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Shakir M, Irshad HA, Altaf A, Ladak S, Aziz HF, Enam SA. Does gender disparity exist in neurosurgery training? Evidence from a nationwide survey from Pakistan. MEDICAL EDUCATION ONLINE 2024; 29:2310385. [PMID: 38290059 PMCID: PMC10829840 DOI: 10.1080/10872981.2024.2310385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical trainees have not been evaluated. We aimed to gauge the gender differences in opportunities and perceptions of neurosurgery training in Pakistan by comparing responses between males and females. A nationwide web-based survey was conducted in Pakistan, covering 22 College of Physicians and Surgeons of Pakistan (CPSP) accredited neurosurgery training programs. Convenience sampling was used with a pilot-tested questionnaire. Data analysis was performed using SPSS version 26. A total of 120 trainees participated in our survey. The mean age of the participants was 30.4 ± 4.1 years, with 29.2% females and 70.8% males. Concerns about gender equity were more among females (34.3%) than males (27.1%). Poor work-life balance was reported by more females (34.3%) than males (30.6%). Burnout due to working hours was strongly agreed by more females (54.3%) than males (35.3%). More females (40%) acknowledged sufficient mentorship opportunities versus males (25%). Female respondents (65.7%) worked 50-100 hours per week, less than males (69.4%). Satisfaction with surgical exposure was lower among females (2.9%) compared to males (18.8%). More females reported access to teaching courses (82.9% vs. 77.6% males) and neurosurgical conferences (85.7% vs. 80.0% males), cadaver workshops (17.1% vs. 12.9% males), morbidity and mortality meetings (88.6% vs. 82.4% males), case-based sessions (82.9% vs. 75.3% males), and radiology discussions (82.9% vs. 74.1% males). Our study highlights substantial gender gaps in neurosurgical training, concerns over working hours, burnout, mentorship, work-life balance, and gender equity. These findings underscore the necessity for interventions to rectify these disparities and foster gender equity in neurosurgical training.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Hammad Atif Irshad
- Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
| | - Ahmed Altaf
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shamila Ladak
- Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
| | - Hafiza Fatima Aziz
- Neuro-oncology Fellow, Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Wu Y, Wu M, Wang C, Lin J, Liu J, Liu S. Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis. JMIR Med Inform 2024; 12:e54811. [PMID: 38865188 DOI: 10.2196/54811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. OBJECTIVE This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. METHODS We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. RESULTS The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4% (95% CI 37.5%-43.2%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95% CI 2.31-2.57). CONCLUSIONS The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281173.
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Affiliation(s)
- Yuxuan Wu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyue Wu
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changyu Wang
- West China College of Stomatology, Sichuan University, Chengdu, China
| | - Jie Lin
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Khatab Z, Hanna K, Rofaeil A, Wang C, Maung R, Yousef GM. Pathologist workload, burnout, and wellness: connecting the dots. Crit Rev Clin Lab Sci 2024; 61:254-274. [PMID: 38809116 DOI: 10.1080/10408363.2023.2285284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/15/2023] [Indexed: 05/30/2024]
Abstract
No standard tool to measure pathologist workload currently exists. An accurate measure of workload is needed for determining the number of pathologists to be hired, distributing the workload fairly among pathologists, and assessing the overall cost of pathology consults. Initially, simple tools such as counting cases or slides were used to give an estimate of the workload. More recently, multiple workload models, including relative value units (RVUs), the Royal College of Pathologists (RCP) point system, Level 4 Equivalent (L4E), Work2Quality (W2Q), and the University of Washington, Seattle (UW) slide count method, have been developed. There is no "ideal" model that is universally accepted. The main differences among the models come from the weights assigned to different specimen types, differential calculations for organs, and the capture of additional tasks needed for safe and timely patient care. Academic centers tend to see more complex cases that require extensive sampling and additional testing, while community-based and private laboratories deal more with biopsies. Additionally, some systems do not account for teaching, participation in multidisciplinary rounds, quality assurance activities, and medical oversight. A successful workload model needs to be continually updated to reflect the current state of practice.Awareness about physician burnout has gained attention in recent years and has been added to the World Health Organization's International Classification of Diseases (World Health Organization, WHO) as an occupational phenomenon. However, the extent to which this affects pathologists is not well understood. According to the WHO, burnout syndrome is diagnosed by the presence of three components: emotional exhaustion, depersonalization from one's work (cynicism related to one's job), and a low sense of personal achievement or accomplishment. Three drivers of burnout are the demand for productivity, lack of recognition, and electronic health records. Prominent consequences of physician burnout are economic and personal costs to the public and to the providers.Wellness is physical and mental well-being that allows individuals to manage stress effectively and to thrive in both their professional and personal lives. To achieve wellness, it is necessary to understand the root causes of burnout, including over-work and working under stressful conditions. Wellness is more than the absence of stress or burnout, and the responsibility of wellness should be shared by pathologists themselves, their healthcare organization, and governing bodies. Each pathologist needs to take their own path to achieve wellness.
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Affiliation(s)
- Ziyad Khatab
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kattreen Hanna
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Andrew Rofaeil
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Catherine Wang
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Raymond Maung
- University Hospital of Northern British Columbia, Prince George, BC, Canada
| | - George M Yousef
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Yeter E, Bhamra H, Butcher I, Morrison R, Donnelly P, Shaw R. Managing well-being in paediatric critical care: a multiperspective qualitative study of nurses' and allied health professionals' experiences. BMJ Open 2024; 14:e084926. [PMID: 38806418 PMCID: PMC11138289 DOI: 10.1136/bmjopen-2024-084926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVES It is well evidenced that healthcare professionals working in paediatric critical care experience high levels of burn-out, compassion fatigue and moral distress. This worsened during the COVID-19 pandemic. This work examines the nature of challenges to workplace well-being and explores what well-being means to staff. This evidence will inform the development of staff interventions to improve and maintain staff well-being. DESIGN Qualitative study. SETTING Paediatric critical care units in the UK. PARTICIPANTS 30 nurses and allied health professionals took part in online interviews and were asked about well-being and challenges to well-being. Lived experiences of well-being were analysed using interpretative phenomenological analysis. RESULTS Themes generated were as follows: perception of self and identity; relationships and team morale; importance of control and balance and consequences of COVID-19. They focused on the impact of poor well-being on participants' sense of self; the significance of how or whether they feel able to relate well with their team and senior colleagues; the challenges associated with switching off, feeling unable to separate work from home life and the idealised goal of being able to do just that; and lessons learnt from working through the pandemic, in particular associated with redeployment to adult intensive care. CONCLUSIONS Our findings align closely with the self-determination theory which stipulates autonomy, belonging and competence are required for well-being. Participants' accounts supported existing literature demonstrating the importance of empowering individuals to become self-aware, to be skilled in self-reflection and to be proactive in managing one's own well-being. Change at the individual and staff group level may be possible with relatively low-intensity intervention, but significant change requires systemic shifts towards the genuine prioritisation of staff well-being as a prerequisite for high-quality patient care.
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Affiliation(s)
- Esra Yeter
- College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Harmeet Bhamra
- College of Health & Life Sciences, Aston University, Birmingham, UK
| | | | - Rachael Morrison
- Paediatric Intensive Care, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Peter Donnelly
- Paediatric Intensive Care Unit, Royal Hospital for Children, Glasgow, UK
| | - Rachel Shaw
- Institute of Health & Neurodevelopment, Aston University, Birmingham, UK
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Baatiema L, de-Graft Aikins A, Koram KK, Kunfah SMP, Allen LN, Abimbola S, Kruk M. Frontline health workers' experiences of providing care for people living with non-communicable diseases during the COVID-19 pandemic in Ghana: a qualitative study. BMJ Open 2024; 14:e078957. [PMID: 38719303 PMCID: PMC11086292 DOI: 10.1136/bmjopen-2023-078957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted frontline health workers. However, a neglected dimension of this discourse was the extent to which the pandemic impacted frontline healthcare workers providing non-communicable diseases (NCDs) care. This study aims to understand the experiences of healthcare workers with no prior exposure to pandemics who provided care to people living with NCDs (PLWNCDs). METHODS A qualitative study design was employed, using a face-to-face in-depth interviews. Interviews were conducted in primary healthcare facilities in three administrative regions of Ghana, representing the Northern, Southern and Middle Belts. Only frontline health workers with roles in providing care for PLWNCDs were included. Purposive snowballing and convenience sampling methods were employed to select frontline health workers. An open-ended interview guide was used to facilitate data collection, and thematic content analysis was used to analyse the data. RESULTS A total of 47 frontline health workers were interviewed. Overall, these workers experienced diverse patient-driven and organisational challenges. Patient-level challenges included a decline in healthcare utilisation, non-adherence to treatment, a lack of continuity, fear and stigma. At the organisational levels, there was a lack of medical logistics, increased infection of workers and absenteeism, increased workload and burnout, limited motivational packages and inadequate guidelines and protocols. Workers coped and responded to the pandemic by postponing reviews and consultations, reducing inpatient and outpatient visits, changing their prescription practices, using teleconsultation and moving to long-shift systems. CONCLUSION This study has brought to the fore the experiences that adversely affected frontline health workers and, in many ways, affected the care provided to PLWNCDs. Policymakers and health managers should take these experiences into account in plans to mitigate the impact of future pandemics.
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Affiliation(s)
- Leonard Baatiema
- School of Public Health, University of Ghana, Accra-Legon, Ghana
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Kwadwo K Koram
- Epidemiology, University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | - Luke N Allen
- Center for Global Primary Care, University of Oxford, Oxford, UK
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Margaret Kruk
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Lim R, Alvarez A, Cameron B, Gray S. Breaking point: the hidden crisis of emergency physician burnout. CAN J EMERG MED 2024; 26:297-301. [PMID: 38598075 DOI: 10.1007/s43678-024-00659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Rodrick Lim
- Department of Paediatrics, Schulich School of Medicine and Dentistry at the University of Western Ontario, Children's Health Research Institute, Children's Hospital at London Health Sciences Centre, London, ON, Canada.
| | - Al'ai Alvarez
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Brittany Cameron
- Department of Emergency Medicine, Michael Garron Hospital, Toronto, ON, Canada
| | - Sara Gray
- Division of Emergency Medicine and the Interdepartmental Division of Critical Care, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kunkle R, Xu H, Thomas LE, Webb LE, O'Brien EC, Geary CR. Nursing Home Workers' Experience During the COVID-19 Pandemic. Res Gerontol Nurs 2024; 17:131-140. [PMID: 38815218 DOI: 10.3928/19404921-20240423-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE To understand nursing home workers' experience during the coronavirus disease 2019 (COVID-19) pandemic and investigate the prevalence of health-related quality of life, emotional distress, job satisfaction, and the impact of the pandemic. METHOD The Healthcare Worker Exposure Response and Outcomes (HERO) Registry served as the data source for this descriptive cross-sectional analysis. Recruitment was conducted nationally. Eligible nursing home workers (N = 1,409) enrolled in the study online, self-reported demographic and employment characteristics, and completed electronic surveys. RESULTS Nursing home workers reported overall good physical health, frequent depressive symptoms, burnout, and a high prevalence of feeling tired, stressed, having trouble sleeping, and feeling worried. Age and race were found to be positively associated with the impact of the pandemic. CONCLUSION Findings demonstrate the difficulties and challenges nursing home workers faced during the COVID-19 pandemic. Future research needs to evaluate the relationships among nursing home workers' roles, mental health, depressive symptoms, and prevalence of burnout with a larger, more diverse sample. [Research in Gerontological Nursing, 17(3), 131-140.].
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Stouder A, Ayars CL. Burnout, Personal, and Occupational Factors as Predictors of Physician Assistant Faculty Intent to Leave After the COVID-19 Pandemic. J Physician Assist Educ 2024:01367895-990000000-00133. [PMID: 38595214 DOI: 10.1097/jpa.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION This study addressed whether burnout, personal, or occupational factors predicted physician assistant (PA) faculty intent to leave and established a new postpandemic national benchmark for PA faculty burnout and intent to leave. METHODS In spring 2023, a nonexperimental, cross-sectional survey was emailed to 2031 PA faculty drawn from program faculty listings and the PA Education Association member database. Descriptive statistics were used to describe the sample, and a multiple regression analysis was conducted to analyze the predictive ability of the independent variables on intent to leave. RESULTS The response rate was 30% (609 of 2031), with 496 responses (24.4%) included in the analysis. The sample reflected the population of PA faculty. The regression model significantly predicted intent leave (P < .001). The adjusted R2 was 0.46, indicating the combination of independent variables predicted 46% of the variance in PA faculty intent to leave. Significant predictors included emotional exhaustion and identifying as multiracial (P < .001), control and values (P < .01), and depersonalization, fairness, rewards, and clinical year faculty role (P < .05). The sample had moderate levels of burnout and experienced burnout at higher rates than in prepandemic studies. Physician assistant faculty in administrative leadership roles had the highest levels of burnout and intent to leave. Despite this, PA faculty intent to leave measures were similar to prepandemic levels. DISCUSSION Several of the predictive variables were related to well-being and social-emotional aspects of the workplace. These findings have implications for institutional policies and practices that support faculty well-being and workplace culture to enhance retention.
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Affiliation(s)
- April Stouder
- April Stouder, EdD, MHS, PA-C, is an associate professor, associate program director of Duke Physician Assistant Program, Durham, North Carolina
- Candace L. Ayars, PhD, is an associate professor, A.T. Still University, College of Graduate Health Studies, Kirksville, Missouri
| | - Candace L Ayars
- April Stouder, EdD, MHS, PA-C, is an associate professor, associate program director of Duke Physician Assistant Program, Durham, North Carolina
- Candace L. Ayars, PhD, is an associate professor, A.T. Still University, College of Graduate Health Studies, Kirksville, Missouri
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Leigh R, Kim D, Ibraheim MK, Kraus C, Chow C, Luke J, Dao H, Anderson N, Chou FS, Elsensohn A. Perceptions and impact of patient reviews: a survey of academic dermatologists. Int J Dermatol 2024; 63:512-516. [PMID: 38305475 DOI: 10.1111/ijd.17066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Patient reviews (PRs) have emerged as a method to assess patient experiences with healthcare in order to improve the quality of care. Both institutional and third-party organizations collect quantitative data and comments from these patient surveys, usually accessible to the public for review. Our study examined dermatologists' perceptions of PRs and assessed their impact on dermatologists. METHODS A survey was sent to the Association of Professors of Dermatology listserv (response rate 30%). RESULTS Most respondents disagreed with the statements that PRs are good for doctors (63%), good for patients (58%), helpful for doctors (58%), or that high PRs indicate being a good doctor (65%). The majority disagreed that PRs should be available publicly (60%). Respondents agreed that PRs contribute to depersonalization (60%), energy depletion or exhaustion (55%), added stress at work (70%), negativism/cynicism about work (60%), and diminished professional efficacy (29%). Self-identified female respondents were more likely to agree that PRs added stress to work compared to self-identified males (66% vs. 42%, P < 0.05). CONCLUSIONS Overall, these findings suggest that PRs may negatively impact dermatologists' well-being and perceived stress levels.
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Affiliation(s)
- Rebekah Leigh
- Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | - Dahyeon Kim
- Loma Linda University, School of Medicine, Loma Linda, CA, USA
| | | | - Christina Kraus
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Conroy Chow
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
| | - Janiene Luke
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
| | - Harry Dao
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
| | - Nancy Anderson
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
| | - Fu-Sheng Chou
- Southern California Permanente Medical Group, Pasadena, CA, USA
- Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| | - Ashley Elsensohn
- Loma Linda University, Department of Dermatology, Loma Linda, CA, USA
- Loma Linda University, Department of Pathology and Human Anatomy, Loma Linda, CA, USA
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Wash A, Moczygemba LR, Brown CM, Crismon ML, Whittaker TA. A narrative review of the well-being and burnout of U.S. community pharmacists. J Am Pharm Assoc (2003) 2024; 64:337-349. [PMID: 37967722 DOI: 10.1016/j.japh.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES The purpose of this narrative review is to summarize the literature on well-being and burnout among community pharmacists in the U.S. and provide recommendations for future research. METHODS Relevant literature was identified by searching PubMed for combinations of keywords such as "burnout" and "well-being" combined with "pharmacists." Titles and abstracts were reviewed for relevancy, and full text articles were reviewed when applicable. RESULTS While burnout is defined by its 3 core symptoms of emotional exhaustion, depersonalization, and low personal accomplishment, well-being is more challenging to define and measure, which has led to it being less studied. Community pharmacists faced high rates of burnout, low quality of life (QOL), and extreme fatigue prior to the COVID-19 pandemic, a situation that has likely only worsened. Factors such as workload, the type of community pharmacy, the level of education or training of the pharmacist, and stress may be some of the contributors to high rates of burnout. Clinician burnout may be related to high rates of mental health disorders seen in pharmacists, may impact patient safety and satisfaction, and may affect productivity and costs to employers and the healthcare system overall. There has been no research into interventions or strategies to support well-being and reduce burnout among community pharmacists, but having a workplace that is perceived as supporting well-being may have some impact. Recommendations for future research include the following: (1) define well-being, (2) explore why various factors support well-being or contribute to burnout, (3) determine the impact of community pharmacists experiencing well-being or burnout, and (4) develop strategies to support well-being and reduce burnout that are specific to community pharmacy. CONCLUSION There is a sparsity of evidence regarding community pharmacist well-being and burnout. Further research is needed to generate the evidence needed to support interventions that are specific to the unique work setting of community pharmacists.
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Chiou PZ, Herring RP, Oh J, Medina E. Health impacts in pathology workforce during mergers and acquisitions (M&A). J Clin Pathol 2024; 77:98-104. [PMID: 37914381 DOI: 10.1136/jcp-2023-209124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023]
Abstract
AIMS To compare burn-out in laboratory professionals (LPs) with exposure to consolidation to those without, and to investigate the role of social support as a moderator in the exposure to mergers and acquisitions (M&A). METHODS Surveys were sent to the clinical LPs, including 732 with exposure to M&A and 819 without. The dependent variable was burn-out, and the independent variable was exposure to M&A. In investigating the role of social support in exposure group, a logistic regression was used with education, time since M&A, gender, merger types, practice setting, lab hierarchy and race as covariates. RESULTS Exposure to M&A was associated with higher levels of burn-out (p<0.05). In logistic regression of the workforce exposed to M&A, the odds for LP developing a high level of burn-out are lowered by 7.1% for every unit of increase in social support (OR 0.93; 95% CI 0.88 to 0.98; p=0.004). CONCLUSION LPs exposed to M&A are more likely to experience higher levels of burn-out but having social support can protect against burn-out, which has policy implications for leadership managing laboratories in times of M&A.
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Affiliation(s)
- Paul Zone Chiou
- Clinical Laboratory Science, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
- Loma Linda University School of Public Health, Loma Linda, California, USA
| | - R Patti Herring
- Loma Linda University School of Public Health, Loma Linda, California, USA
| | - Jisoo Oh
- Loma Linda University School of Public Health, Loma Linda, California, USA
| | - Ernest Medina
- Loma Linda University School of Public Health, Loma Linda, California, USA
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Agarwal AK, Gonzales R, Munden C, Albright D, Tsao S. Medical Students' Perceptions on Identifying and Addressing Emotional Responses in Emergency Medicine: Pilot Investigation. JMIR Form Res 2024; 8:e50827. [PMID: 38198202 PMCID: PMC10809065 DOI: 10.2196/50827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Training in acute care, such as emergency medicine (EM), where exposure to critically ill and injured patients is high, impacts the well-being of trainees and contributes to burnout. Investigating how, and if, trainees prepare for these situations is necessary to ensure they are supported. OBJECTIVE This study aimed to evaluate medical students' perspectives and emotional preparedness for handling acute care and trauma. METHODS We conducted a pilot investigation using a remote digital survey of medical students during their EM clerkship at a large, urban academic institution. The primary outcome of interest was student-reported preparedness and comfort in handling trauma and critical care patient encounters. Secondary outcomes included awareness of well-being resources and comfort in accessing digital well-being resources. RESULTS A total of 57 medical students completed the voluntary digital survey, and half of the students (n=28, 49%) reported having witnessed the care of a critically ill or a penetrating trauma patient (eg, a victim of gun violence). A majority (n=40, 70%) had thought about how these events may impact them, and over half felt unprepared to identify the emotional impact these cases may have on them (n=31, 54%) or address the emotional or mental health impact (n=36, 63%). Less than a quarter (n=14, 25%) were aware of digital mental health resources, and 58% (n=33) did not feel fully comfortable connecting with resources if needed. Students who had previously witnessed critical care were significantly more likely to report feeling well prepared in identifying the emotional impact and addressing this impact. CONCLUSIONS In this cross-sectional survey, students did not feel fully prepared to identify or address the emotional impact of working in EM. Additionally, they lacked awareness of or comfort with accessing digital institutional resources meant to support their well-being, such as a large web-based platform. These findings can help inform and guide interventions by educational and academic leaders. The aim would be to create and promote environments that empower students with tools to identify their own emotions and connect to well-being resources.
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Affiliation(s)
- Anish Kumar Agarwal
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, PA, United States
| | - Rachel Gonzales
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, PA, United States
| | - Cory Munden
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - DaCarla Albright
- Department of Obstetrics and Gynecology, University of Pennyslvania, Philadelphia, PA, United States
| | - Suzana Tsao
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Underdahl L, Ditri M, Duthely LM. Physician Burnout: Evidence-Based Roadmaps to Prioritizing and Supporting Personal Wellbeing. J Healthc Leadersh 2024; 16:15-27. [PMID: 38192639 PMCID: PMC10773242 DOI: 10.2147/jhl.s389245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
Current literature validates the magnitude of physician burnout as a complex challenge affecting physicians, patients, and healthcare delivery that mandates science-informed intervention. Physician burnout affects both individual practitioners and patient care delivery. Interventions, defined as roadmaps, to prioritizing and supporting personal wellbeing encompass organizational, individual, and moral injury, with virtually no consensus on optimal approaches. The purpose of this conceptual review is to present evidence-based innovative insights on contributing factors, mitigation, and designing adaptive systems to combat and prevent burnout. Science-informed policy initiatives that support long-term organizational changes endorsed by both leadership and institutional stakeholders are keys to sustaining personal wellbeing and ending burnout.
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Affiliation(s)
- Louise Underdahl
- College of Doctoral Studies, University of Phoenix, Phoenix, AZ, USA
| | - Mary Ditri
- Community Health, New Jersey Hospital Association, Princeton, NJ, USA
| | - Lunthita M Duthely
- Obstetrics, Gynecology and Reproductive Sciences and the Department of Public Health Sciences, University of Miami Health System, Miami, FL, USA
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Funk KA, Stillman M, Wang Q, Manser ST, Rogers EA. Association of Burnout With Primary Care Clinician Perception of Team-Based Scheduling Support. J Prim Care Community Health 2024; 15:21501319231222372. [PMID: 38361419 PMCID: PMC10874136 DOI: 10.1177/21501319231222372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Primary care clinician burnout is pervasive and detrimental. How components of teamwork and clinic culture might contribute to burnout remains unsettled. OBJECTIVE To examine associations between primary care clinician perceptions of specific components of teamwork and of organizational culture, and perceived stress and burnout. METHODS Cross-sectional survey study of primary care clinicians from 5 county health system clinics. Measures: Perceptions of teamwork related to coordination of care, and clinic provision of chronic disease self-management support; values alignment and workplace equity; and demographics. DATA ANALYSIS Descriptive statistics and Spearman's correlations to examine associations, controlling for clinic and examining response variability by clinic. RESULTS Of 72 clinicians, 64% were female and 32% non-white. About 56% had worked at least 4 years and half worked 5 to 6 half days/week or more in their clinic. Clinicians who reported having someone on the clinician's care team routinely schedule follow-up appointments for patients with complex chronic illnesses reported lower stress and burnout. Those who perceived greater values alignment with their clinic and greater personal and employee equitable treatment had lower stress and burnout. CONCLUSIONS Teamwork among clinicians and non-clinical staff, a component of teamwork that is not well-considered in current literature, could be an important piece of the puzzle to decrease the persistent and challenging issue of stress and burnout among primary care clinicians.
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Affiliation(s)
- Kylee A. Funk
- University of Minnesota College of Pharmacy, Department of Pharmaceutical Care and Health Systems, Minneapolis, MN, USA
| | - Martin Stillman
- Hennepin Healthcare, Minneapolis, MN, USA
- University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, USA
| | - Qi Wang
- University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, USA
| | - Sarah Turcotte Manser
- University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, USA
| | - Elizabeth A. Rogers
- University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, USA
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Zeeman JM, Pickering ES, Nana AA, Harris SC. Assessing Workplace Factors That Influence Burnout and Identifying Recommendations to Support Well-being in Pharmacy Faculty. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100628. [PMID: 37981071 DOI: 10.1016/j.ajpe.2023.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Creating environments that promote well-being is critical as studies have shown that burnout, and thus poor well-being, results in poor health outcomes and declining workplace retention. While studies have measured the prevalence of burnout in pharmacy faculty, a gap exists regarding workplace factors that impact faculty well-being. The purpose of this study was to assess factors influencing pharmacy faculty burnout and identify recommendations to improve faculty well-being. METHODS Full-time pharmacy faculty were invited to participate in this exploratory study. Focus groups were divided by faculty rank (ie, assistant, associate, full professor). A semistructured interview format was used to identify factors contributing to faculty burnout and fulfillment as well as solicit suggestions for strategies to improve well-being. Inductive coding was used to identify themes. RESULTS Eleven faculty participated in 4 focus groups: 6 assistant professors in 2 focus groups (n = 3 faculty/focus group), 3 associate professors in 1 focus group, and 2 full professors in 1 focus group. Common factors influencing faculty burnout included overwhelming workload, workplace inefficiencies, and unexpected factors. Factors contributing to faculty fulfillment included impact, having a passion for work, and connecting with others. Recommendations for improving well-being included school-level well-being initiatives from leadership, encouraging work-life balance, and implementing intentional well-being initiatives and resources. CONCLUSION Participants identified several workplace factors that contribute to burnout and faculty fulfillment. This study fills a critical gap in the literature regarding factors that influence pharmacy faculty well-being and burnout and can inform strategies for fostering faculty well-being in pharmacy education.
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Affiliation(s)
- Jacqueline M Zeeman
- University of North Carolina at Chapel Hill, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Emily S Pickering
- University of North Carolina at Chapel Hill, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Akina A Nana
- University of North Carolina at Chapel Hill, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Suzanne C Harris
- University of North Carolina at Chapel Hill, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
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Cunningham T, Caza B, Hayes R, Leake S, Cipriano P. Design health care systems to protect resilience in nursing. Nurs Outlook 2024; 72:101999. [PMID: 37481349 DOI: 10.1016/j.outlook.2023.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/30/2023] [Accepted: 06/11/2023] [Indexed: 07/24/2023]
Abstract
This panel paper is the fourth installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic(s) of discussion, and this panel paper is focused on resilience in nursing. It addresses the importance of organizational culture in nursing retention, the role of leadership in reducing nurse turnover, and strategies for how to build resilience systems that counteract or eliminate sources of moral distress. Cost rationales are discussed as part of 'the busienss case' for investing in resilience systems.
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Affiliation(s)
| | - Brianna Caza
- University of North Carolina Greensboro, Greensboro, NC.
| | - Rose Hayes
- Emory University School of Nursing, Atlanta, GA.
| | - Sandy Leake
- The University of Tennessee Medical Center, Knoxville, TN.
| | - Pamela Cipriano
- University of Virginia School of Nursing, Charlottesville, VA.
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Morgan P, Barnes H, Batchelder HR, Tuttle B, Covelli AF, Everett C, Jackson GL, Anglin L, Pate NO, Dieter P, Bludorn J. NP and PA transition to practice: A scoping review of fellowships and onboarding programs. JAAPA 2023; 36:1-9. [PMID: 37943670 DOI: 10.1097/01.jaa.0000991352.36720.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Newly graduated NPs and physician associates/assistants (PAs) benefit from transition to practice (TTP) support to move successfully into practice. TTP programs (such as onboarding programs, fellowships, and residencies) hold promise for improving workforce outcomes. The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs. METHODS Using the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included if they addressed fellowships, residencies, or onboarding programs for NPs or PAs. Final data extraction involved 216 articles. RESULTS The pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships or residencies, NPs, and programs set in nonrural, acute care US settings and in academic health centers. CONCLUSIONS A gap exists in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, few articles assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas.
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Affiliation(s)
- Perri Morgan
- Perri Morgan is a professor in the PA program at Duke University in Durham, N.C. Hilary Barnes is an assistant professor at Widener University School of Nursing in Chester, Pa. Heather R. Batchelder is a research program leader in the Department of Family Medicine and Community Health at Duke University. Brandi Tuttle is a research and education librarian at Duke University Medical Center Library and Archives. Asefeh Faraz Covelli is an associate professor in the School of Nursing at George Washington University in Washington, D.C. Christine Everett is founding PA program director and division chief of PA studies at the Medical College of Wisconsin in Milwaukee, Wisc. George L. Jackson is a professor and director of the Program on Implementation and Improvement Science at the Peter O'Donnell Jr. School of Public Health at the University of Texas Southwestern Medical Center in Dallas, Tex., and a research health scientist and director of the Implementation and Improvement Science Lab in the Center of Innovation to Accelerate Discovery and Practice Transformation at Durham (N.C.) Veterans Affairs Health Care System. Lorraine Anglin is an assistant professor and academic coordinator of the PA program at Duke University and practices at Triangle Residential Options for Substance Abusers medical clinic in Durham, N.C. Nathalie Ortiz Pate is an assistant professor in the PA program at Campbell University in Buies Creek, N.C., and practices family medicine at Moncure (N.C.) Community Health Center. Patricia Dieter is a professor emeritus in the Department of Family Medicine and Community Health at Duke University School of Medicine. Janelle Bludorn is an assistant professor and academic coordinator of the PA program at Duke University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Tanabe R, Hongo T, Obara T, Nojima T, Nakao A, Elmer J, Naito H, Yumoto T. Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order. Resusc Plus 2023; 16:100507. [PMID: 38026140 PMCID: PMC10665952 DOI: 10.1016/j.resplu.2023.100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This research investigated treatment patterns for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders in Japanese emergency departments and the associated clinician stress. Methods A cross-sectional survey was conducted at 9 hospitals in Okayama, Japan, targeting emergency department nurses and physicians. The questionnaire inquired about the last treated out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation. We assessed emotional stress on a 0-10 scale and moral distress on a 1-5 scale among clinicians. Results Of 208 participants, 107 (51%) had treated an out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation order in the past 6 months. Of these, 65 (61%) clinicians used a "slow code" due to perceived futility in resuscitation (42/65 [65%]), unwillingness to terminate resuscitation upon arrival (38/65 [59%]), and absence of family at the time of patient's arrival (35/65 [54%]). Female clinicians had higher emotional stress (5 vs. 3; P = 0.007) and moral distress (3 vs. 2; P = 0.002) than males. Nurses faced more moral distress than physicians (3 vs. 2; P < 0.001). Adjusted logistic regression revealed that having performed a "slow code" (adjusted odds ratio, 5.09 [95% CI, 1.68-17.87]) and having greater ethical concerns about "slow code" (adjusted odds ratio, 0.35 [95% CI, 0.19-0.58]) were associated with high stress levels. Conclusions The prevalent use of "slow code" for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders underscores the challenges in managing these patients in clinical practice.
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Affiliation(s)
- Ryo Tanabe
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Morgan P, Barnes H, Batchelder HR, Tuttle B, Faraz Covelli A, Everett C, Jackson GL, Anglin L, Ortiz Pate N, Dieter P, Bludorn J. Nurse practitioner and physician assistant transition to practice: A scoping review of fellowships and onboarding programs. J Am Assoc Nurse Pract 2023; 35:776-783. [PMID: 38047888 DOI: 10.1097/jxx.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/28/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Newly graduated nurse practitioners (NPs) and physician assistants (PAs) benefit from transition-to-practice (TTP) support to move successfully into practice. Transition-to-practice programs (i.e., onboarding programs and fellowships/residencies) hold promise for improving workforce outcomes. PURPOSE The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs. METHODOLOGY Using the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included for review if they addressed fellowships/residencies or onboarding programs for NPs or PAs. Final data extraction involved 216 articles. RESULTS The pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships/residencies, NPs, and programs set in United States nonrural, acute care settings, and academic health centers. CONCLUSIONS/IMPLICATIONS There is a gap in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, there are few articles that assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas.
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Affiliation(s)
- Perri Morgan
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Hilary Barnes
- School of Nursing, Widener University, Chester, Pennsylvania
| | - Heather R Batchelder
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Brandi Tuttle
- Medical Center Library and Archives, Duke University, Durham, North Carolina
| | - Asefeh Faraz Covelli
- School of Nursing, George Washington University, Washington, District of Columbia
| | - Christine Everett
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Physician Associate Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - George L Jackson
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, North Carolina
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lorraine Anglin
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Nathalie Ortiz Pate
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina. JAANP and JAAPA have arranged to publish this article simultaneously in the December 2023 issues. Although the two articles have minor style differences, they are essentially the same
| | - Patricia Dieter
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Janelle Bludorn
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
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Sinskey JL, Chang JM, Lu AC, Pian-Smith MC. Patient Safety and Clinician Well-Being. Anesthesiol Clin 2023; 41:739-753. [PMID: 37838381 DOI: 10.1016/j.anclin.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Clinician well-being and patient safety are intricately linked. We propose that organizational factors (ie, elements of the perioperative work environment and culture) affect both, as opposed to a bidirectional causal relationship. Threats to patient safety and clinician well-being include clinician mental health issues, negative work environments, poor teamwork and communication, and staffing shortages. Opportunities to mitigate these threats include the normalization of mental health care, peer support, psychological safety, just culture, teamwork and communication training, and creative staffing approaches.
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Affiliation(s)
- Jina L Sinskey
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, 4th Floor, San Francisco, CA, USA.
| | - Joyce M Chang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, 4th Floor, San Francisco, CA, USA
| | - Amy C Lu
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - May C Pian-Smith
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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21
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Ekezie W, Martin CA, Baggaley RF, Teece L, Nazareth J, Pan D, Sze S, Bryant L, Woolf K, Gray LJ, Khunti K, Pareek M. Association between ethnicity and migration status with the prevalence of single and multiple long-term conditions in UK healthcare workers. BMC Med 2023; 21:433. [PMID: 38031115 PMCID: PMC10688453 DOI: 10.1186/s12916-023-03109-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Healthcare workers' (HCW) well-being has a direct effect on patient care. However, little is known about the prevalence and patterns of long-term medical conditions in HCWs, especially those from ethnic minorities. This study evaluated the burden of multiple long-term conditions (MLTCs), i.e. the presence of two or more single long-term conditions (LTCs), among HCWs in the United Kingdom (UK) and variation by ethnicity and migration status. METHODS We used baseline data from the UK-REACH cohort study collected December 2020-March 2021. We used multivariable logistic regression, adjusting for demographic, occupational and lifestyle factors to examine the relationship between self-reported LTCs/MLTCs and ethnicity, migration status and time since migration to the UK. RESULTS Of 12,100 included HCWs, with a median age of 45 years (IQR: 34-54), 27% were overseas-born, and 30% were from non-White ethnic groups (19% Asian, 4% Black, 4% Mixed, 2% Other). The most common self-reported LTCs were anxiety (14.9%), asthma (12.2%), depression (10.7%), hypertension (8.7%) and diabetes (4.0%). Mental health conditions were more prevalent among UK-born than overseas-born HCWs for all ethnic groups (adjusted odds ratio (aOR) using White UK-born as the reference group each time: White overseas-born 0.77, 95%CI 0.66-0.95 for anxiety). Diabetes and hypertension were more common among Asian (e.g. Asian overseas, diabetes aOR 2.97, 95%CI 2.30-3.83) and Black (e.g. Black UK-born, hypertension aOR 1.77, 95%CI 1.05-2.99) groups than White UK-born. After adjustment for age, sex and deprivation, the odds of reporting MLTCs were lower in most ethnic minority groups and lowest for those born overseas, compared to White UK-born (e.g. White overseas-born, aOR 0.68, 95%CI 0.55-0.83; Asian overseas-born aOR 0.75, 95%CI 0.62-0.90; Black overseas-born aOR 0.52, 95%CI 0.36-0.74). The odds of MLTCs in overseas-born HCWs were equivalent to the UK-born population in those who had settled in the UK for ≥ 20 years (aOR 1.14, 95%CI 0.94-1.37). CONCLUSIONS Among UK HCWs, the prevalence of common LTCs and odds of reporting MLTCs varied by ethnicity and migrant status. The lower odds of MLTCs in migrant HCWs reverted to the odds of MLTCs in UK-born HCWs over time. Further research on this population should include longitudinal studies with linkage to healthcare records. Interventions should be co-developed with HCWs from different ethnic and migrant groups focussed upon patterns of conditions prevalent in specific HCW subgroups to reduce the overall burden of LTCs/MLTCs.
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Affiliation(s)
- Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK
- School of Social Sciences and Humanities, Aston University, Birmingham, UK
| | - Christopher A Martin
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Rebecca F Baggaley
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Lucy Teece
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Joshua Nazareth
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Daniel Pan
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, Oxford, UK
| | - Shirley Sze
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
| | | | - Laura J Gray
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK
| | - Manish Pareek
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK.
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK.
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK.
- Development Centre for Population Health, University of Leicester, Leicester, UK.
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Apaydin EA, Rose DE, McClean MR, Mohr DC, Yano EM, Shekelle PG, Nelson KM, Guo R, Yoo CK, Stockdale SE. Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic. BMC Health Serv Res 2023; 23:1306. [PMID: 38012726 PMCID: PMC10683139 DOI: 10.1186/s12913-023-10270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017-2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic. METHODS We analyzed individual- and healthcare system-level data from 19,894 primary care HCWs in 139 healthcare systems in 2020. We modeled potential relationships between individual-level burnout and turnover intent as outcomes, and individual-level employee engagement, perceptions of workload, leadership, and workgroups. At healthcare system-level, we assessed prior-year levels of burnout and turnover intent, COVID-19 burden (number of tests and deaths), and the extent of virtual care use as potential determinants. We conducted multivariable analyses using logistic regression with standard errors clustered by healthcare system controlled for individual-level demographics and healthcare system complexity. RESULTS In 2020, 37% of primary care HCWs reported burnout, and 31% reported turnover intent. Highly engaged employees were less burned out (OR = 0.57; 95% CI 0.52-0.63) and had lower turnover intent (OR = 0.62; 95% CI 0.57-0.68). Pre-pandemic healthcare system-level burnout was a major predictor of individual-level pandemic burnout (p = 0.014). Perceptions of reasonable workload, trustworthy leadership, and strong workgroups were also related to lower burnout and turnover intent (p < 0.05 for all). COVID-19 burden, virtual care use, and prior year turnover were not associated with either outcome. CONCLUSIONS Employee engagement was associated with a lower likelihood of primary care HCW burnout and turnover intent during the pandemic, suggesting it may have a protective effect during stressful times. COVID-19 burden and virtual care use were not related to either outcome. Future research should focus on understanding the relationship between engagement and burnout and improving well-being in primary care.
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Affiliation(s)
- Eric A Apaydin
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Danielle E Rose
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - Michael R McClean
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - David C Mohr
- National Center for Organization Development, Veterans Health Administration, Cincinnati, OH, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Paul G Shekelle
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Karin M Nelson
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, University of Washington, Seattle, WA, USA
| | - Rong Guo
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - Caroline K Yoo
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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23
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Geoffrion S, Morse C, Dufour MM, Bergeron N, Guay S, Lanovaz MJ. Screening for Psychological Distress in Healthcare Workers Using Machine Learning: A Proof of Concept. J Med Syst 2023; 47:120. [PMID: 37971690 DOI: 10.1007/s10916-023-02011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
The purpose of this study was to train and test preliminary models using two machine learning algorithms to identify healthcare workers at risk of developing anxiety, depression, and post-traumatic stress disorder. The study included data from a prospective cohort study of 816 healthcare workers collected using a mobile application during the first two waves of COVID-19. Each week, the participants responded to 11 questions and completed three screening questionnaires (one for anxiety, one for depression, and one for post-traumatic stress disorder). Then, the research team selected two questions (out of the 11), which were used with biological sex to identify whether scores on each screening questionnaire would be positive or negative. The analyses involved a fivefold cross-validation to test the accuracy of models based on logistic regression and support vector machines using cross-sectional and cumulative measures. The findings indicated that the models derived from the two questions and biological sex accurately identified screening scores for anxiety, depression, and post-traumatic stress disorders in 70% to 80% of cases. However, the positive predictive value never exceeded 50%, underlining the importance of collecting more data to train better models. Our proof of concept demonstrates the feasibility of using machine learning to develop novel models to screen for psychological distress in at-risk healthcare workers. Developing models with fewer questions may reduce burdens of active monitoring in practical settings by decreasing the weekly assessment duration.
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Affiliation(s)
- Steve Geoffrion
- Research center of l'Institut universitaire en santé mentale de Montréal (CR-IUSMM), Montréal, Québec, Canada.
- School of Psychoeducation, University of Montreal, Université de Montréal Pavillon Marie-Victorin École de psychoéducation, C. P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - Catherine Morse
- Research center of l'Institut universitaire en santé mentale de Montréal (CR-IUSMM), Montréal, Québec, Canada
- School of Psychoeducation, University of Montreal, Université de Montréal Pavillon Marie-Victorin École de psychoéducation, C. P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Marie-Michèle Dufour
- School of Psychoeducation, University of Montreal, Université de Montréal Pavillon Marie-Victorin École de psychoéducation, C. P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Nicolas Bergeron
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
- Research Center of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Stéphane Guay
- Research center of l'Institut universitaire en santé mentale de Montréal (CR-IUSMM), Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
- School of Criminology, Université de Montréal, Montréal, Québec, Canada
| | - Marc J Lanovaz
- Research center of l'Institut universitaire en santé mentale de Montréal (CR-IUSMM), Montréal, Québec, Canada
- School of Psychoeducation, University of Montreal, Université de Montréal Pavillon Marie-Victorin École de psychoéducation, C. P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada
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24
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Kraus M, Stegner C, Reiss M, Riedel M, Børsch AS, Vrangbaek K, Michel M, Turmaine K, Cseh B, Dózsa CL, Dandi R, Mori AR, Czypionka T. The role of primary care during the pandemic: shared experiences from providers in five European countries. BMC Health Serv Res 2023; 23:1054. [PMID: 37784101 PMCID: PMC10546726 DOI: 10.1186/s12913-023-09998-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience. METHODS The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care. RESULTS Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues. CONCLUSION Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.
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Affiliation(s)
- Markus Kraus
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria.
| | - Christoph Stegner
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Miriam Reiss
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Monika Riedel
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Anne Sofie Børsch
- University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1353, Denmark
| | - Karsten Vrangbaek
- University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1353, Denmark
| | - Morgane Michel
- Université Paris Cité, ECEVE, UMR 1123, 10 avenue de Verdun, Inserm, Paris, 75010, France
- Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 48 boulevard Sérurier, Paris, 75019, France
| | - Kathleen Turmaine
- Université Paris Cité, ECEVE, UMR 1123, 10 avenue de Verdun, Inserm, Paris, 75010, France
| | - Borbála Cseh
- University of Miskolc, Egyetem út 1, Miskolc-Egyetemváros, 3515, Hungary
| | - Csaba László Dózsa
- University of Miskolc, Egyetem út 1, Miskolc-Egyetemváros, 3515, Hungary
| | - Roberto Dandi
- Luiss Business School, Via Nomentana 216, Roma, 00162, RM, Italy
| | - Angelo Rossi Mori
- Institute for Research on Population and Social Policies, Via Palestro 32, Roma, 00185, Italy
| | - Thomas Czypionka
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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25
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Wood RE, Bleich M, Chung J, Elswick RK, Nease E, Sargent L, Kinser PA. A mixed-methods exploration of nurse loneliness and burnout during COVID-19. Appl Nurs Res 2023; 73:151716. [PMID: 37722784 DOI: 10.1016/j.apnr.2023.151716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/23/2023] [Accepted: 07/23/2023] [Indexed: 09/20/2023]
Abstract
AIM This study investigated the phenomenon of nurse loneliness as a potential contributor to burnout. BACKGROUND Nurse wellbeing is critical for safe and efficient healthcare delivery. However, evidence indicates nurses' wellbeing is at risk. The levels of burnout, the most commonly measured symptom of suboptimal wellbeing, are rising and may relate to a largely unexplored phenomenon: loneliness. METHODS A mixed-methods approach was used to investigate burnout and loneliness in direct-care nurses in four diverse hospitals in the midwestern and southeastern United States. Burnout and loneliness were measured, prevalence was estimated, and correlation was examined. Interpretive descriptive inquiry and analysis was used to develop a richer understanding of nurse loneliness in the context of burnout. While this study did not explicitly explore the impact of the global pandemic, data was collected in late 2021 and early 2022, during the Delta variant wave. RESULTS In the study population (n = 117), rates of burnout are high and positively correlate with loneliness. Qualitative interviews (n = 11) revealed that nurses feel unseen, emotionally detached from their work, and dehumanized. However, social connection with peers is protective and nurses still report a strong sense of devotion to the profession and solidarity with peers. CONCLUSIONS This study offers insight into nurse loneliness, highlighting the importance of social connectedness to improve nurse wellbeing.
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Affiliation(s)
- Rachel E Wood
- Virginia Commonwealth University School of Nursing, Box 980567, 1100 East Leigh Street, Richmond, VA 23298-0567, United States.
| | - Michael Bleich
- Virginia Commonwealth University School of Nursing, Box 980567, 1100 East Leigh Street, Richmond, VA 23298-0567, United States
| | - Jane Chung
- Virginia Commonwealth University School of Nursing, Box 980567, 1100 East Leigh Street, Richmond, VA 23298-0567, United States
| | - R K Elswick
- Virginia Commonwealth University School of Nursing, Box 980567, 1100 East Leigh Street, Richmond, VA 23298-0567, United States
| | - Elizabeth Nease
- Bon Secours Mercy Health System, 1701 Mercy Health Place, Cincinnati, OH 45237, United States
| | - Lana Sargent
- Virginia Commonwealth University School of Nursing, Box 980567, 1100 East Leigh Street, Richmond, VA 23298-0567, United States
| | - Patricia A Kinser
- Virginia Commonwealth University School of Nursing, Box 980567, 1100 East Leigh Street, Richmond, VA 23298-0567, United States
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26
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Hill C, Justo S, Park H, Bair-Merritt M, Morris A, Feinberg E, Sheldrick RC. Pediatric Provider and Staff Burnout in Federally Qualified Community Health Centers. J Ambul Care Manage 2023; 46:265-271. [PMID: 37540093 DOI: 10.1097/jac.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
This study examined changes in provider and staff burnout in 4 Boston-area federally qualified community health centers (FQHCs) participating in a pediatric behavioral health integration project. Utilizing the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSSMP), the study found that emotional exhaustion among primary care providers ( M = 20.5; confidence interval [CI], 17.8-23.2) was higher ( P = .001) than that among behavioral health clinicians ( M = 13.6; CI, 10.4-16.8) and ( P = .00005) community health workers ( M = 10.8; CI, 7.3-14.2). Emotional exhaustion among staff increased ( P = .04) from baseline ( M = 16.8; CI, 15.0-18.6) to follow-up ( M = 20.8; CI, 17.5-24.2), but burnout at follow-up was lower than national averages. FQHCs are integral in caring for marginalized patients; therefore, supporting a stable workforce by minimizing burnout is essential.
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Affiliation(s)
- Cameron Hill
- Department of Pediatrics, Boston Medical Center/Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts (Mr Hill and Mss Justo, Park, and Morris and Drs Bair-Merritt and Feinberg); and Department of Psychiatry, UMass Chan Medical School, Worcester, Massachusetts (Dr Sheldrick)
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27
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Wilkie T, Tajirian T, Thakur A, Mistry S, Islam F, Stergiopoulos V. Evolution of a physician wellness, engagement and excellence strategy: lessons learnt in a mental health setting. BMJ LEADER 2023; 7:182-188. [PMID: 37200187 DOI: 10.1136/leader-2022-000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to evaluate the impact of several organisational initiatives implemented as part of a physician engagement, wellness and excellence strategy at a large mental health hospital. Interventions that were examined include: communities of practice, peer support programme, mentorship programme and leadership and management programme for physicians. METHODS A cross-sectional study, guided by the Reach, Effectiveness/Efficacy, Adoption, Implementation and Maintenance evaluation framework, was conducted with physicians at a large academic mental health hospital in Toronto, Canada. Physicians were invited to complete an online survey in April 2021, which composed of questions on the awareness, use and perceived impact of the organisational wellness initiatives and the two-item Maslach Burnout Inventory tool. The survey was analysed using descriptive statistics and a thematic analysis. RESULTS 103 survey responses (40.9% response rate) were gathered from physicians, with 39.8% of respondents reporting experiences of burn-out. Overall, there was variable reach and suboptimal use of the organisational interventions reported by physicians. Themes emerging from open-ended questions included the importance of addressing: workload and resource related factors; leadership and culture related factors; and factors related to the electronic medical record and virtual care. CONCLUSIONS Organisational strategies to address physician burn-out and support physician wellness require repeated evaluation of the impact and relevance of initiatives with physicians, taking into account organisational culture, external variables, emerging barriers to access and participation, and physician needs and interest over time. These findings will be embedded as part of ongoing review of our organisational framework to guide changes to our physician engagement, wellness and excellence strategy.
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Affiliation(s)
- Treena Wilkie
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Tania Tajirian
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Anupam Thakur
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Smit Mistry
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Faisal Islam
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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28
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Ssegujja E, Ddumba I, Andipatin M. An exploration of health workers' experiences in providing bereavement care to mothers following a stillbirth: results from a subnational level health system in Uganda. BMC Pregnancy Childbirth 2023; 23:588. [PMID: 37592205 PMCID: PMC10433559 DOI: 10.1186/s12884-023-05913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Stillbirth is a profound emotion-laden event to the mothers and health workers who provide care due to its sudden and unexpected occurrence. Health workers offering support in regions shouldering the highest-burden experience providing support to a stillbirth mother in their professional lifetime. However, their experiences seldom get documented as much of the focus is on mothers causing a dissonance between parental and clinical priorities. This study aimed to explore the health worker's experiences in the provision of bereavement care to mothers following a stillbirth. METHODS An exploratory cross-sectional qualitative study was undertaken on a purposively selected sample of key informants drawn from frontline health workers and health systems managers providing maternal health services at a subnational level health system in Uganda. An interview guide was used to collect data with the audio-recorded interviews transcribed using Microsoft office word. Atlas. ti a qualitative data management software aided in coding with analysis following a thematic content analysis technique. RESULTS There was no specialised bereavement care provided due to inadequate skills, knowledge of content, resources and support supervision for the same. However, health workers improvised within the available resources to comfort mothers upon news of a stillbirth. Disclosure to mothers about the stillbirth loss often took the form of forewarnings, direct and sometimes delayed disclosure. A feeling of unpreparedness to initiate the disclosure process to the mother was common while the whole experience had an emotional effect on the health workers when establishing the cause, particularly for cases without clear risk factors. The emotional breakdown was often a reflexive response from the mothers which equally affected the care providers. Health workers engaged in comforting and rebuilding the mothers to transition through the loss and validate the loss. Efforts to identify the skills and health systems gaps for address were a common response targeted at improving the quality of maternal healthcare services to avert similar occurrences in the future. CONCLUSION Providing care to mothers after stillbirth was an emotional and challenging experience for health workers requiring different approaches to disclosure and provision of emotional support. The aspect of specialised bereavement care was lacking within the current response. Reflection of unpreparedness to handle the tasks demonstrates a deficit in the required skills. It is a critical gap missing hence calling for dedicated efforts to address it. Targeting efforts to improve health workers' competencies and preparedness to manage grieving mothers is one way to approach it.
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Affiliation(s)
- Eric Ssegujja
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, Republic of South Africa.
| | - Isaac Ddumba
- Mukono District Local Government, Mukono, Uganda
| | - Michelle Andipatin
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, Republic of South Africa
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29
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McQuade BM, Park YS, Jarrett JB, Riddle J. Leveraging Mindfulness to Reduce Stress and Improve Quality of Life Among Pharmacy Students. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100096. [PMID: 37597912 DOI: 10.1016/j.ajpe.2023.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Methods to improve stress and well-being for health profession trainees are limited. Mindfulness, elevating awareness to the present moment experience with compassion, has been shown to demonstrate effectiveness to enhance well-being. This research leverages techniques from mindfulness to develop and evaluate a credit-bearing longitudinal mindfulness elective, designed to teach mindfulness to improve stress and quality of life (QoL). METHODS A mindfulness elective was created for pharmacy students. A longitudinal, case-control, survey-based design was used to compare stress and QoL between mindfulness participants and nonparticipant controls. Stress was assessed by the Perceived Stress Scale (PSS) and QoL by the SF-12 v2 Health-Related QoL Scale (SF-12 v2 QoL). RESULTS Four weeks after course completion, the average PSS score was lower among participants compared to controls (18.58 SD 5.85 vs 20.79 SD 6.31, Cohen's d = 0.36). The Mental Health Component score of SF-12 v2 QoL was higher among participants versus controls (41.94 SD 8.58 vs 36.93 SD 9.59, Cohen's d = 0.55). The Physical Health Component score of SF-12 v2 QoL was lower among participants than the control group (46.13 SD 5.48 vs 48.62 SD 6.53, Cohen's d = 0.41). CONCLUSION The results indicate small to moderate effect sizes associated with participation in a mindfulness elective, reducing stress and improving mental QoL among pharmacy students. The structure and potential benefits of the course can be extrapolated to other institutions. By offering course credit for mindfulness practice, health profession schools can support student wellness.
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Affiliation(s)
- Brianna M McQuade
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA.
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Jennie B Jarrett
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA; American Medical Association, Chicago, IL, USA
| | - Janet Riddle
- Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
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Hlongwa M, Moyo E, Dzinamarira T. Approaches for improving linkage to HIV care among HIV self-testing individuals in sub-Saharan Africa. BMJ Glob Health 2023; 8:e012664. [PMID: 37451688 PMCID: PMC10351227 DOI: 10.1136/bmjgh-2023-012664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Mbuzeleni Hlongwa
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria, South Africa
- School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Enos Moyo
- Medical Centre Oshakati, Oshakati, Namibia
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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31
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Spark A, Schweitzer D, Ting J. Leveraging personality science to enhance junior doctor well-being, leadership and performance: It's not just about who we are, but also how we act. Intern Med J 2023; 53:1100-1104. [PMID: 37474461 DOI: 10.1111/imj.16158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Andrew Spark
- School of Management, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Joseph Ting
- Mater Hospital Brisbane, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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32
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O’Ferrell Beacham A, Westfall King A, Nash BF. Psychologists' Role in Addressing Healthcare Provider Burnout and Well-Being. JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2023; 49:1-13. [PMID: 37360220 PMCID: PMC10251314 DOI: 10.1007/s42843-023-00083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Burnout in health care has received considerable attention; widespread efforts to implement burnout reduction initiatives are underway. Healthcare providers with marginalized identities may be especially at risk. Health service psychologists are often key members of interprofessional teams and may be asked to intervene with colleagues exhibiting signs of burnout. Consequently, psychologists in these settings can then find themselves in professional quandaries. In the absence of clear guidelines, psychologists are learning to enhance their scope of practice and navigate ethical guidelines while supporting colleagues and simultaneously satisfying organizational priorities. In this paper we (a) provide an overview of burnout and its scope, (b) discuss ethical challenges health service psychologists face in addressing provider burnout, and (c) present three models to employ in healthcare provider burnout and well-being.
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Wietlisbach LE, Asch DA, Eriksen W, Barg FK, Bellini LM, Desai SV, Yakubu AR, Shea JA. Using poetry to elicit internal medicine residents' perspectives on wellness. Postgrad Med J 2023; 99:428-432. [PMID: 37294722 PMCID: PMC9530064 DOI: 10.1136/postgradmedj-2021-141493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/19/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To elicit internal medicine residents' perspectives on wellness through poetry writing, examining (1) response rates, (2) the tone/sentiment of their submissions and (3) the primary thematic content. STUDY DESIGN In academic year 2019-2020, a random sample of 88 residents from four internal medicine residency programmes was invited to participate in a year-long study of wellness. In December 2019, an open-ended prompt asked residents to write a poem reflecting on their well-being. Responses were inductively coded using content analysis techniques. RESULTS The response rate for the poetry prompt was 94%. The tone of the entries was most often neutral or contradictory (42%), followed by negative (33%) and positive (25%). There were three main themes: (1) Mindsets: most residents simply wanted to make it through their programme; (2) wellness influencers: the main wellness supporters were external to the programme such as vacationing and exercise; within hospitals, friendships with colleagues and boosted wellness and (3) scheduling/repetition: difficult schedules drained energy as did the monotony of administrative tasks. CONCLUSIONS Poetry appears to be an innovative and effective vehicle to elicit residents' perspectives without compromising response rate. Poetry survey techniques allow medical trainees to provide powerful messaging to leadership. Most of what is known about trainee wellness is derived from quantitative surveys. This study showed medicine trainees' willingness to engage in poetry and add richness and personal detail to highlight key drivers of wellness. Such information provides context and brings attention in a compelling manner to an important topic.
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Affiliation(s)
- Larissa E Wietlisbach
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Asch
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Whitney Eriksen
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances K Barg
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa M Bellini
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay V Desai
- Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abdul-Rakeem Yakubu
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Heming M, Siegrist J, Erschens R, Genrich M, Hander NR, Junne F, Küllenberg JK, Müller A, Worringer B, Angerer P. Managers perception of hospital employees' effort-reward imbalance. J Occup Med Toxicol 2023; 18:8. [PMID: 37280659 DOI: 10.1186/s12995-023-00376-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Hospitals are frequently associated with poor working conditions that can lead to work stress and increase the risk for reduced employee well-being. Managers can shape and improve working conditions and thereby, the health of their teams. Thus, as a prerequisite, managers need to be aware of their employees' stress levels. This study had two objectives: At first, it aimed to test the criterion validity of the Effort-Reward Imbalance (ERI) questionnaire measuring psychosocial workload in hospital employees. Secondly, mean scales of the ERI questionnaire filled in by employees were compared with mean scales of an adapted ERI questionnaire, in which managers assessed working conditions of their employees. METHODS Managers (n = 141) from three hospitals located in Germany assessed working conditions of their employees with an adapted external, other-oriented questionnaire. Employees (n = 197) of the mentioned hospitals completed the short version of the ERI questionnaire to assess their working conditions. Confirmatory factor analyses (CFA) were applied to test factorial validity, using the ERI scales for the two study groups. Criterion validity was assessed with multiple linear regression analysis of associations between ERI scales and well-being among employees. RESULTS The questionnaires demonstrated acceptable psychometric properties in terms of internal consistency of scales, although some indices of model fit resulting from CFA were of borderline significance. Concerning the first objective, effort, reward, and the ratio of effort-reward imbalance were significantly associated with well-being of employees. With regard to the second objective, first tentative findings showed that managers' ratings of their employees' effort at work was quite accurate, whereas their reward was overestimated. CONCLUSIONS With its documented criterion validity the ERI questionnaire can be used as a screening tool of workload among hospital employees. Moreover, in the context of work-related health promotion, managers' perceptions of their employees' workload deserve increased attention as first findings point to some discrepancies between their perceptions and those provided by employees.
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Affiliation(s)
- Meike Heming
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Johannes Siegrist
- Institute of Medical Sociology, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, University of Tuebingen, 72076, Tuebingen, Baden-Wuerttemberg, Germany
| | - Melanie Genrich
- Institute of Psychology, Work and Organisational Psychology, University of Duisburg-Essen, Universitätsstr. 2, 45141, Essen, Germany
| | - Nicole R Hander
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert- Einstein-Allee 23, 89081, Ulm, Germany
| | - Florian Junne
- University Clinic for Psychosomatic Medicine and Psychotherapy, University Medicine, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Janna K Küllenberg
- Institute for Medical Psychology, Centre for Psychosocial Medicine, University Heidelberg, University Hospital Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany
- Institute for Research and Development of Collaborative Processes, FHNW School of Applied Psychology, Riggenbachstrasse 16, Olten, 4600, Switzerland
| | - Andreas Müller
- Institute of Psychology, Work and Organisational Psychology, University of Duisburg-Essen, Universitätsstr. 2, 45141, Essen, Germany
| | - Britta Worringer
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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d'Arqom A, Nasution MZ, Kadir SZSA, Yusof J, Govindaraju K. Practice and knowledge of dietary supplement consumption among Indonesian adults post-delta wave of the COVID-19 pandemic. F1000Res 2023; 12:3. [PMID: 37469719 PMCID: PMC10352623 DOI: 10.12688/f1000research.129045.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/21/2023] Open
Abstract
Background: Increasing dietary supplement (DS) consumption was observed during the COVID-19 pandemic, including during the post-Delta wave period. This study aimed to measure the practice of DS consumption and respondents' knowledge of DS. Methods: An internet-based survey was distributed from October-December 2021 and obtained 541 valid and completed responses. Descriptive analysis was performed to present the practice of DS consumption, including frequency, duration, aim, preferable dosage form etc. Level of knowledge on DS principles, side effects and regulation were also measured. Inferential analyses were conducted to determine the predictors of the respondents' DS practice and level of knowledge. Results: Data from 541 valid responses showed that 77.63% of respondents consumed DS in the last 3 months, with only 59.52% reporting also consuming DS before the COVID-19 pandemic. One half of the respondents had good knowledge about DS; however, some knowledge regarding side effects and possible drug-supplement interaction needed improvement. Their DS consumption practice was affected by their economic status and history of contracting COVID-19. Nevertheless, the level of knowledge was not affected by the sociodemographic factors and DS supplement experience. Conclusions: Taken together, the practice of self-consumption of DS in Indonesia is increasing; hence, knowledge of DS is necessary to avoid detrimental effects that might occur in the future. Increasing access to information on better labelling and educating consumers about DS are important actions to consider.
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Affiliation(s)
- Annette d'Arqom
- Translational Medicine and Therapeutics Research Group, Universitas Airlangga, Surabaya, 60131, Indonesia
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60131, Indonesia
| | - Mhd Zamal Nasution
- Postgraduate School, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia
| | | | - Junaidah Yusof
- School of Human Resource Development & Psychology, Faculty of Social Sciences & Humanities, Universiti Teknologi Malaysia, Johor Bahru, 81310, Malaysia
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Agarwal AK, Mittal J, Tran A, Merchant R, Guntuku SC. Investigating Social Media to Evaluate Emergency Medicine Physicians' Emotional Well-being During COVID-19. JAMA Netw Open 2023; 6:e2312708. [PMID: 37163264 PMCID: PMC10173019 DOI: 10.1001/jamanetworkopen.2023.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/27/2023] [Indexed: 05/11/2023] Open
Abstract
Importance Emergency medicine (EM) physicians experience tremendous emotional health strain, which has been exacerbated during COVID-19, and many have taken to social media to express themselves. Objective To analyze social media content from academic EM physicians and resident physicians to investigate changes in content and language as indicators of their emotional well-being. Design, Setting, and Participants This cross-sectional study used machine learning and natural language processing of Twitter posts from self-described academic EM physicians and resident physicians between March 2018 and March 2022. Participants included academic EM physicians and resident physicians with publicly accessible posts (at least 300 total words across the posts) from the US counties with the top 10 COVID-19 case burdens. Data analysis was performed from June to September 2022. Exposure Being an EM physician or resident physician who posted on Twitter. Main Outcomes and Measures Social media content themes during the prepandemic period, during the pandemic, and across the phases of the pandemic were analyzed. Psychological constructs evaluated included anxiety, anger, depression, and loneliness. Positive and negative language sentiment within posts was measured. Results This study identified 471 physicians with a total of 198 867 posts (mean [SD], 11 403 [18 998] words across posts; median [IQR], 3445 [1100-11 591] words across posts). The top 5 prepandemic themes included free open-access medical education (Cohen d, 0.44; 95% CI, 0.38-0.50), residency education (Cohen d, 0.43; 95% CI, 0.37-0.49), gun violence (Cohen d, 0.37; 95% CI, 0.32-0.44), quality improvement in health care (Cohen d, 0.33; 95% CI, 0.27-0.39), and professional resident associations (Cohen d, 0.33; 95% CI, 0.27-0.39). During the pandemic, themes were significantly related to healthy behaviors during COVID-19 (Cohen d, 0.83; 95% CI, 0.77-0.90), pandemic response (Cohen d, 0.71; 95% CI, 0.65-0.77), vaccines and vaccination (Cohen d, 0.60; 95% CI, 0.53-0.66), unstable housing and homelessness (Cohen d, 0.40; 95% CI, 0.34-0.47), and emotional support for others (Cohen d, 0.40; 95% CI, 0.34-0.46). Across the phases of the pandemic, thematic content within social media posts changed significantly. Compared with the prepandemic period, there was significantly less positive, and concordantly more negative, language used during COVID-19. Estimates of loneliness, anxiety, anger, and depression also increased significantly during COVID-19. Conclusions and Relevance In this cross-sectional study, key thematic shifts and increases in language related to anxiety, anger, depression, and loneliness were identified in the content posted on social media by academic EM physicians and resident physicians during the pandemic. Social media may provide a real-time and evolving landscape to evaluate thematic content and linguistics related to emotions and sentiment for health care workers.
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Affiliation(s)
- Anish K. Agarwal
- Penn Medicine Center for Digital Health, Philadelphia, Pennsylvania
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Juhi Mittal
- Computer and Information Science, University of Pennsylvania, Philadelphia
| | - Annie Tran
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raina Merchant
- Penn Medicine Center for Digital Health, Philadelphia, Pennsylvania
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sharath Chandra Guntuku
- Penn Medicine Center for Digital Health, Philadelphia, Pennsylvania
- Computer and Information Science, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Kelsey EA. Joy in the Workplace: The Mayo Clinic Experience. Am J Lifestyle Med 2023; 17:413-417. [PMID: 37304741 PMCID: PMC10248366 DOI: 10.1177/15598276211036886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
The COVID-19 pandemic has changed dynamics in the healthcare setting, through social distancing guidelines and new protocols to promote safety for employees and patients. Although some find themselves more productive in this spread out or virtual environment, the social aspect of the work day has dramatically changed. Staying connected during the day or week comes with additional efforts to seek out opportunities to network and collaborate with colleagues with this work environment shift. Healthcare workers are already at high risk of occupational burnout. In addition, the COVID-19 pandemic has brought additional stressors to individuals outside of their workload compromising a balanced work-life integration. Consequently, personal well-being may become jeopardized due to physical, mental, and social constraints brought on by the pandemic. Mayo Clinic has implemented a joy in the workplace structure to support individual well-being and create space for healthcare workers to be energized in order to put the needs of the patient first and deliver excellent care. Joy at Mayo Clinic contributes to joy in the workplace, reduced burnout, and personal well-being.
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Affiliation(s)
- Elizabeth A. Kelsey
- Elizabeth A. Kelsey, DNP, APRN, FNP-C, Internal
Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Schimmels J, Groh C, Neft M, Wocial L, Young C, Davidson JE. American Academy of Nursing Expert Panel Consensus Statement on leveraging equity in policy to improve recognition and treatment of mental health, substance use disorders, and nurse suicide. Nurs Outlook 2023; 71:101970. [PMID: 37104889 PMCID: PMC10129051 DOI: 10.1016/j.outlook.2023.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 04/29/2023]
Abstract
Rates of nurse mental health and substance use disorders are high. Heightened by the COVID-19 pandemic, nurses are challenged to care for patients in ways that often jeopardize their own health and increase risks for their families. These trends exacerbate the epidemic of suicide in nursing underscored by several professional organization clarion calls to nurses' risk. Principles of health equity and trauma-informed care dictate urgent action. The purpose of this paper is to establish consensus among clinical and policy leaders from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and factors contributing to nurse suicide. Recommendations for mitigating barriers drew from the CDC's 2022 Suicide Prevention Resource for Action strategies to guide the nursing community to inform policy, education, research, and clinical practice with the goals of greater health promotion, risk reduction, and sustainment of nurses' health and well-being are provided.
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Affiliation(s)
- JoEllen Schimmels
- Psychiatric Mental Health and Substance Use Expert Panel, Detroit, MI; Military and Veterans Health Expert Panel.
| | - Carla Groh
- Psychiatric Mental Health and Substance Use Expert Panel, Detroit, MI
| | - Michael Neft
- Psychiatric Mental Health and Substance Use Expert Panel, Detroit, MI
| | | | - Cara Young
- Psychiatric Mental Health and Substance Use Expert Panel, Detroit, MI
| | - Judy E Davidson
- Psychiatric Mental Health and Substance Use Expert Panel, Detroit, MI
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Zhang Y, Dugan AG, El Ghaziri M, Siddique S, Punnett L. Work-Family Conflict and Depression Among Healthcare Workers: The Role of Sleep and Decision Latitude. Workplace Health Saf 2023; 71:195-205. [PMID: 36636904 PMCID: PMC10655495 DOI: 10.1177/21650799221139998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Healthcare workers report a higher incidence of depression than the general population. Work-family conflict is a risk factor, but the mechanisms explaining its association with depression are not well understood. This study examines the potential mediating and moderating role of sleep and decision latitude in translating work-family conflict into depression. METHODS In 2018, a cross-sectional survey was collected from healthcare workers (n = 1,059) in five public sector facilities in the northeast United States. The survey included questions on participants' work-family conflict, depression, sleep duration and disturbances, decision latitude, and other work environments and socio-demographic characteristics. Multivariable linear and Poisson regression modeling were used to examine associations among variables. FINDINGS There was a significant association between work-family conflict and depression (β = 2.70, p < .001). Sleep disturbances, although not short sleep duration, partially mediated this association. The association between work family-conflict and depression was stronger among workers with low decision latitude. CONCLUSIONS Depression was prevalent among healthcare workers and was associated with work-family conflict. Sleep disturbances served as a significant mediator, while decision latitude modified the strength of the association. APPLICATION TO PRACTICE Evidence-based interventions seeking to alleviate the effect of work-family conflict and improve healthcare workers' mental health should consider promoting employee sleep quality and improving employees' decision-making on the job.
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Kim LY, Martinez-Hollingworth A, Aronow H, Caffe I, Xu W, Khanbijian C, Lee M, Coleman B, Jun A. The Association Between Korean American Nurse and Primary Care Provider Burnout, Areas of Worklife, and Perceptions of Pandemic Experience: Cross-sectional Study. Asian Pac Isl Nurs J 2023; 7:e42490. [PMID: 36884284 PMCID: PMC10034608 DOI: 10.2196/42490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/22/2023] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Korean immigrants are among the fastest-growing ethnic minority groups and make up the fifth-largest Asian group in the United States. A better understanding of the work environment factors and its impact on Korean American nurse and primary care provider (PCP) burnout may guide the development of targeted strategies to help mitigate burnout and workplace stressors, which is critical for the retention of Korean American nurses and PCPs to promote better alignment of national demographic trends and meet patients' preference for cultural congruence with their health care providers (HCPs). Although there is a growing number of studies on HCP burnout, a limited number of studies specifically focus on the experience of ethnic minority HCPs, particularly during the COVID-19 pandemic. OBJECTIVE In light of these gaps in literature, the aim of this study was to assess burnout among Korean American HCPs and to identify work conditions during a pandemic that may be associated with Korean American nurse and PCP burnout. METHODS A total of 184 Korean American HCPs (registered nurses [RNs]: n=97; PCPs: n=87) practicing in Southern California responded to a web-based survey between February and April 2021. The Maslach Burnout Inventory, Areas of Worklife Survey, and Pandemic Experience & Perceptions Survey were used to measure burnout and work environment factors during the pandemic. A multivariate linear regression analysis was used to assess work environment factors associated with the 3 subcategories of burnout. RESULTS No significant differences were found in the level of burnout experienced by Korean American nurses and PCPs. For RNs, greater workload (P<.001), lower resource availability (P=.04), and higher risk perception (P=.02) were associated with higher emotional exhaustion. Greater workload was also associated with higher depersonalization (P=.003), whereas a greater (professional) community (P=.03) and higher risk perception (P=.006) were associated with higher personal accomplishment. For PCPs, greater workload and poor work-life balance were associated with higher emotional exhaustion (workload: P<.001; worklife: P=.005) and depersonalization (workload: P=.01; worklife: P<.001), whereas only reward was associated with personal accomplishment (P=.006). CONCLUSIONS Findings from this study underscore the importance of strategies to promote a healthy work environment across multiple levels that recognize demographic variation among Korean American RNs and PCPs, potentially influencing their burnout mitigation needs. A growing recognition of identity-informed burnout experiences across frontline Korean American RNs and PCPs argues for future explorations that capture nuance both across and within this and other ethnic minority nurse and PCP groups. By recognizing and capturing these variations, we may better support the creation of targeted, burnout-mitigating strategies for all.
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Affiliation(s)
- Linda Y Kim
- Nursing Research, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | | | - Harriet Aronow
- Nursing Research, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Isa Caffe
- College of Nursing, Samuel Merritt University, Oakland, CA, United States
| | - Wenrui Xu
- Nursing Research, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | | | - Mason Lee
- Nursing Research, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Bernice Coleman
- Nursing Research, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Angela Jun
- Sue and Bill School of Nursing, University of California, Irvine, Irvine, CA, United States
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Elliott AN, Buzzard LN, Villa KR, Gadbois NR. Physicians' and advanced practice providers' perceptions of the impact of embedded clinical pharmacists on the work environment in ambulatory care clinics. Am J Health Syst Pharm 2023; 80:200-206. [PMID: 36308341 DOI: 10.1093/ajhp/zxac323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Clinical pharmacists are recognized as valuable team members in primary care clinics due to the variety of patient care services they provide. This study examined nonpharmacist healthcare providers' perceptions of how embedded clinical pharmacists impact the work environment in ambulatory care clinics. SUMMARY This was an exploratory mixed methods study consisting of semistructured interviews and a subsequent survey. Participants included attending and resident physicians, and advanced practice providers (APPs) practicing in clinics with an embedded clinical pharmacist. Coded interview transcripts were analyzed to identify themes that were used to develop a survey. Interview participants were not asked to complete the survey. Survey responses were analyzed utilizing descriptive statistics. Subgroup analysis assessed for differences in responses based on provider type, gender, clinical practice area, years of practice, and pharmacy services utilization. Fourteen physicians and APPs participated in the semistructured interviews, and 43 other providers completed the survey. In the interviews, participants stated the clinical pharmacist contributed positively in terms of work environment, workload, work-related stress, and burnout. The major themes identified were sharing patient care responsibilities, saving provider time, and being a knowledgeable resource. Survey responses were consistent with interview statements; however, the positive impact differed between nonusers and moderate to high utilizers of clinical pharmacy services. The main barrier to collaborating with clinical pharmacists was their limited availability. CONCLUSION Embedded clinical pharmacists positively impact the work environment in ambulatory care clinics by reducing provider workload, work-related stress, and burnout. Participants also noted clinical pharmacists are a trusted resource for patient care and drug information questions.
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Affiliation(s)
- Amber N Elliott
- Ascension Via Christi, Wichita, KS.,University of Kansas School of Pharmacy, Wichita, KS, USA
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Lewis JH, Appikatla S, Anderson E, Glaser K, Whisenant EB. The Primary Care Transformation Executive Fellowship to Develop Community Health Center Leaders. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:123-136. [PMID: 36816051 PMCID: PMC9934813 DOI: 10.2147/amep.s395394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Although many primary care providers from community health centers recognize health disparities and work to transform healthcare, skill gaps and limited support may hinder their ability to be change agents. The Primary Care Transformation Executive (PCTE) Fellowship at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA) seeks to address these barriers by providing professional development and support to primary care providers interested in leading change in the nation's health centers. METHODS The PCTE Fellowship is a structured, one-year interprofessional learning experience that emphasizes topics such as healthcare transformation, interprofessional practice, leadership development, and systems thinking. Quantitative and qualitative evaluation of the program was accomplished through surveys and semi-structured interviews throughout the fellowship. RESULTS Feedback from 18 fellows showed perceived improvements in knowledge and skills related to the various curricular topics, increased engagement in leadership activities, and career advancement. Fellows developed practice and quality improvement projects and successfully implemented the projects within their health systems, addressing observed disparities. CONCLUSION Professional development and directed support for primary care providers can enhance their engagement in healthcare transformation and advance health equity.
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Affiliation(s)
- Joy H Lewis
- Department of Public Health, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
| | - Surekha Appikatla
- Department of Public Health, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
| | - Eboni Anderson
- Department of Public Health, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
| | - Kelli Glaser
- Department of Primary Care, Rocky Vista University, Parker, CO, USA
| | - Ebony B Whisenant
- Department of Public Health, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
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Radike M, Zuromskis T. Lithuanian physicians practising abroad: Reasons to leave and conditions to return to Lithuania. A survey. Health Policy 2023; 128:75-83. [PMID: 36435631 DOI: 10.1016/j.healthpol.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 10/10/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
This study aimed to assess the factors of emigration and return among Lithuanian doctors practicing abroad. A call for participation in an online survey was distributed via social media. Questions covered demographics, reasons to emigrate and factors that would favor returning to practice in Lithuania. Survey data were analysed with appropriate statistical methods. Out of 465 respondents, the majority (453/465, 97.4%) work in Europe. The majority (334/465, 71.8%) were women, and 304/465 (65.4%) were trainees (residents). The top three factors to emigrate from and come back to Lithuania were: economic reasons, perceived corruption and the work environment. Most respondents listed more than two factors to emigrate and return (>70% in each category). Out of all respondents, 230 (49.5%) reported an attractive net monthly salary for a full-time post in Lithuania to be >3500 EUR; 173/465 (37.2%) respondents declared intention of not returning to practice in Lithuania. There were statistically significant gender- and training level-related differences in emigration factors. In conclusion, doctors' reasons for leaving and returning to practice in Lithuania are multifactorial, with economic and non-economic circumstances prompting them to choose to work in another country.
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Affiliation(s)
- Monika Radike
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom; Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.
| | - Tadas Zuromskis
- Department of Neurology, Great Western Hospitals NHS Foundation Trust, Marlborough Rd, Swindon, SN3 6BB, United Kingdom.
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Küçükali H, Türkoğlu SN, Hasanli S, Dayanır Çok FN, Culpan HC, Hayran O. Comparison of the burnout among medical residents before and during the pandemic. J Psychosom Res 2023; 165:111118. [PMID: 36565658 PMCID: PMC9758755 DOI: 10.1016/j.jpsychores.2022.111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/10/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to compare the level of burnout syndrome in medical residents before and during the COVID-19 pandemic and identify potential risk factors. METHODS This cross-sectional study was conducted on medical residents from three different university hospitals in Turkey in March 2021, one year after the pandemic hit Turkey. Burnout is measured by the Maslach Burnout Inventory which assesses three dimensions of it: emotional exhaustion, depersonalization, and personal accomplishment. Collected data were combined and compared with data from a previous study which was held in the same hospitals in December 2019, three months before the pandemic. RESULTS 412 medical residents from three universities participated. The mean age was 27.8 ± 2.4 and half of them were female. Compared to pre-pandemic levels, no significant differences in emotional exhaustion (pre:19.0 ± 7.6 post:18.8 ± 7.8), depersonalization (pre:7.3 ± 4.3 post:7.2 ± 4.4), and personal accomplishment (pre:20.8 ± 5.1 post:21.1 ± 5) scores were observed one year after pandemic. Adjusting for confounders, multiple linear regression models indicated that who are female, are in surgical specialty, have vulnerable cohabitant, and have more night shifts faces higher emotional exhaustion. Depersonalisation is higher among who spent more years in residency, have more night shifts, or COVID-19 outpatient duty. Females and those who have vulnerable cohabitant has lower levels of Personal Achievement. CONCLUSION This study does not support the hypothesis that pandemic increases the burnout levels. Yet it identifies a couple of pandemic related factors that are associated with burnout and confirming the association of several previously known factors.
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Affiliation(s)
- Hüseyin Küçükali
- Queen's University Belfast, Centre for Public Health, Belfast, UK; Istanbul Medipol University, School of Medicine, Department of Public Health, Istanbul, Türkiye.
| | - Sezanur Nazlı Türkoğlu
- Bezmialem Vakif University, School of Medicine, Department of Public Health, Istanbul, Türkiye.
| | - Shams Hasanli
- University of Health Sciences, Hamidiye International School of Medicine, Istanbul, Türkiye.
| | - Fatma Nur Dayanır Çok
- Dicle University, School of Medicine, Department of Public Health, Diyarbakir, Türkiye.
| | | | - Osman Hayran
- Istanbul Medipol University, School of Medicine, Department of Public Health, Istanbul, Türkiye.
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Goldman AL, Barnett ML. Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021. JAMA Intern Med 2023; 183:106-114. [PMID: 36534376 PMCID: PMC9857188 DOI: 10.1001/jamainternmed.2022.5792] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Physician work hours are an underexplored facet of the physician workforce that can inform policy for the rapidly changing health care labor market. Objective To examine trends in individual physician work hours and their contribution to clinical workforce changes over a 20-year period. Design, Setting, and Participants This cross-sectional study focused on active US physicians between January 2001 and December 2021 who were included in the Current Population Survey. Outcomes for physicians, advanced practice professionals (APPs), and nonphysician holders of doctoral degrees were compared, and generalized linear models were used to estimate differences in time trends for weekly work hours across subgroups. Main Outcomes and Measures Physician and APP workforce size, defined as the number of active clinicians, 3-year moving averages of weekly work hours by individual physicians, and weekly hours contributed by the physician and APP workforce per 100 000 US residents. Results A total of 87 297 monthly surveys of physicians from 17 599 unique households were included in the analysis. The number of active physicians grew 32.9% from 2001 to 2021, peaking in 2019 at 989 684, then falling 6.7% to 923 419 by 2021, with disproportionate loss of physicians in rural areas. Average weekly work hours for individual physicians declined by 7.6% (95% CI, -9.1% to -6.1%), from 52.6 to 48.6 hours per week from 2001 to 2021. The downward trend was driven by decreasing hours among male physicians, particularly fathers (11.9% decline in work hours), rural physicians (-9.7%), and physicians aged 45 to 54 years (-9.8%). Physician mothers were the only examined subgroup to experience a statistically significant increase in work hours (3.0%). Total weekly hours contributed by the physician workforce per 10 000 US residents increased by 7.0%, from 13 006 hours in 2001 to 2003 to 13 920 hours in 2019 to 2021, compared with 16.6% growth in the US population over that time period. Weekly hours contributed by the APP workforce per 100 000 US residents grew 71.2% from 2010 through 2012 to 2019 through 2021. Conclusions and Relevance This cross-sectional study showed that physician work hours consistently declined in the past 20 years, such that physician workforce hours per capita lagged behind US population growth. This trend was offset by rapid growth in hours contributed by the APP workforce. The gap in physician work hours between men and women narrowed considerably, with diverging potential implications for gender equity. Increasing physician retirement combined with a drop in active physicians during the COVID-19 pandemic may further slow growth in physician workforce hours per capita in the US.
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Affiliation(s)
- Anna L Goldman
- Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Michael L Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Norful AA, Brewer KC, Adler M, Dierkes A. Initial psychometric properties of the provider-co-management index-RN to scale registered nurse-physician co-management: Implications for burnout, job satisfaction, and intention to leave current position. J Interprof Care 2023:1-10. [PMID: 36688514 DOI: 10.1080/13561820.2022.2164563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Team-based care has become a cornerstone of care delivery to meet the demands of high-quality patient care. Yet, there is a lack of valid and reliable instruments to measure the effectiveness of co-management between clinician dyads, particularly physicians and registered nurses (RNs). The purpose of this study was to adapt an existing instrument, Provider Co-Management Index (PCMI), previously used among primary care providers into a new version to scale RN-physician co-management (called PCMI-RN). We also aimed to explore preliminary associations between RN-physician co-management and burnout, job satisfaction, and intention to leave current job. Face, cognitive, and content validity testing, using mixed methods approaches, were preceded by initial pilot testing (n = 122 physicians and nurses) in an acute care facility. The internal consistency reliability (α=.83) was high. One-quarter of participants reported burnout, 27% were dissatisfied with their job, and 20% reported intention to leave their job. There was a weak significant correlation between co-management and burnout (p = .010), and co-management and job satisfaction (p = .009), but not intention to leave current position. Construct validity testing is recommended. Future research using PCMI-RN may help to isolate factors that support or inhibit effective physician-nurse co-management.
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Affiliation(s)
- Allison A Norful
- School of Nursing, Columbia University School of Nursing, New York, NY, USA
| | | | - Margaret Adler
- Department of Nursing Quality, NewYork-Presbyterian Hudson Valley Hospital, Cortlandt, NY, USA
| | - Andrew Dierkes
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Abate LE, Greenberg L. Incivility in medical education: a scoping review. BMC MEDICAL EDUCATION 2023; 23:24. [PMID: 36635675 PMCID: PMC9838055 DOI: 10.1186/s12909-022-03988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Incivility in the workplace, school and political system in the United States has permeated mass and social media in recent years and has also been recognized as a detrimental factor in medical education. In this scoping review, we use the term incivility to encompass a spectrum of behaviors that occur across the continuum of medical education, and which include verbal abuse including rude or dismissive conduct, sexual and racial harassment and discrimination, and sexual and physical assault. We identified research on incivility involving medical students, residents and fellows, and faculty in North America to describe multiple aspects of incivility in medical education settings published since 2000. Our results reinforce that incivility is likely under-reported across the continuum of medical education and also confirmed incidences of incivility involving nursing personnel and patients, not emphasized in previous reviews. The authors suggest a zero-tolerance national policy if this problem is to be resolved.
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Affiliation(s)
- Laura E. Abate
- School of Medicine & Health Sciences, The George Washington University, 2300 Eye St NW, Washington, DC 20037 USA
| | - Larrie Greenberg
- School of Medicine & Health Sciences, The George Washington University, 2300 Eye St NW, Washington, DC 20037 USA
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48
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How Does Workplace Violence–Reporting Culture Affect Workplace Violence, Nurse Burnout, and Patient Safety? J Nurs Care Qual 2023; 38:11-18. [DOI: 10.1097/ncq.0000000000000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Breitbach AP, Ulrich G. Job satisfaction in sport science and sports medicine, an international cross-sectional survey. BMJ Open Sport Exerc Med 2023; 9:e001542. [PMID: 37101910 PMCID: PMC10124288 DOI: 10.1136/bmjsem-2023-001542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
Background/Aim Job satisfaction (JS) and professional burnout among health professionals have been shown to affect several factors: healthcare quality, patient safety, patient satisfaction, turnover/reduction of work effort, healthcare costs and other personal consequences. In general, factors that impact JS for health professionals include professional autonomy, workplace conditions, rewards/recognition, compensation and work-life balance. However, less is known about JS of professions working in sport science and sports medicine (SSSM) especially from an international perspective. This paper addresses JS among SSSM professionals in an international context. Methods In a cross-sectional study design, the Interprofessional Collaboration (IPC) in SSSM survey, an online survey which included the Warr-Cook-Wall JS questionnaire for international respondents working in fields associated with SSSM, was distributed globally to persons working in SSSM. Data from 320 respondents with complete data sets from USA (n=83), Canada (n=179) and Europe (n=58) were collected. Results High values were detected in the overall JS of the total sample with some differences in variables relevant for JS internationally and a relationship between positive perceptions of IPC and overall JS. The most important determinant for overall JS in professionals working in SSSM is the opportunity to use abilities. Conclusion JS has an important influence on the work and services provided by SSSM professionals and experience with IPC can have a positive effect on JS which, in turn, can improve quality of life for clients, patients and professionals. Employers should regard most impactful determinants of overall JS when designing working conditions for their employees.
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Affiliation(s)
| | - Gert Ulrich
- Strategy and Innovation, Careum Foundation, Zurich, Switzerland
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50
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Gibson CM, Larson S, Behnen EM, Dugan SE, Moody AE, Wagner JL. Feeding the Soul via Creation of a Suborganization to Promote a Sense of Community. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe8927. [PMID: 35318246 PMCID: PMC10159595 DOI: 10.5688/ajpe8927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/17/2022] [Indexed: 05/06/2023]
Abstract
Pharmacy faculty commonly report feeling stressed, overwhelmed, exhausted, and burnt out. Women may be disproportionally impacted by personal and professional demands. The purpose of this commentary is to describe one mechanism for creating a suborganization (Circle) that establishes a supportive community to combat burnout and promote professional fulfillment. This commentary is a description of one American Academy of Colleges of Pharmacy (AACP) Women Faculty Special Interest Group (SIG) Circle. The authors describe how one Circle sought to enhance the well-being of its members through the various domains of the Stanford Model of Professional Fulfillment, including personal resilience, workplace efficiency, and creating a culture of well-being. Circles and similar frameworks may be effective tools for combatting burnout, improving fulfillment, and promoting wellness and well-being among women and other groups of faculty.
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Affiliation(s)
- Caitlin M Gibson
- Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia
| | - Suzanne Larson
- Midwestern University, College of Pharmacy, Glendale Campus, Glendale, Arizona
| | - Erin M Behnen
- Belmont University, College of Pharmacy, Nashville, Tennessee
| | - Sara E Dugan
- Northeast Ohio Medical University, Rootstown, Ohio
| | - Ashley E Moody
- Notre Dame of Maryland University, School of Pharmacy, Baltimore, Maryland
| | - Jamie L Wagner
- University of Mississippi, School of Pharmacy, Jackson, Mississippi
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