Targeted interventions are essential to mitigate burnout among primary healthcare nurses. Specific measures could include mindfulness-based stress reduction programmes to address emotional exhaustion, peer support sessions to reduce depersonalisation and skill-building workshops to enhance self-efficacy. These interventions can improve nurse well-being and ensure sustainable healthcare delivery in primary care settings.

Recognizing and addressing burnout among healthcare workers in rural Nepal: a proof-of-concept study using Kern's six-step theoretical framework

INTRODUCTION

Healthcare provider burnout is highly prevalent and has negative consequences. However, many healthcare workers in LMICs, including Nepal, rarely recognize or ameliorate it. This problem is worse in rural settings. Competency-focused interventions that are developed using theoretical frameworks can address this gap.

METHODS

We used Kern's framework of curriculum development to create, refine, and assess a theory-driven intervention tailored to the needs and constraints of rural healthcare workers in Nepal. During the first phase, we conducted a targeted needs assessment using an online survey among nine rural primary care physicians working in Charikot Hospital. We then developed learning objectives for knowledge, attitude, and skills domains based on the World Health Organization (WHO) definition of burnout. Then, we created animated educational videos designed to meet the learning objectives. We then implemented the educational intervention with rural physicians and assessed their knowledge, attitudes, and feedback. During the second phase, we further developed the intervention based on findings from the first phase and assessed acceptability, feasibility, and preliminary impact using pre- and post-intervention questionnaires and key informant interviews.

RESULTS

In the first phase, nine physicians participated in the targeted needs assessment, and eight responded to the post-intervention assessment. In the second phase, 18 attendees completed the pre-intervention burnout assessment, and 16 completed both the pre-test and post-test questionnaires. On the pre-test, correct answers across questions ranged from 31-88%, while on the post-test, participants responded correctly 88-100% of the time. Related-samples Wilcoxon signed-rank test showed a statistically significant difference (P = 0.007) in the post-test scores on the knowledge domain. Qualitative results showed burnout as an unrecognized and unreported issue, and its drivers included stigma and feelings of helplessness. Participants praised the interventions and reported that they translated learned skills into practice.

CONCLUSION

In this proof-of-concept study, we found that educational interventions developed using a theory-driven framework to meet the unique needs of rural healthcare workers are acceptable and feasible. Future studies can test the intervention impact in well-powered trials to support scale-up efforts to identify and address burnout.

Anxiety and depression screening reveals the importance of advancing mental health support for Haitian healthcare providers

Despite the recent momentum of mental health advocacy and resource allocation in several nations worldwide, the same progress is yet to be experienced in Haiti and other countries in the global south. In addition to the ongoing humanitarian crisis that continues to pre-dispose the people of Haiti to a variety of health conditions and mental illnesses, Haitian healthcare providers face further vulnerability to mental illness due to the high-stress nature of their work in a resource-limited environment. This study was conducted using a self-report questionnaire containing the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 screening tools, distributed to Haitian healthcare providers nationwide. The results revealed that 84% of the 106 participants experienced mild to severe symptoms of depression, while 69% reported mild to severe symptoms of anxiety. This study also found that social determinants, including community violence, economic and social instability, and poverty, are among the most detrimental contributing factors to the mental health of Haitian healthcare providers. Despite the acute need for support, 76% of participants also reported having either no awareness or no access to mental health support. These findings serve as an urgent call for action to improve access to mental health resources for Haitian healthcare providers.

Exploring the bidirectional relationship between job burnout and empathy in nurses: A longitudinal study

OBJECTIVES

This study explored the bidirectional relationship between job burnout and empathy among Chinese nurses.

METHODS

A nurse cohort was assessed longitudinally in 2020 (T1) and 2022 (T2). Participants completed the Maslach Burnout Inventory (MBI)-Human Services Survey and the Jefferson Scale of Empathy-Health Professionals.

RESULTS

Out of the 1090 nurses who participated in both assessments, 551 (50.6 %) exhibited job burnout. Nurses with no burnout, discontinued burnout, and newly developed burnout groups had higher levels of empathy than the persistent burnout group. There is a bidirectional negative association between empathy and job burnout, particularly in the depersonalization and low personal accomplishment. Notably, empathy did not predict the emotional exhaustion from burnout, but heightened emotional exhaustion predicted diminished empathy.

CONCLUSION

The findings suggest a significant bidirectional negative association between empathy and job burnout, especially in depersonalization and low personal accomplishment. Notably, nurses without burnout, discontinued burnout, and newly developed burnout exhibited higher levels of empathy, emphasizing the potential impact of addressing and mitigating burnout on fostering empathetic behavior.

PRACTICE IMPLICATIONS

Interventions targeting both burnout and empathy are vital for nurses. Recognizing and addressing burnout can positively impact fostering empathetic behavior in nursing practice.

Changes in primary healthcare workforce burnout during and after the termination of COVID-19 emergency response: A one-and-half-year observational study

Background

Primary healthcare workforce (PHCW) should be suffered from less burnout after the termination of the COVID-19 response. The current study compared the changes in the three dimensions of burnout in PHCW during and after the response.

Methods

Two convenience-sampling, online, cross-sectional questionnaire studies were conducted in local PHCW. Studies were administered in April 2022 and 8 months after the termination. Burnout was measured by the Chinese version of 15-item Maslach Burnout Inventory-General Survey, which assesses three dimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (reduced PA). The primary outcome was the prevalence of its three dimensions. Data on demographics, work environment, health conditions, and outlets for stress reduction were collected. We compared burnout and associated factors between the study periods by using Student's t-test, Chi test, or Mann‒Whitney test. The association between factors and burnout was identified by a logistic regression model.

Results

In total, 162 and 200 participants completed the questionnaires during and after the response. No significant differences in demographics, including age, gender, education attainment, work experience, or seniority level were observed. The prevalence of burnout-free status was similar (9.9% vs 12.5%, P = 0.434) between the two periods. Severe burnout decreased from 45.7% to 0%, and moderate burnout nearly doubled after the response. The prevalence of EE decreased the most, by 55.0%, followed by that of DP, which decreased by 38.4% (all P < 0.001); however, there was no difference in the prevalence of reduced PA (77.2% vs 74.5%, P = 0.557). Logistic regression showed that promotion and alcohol consumption decreased the risk of EE. Considering leaving the job increases the risk of DP, a lower self-evaluated health score and more distress were associated with EE and DP. Exercise decreased the risk of reduced PA.

Conclusions

Inconsistent with the hypothesis, we found that severe burnout decreased, but moderate burnout increased in PHCWs after the response. EE and DP decreased more, but reduced PA had no change. Incentives, improved self-evaluated health conditions, alcohol consumption, and exercise ameliorate burnout. Healthcare policy makers must consider multiple effective ways to mitigate burnout in the post-epidemic era.

Promoting Global Cardiovascular Health to Advance the Sustainable Development Agenda

The burden of cardiovascular disease has declined in high-income countries in the past 3 decades but is growing in low- and middle-income countries due to epidemiological, demographic, and socioeconomic shifts. A range of cost-effective policies and interventions are available for advancing cardiovascular health (CVH) through primordial, primary, and secondary prevention. We showcase multifaceted challenges that stifle the global progress of CVH including shortcomings in financial protection, health systems, primary health care, national health policies, service coverage, and surveillance. We highlight the under-acknowledged global disparities in health expenditure and health workforce capacities. We emphasize the need of addressing social and commercial determinants of health and a more granular analysis of challenges to implement context-appropriate national CVH responses, particularly in low- and middle-income countries. Finally, we propose progressive realization of universal health coverage and national health policy reform as sustainable strategies for overcoming the barriers to achieve CVH in order to reduce premature mortality from noncommunicable diseases by one-third by 2030 (Sustainable Development Goal target 3.4).

Feasibility of a custom-tailored, evidence-based, theory-informed, intervention to prevent burnout and reduce stress for healthcare professionals: protocol for a single-arm trial

BACKGROUND

Healthcare professionals face high levels of occupational stress, time pressure, workload, and poor organizational support. This makes them particularly vulnerable to burnout. The COVID-19 pandemic has further exacerbated this situation. This single-arm, multicenter, mixed-methods feasibility study pilots the LAGOM program: A tailored, evidence-based intervention to prevent burnout and reduce stress among healthcare professionals.

METHODS

Participants will include healthcare professionals (N = 30) working at Charité-Universitätsmedizin Berlin and Immanuel Hospital, Berlin. LAGOM focuses on support for individual behavior change and personal resources and also addresses the organizational level. The intervention´s feasibility will be evaluated through a non-randomized feasibility trial with a mixed methods process evaluation. The exploratory primary study aims are to assess the acceptability and feasibility of the (1) evaluation procedures and of the (2) intervention content and structure using study records, standardized questionnaires, protocol checklists, and diaries. Exploratory effectiveness analysis will take place as well. Further, semi-structured interviews (n = 3 to 6) and electrophysiological measurements (n = 20) will be conducted.

DISCUSSION

Custom-tailored, well-implemented multi-level interventions are needed to prevent burnout and reduce stress among healthcare professionals. Long-term strategies are warranted to sustainably implement effective programs. This feasibility study helps to refine trial procedures and content of the LAGOM program for a randomized controlled trial to evaluate the intervention's effectiveness.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00032014 , registered 17th October 2023.

Beyond the Pandemic: Longitudinal Lessons on Social Support, Sleep Quality, and Burnout Among Healthcare Workers

OBJECTIVES

To assess occupational burnout (OB) changes among Brazilian healthcare workers (HCWs) from COVID-19 onset to 6 months later (T1) and identify risk and protective factors.

METHODS

Using the Copenhagen Burnout Inventory and hierarchical multivariate linear regression in a two-stage online survey (initial n = 1054; T1 n = 316), this study examined the impact of various factors on OB.

RESULTS

Significant increases in personal and work-related OB were observed by T1. Psychiatric diagnosis and workload emerged as risk factors ( P < 0.01), while having a partner, good family relations, workplace well-being, and adequate sleep were protective ( P < 0.001).

CONCLUSIONS

OB levels among Brazilian HCWs increased during the COVID-19 pandemic. Interventions should target personal and organizational wellness to alleviate burnout, emphasizing the importance of strong relationships, workplace health, and good sleep practices.

Factors Associated with Stress among Healthcare Personnel after COVID-19 in Northeast Thailand: A Cross-sectional Study

Background

The coronavirus disease (COVID-19) has affected people psychologically worldwide, particularly healthcare personnel. Even though the COVID-19 pandemic situation has eased, healthcare personnel must still perform their duties, which has resulted in psychological impacts, particularly stress.

Objectives

This study aimed to examine the risk factors associated with stress among healthcare personnel post-COVID-19 pandemic in northeast Thailand.

Methods

A cross-sectional analytic design was conducted from January to April 2023. One thousand and three hundred healthcare workers were selected from primary, secondary, and tertiary hospitals across 16 districts within Chaiyaphum province. The questionnaires were used to collect data, and the stress test 5 (ST-5) questionnaire was used to investigate stress among healthcare personnel.

Results

The overall stress rate for healthcare workers was 15.47%, including very severe (8.85%) and severe (6.62%). The factors associated with stress consisted of work position, environment of work, personal life such as education level and income, and responsibility for taking care of family members, in addition to experiencing quarantine from COVID-19 were more likely to have a high risk of stress problems among healthcare workers.

Conclusion

This result highlighted that the mental health of personnel should be in critical situations, and those found severely afflicted should undergo professional care. To prevent psychological issues, particularly stress, health organizations should be concerned with strong organizational management, which includes supporting bonuses and providing high-quality personal protective equipment (PPE) to healthcare staff.

Mitigating burnout and suicidal ideation in the Brazilian health care workforce: the role of workplace support during COVID-19

Introduction

The mental health of health care workers has become a major concern, especially in the context of the COVID-19 pandemic. Identifying associated factors that could be targeted for prevention and specific interventions is crucial.

Objectives

To investigate burnout, suicidal ideation, and associated factors among Brazilian health care workers during the pandemic.

Methods

A cross-sectional web-based survey was conducted from May 22 to June 22, 2020. The Copenhagen Burnout Inventory was used to assess three dimensions of burnout (personal, work-related, and client-related). Individual and occupational data were also evaluated.

Results

Among 844 participants (81% female, age 41.9 ± 10.9 years), clinically relevant burnout rates were 54.6% according to the Copenhagen Burnout Inventory personal dimension, with an 8.3% incidence of suicidal ideation in the last month. Workplace support exhibited the strongest association with all three burnout dimensions (β = -0.29-0.37; p < 0.001) and suicidal ideation (Exp[b] = 0.95; p = 0.002), emerging as a crucial protective factor, even when adjusting for other variables. Older age, higher household income, and regular physical exercise also emerged as protective factors against burnout, but not against suicidal ideation. Female gender, direct involvement in care of COVID-19 patients, longer working hours, and self-perceived high-risk status for COVID were risk factors solely for burnout. Childhood trauma and a history of psychiatric diagnosis were associated with both burnout and suicidal ideation.

Conclusions

Fostering a supportive work environment could prove to be an efective strategy to mitigate mental health risks among health care workers in response to chronic stress, even in vulnerable contexts such as major health crises.

Workplace Violence and Burnout among Health Workers Two Years after the COVID-19 Outbreak in Wuhan, China: The Chain Mediation Effect of Sleep Disturbance and Work Ability

BACKGROUND

Health workers (HWs) faced considerable psychosocial hazards during the COVID-19 pandemic, which profoundly affected their occupational health and job performance. The potential indirect relationship between workplace violence (WPV) and burnout among HWs needs to be further explored. The purpose of this study is to examine the chain mediating effects of sleep disturbance and work ability in the relationship between WPV and burnout among HWs.

METHODS

A cross-sectional study was conducted in a secondary hospital two years after the COVID-19 outbreak in Wuhan, China. A sample of 571 HWs was recruited using a cluster sampling method, achieving a response rate of 80.06%. Participants completed self-report questionnaires that included demographic information and measures of WPV, burnout, sleep disturbance, and work ability.

RESULTS

The prevalence rates of burnout and WPV among HWs two years after the COVID-19 outbreak were 37.30% and 31.52%, respectively. WPV was significantly associated with burnout (β = 0.446, p < 0.001). Sleep disturbance was identified as a mediator in the relationship between WPV and burnout (β = 0.063, 95% CI: 0.027-0.105), accounting for 14.13% of the total effect. Similarly, work ability also played a mediating role in this relationship (β = 0.142, 95% CI: 0.065-0.225), accounting for 31.84%. Additionally, both sleep disturbance and work ability exhibited a chain mediation effect on the association between WPV and burnout (β = 0.020, 95% CI: 0.008-0.036), and the total indirect effect accounted for 50.67%.

CONCLUSIONS

Among Chinese HWs, WPV exerts significant direct and indirect effects on burnout symptoms, mediated by sleep disturbance and work ability. This finding provides valuable empirical insights for designing interventions to mitigate the adverse effects of psychosocial factors such as WPV and burnout among HWs. After exposure to WPV, measures focused on reducing sleep disturbance and enhancing work ability may prove effective in alleviating burnout in subsequent interventions.

Prevalence of burnout among physiotherapists: a systematic review and meta-analysis

BACKGROUND

Work-related burnout is a significant concern amongst healthcare professionals, including physiotherapists. It can negatively impact on both staff well-being and the quality of care delivered to patients.

OBJECTIVES

To estimate the prevalence of burnout among physiotherapists.

DATA SOURCES

PubMed, CINAHL, Web of Science, Embase, Scopus and PsycINFO, from inception to February 1st, 2022.

STUDY SELECTION OR ELIGIBILITY CRITERIA

Studies reporting burnout prevalence among physiotherapists.

DATA EXTRACTION AND DATA SYNTHESIS

Prevalence of burnout. Sub-analyses were performed grouping studies based on countries where surveys were conducted, classified as developed or developing countries. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale.

RESULTS

32 studies were included in the systematic review and 31 in the meta-analysis, enrolling a total of 5984 physiotherapists from 17 countries. Pooled prevalence (95% confidence interval) of burnout was 8% (4-15). Prevalence figures for Maslach Burnout Inventory dimensions were: (i) emotional exhaustion, 27% (21-34) (ii) depersonalization, 23% (15-32) (iii) low personal accomplishment, 25% (15-40). Both overall and single components prevalence was higher, although not significantly, in studies from developing than in developed countries.

LIMITATIONS

Tools used to assess burnout and cut-off scores chosen to identify the burnout prevalence differed across studies.

CONCLUSION AND IMPLICATIONS OF KEY FINDINGS

Prevalence of burnout reported by physiotherapists appears high worldwide, in particular in developing countries, and compares with that reported by nurses and physicians. Substantial heterogeneity in the prevalence of burnout, in its definition and assessment methods across studies, and limited quality of most studies precludes drawing definitive conclusions.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42022307876 CONTRIBUTION OF THE PAPER.

Psychometric testing of the nurses professional values scale-revised on family and community health nurses

BACKGROUND

Family and Community Health Nurses (FCHNs) are at a higher risk of experiencing emotional exhaustion and feelings of low personal accomplishment. Higher levels of professional identity may decrease these negative feelings. Its measurement could produce positive effects for FCHNs and the quality of care they offer.

AIM

This study aims to evaluate the psychometric properties (validity and reliability) of the Nurses Professional Values Scale-Revised (NPVS-R) on FCHNs in Italy.

RESEARCH DESIGN

A cross-sectional research design was used.

PARTICIPANTS AND RESEARCH CONTEXT

A convenience sample of FCHNs was recruited in an out-of-hospital setting from Italy. A total of 202 nurses were eligible (mean age of 41.11 ± 10.55 years; 78.2% female).

ETHICAL CONSIDERATIONS

The study was performed in accordance with the World Medical Association Declaration of Helsinki. Participants were asked for their consent and were guaranteed anonymity in the information collected. The study was approved by the internal review board of the university.

RESULTS

Confirmatory Factor Analysis (CFA) supported a unidimensional factorial structure of the NPVS-R with an adequate fit to the data. Internal consistency reliability was also supported. The construct validity was further reinforced by the concurrent validity results showing a positive and significant correlation of professional identity with job satisfaction.

CONCLUSION

The NPVS-R is a valid and reliable instrument to measure professional identity among FCHNs. It can be used in clinical practice to improve FCHNs' psychological-emotional feelings and quality of care provided, in research to allow comprehensive understanding of professional identity, and in educational settings to monitor the professional identity levels of Family and Community Health Nursing students.

Burnout and predictive factors among medical students: a cross-sectional survey

BACKGROUND

Burnout is a growing problem in medical education, and is usually characterised by three dimensions: emotional exhaustion, cynicism, and reduced professional efficacy. Currently, the majority of burnout studies have been conducted in western high-income countries, overshadowing findings from low- and middle-income countries. Our objective is to investigate burnout and its associated predictive factors in Morocco, aiming to guide intervention strategies, while also assessing differences between the preclinical and clinical years.

METHODS

A cross-sectional, self-administered online survey assessing burnout dimensions and its main determinants was distributed among medical students at Université Mohammed VI des Sciences et de la Santé (UM6SS, Casablanca, Morocco). Descriptive analyses involved computing mean scores, standard deviations and Pearson correlations. Further, t-tests were performed to check for significant differences in burnout dimensions across the preclinical and clinical learning phase, and stepwise linear regression analyses were conducted using a backward elimination method to estimate the effects of the selected variables on the three burnout dimensions.

RESULTS

A t-test assessing the difference in cynicism found a significant difference between students at the preclinical phase and the clinical phase, t(90) = -2.5, p = 0.01. For emotional exhaustion and reduced professional efficacy no significant difference was observed. A linear regression analysis showed that emotional exhaustion was significantly predicted by workload, work-home conflict, social support from peers and neuroticism. Cynicism was predicted by the learning phase, workload, meaningfulness and neuroticism; and reduced professional efficacy by neuroticism only.

CONCLUSIONS

Our findings suggest a potential gradual increase in cynicism during medical education in Morocco. Conducting this study in a low- and middle income country has enhanced the scientific understanding of burnout in these regions. Given the identified predictive factors for burnout, such as workload, work-home conflict, support from peers, neuroticism, and meaningfulness, it is necessary to focus on these elements when developing burnout interventions.

The relationship between effort-reward imbalance and quality of working life among medical caregivers: mediating effects of job burnout

Background

To determine the relationship between effort-reward imbalance (ERI) and quality of working life (QWL) among medical caregivers and the mediating role of job burnout.

Methods

This was a cross-sectional survey. A total of 787 medical caregivers at seven hospitals from Sichuan and Chongqing, China, between May to September 2023 were included in this observational study. The General Information Questionnaire, Effort-Reward Imbalance Questionnaire (ERI), Maslach Burnout Inventory-General Survey (MBI-GS), and Quality of Working Life Scale (QWL7-32) were used for data collection. SPSS 26.0 and PROCESSv3.3 were used for all data analyses, including descriptive statistics.

Results

A total of 820 questionnaires were distributed, of which only 787 were valid (return rate; 95.98%). The QWL score of medical caregivers was 126.94 ± 16.69. However, QWL scores were significantly different depending on age, number of children, family support status, department, years of experience, night shift status, number of night shifts per month, number of hours worked per day, monthly income, and occurrence of errors or adverse events (p < 0.05). Furthermore, job burnout and ERI were negatively correlated with QWL (p < 0.01). Job burnout mediated (95% CI = -0.365, -0.260) the relationship between ERI and QWL, accounting for 58.65% of the total effect.

Conclusion

Medical caregivers have a medium level of QWL. Job burnout partially mediates the relationship between ERI and QWL. Medical caregiver managers can improve QWL by directly intervening in occupational stress and indirectly intervening in job burnout.

Mapping of the network connection between sleep quality symptoms, depression, generalized anxiety, and burnout in the general population of Peru and El Salvador

BACKGROUND

A meta-analysis of randomized controlled trials has suggested a bidirectional relationship between sleep problems and mental health issues. Despite these findings, there is limited conclusive evidence on the relationship between sleep quality, depression, anxiety, and burnout.

OBJECTIVE

The current study aimed to evaluate the relationships between sleep quality symptoms, anxiety, depression, and burnout in samples of adult individuals from two Latin American countries, Peru and El Salvador, through network analysis and to identify key symptoms that reinforce the correlation and intensify the syndromes.

METHODS

A total of 1012 individuals from El Salvador and Peru participated, with an average age of 26.5 years (SD = 9.1). Symptom networks were constructed for both countries based on data from the Jenkins Sleep Scale, Patient Health Questionnaire-2, General Anxiety Disorder-2, and a single burnout item.

RESULTS

The results indicated that Depressed Mood, Difficulty Falling Asleep, and Nervousness were the most central symptoms in a network in the participating countries. The strongest conditional associations were found between symptoms belonging to the same construct, which were similar in both countries. Thus, there is a relationship between Nervousness and Uncontrollable Worry, Anhedonia and Depressed Mood, and Nighttime Awakenings and Difficulty in Staying Asleep. It was observed that burnout is a bridge symptom between both countries and presents stronger conditional associations with Tiredness on Awakening, Depressed Mood, and Uncontrollable Worry. Other bridge symptoms include a Depressed Mood and Nervousness. The network structure did not differ between the participants from Peru and El Salvador.

CONCLUSION

The networks formed by sleep quality, anxiety, depression, and burnout symptoms play a prominent role in the comorbidity of mental health problems among the general populations of Peru and El Salvador. The symptom-based analytical approach highlights the different diagnostic weights of these symptoms. Treatments or interventions should focus on identifying central and bridge symptoms.

Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda

BACKGROUND

Effective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda.

METHODS

We installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device).

RESULTS

Chlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products.

CONCLUSION

The STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.

Burnout, motivation and job satisfaction among community health workers recruited for a depression training in Madhya Pradesh, India: a cross-sectional study

Introduction

Burnout, low motivation, and poor job satisfaction among community health workers (CHWs) have negative impacts on health workers and on patients. This study aimed to characterize levels of burnout, motivation, and job satisfaction in CHWs in Madhya Pradesh, India and to determine the relation between these levels and participant characteristics. This study can inform efforts to promote wellbeing and address stress in this population.

Methods

In this cross-sectional study, we recruited participants via simple random sampling without replacement. We administered two validated questionnaires, the Copenhagen Burnout Inventory and a Motivation and Job Satisfaction Assessment, to CHWs who had enrolled in a training program to deliver a brief psychological intervention for depression. We calculated mean scores for each questionnaire item, examined the reliability of the measures, and analyzed associations between participant demographic characteristics and questionnaire scores.

Results

339 CHWs completed the questionnaires. The personal burnout domain had the highest mean burnout score (41.08, 95% CI 39.52-42.64, scale 0-100) and 33% of participants reported moderate or greater levels of personal burnout. Items that reflected physical exhaustion had the highest item-test correlations. The organization commitment domain had the highest mean motivation score (mean 3.34, 95% CI 3.28 - 3.40, scale 1-4). Items describing pride in CHWs' work had the highest item-test correlations. Several pairwise comparisons showed that higher education levels were associated with higher motivation levels (degree or higher vs. 8th standard [p=0.0044] and 10th standard [p=0.048], and 12th standard vs. 8th standard [p= 0.012]). Cronbach's alpha was 0.82 for the burnout questionnaire and 0.86 for the motivation and job satisfaction questionnaire.

Conclusion

CHWs report experiencing burnout and feeling physically tired and worn out. A sense of pride in their work appears to contribute to motivation. These findings can inform efforts to address burnout and implement effective task-sharing programs in low-resource settings.

The relationship between medical staff burnout and subjective wellbeing: the chain mediating role of psychological capital and perceived social support

Background

Medical staff play a crucial role in delivering healthcare services, especially during epidemics of infectious diseases such as coronavirus disease 2019 (COVID-19). However, there is a growing issue of burnout and low wellbeing among this group. While it is widely recognized that burnout has a negative impact on subjective wellbeing, the exact relationship between the two is not yet completely understood. The purpose of this study is to explore the chain mediating role of psychological capital and perceived social support between burnout and subjective wellbeing among medical staff.

Methods

Using the convenient sampling method, 604 medical staff were selected for a cross-sectional study. All participants completed a self-report questionnaire that collected demographic information, as well as data from the Maslach Burnout Inventory-Human Services Survey, General Wellbeing Schedule, Psychological Capital Questionnaire, and Perceived Social Support Scale. SPSS 27.0 and SPSS PROCESS macro were used for data analysis.

Results

There was a significant correlation between burnout, psychological capital, perceived social support, and subjective wellbeing (p < 0.01). Burnout not only has a direct negative impact on the subjective wellbeing of medical staff (effect: -0.2045; Bootstrap 95%CI: -0.2506, -0.1583), but also exerts an indirect influence on subjective wellbeing through three pathways: the independent mediating effect of psychological capital (effect: -0.0481; Bootstrap 95%CI: -0.0876, -0.0109), the independent mediating effect of perceived social support (effect: -0.0092; Bootstrap 95%CI: -0.0203, -0.0003), and the chained mediating effect of psychological capital and perceived social support (effect: -0.0092; Bootstrap 95%CI: -0.0183, -0.0019).

Conclusion

High burnout in medical staff can impair the level of psychological capital, leading to diminished perceived social support and ultimately reduced subjective wellbeing. The findings of this study contribute to understanding the potential pathways between burnout and subjective wellbeing and provide preliminary data support for developing strategies to improve the mental health of medical staff.

Job satisfaction and burnout syndrome among intensive-care unit nurses: A systematic review and meta-analysis

INTRODUCTION

The severe conditions often experienced in an intensive care unit, combined with poor working conditions, increase stress and therefore decrease job satisfaction. Sustained stress in the workplace leads to the development of burnout, a syndrome characterised by three dimensions: emotional exhaustion, depersonalisation and perceived lack of personal fulfilment.

OBJECTIVE

To analyse the relationship between burnout syndrome and job satisfaction among ICU personnel.

DATA SOURCES

The PubMed, CINAHL and Scopus databases were used.

STUDY DESIGN

A systematic review and meta-analysis. The study sample consisted of 18 quantitative primary studies conducted in the last five years. Validated questionnaires were used to assess burnout in ICU healthcare workers, the most commonly used being the Maslach Burnout Inventory.

EXTRACTION METHODS

The search equation applied was: "job satisfaction AND nurs* AND burnout AND (ICU OR intensive care units)". The search was performed in October 2022.

PRINCIPAL FINDINGS

The search returned 514 results. Only 73 articles met the eligibility criteria. After reading the title and abstract, 20 articles were selected. After reading the full texts, 12 articles remained and after the reverse search, 18 articles were finally selected. The studies reported a 50% prevalence of burnout, all three dimensions of which were heightened by the COVID-19 pandemic. Analysis of the study findings revealed an inverse association between burnout and job satisfaction.

CONCLUSIONS

Job dissatisfaction of ICU nurses depends on lack of experience, working conditions or working environment among others. ICU nurses with lower job satisfaction have higher levels of burnout.

IMPLICATIONS FOR CLINICAL PRACTICE

This meta-analysis shows the potential value of job satisfaction on improving health outcomes related to burnout syndrome for nursing professional in Intensive Care Units. Different factors that could increase job satisfaction and consequently protect them from suffering high levels of burnout, such as salary, permanence in the service, mental health care are the responsibility of the hospital supervisor and, finally, of the own Health System. Knowledge of a risk profile based on the factors influencing job dissatisfaction would enable the implementation of effective workplace interventions to reduce or prevent the risk of burnout. Health policies should focus on protecting the worker, so in addition to improving working conditions, it would be interesting to promote coping skills in order to improve the quality of care and patient safety.

Effort-reward imbalance and common mental disorders among public sector employees of Iran: a cross-sectional analysis

BACKGROUND

The effort-reward imbalance (ERI) model is a widely used theoretical model to measure stress in the workplace. The objective of this study was to investigate the relationship between ERI and three common mental disorders: major depressive disorder (MDD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD).

METHODS

In this cross-sectional analysis, the study sample consisted of 4453 baseline participants of the Employees' Health Cohort Study of Iran (EHCSIR). Trained psychologists utilized the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) during the baseline assessment to identify common mental disorders. Additionally, the validated Persian version of the 23-item ERI questionnaire was employed to assess effort, reward, overcommitment, and effort-reward ratio. To examine the association of ERI components with three common mental disorders (MDD, GAD, and OCD) over the past twelve months, multiple logistic regression analyses were conducted.

RESULTS

The prevalence of effort-reward imbalance in the study sample was 47.1%. Higher ERI score was significantly associated with MDD (OR: 3.43, 95% CI: 2.30-5.13), GAD (OR: 2.42, 95% CI: 1.27-4.63), and OCD (OR: 2.23, 95% CI:1.19-4.19). The study participants who reported higher scores on work overcommitment had a higher likelihood of having MDD (OR: 1.16, 95% CI:1.10-1.23), GAD (OR: 1.07, 95% CI: 1.01-1.14), and OCD (OR: 1.19, 95% CI: 1.09-1.29).

CONCLUSIONS

According to the study's findings, work-related stress, as determined by the ERI model, is a significant factor in the development of common mental disorders among employees in the public sector.

Physician wellbeing and burnout in emergency medicine in Switzerland

Emergency physicians are the most at-risk medical specialist group for burnout. Given its consequences for patient care and physician health and its resulting increased attrition rates, ensuring the wellbeing of emergency physicians is vital for preserving the integrity of the safety net for the healthcare system that is emergency medicine. In an effort to understand the current state of practicing physicians, this study reviews the results of the first national e-survey on physician wellbeing and burnout in emergency medicine in Switzerland. Addressed to all emergency physicians between March and April 2023, it received 611 complete responses. More than half of respondents met at least one criterion for burnout according to the Maslach Burnout Inventory - Human Services Survey (59.2%) and the Copenhagen Burnout Inventory (54.1%). In addition, more than half reported symptoms suggestive of mild to severe depression, with close to 20% screening positively for moderate to severe depression, nearly 4 times the incidence in the general population, according to the Patient Health Questionnaire-9. We found that 10.8% of respondents reported having considered suicide at some point in their career, with nearly half having considered this in the previous 12 months. The resulting high attrition rates (40.6% of respondents had considered leaving emergency medicine because of their working conditions) call into question the sustainability of the system. Coinciding with trends observed in other international studies on burnout in emergency medicine, this study reinforces the fact that certain factors associated with wellbeing are intrinsic to emergency medicine working conditions.

Assessing public health service capability of primary healthcare personnel: a large-scale survey in Henan Province, China

BACKGROUND

The public health service capability of primary healthcare personnel directly affects the utilization and delivery of health services, and is influenced by various factors. This study aimed to examine the status, factors, and urban-rural differences of public health service capability among primary healthcare personnel, and provided suggestions for improvement.

METHODS

We used cluster sampling to survey 11,925 primary healthcare personnel in 18 regions of Henan Province from 20th to March 31, 2023. Data encompassing demographics and public health service capabilities, including health lifestyle guidance, chronic disease management, health management of special populations, and vaccination services. Multivariable regression analysis was employed to investigate influencing factors. Propensity Score Matching (PSM) quantified urban-rural differences.

RESULTS

The total score of public health service capability was 80.17 points. Chronic disease management capability scored the lowest, only 19.60. Gender, education level, average monthly salary, professional title, health status, employment form, work unit type, category of practicing (assistant) physician significantly influenced the public health service capability (all P < 0.05). PSM analysis revealed rural primary healthcare personnel had higher public health service capability scores than urban ones.

CONCLUSIONS

The public health service capability of primary healthcare personnel in Henan Province was relatively high, but chronic disease management required improvement. Additionally, implementing effective training methods for different subgroups, and improving the service capability of primary medical and health institutions were positive measures.

Impact of Burnout on Anaesthesiologists

Professional burnout syndrome (PBS) is an issue affecting individuals and organizations alike, characterized by emotional exhaustion and reduced effectiveness resulting from overwhelming work demands. Root causes include excessive workload, unrealistic expectations, and blurred work-life boundaries, which are often intensified by organizational culture and inadequate support systems. The consequences range from decreased productivity and creativity to high turnover rates and financial strain on organizations. Mitigating PBS requires a comprehensive approach that addresses both individual and organizational levels. Individually, stress management techniques and self-care practices are crucial for building resilience and coping with work-related stressors. Organizations play a vital role in promoting employee well-being by fostering a supportive work environment, promoting work-life balance and providing access to support systems such as counseling and mentorship programs. Leadership is key in creating a culture that values employee health and prioritizes open communication and empathy. Policy interventions can further support efforts to combat PBS by enforcing labor laws that protect employee rights, such as setting limits on working hours and ensuring access to mental health services. Additionally, incentivise organizations to prioritize employee well-being through tax incentives or certification programs can encourage proactive measures against burnout. The aim of this review is to provide a comprehensive exploration of PBS, examining its causes, consequences, and potential mitigation strategies in individuals and organizations, with a focus on anaesthesiology.

[Prevalence of burnout syndrome in physicians working in Spain: systematic review and meta-analysis]

OBJECTIVE

To analyze the prevalence of burnout syndrome in physicians working in Spain through a systematic review with meta-analysis METHOD: We searched PubMed/MEDLINE, Embase, and PsycINFO (up to June 2023). Observational studies conducted in Spain reporting the prevalence of burnout in physicians were included. From each study, methodological characteristics and results were extracted, and their quality was evaluated. We performed a narrative synthesis with random effects meta-analysis to calculate proportions.

RESULTS

Sixty-seven studies with 16,076 participants were included. For the primary outcome, the meta-analysis revealed a global prevalence of burnout in physicians of 24% (95%CI: 19%-29%; 46 studies; 8821 participants; I2=97%). From subgroup analysis, differences were observed depending on the diagnostic criteria used: 18% (95%CI: 13%-23%) for three dimensions of burnout, 29% (95%CI: 24%-34%) for two dimensions and 51% (95%CI: 42%-60%) for one dimension. The heterogeneity between studies could not be fully explained through additional analyses where non-statistically significant differences were found with other variables (e.g., study quality, setting, professional category or medical specialty).

CONCLUSIONS

A high prevalence of burnout syndrome was found in physicians working in Spain. These results can contribute to estimating the burden associated with burnout in physicians at a national level and to the design of future studies. Strategies appear to be necessary to prevent and mitigate this situation.

PROTOCOL REGISTRATION

Open Science Framework: https://osf.io/b2h4m/.

HIV Inequities, the Therapeutic Alliance, Moral Injury, and Burnout: A Call for Nurse Workforce Participation and Action

ABSTRACT

Health inequities for those living with HIV have persisted for key populations in the United States and globally. To address these inequities, in accordance with Goals 2 and 3 of the National HIV/AIDS Strategy for the United States, the evidence indicates that the therapeutic alliance could be effective in addressing impediments that undermine HIV outcomes. Nonetheless, the therapeutic alliance relies on health care providers, particularly nurses, reporting burnout and moral injury, further exacerbated by COVID-19. Burnout and moral injury have forced the systemic undervaluing of nurses as a social-cultural norm to the fore-in part a legacy of the economic model that underpins the health care system. Given a looming health workforce shortage and negative effects for key populations with HIV already experiencing health inequities, historic opportunities now exist to advance national institutional reforms to support nurses and other health professionals. This opportunity calls for concerted attention, multisectoral dialogue, and action, with nurses participating in and leading policy and interventions.

Cognitive function and work resilience of healthcare professionals: A comparative cross-sectional study

BACKGROUND

Healthcare professionals (HCPs) face a variety of work-related stressors that have impact on their mental health and cognitive performance. Work resilience is a psychological resource that helps workers cope with stress and prevents unfavorable psychological impact. The aim of this study was to assess the associations between working as HCPs and cognitive function as well as work resilience.

MATERIALS AND METHODS

This was a comparative cross-sectional study conducted among HCPs at Suez Canal University Hospital in Ismailia Governorate, Egypt, during April 2023 to August 2023. Two hundred and thirty-five HCPs and 107 administrative employees (Admins) were invited to participate in this study. A self-administered questionnaire was used to obtain sociodemographic and other relavent data. Cognitive function was assessed with the Mini-Mental State Examination test; work resilience was assessed with the Brief Resilience Scale; and psychological distress was measured with the Depression, Anxiety, and Stress Scale - 21-items (DASS-21) scale. Statistical significance was determined by Mann Whitney U-test for continuous variables, and Chi-square test or Fisher's exact, as appropriate, for categorical variables. Multiple logistic regression models were employed to determine associations between the main outcomes (cognitive impairment and low resilience) and the main covariate (working as HCPs vs. Admins), adjusting for all potential confounders.

RESULTS

HCPs showed a significantly greater cognitive impairment, less resilience, and DASS-21 than the Admins. The odds of impaired cognitive function in HCPs were significantly higher than the Admins (odds ratio [OR]: 4.45, 95% confidence interval [CI]: 1.27-15.67, P = 0.020), adjusted for all potential covariates. Similarly, the odds of low resilience in HCPs were significantly higher than Admins (OR: 5.81, 95% CI: 2.72-12.44, P < 0.001), adjusted for all potential covariates. However, the adjusted association between impaired cognitive function and low resilience was not statistically significant (OR: 0.55, 95% CI: 0.23-1.33, P = 0.185).

CONCLUSION

HCPs had significantly impaired cognitive function and low work resilience. Workplace policies and interventions to control depression, stress, and anxiety are required as it is the encouragement of physical activity. Programs that combine positive coping skills training (e.g., relaxation training, positive thinking, and problem solving) with resilience-building interventions (e.g., taking a proactive approach to solving problems, being flexible and adaptive) should be developed, with special attention to HCPs who have a higher sense of self-efficacy.

"Early in the morning, there's tolerance and later in the day it disappears" - The intersection of resource scarcity, stress and stigma in mental health and substance use care in South Africa

Stress is a challenge among non-specialist health workers worldwide, particularly in low-resource settings. Understanding and targeting stress is critical for supporting non-specialists and their patients, as stress negatively affects patient care. Further, stigma toward mental health and substance use conditions also impacts patient care. However, there is little information on the intersection of these factors. This sub-analysis aims to explore how substance use and mental health stigma intersect with provider stress and resource constraints to influence the care of people with HIV/TB. We conducted semi-structured interviews (N=30) with patients (n=15) and providers (n=15, non-specialist health workers) within a low-resource community in Cape Town, South Africa. Data were analyzed using thematic analysis. Three key themes were identified: (1) resource constraints negatively affect patient care and contribute to non-specialist stress; (2) in the context of stress, non-specialists are hesitant to work with patients with mental health or substance use concerns, who they view as more demanding and (3) stress contributes to provider stigma, which negatively impacts patient care. Findings highlight the need for multilevel interventions targeting both provider stress and stigma toward people with mental health and substance use concerns, especially within the context of non-specialist-delivered mental health services in low-resource settings.

Attention Deficits in Healthcare Workers with Non-Clinical Burnout: An Exploratory Investigation

Burnout syndrome is characterized by exhaustion, cynicism, and reduced effectiveness. Workers with high burnout scores who continue their professional activities are identified as experiencing non-clinical burnout (NCB), which includes early stages where burnout symptoms (BNS) are present but not yet severe enough to necessitate work leave. This study aimed to investigate the impact of BNS on attention performance among healthcare workers (HCWs) at a COVID-19 reference hospital during the pandemic. The Maslach Burnout Inventory (MBI) was applied to assess the three burnout dimensions. The Continuous Visual Attention Test (CVAT) evaluated four different attention subdomains. Participants were divided into two groups based on their scores on the MBI: controls and NCB. Thirteen controls were matched with 13 NCB subjects based on age, sex, and HCW category. This sample (n = 26, 65% male) consisted of 11 physicians and 15 nursing professionals with a mean age of 35.3 years (standard deviation = 5.47). NCB subjects had higher impulsivity than controls. There were not any significant group differences in the other attention subdomains. We found significant correlations between impulsivity and all burnout dimensions: higher absolute scores in BNS are associated with higher impulsivity. We concluded that NCB leads to executive attention deficits.

Burnout increased among university students during the COVID-19 pandemic: a systematic review and meta-analysis

Generally, university students are at risk of burnout. This likely was exacerbated during the COVID-19 pandemic. We aimed to investigate burnout prevalence among university students during the COVID-19 pandemic and examine its distribution across countries, sexes, fields of study, and time-period. PubMed, EMBASE, PsycINFO, World Health Organization's Global COVID-19 database, Scopus, Epistemonikos, ERIC and Google Scholar were searched (protocol: https://doi.org/10.17605/OSF.IO/BYRXW ). Studies were independently screened and extracted. Random-effects meta-analysis was performed. Study quality was appraised, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We identified 44 primary studies comprising 26,500 students. Global prevalence rates were 56.3% for high emotional exhaustion (EE), 55.3% for high cynicism (CY) and 41.8% for low personal accomplishment (PA). Prevalence of EE, CY, and PA domains varied significantly across fields of study, countries and WHO and World Bank regions, but not sex. All studies demonstrated good internal validity, although substantial heterogeneity existed between studies. The certainty of evidence was rated as moderate. Considering its potentially severe consequences, burnout is a significant public health concern. The development and implementation of evidence-based localized interventions at organizational and individual levels are necessary to mitigate burnout.

Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India

Background

Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India.

Methods

A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app.

Results

In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India.

Conclusions

This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.

Creating work-life balance among physicians in the age of digitalization: the role of self-consciousness and communication - a qualitative study

BACKGROUND

Besides the positive effects of using digital health solutions, digitalization can affect the healthcare worker burnout. The ability to coordinate different aspects of life (WLB) also plays a significant role in the development of burnout among medical workers. The aim of our study is to show, through qualitative interviews, the impact of digitalization on work-life balance in Hungarian physicians.

METHODS

62 semi-structured interviews were conducted between October 2021 and June 2022, of which, a total of 31 interviews were used for the analysis, which were all related to the theme of work-life balance. Purposive sampling and inductive thematic approach were used to collect and analyse the data and identify patterns of the themes.

RESULTS

Based on this analysis, 5 main themes emerged: (1) the use of digital health tools, (2) Impact of digital tools on everyday work, (3) Work-life balance, (4) Setting and maintaining work-life boundaries, (5) Potential solutions. With the spread of digital communication, most of the respondents feel that their working hours increased even at the expense of their private life. The majority considers constant availability as a serious problem, however, several physicians indicated that as a result of a learning curve, they are able to change and set the necessary boundaries. Respondents were divided on whether or not they were successful in setting and maintaining boundaries. The 2 most important factors of establishing WLB in a digital age are self-consciousness and communication. However, these skills are not self-evident: the responses also show that in many cases there is a need for external support, but also for health professionals to actively reflect from time to time on their role as healers and their relationship with technology.

CONCLUSION

Basic principles and tools for establishing successful digital work-life balance in healthcare should be involved in the training curriculum of future physicians and healthcare professionals, while institutions should elaborate specific policies to include digital work-life balance in the institutional setting, as part of the preventive measures against burnout.

Workplace wellbeing among health care workers providing HIV services in primary care in Johannesburg: a mixed methods study

Background

Burnout among Health Care workers (HCWs) impacts on provider-patient relations and quality of care. Anova Health Institute (Anova) is a large South African non-profit organization and PEPFAR/USAID implementing partner. We conducted a study among HCWs providing HIV-related services in primary care settings in Johannesburg, South Africa, to examine levels of burnout, understand factors affecting workplace wellbeing, and explore strategies to prevent burnout.

Methods

We used a sequential mixed-method approach. Data were collected between February and April 2022. The first phase consisted of a survey using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) to measure levels of burnout. We then interviewed a subset of survey participants to understand the experiences that may affect wellbeing. We used descriptive statistics to quantify burnout rates for each MBI dimension (emotional exhaustion, personal accomplishment, and depersonalization). Qualitative data analysis was guided by the Job Demands-Resources Framework that explores the interactions between demands and resources in the workplace.

Results

Survey findings (n = 194) revealed that although depersonalization rates were low at 6%, 21% of participants had high emotional exhaustion and 24% reported low professional accomplishment. Less than half (41%, n = 80) had scores in the high category for any one of the three MBI-HSS dimensions. The MBI-HSS dimensions differed significantly by type of work and job title. Roving positions (HCW working in more than one health facility) were more likely to experience higher emotional exhaustion and lower professional accomplishment. Qualitative findings (n = 25) indicate that a number of job demands, including high workload, inadequate mental health support, and challenging relationships with stakeholders, had a negative effect on HCWs' wellbeing. However, finding meaningfulness in their work, working as a team, and practicing autonomy were experienced as resources that reduced the negative effect of these demands.

Conclusion

While measured burnout syndrome rates were low, various experiences negatively impacted at least one in five HCW. We identified key resources that provided buffering against workplace stressors. We recommend that as well as addressing key drivers of burnout, access to these resources should be fostered, for example by strengthening interventions that offer recognition, and promoting team interactions through social activities and support groups.

Healthcare in distress: A survey of mental health problems and the role of gender among nurses and physicians in Sweden

INTRODUCTION

The present article aimed to investigate 1) if mental health problems (depression and burnout including the dimensions; emotional exhaustion, mental distance and cognitive and emotional impairment) differed between nurses and physicians in Sweden, 2) if any differences were explained by differences in sex compositions, and 3) if any sex differences were larger within either of the two professions.

METHOD

Data were derived from a representative sample of nurses (n = 2903) and physicians (n = 2712) in 2022. Two scales were used to assess burnout (KEDS and BAT) and one to assess depression (SCL-6). The BAT scale has four sub-dimensions. Descriptive statistics and logistic regression were used to analyse each scale and dimension separately.

RESULTS

Results showed that 16-28 % of nurses and physicians reported moderate to severe symptoms of burnout. The prevalence differed between occupations across the scales and dimensions used. Nurses reported higher scores on KEDS while physicians reported higher scores on BAT including the four dimensions. Also, 7 % of nurses' and 6 % of physicians' scores were above the cut-off for major depression. The inclusion of sex in the models changed the odds ratios of differences between doctors and nurses in all mental health dimensions except mental distance and cognitive impairment.

LIMITATIONS

This study was based on cross-sectional survey data which has some limitations.

CONCLUSION

Our study suggests that the prevalence of mental health problems is prominent among nurses and physicians in Sweden. Sex plays an important role in the difference in the prevalence of mental health problems between the two professions.

Cost Evaluation of Professional Services in a Rural Community Pharmacy: A Monocentric Exploratory Approach

The increasing pressure on healthcare systems (HCSs) is a cause for concern worldwide. Rising costs, uncertainty about sustainability, and aging populations are the main issues that make it challenging to allocate scarce resources to the needs of HCSs. Clinical professional pharmacy services (PSs) have been shown to help alleviate system stress and to reach the entire population, although a cost of provision is borne. The objective of this study was to evaluate the provision costs of three PSs, a medicine-dispensing service (MDS), a multicompartmental compliance aid system service (MCAS), and a cognitive impairment screening service (CISS), in a rural community pharmacy. A cost analysis was performed using a time-driven activity-based costing model. The time dedicated to PS provision was appropriately recorded, and the corresponding expenses were extracted from the accounting records. A provision time of 4.80 min and a cost of EUR 2.24 were estimated for the MDS, while 18.33 min and EUR 8.73 were calculated for the MCAS, and 122.20 min and EUR 56.72 were calculated for the CISS. The total provision time represented 85% of the pharmacist's effective working time. Tailored cost analysis is a useful tool for making decisions on the implementation of a PS. Larger studies including a variety of pharmacies and locations are necessary to accurately assess costs and engage in discussions on funding and remuneration.

Evaluation of the reboot coaching workshops among urology trainees: A mixed method approach

Background

Urology trainees experience high burnout, and there is an urgent need for acceptable and effective interventions. The current study evaluated Reboot coaching workshops (Reboot-C), a tailored intervention based on cognitive-behavioural principles, with urology trainees.

Objective

Our primary objective was to evaluate the acceptability of Reboot-C among urology trainees. In addition, this study aimed to investigate whether there were changes in confidence, resilience, depression and burnout levels.

Materials and method

A single-arm design was used, including pre- and post-online questionnaires and semi-structured interviews.

Result

Twenty-one urology trainees replied to the survey, attended both Reboot-C workshops and responded to the post-intervention questionnaire. Thirteen of 21 (61%) urology trainees participated in the interview. Participating in Reboot-C was associated with significant improvements in resilience and confidence and a significant reduction in burnout. However, there was no significant reduction in depression. Qualitative data indicated that Reboot was acceptable and helped participants develop useful skills.

Conclusion

These findings pave the way for more conclusive studies on the efficacy of Reboot-C for surgeons.

Burnout and resilience at work among health professionals serving in tertiary hospitals, in Ethiopia

Background

The quality of healthcare service is strongly affected by the health professionals' levels of burnout and resilience at work (RaW). Developing resilience is a key component of medical professionalism. Although burnout and resilience are indicators used to assess the level of workplace hardship, there is a dearth of information in most developing countries, including Ethiopia.

Objective

To assess the levels of burnout and 'resilience at work' among health professionals who work in the surgical care departments in teaching Ethiopian hospitals.

Methods

A cross-sectional study design was applied among health professionals employed in surgical, gynecologic, and obstetric (Gyn/Obs) departments of two acute-care hospitals (n = 388). A structured self-administered English version questionnaire, consisting of validated scales to measure RaW and burnout, was used to collect the data;22 items of Maslach's burnout inventory human service survey tool and 20 items of Win wood's resilience at work' measuring tool" was employed to assess the health professionals' burnout level and Resilience at work, respectively. Linear logistics regression was employed for inferential statistical analysis to identify factors that predict RaW and burnout.

Results

Burnout syndrome was shown among 101 (26.0%) study participants. Furthermore, 205 (52.8%), 150 (38.7%), and 125 (32.2%) participants presented high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Emotional exhaustion was predicted by the participants' profession, the hope of promotion, professional recognition, and workload. Depersonalization was predicted by age, profession, and perceived workload of the participants. The predictors for personal accomplishment were profession, relationship at work, professional recognition, and having a managerial position in addition to clinical duty. The participants' mean RaW score was 78.36 (Standard deviation ±17.78). A negative association was found between RaW and emotional exhaustion and depersonalization. In contrast, a positive association was identified between RaW and personal accomplishment. The type of profession and marital status were positive predictors of RaW.

Conclusion

A substantial amount of health professionals experience high burnout in one or more burnout dimensions. Level of RaW is more affected by burnout syndrome. Therefore, promoting activities that increase the level of professional RaW and recognition in their professional practice is needed to reduce job burnout. These findings are especially important concerning low socio-economic countries, as resilience is a vital component of the development of healthcare systems.

Burnout and patient safety perceptions among surgeons in the United Kingdom during the early phases of the coronavirus disease 2019 pandemic: A two-wave survey

BACKGROUND

Surgeons in the UK report high burnout levels. Burnout has been found to be associated with adverse patient outcomes but there are few studies that have examined this association in surgeons and even fewer which have examined this relationship over time.

PURPOSE

The main aim was to examine the relationships between surgeon burnout and surgeons' perceptions of patient safety cross-sectionally and longitudinally. The secondary aim was to test whether surgeons' burnout levels varied over the first six months of the coronavirus disease 2019 pandemic.

METHODS

This paper reports data from a two-wave survey (first wave from 5 May and 30 June 2020, the second wave 5 January to 30 February 2021). The dataset was divided into a longitudinal group (for surgeons who responded at both the time points) and two cross-sectional groups (for surgeons who responded at a one-time point, but not the other).

RESULTS

The first key finding was that burnout was associated with patient safety outcomes measured at the same time point (Group 1 = 108, r = 0.309, p < 0.05 and Group 2 = 84, r = 0.238, p < 0.05). Second, burnout predicted poor patients' safety perceptions over time, and poor patient safety predicted burnout over time (Group 3 = 39, p < 0.05). Third, burnout increased between the first and second surveys (t = -4.034, p < 0.05).

CONCLUSION

Burnout in surgeons may have serious implications for patient safety. Interventions to support surgeons should be prioritised, and healthcare organisations, surgeons and psychological specialists should collaborate on their development.

Burnout and associative emotional status and coping style of healthcare workers in COVID-19 epidemic control: A cross-sectional study

Objective

The aim of this study was to evaluate the prevalence of burnout, clinical anxiety, depression, and insomnia and to estimate the associations of adverse emotional status, coping style, and level of self-efficacy with burnout of healthcare workers in the Shenzhen Longgang District Frontline District Headquarters of COVID-19 epidemic control, China.

Methods

In this cross-sectional study, 173 staff completed the anonymous questionnaires of the Maslach Burnout Inventory, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), Insomnia Severity Index (ISI), General Self-efficacy Scale, and Simplified Coping Style Questionnaire electronically (https://www.wjx.cn/) in June 2022. Hierarchical logistic regression was used to explore the associated factors of burnout in this study.

Results

The prevalence of burnout in our participants (defined as high emotional exhaustion or high depersonalization) was 47.40%, and reduced personal accomplishment was 92.49%. The prevalence of clinically significant depression (the cutoff score of ≥15), anxiety (the cutoff score of ≥10), and insomnia (the cutoff score of ≥15) was 11.56, 19.08, and 19.08%, respectively. There was a degree of overlap between burnout and other measures of adverse mental status, most notably for anxiety (odds ratio, 27.049; 95% CI, 6.125–117.732; p &lt; 0.001). Hierarchical logistic regression demonstrated that burnout was strongly associated with anxiety (OR = 23.889; 95% CI, 5.216–109.414; p &lt; 0.001) and negative coping style (OR = 1.869; 95% CI, 1.278–2.921; p &lt; 0.01) independently.

Conclusion

Medical staff involved in COVID-19 epidemic control in the post-epidemic era were at high risk of burnout, and most of them were in low personal accomplishment. Reducing anxiety and improving coping style by medical management institutions from the system level may be effective in alleviating burnout in healthcare workers.

Common herbs for stress: The science and strategy of a botanical medicine approach to self-care

Frontline healthcare workers have reported elevated levels of stress and increase prevalence of burnout symptoms since the onset of the COVID-19 pandemic. With these heightened levels of stress and burnout comes a need for more evidence-based interventions to address these symptoms earlier, in both a safe and effective way. Some common botanical medicines have a measurable effect on perceived stress, neurotransmitter levels, and circulating cortisol levels indicating their ability to modify the stress response. Botanical medicines are often relatively low cost, increasingly available in retail stores and online marketplaces, and show relatively low reports of adverse effects, making these medicinal herbs an important option for addressing work-related stress for healthcare workers.

Burnout, mental health, physical symptoms, and coping behaviors in healthcare workers in Belize amidst COVID-19 pandemic: A nationwide cross-sectional study

BACKGROUND

Healthcare workers are vulnerable to burnout, especially during the COVID-19 pandemic in the low resource settings. Belize is a small Central American developing country known for its chronic healthcare worker shortage and this is the first study to assess burnout prevalence and its associated factors among healthcare workers in Belize.

AIM

To evaluate the prevalence of burnout and its associated factors in HCWs in Belize covering multiple domains (mental health, physical symptoms, and coping behaviors) during the COVID-19 pandemic.

METHODS

A cross-sectional survey that was developed and validated by a panel of experts was delivered online to all the healthcare workers in Belize from September to November 2021. Burnout was assessed using Copenhagen Burnout Inventory. Depression and anxiety screening was carried out using the Patient Health Questionnaire - 2 (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2). Burnout associated factors were estimated using logistic regression models.

FINDINGS

Of the total of 263 participants, 27.76% had overall burnout: 56.65% had personal, 54.37% had work-related, and 19.39% had patient-related burnout. Burnout was positively associated with anxiety (OR: 3.14 [1.67, 5.92]), depression (OR: 4.45 [2.30, 8.61]), intentions of quitting their jobs (OR: 2.59 [1.49, 4.51]), health status worsening (OR: 2.21 [1.26, 3.87]), multiple physical symptom presentation (OR: 1.19, [1.10, 1.29]), and use of multiple maladaptive coping behaviors (OR: 1.66, [1.30, 2.12]).

INTERPRETATION

Healthcare workers in Belize showed substantial levels of burnout which were significantly associated with using maladaptive coping behaviors, presenting multiple physical symptoms, quitting their jobs, health status worsening, and other mental health issues. These findings should be used to develop and implement programs such as regular health check-ups, health promotion awareness campaigns, and worker recruitment strategies which would improve the working conditions, quality of life, and psychological well-being of our healthcare workers.