Burnout, Compassion Fatigue and Psychological Flexibility among Geriatric Nurses: A Multicenter Study in Spain

The impact of the nursing work environment on compassion fatigue: The mediating role of general self-efficacy

AIM

To explore the interplay between the perceived nursing work environment, general self-efficacy, and compassion fatigue among registered nurses in Chinese hospitals.

BACKGROUND

Compassion fatigue emerges as a significant occupational stress response globally, with the nursing work environment being a pivotal influencer. There is a knowledge gap in understanding how the nursing work environment and general self-efficacy interrelate to affect compassion fatigue, particularly among Chinese nurses.

METHODS

Employing a cross-sectional, descriptive design, this study utilized validated questionnaires to gather data from 7085 nurses across public and private hospitals in China. The analysis focused on assessing the interrelations among the perceived nursing work environment, general self-efficacy, and different dimensions of compassion fatigue.

FINDING

More than half (65.67%) of the participants experienced moderate or high burnout levels, with 76.43% experiencing secondary traumatic stress. The lowest rating in the nursing work environment was for nurse/physician collaboration (10 ± 2.07), while general self-efficacy scored higher (27.54 ± 6.26). A positive relationship existed between the work environment and both general self-efficacy and compassion satisfaction, with a negative correlation to burnout and traumatic stress. General self-efficacy was a partial mediator in the link between work environment and compassion fatigue, suggesting that improving the work environment can decrease compassion fatigue by boosting nurses' self-efficacy.

CONCLUSION

This study underscores the profound impact of the nursing work environment on compassion fatigue, mediated by general self-efficacy. It highlights the necessity of fostering a supportive work environment to enhance nurses' self-efficacy and overall well-being.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Healthcare managers and institutions must create supportive work environments to reduce compassion fatigue among nurses. This includes professional development programs to enhance self-efficacy and job satisfaction. Policies should address high workloads and inadequate support. Nurse leaders should foster environments that promote psychological well-being, improving outcomes for both nurses and patients. Regular assessments and adjustments of work conditions are essential to maintain a healthy work environment.

Cross-Cultural Comparison of Burnout, Insomnia and Turnover Intention Among Nurses in Eastern and Western Cultures During the COVID-19 Pandemic: Protective and Risk Factors

Background/Objectives: The COVID-19 pandemic has adversely impacted the mental health of nurses worldwide. Nurse burnout results from chronic workplace stress and is characterized by exhaustion, negative or cynical feelings about work, and a diminished sense of accomplishment. This can lead to turnover intention. Therefore, psychological capacities, such as psychological flexibility, that could help nurses regulate and minimize the impact should be studied. This study aimed to compare burnout, insomnia and turnover intention among nurses from an Eastern and Western cultural context and to investigate the role of psychological flexibility as a protective factor against mental health and related problems such as insomnia and turnover intention. Methods: Nurses from Hong Kong (n = 158) and Switzerland (n = 294) involved in patient care during the COVID-19 pandemic participated in an online mental health survey. Results: We observed high levels of burnout, subthreshold insomnia and turnover intention in nurses from both Switzerland and Hong Kong, with higher burnout rates among Hong Kong nurses and higher turnover intentions among nurses from Switzerland, and that psychological flexibility is a crucial factor that may protect nurses from burnout and insomnia. Conclusions: The nurses from both regions involved in patient care one year after the onset of the pandemic suffered from poor mental health. Psychological flexibility was identified as a critical factor in improving nurses' mental health. The results of this study should be incorporated into health promotions for nursing professionals and help develop specific and effective interventions for practical nursing application.

Nurses' Experience With End-of-Life Care in Geriatric Centers: A Systematic Review

Background

Geriatric nurses provide end-of-life care based on the five pillars of aging. This systematic review assesses the emotions and feelings of geriatric nurses during end-of-life care. It considers the prevalence, triggers, and intensity of emotional responses among geriatric nurses. It also expounds on the strategies for overcoming the emotional challenges.

Methods

The study embarked on a systematic review of literature materials on nurses' emotions and feelings. The eligibility criteria involve literature materials published in the past 5 years, peer reviews, English language, geriatric nurses, and nurses in emergency department, primary care, and intensive care unit. Three databases (Cochrane Library, PubMed, and CINAHL) and Google Scholar were used.

Results

Using a PRISMA flow chart, the literature search led to the discovery of nine significant writings on the emotions and feelings of nurses attending to geriatric patients. Sample sizes in these studies varied from 6 to 126 nurses while three articles involved integrated, scoping, and literature review of published studies. The common emotions and feelings among nurses caring for elderly patients in the geriatric center are compassion fatigue, burnout, grief, and moral distress.

Conclusion

These emotions and feelings affect the performance of nurses. They also influence their physical and mental wellbeing. This situation calls for developing effective coping strategies to address this challenge.

Work stress and professional quality of life in disability support workers: The mediating role of psychological flexibility

BACKGROUND

This study aimed to explore perceived work stress and its association with burnout, compassion fatigue, and compassion satisfaction and the mediating effect of psychological flexibility on these relationships.

METHOD

Two hundred and fifty-one disability support workers across Australia reported on work stress, psychological flexibility, burnout, compassion fatigue, and compassion satisfaction through an online anonymous survey.

RESULTS

Perceived work stress was found to have a significant relationship with burnout, compassion fatigue, and compassion satisfaction. Psychological flexibility had a significant mediating effect on all three relationships.

CONCLUSION

These results highlight the role that psychological flexibility has in response to work stress and the development of burnout, compassion fatigue, and compassion satisfaction in disability support workers.

Validation of the scale compassion fatigue inventory in health professional Spanish-speaking: a cross-sectional study

OBJECTIVES

To validate the Compassion Fatigue Inventory in Spanish-speaking health personnel, its psychometric properties were tested, and the influencing factors were investigated.

METHOD

This was a cross-sectional validation study. Information was collected through a survey of 733 nurses, physician and medical residents using the Compassion fatigue Inventory (CFI), Secondary Traumatic Stress Questionnaire (CETS), The physician burnout syndrome scale (PhBS), the quality-of-life index (SQL -sp) and the reduced Moral Stress Scale (MMDHPr). The psychometric properties of the CFI were tested via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and internal consistency analysis. The final version of the translated CFI was correlated with other scales.

RESULTS

An EFA was performed to evaluate the translated CFI, resulting in 15 items in three dimensions, as reported in the literature: reduced compassion, social life, and workplace. The CFA showed good fit indices and psychometric values (Cronbach´s alpha = 0.87, Omega = 0.87, Comparative Fit Index = 0.99, Tucker Lewis = 0.99, root mean square error of approximation = 0.045, Standardized Root Mean Square Residual = 0.05). The CFI had a negative correlation with the SQL-sp and a positive correlation with the other subscales. Work experience is predictive of a small reduction in CFI scores.

CONCLUSION

The adaptation of the CFI in a sample of Latino health professionals shows satisfactory psychometric indices in the evaluation of compassion fatigue and can be proposed as a specific inventory to differentiate compassion fatigue from other occupational syndromes.

Correlation between moral distress and compassion fatigue in the emergency department nurses: A cross-sectional study from Ardabil Province, Iran

BACKGROUND

Nurses working in the emergency department increasingly face moral distress due to the nature of their profession, negatively affecting their love and compassion toward the patient. Therefore, this study sought to determine the correlation between moral distress and compassion fatigue in the nurses of the emergency departments of the hospitals in Ardabil.

MATERIALS AND METHODS

The current cross-sectional (descriptive correlational) study was conducted using consensus sampling. The study population comprised all nurses working in the emergency departments of hospitals in Ardabil in 2022. Data were gathered using two standard questionnaires, comprising compassion fatigue by Figley (2002) and moral distress by Hamric et al. (2012). The data were analysed using SPSS-20 software and descriptive and inferential statistics, including independent T-test, Pearson's correlation coefficient, and one-way ANOVA.

RESULTS

Moral distress was higher than average in governmental hospitals (2.12±0.58) and below average in private and social security hospitals (1.72±0.68). Besides, the nurses' compassion fatigue was lower than average in all studied hospitals (2.17±0.43). There was also a significant positive correlation equal to 0.29 between moral distress and compassion fatigue in emergency department nurses (P<0.01).

CONCLUSION

According to the results, the higher the level of moral distress, the greater the compassion fatigue. The level of moral distress and its relationship with compassion fatigue reflects the impact of conditions causing moral distress on the quality of care and the necessity to prevent such conditions by providing appropriate solutions. Informing nurses about moral distress and its consequences and providing periodic counseling can contribute to its identification and control.

Mediating effect of self-efficacy between social support and compassion fatigue among Geriatric Services and Management interns: A cross-sectional study

OBJECTIVES

To explore the impact of social support on CF and further clarify the mediating role of self-efficacy among Geriatric Services and Management interns.

METHODS

A cross-sectional survey study examined social support, self-efficacy and CF in 592 interns in Geriatric Services and Management from 46 institutions in China.

RESULT

The level of CF among Geriatric Services and Management interns is low but about one-third of the respondents is at high risk of CF. Social support was positively correlated with self-efficacy (β = 0.114, P < 0.01). Social support significantly reduced CF (β = -0.322, P < 0.01). Similarly, self-efficacy had significant direct effects on CF (β = -0.497, P < 0.01). Additionally, self-efficacy played a partial mediating role in the relationship between social support and CF.

CONCLUSION

Social support can directly affect the CF of Geriatric Services and Management interns and indirectly through self-efficacy. Accordingly, It is necessary to strengthen social support and self-efficacy to relieve CF among Geriatric Services and Management interns.

Resilience in the face of pandemic: exploring the influence of psychological flexibility on turnover intentions and burnout among critical care nurses in COVID-19 hospitals

AIM

Assess the levels of psychological flexibility, burnout, and turnover intention among critical care nurses and assess the impact of psychological flexibility on burnout, and turnover intention among critical care nurses.

BACKGROUND

Burnout and turnover intentions among critical care nurses are rapidly increasing because of the challenges of COVID-19. There is a need for evidence-based interventions like psychological flexibility to be addressed in research to overcome those challenges.

METHODS

A descriptive correlational research. A convenient sample of 200 critical care nurses working in COVID-19 hospitals from two governorates in Egypt. The sociodemographic and clinical data sheet, the work-related acceptance and action questionnaire, the Copenhagen burnout inventory, and the adopted version of the staff nurses' intention to leave the nursing profession questionnaire were used.

RESULTS

The majority of critical care nurses reported a moderate level of psychological flexibility (75.5%, Mean = 31.23), a moderate level of burnout (65.5%, Mean = 59.61), and low to moderate levels of intention to leave (73%, Mean = 5.95). Psychological flexibility has a statistically significant negative correlation with burnout (PC = -0.304, Sig = 0.000) and the intention to leave (PC = -0.258, Sig = 0.000). In addition, psychological flexibility has a predictable effect on decreasing burnout (R2 = 0.232) and intention to leave (R2 = 0.127) among critical care nurses.

CONCLUSION

critical care nurses in COVID-19 hospitals reported varied levels of burnout and an intention to leave that must be considered. The effect of psychological flexibility on burnout and intention to turnover highlighted the importance of improving it among critical care nurses by applying acceptance and commitment therapy as a management intervention.

Nurses' work, work psychology, and the evolution & devolution of care provision in nursing homes: A scoping review

Background

Societal aging is exerting profound impacts on providers of long-term care. Nurses provide much of the direct care in the long-term care sector, and they increasingly provide unit- and facility-level leadership and fill top administrative and clinical roles.The work health and quality of work life of long-term care nurses are emergent concerns and the foci of research across multiple disciplines.

Objectives

To enhance our understanding of factors influencing long-term care nurses' work health and quality of work life, we summarize the findings of disparate studies across diverse disciplines, time, and jurisdictions.

Eligibility criteria

No restrictions were placed on study date, design, or country. Searches were restricted to English language only or translated studies. Included studies reported associations and relationships between/amongst nurses' work (role and work design), work environments, work attitudes, and work outcomes. Published peer-reviewed studies and reviews were included, as were reports. Editorials and opinion pieces were excluded. The search included publications up to March 2022.

Sources of evidence

Medline, CINAHL, PsychINFO, EMBASE, Scopus, PSNet.

Charting methods

Data abstraction from full-text articles.

Results

The evolution of long-term care nurses' work to include both medical and administrative responsibilities has generally not been managed well, resulting in persistent role ambiguity, job dissatisfaction, and burnout. Nurses are concerned about their capacity to provide resident care and the adequacy of their preparation. Their work environments are under-resourced, and they are at high risk for workplace injury or violence. Supervisory and organizational support can be protective of negative aspects of nurses' work environments. Supervisory support can improve the immediate work environment, assist nurses in fulfilling their roles, and afford greater role clarity, and supervisors can influence their nursing staff's perceptions of the work safety and the value that their organization places on them. Organizational support can reduce work stress, enhance feelings of self-worth, and mitigate some of the self-stigmatization that influences long-term care nurses' attitudes toward themselves and their work, which influences work outcomes, including job performance and quality of resident care.

Conclusions

Work stress, burnout, increased turnover, decreased morale and work motivation, increased health and safety concerns, and decreases in job satisfaction accompanied by self-stigmatization are all indicators of a system that has failed nurses, other long-term care staff, and nursing home residents. We consider the implications of our findings for enhancing the work health and quality of life of nurses working in long-term care and identify gaps in knowledge about their psychological health that merit future study.

Tweetable Abstract

The long-term care sector is failing nurses globally. This review is a step toward understanding how we can improve the work psychology, including work-related psychological health, of nurses in long-term care.

Chain mediations of perceived social support and emotional regulation efficacy between role stress and compassion fatigue: insights from the COVID-19 pandemic

Background

Nurses at the frontline faced high risks of the COVID-19 infection, undertook heavy workloads of patient care, and experienced tremendous stress that often led to compassion fatigue.

Aim

This study was to explore the role of positive psychosocial resources (i.e., perceived social support and emotional regulation efficacy) in the relationship between role stress and compassion fatigue.

Methods

A cross-sectional design was conducted in Hubei Province, China between May and September 2021. The Role Stress Questionnaire, the Perceived Social Support Scale, the Emotional Regulation Efficacy Scale, and the Professional Quality of Life Scale were used to measure key variables of interest. Nurse socio-demographic data were also collected. Structural equation modeling was used to explore the relationships, including potential mediating effect, among role stress, perceived social support, emotional regulation efficacy, and compassion fatigue.

Results

A total of 542 nurses participated in this investigation, and 500 were eventually enrolled in the analysis. The incidence of compassion fatigue among nurses was 94.2%, including 65.8% of nurses reporting at least moderate compassion fatigue. Univariate analysis showed that educational level, marital status, hospital rank, sleep time were the factors affecting compassion fatigue of the nurses. The structural equation modeling revealed that: Role stress had a direct positive effect on compassion fatigue; Perceived social support and emotional regulation efficacy partially mediated the link between role stress and compassion fatigue respectively; And there was a chain mediating role of perceived social support and emotional regulation efficacy between role stress and compassion fatigue.

Conclusion

The incidence of compassion fatigue was high during the COVID-19 pandemic among bedside nurses in China. Improving social support and enhancing the efficacy of emotion regulation may help alleviate compassion fatigue directly and/or via buffering the impact of role stress.

Analysis of the Level of Stress and Methods of Coping with Stress among the Nursing Staff

In general, "stress" is the reaction of the body to mental and physical demands placed on it. Stress disrupts mental balance, and reduces the ability to work and function, which negatively affects the performance of duties. The aim of this study was to analyse the level of stress and ways of coping with it among nursing staff. The study covered 220 nurses employed at the Provincial Specialist Hospital in Włocławek. The research tool was the Perceived Stress Scale (PSS-10) and the Brief-COPE. The results of this survey showed the occurrence of average and high levels of experiencing stress in 36% and 40%of staff, respectively. Brief-COPE scale results show that substance use/gender (men) and use of emotional support/place of work (internal medicine department) are significant at p < 0.01. Considering the impact of the workplace on the use of psychoactive substances, it can be seenthat people working in the surgical ward are more likely to use psychoactive substances. Furthermore, nurses in the surgical ward find it easier to think and plan what to do when faced with a difficult life situation. Most often, the respondents with the highest work experience, i.e., the elderly, declared a return to religion. The results of the research indicate that the nursing community experiences stress to an average or significant degree. The strategies are mainly based on active coping and seeking emotional and instrumental support. Further research is needed in this field. This study was not pre-registered on a publicly accessibly registry.

A replication study of a psychotherapy incorporating horses resiliency intervention for healthcare workers

OBJECTIVES

The first aim of this pilot observational study was to replicate a previous study of a resiliency psychotherapy incorporating horses (PIH) intervention for healthcare workers. The second aim was to address some gaps in the literature regarding equine-assisted services more broadly.

DESIGN

Prospective open trial.

SETTING

A large healthcare system and a community equine facility INTERVENTION: A single-session four-hour intervention that focused on participants resilience.

MAIN OUTCOME MEASURES

Safety, feasibility, and utilization were assessed, and psychological instruments were administered. Instruments utilized were the Positive and Negative Affect Scale the Acceptance and Action Questionnaire II, and the Conner-Davidson Resiliency Scale.

RESULTS

Thirty-eight subjects participated in the study, the majority of which were female (71.1 %). The age group with the most representation included those ranging from age 25-34. The intervention was safe but underutilized. Participation was associated with improved psychological flexibility (PF), and positive affect, as well as reduction in negative affect pre- to post-intervention. There was no change in resiliency and there were no associations between improvements in affect and PF.

CONCLUSIONS

Resiliency PIH interventions for healthcare workers can be utilized safely and likely result in short-term psychological benefits for participants. Future randomized controlled investigations are warranted, and these studies should implement methods to maximize utilization. Additionally, this study and the literature suggest that enhanced affect and PF are likely important EAS outcomes across a variety of interventions. These constructs should be investigated with more rigorous studies including comparisons of interventions with and without a psychotherapy component.

Burnout among Junior Nurses: The Roles of Demographic and Workplace Relationship Factors, Psychological Flexibility, and Perceived Stress

Background

Burnout is a common psychological syndrome among nurses, especially in the first few years of working. However, limited studies have evaluated the factors related to burnout among junior nurses.

Aims

To investigate the levels of psychological flexibility, stress, and burnout among junior nurses and examine the role of demographic and workplace relationship factors, psychological flexibility, and perceived stress on burnout among junior nurses.

Materials and Methods

A convenience sample of 481 junior nurses was recruited from three tertiary hospitals in China from July 2021 to August 2022. Data were collected, including demographic data, workplace relationships, psychological flexibility (measured by experiential avoidance and cognitive fusion), perceived stress, and burnout. The Independent t-test, one-way ANOVA, Wilcoxon-Mann-Whitney test, Kruskal-Wallis test, Spearman correlation, and hierarchical regression were used to analyze the data.

Results

Junior nurses had a high level of burnout in different dimensions. Nurses with an undergraduate education, nurses working in the first year, and a lack of support from supervisors and poor colleague (nurse-nurse and nurse-doctor) relationships had the lowest level of psychological flexibility and the highest level of perceived stress and burnout. Spearman correlation indicated that experiential avoidance, cognitive fusion, perceived stress, and burnout were positively associated with each other. The regression model showed that psychological flexibility (especially cognitive fusion) and perceived stress influenced burnout in junior nurses.

Conclusions

Higher psychological flexibility and lower perceived stress appear to improve burnout in junior nurses. Therefore, interventions targeting these two factors may provide a viable direction for the reduction of burnout among junior nurses. Implications for Nursing Management. Hospital authorities should create a harmonious working environment and provide some psychology training programs for junior nurses.

A pilot observational study of horsemanship skills training for veterans with posttraumatic stress disorder

OBJECTIVES

Pilot assessment of an equine-assisted services intervention for Veterans with posttraumatic stress disorder.

DESIGN

Prospective cohort.

SETTING

A large Veterans Administration healthcare system.

INTERVENTION

Two sessions of instruction in horsemanship skills and two sessions of trail rides.

MAIN OUTCOME MEASURES

Safety and feasibility of recruitment, retention, providing the intervention, and measuring outcomes, as well as acceptability of the intervention to the population studied were the main outcome measures.

RESULTS

There were no injuries among the 18 participants, 6 staff, or 11 equines over the 3 months of the study. Eleven of 12 (92 %) planned intervention sessions were provided, with one being canceled due to weather. Out of approximately 1800 potential subjects, 21 were enrolled within three months and three dropped out before the first session. The mean number of sessions attended was 3 % and 52 % of participants completed all sessions. The mean PACES score for all sessions together was 109 (SD = 12), with a range of 50-126. Pre- to one-month post-intervention exploratory results indicated increased psychological flexibility (p = 0.008) and positive affect (p = 0.008) as measured by the Acceptance and Action Questionnaire II and the Positive and Negative Affect Scale, respectively as well as decreased PTSD (p = 0.001) and depressive symptoms (p = 0.017) as measured by the PTSD Checklist for DSM 5 and the Beck Depression Inventory, respectively.

CONCLUSIONS

Results suggest the intervention can be conducted with minimal risk. Further, it was feasible to recruit participants as well as provide the intervention and measure exploratory outcomes. Session attendance and PACES scores indicate acceptability to the Veteran population. The exploratory results will provide sample size estimates for future randomized controlled studies of this intervention Future studies should plan for missed sessions due to weather and consider compensating subjects to enhance retention. Finally, this work provides preliminary evidence that this intervention, without a mental health treatment component, might benefit the mental health of Veterans with PTSD.

Professional quality of life among Spanish veterinarians

Background

In Spain, the perceived professional quality of life among veterinarians has not been explored.

Methods

Veterinarians were invited to complete an online questionnaire in which they answered the Professional Quality of Life scale, the Medical Outcomes Study Social Support Survey and the Warwick-Edinburgh Mental Well-Being Scale. Participants were asked whether they were receiving psychological therapy or were taking anxiolytics, hypnotics or antidepressant medication. Alcohol consumption was measured using the Alcohol Use Disorders Identification Test and nicotine dependence was assessed using the Fagerström test; participants were asked whether they took illegal drugs.

Results

The study sample comprised a total of 602 veterinarians, most of whom reported average levels of compassion satisfaction, secondary stress trauma and burnout. Emotional support and mental wellbeing influenced participants' professional quality of life. The percentage of veterinarians in psychological therapy and/or taking anxiolytics was higher than in the general population.

Conclusions

A considerable number of clinical veterinarians in Spain may be suffering from work-related stress. Our study identifies salary, emotional support and mental wellbeing as important factors that affect the professional quality of life. Interventions to improve veterinary clinicians' professional quality of life should therefore focus on these factors.

Factors Associated with Burnout in Healthcare Professionals

Burnout in healthcare professionals remains an ongoing concern. There are a number of variables associated with reactivity to stress in healthcare staff. This study wants to identify risk factors which predispose healthcare professionals to burnout.

MATERIAL AND METHODS

The cross-sectional study included a group of 200 subjects, medical staff and auxiliary staff from the national health units, who gave their free consent to answer the questions regarding the level of perceived stress at work. The screening tool used was disseminated through the Google Forms platform, maintaining the anonymity of the participants.

RESULTS

Resident doctors (42%) responded predominantly, reporting the highest level of burnout, with nurses (26.5%) being the least affected (χ² = 36.73, p < 0.01). Less work experience is correlated with increased burnout (rho = 0.29, p < 0.01). Reactivity to stress was highly associated with workplace, with ambulance staff being the most vulnerable (χ² = 6.58, p < 0.05). Participants' relationship status significantly influenced the burnout rate, the unmarried, with or without a partner, being more affected (χ² = 16.14, p < 0.01). There are no significant differences between male and female gender, regarding the average level of burnout (U = 1.47; p > 0.05), nor between living in a house or apartment (U = 4.66; p > 0.05). Positive associations were identified between the level of burnout and variables such as: management pressure, administrative work, routine, regretting decisions regarding patients, harassment at work and sacrifice of personal time.

CONCLUSIONS

The results of this study identify age, profession, workplace seniority and relationship status as factors associated with burnout in medical personnel.

Characteristics of Occupational Burnout among Nurses of Various Specialties and in the Time of the COVID-19 Pandemic-Review

Occupational burnout is particularly common among nurses due to their work being associated with stress, showing understanding, compassion, and commitment, along with the simultaneous need to maintain the necessary emotional distance. The aim of this review was to assess the occurrence and characterization of burnout among nurses working within neurology, geriatric care, intensive care units and with patients infected with the novel COVID-19 virus. PRISMA guidelines were used to conduct the review. The search for literature was limited to articles meeting the inclusion criteria and published from 2017 to 2022 in PubMed, Scopus, Science Direct, Google Scholar, and Wiley. A total of 768 articles from this category have been found. Ultimately, after in-depth analysis, 20 articles were included in the study. The group of respondents ranged from 49 to 3100 participants. According to the data, the percentages of nurses suffering from burnout in the presented research ranged from 14.3% to 84.7%, with the highest value of burnout among nurses who worked in the ICU during the COVID-19 pandemic. There are certain factors among nurses that significantly affect the occurrence of burnout. These include, among others, working time, age, exposure to infection and contact with infected patients, lack of training on COVID-19 prevention, providing care to an increased number of COVID-19 patients per shift, lack of personal protective equipment, lack of support of administration, lack of pay satisfaction, intrinsic motivation and turnover intention.

Frequency of changed behaviours in residential aged care and common mitigation strategies - A retrospective review of behavioural report logs

BACKGROUND

Changed behaviours in residential aged care facilities (RACF) are frequently reported in the literature. How RACF staff routinely respond to these observed changed behaviours represents a significant gap.

OBJECTIVE

To analyse the frequency of changed behaviour reported within RACF behavioural report logs and to ascertain how staff typically manage these behaviours.

METHODS

Residents (N = 25) with varying levels of cognitive function were recruited from a 160 bed RACF in Queensland, Australia. A retrospective analysis of behavioural report logs was conducted to elucidate prevalence of reported changed behaviours as categorised by RACF staff. Thematic analysis of staff recorded behavioural mitigation strategies was used to categorise staff actions. A case analysis was also conducted to highlight the challenges faced by RACF staff managing persistent acute changed behaviours using identified common mitigation strategies. The STROBE guidelines were followed for reporting.

RESULTS

There were 395 behaviours recorded in a two-month period. Physical agitation, interfering while wandering, trying to get to inappropriate places, verbal refusal of care, physical aggression, and verbal disruption were most frequently reported by staff. Management strategies included redirection, PRN psychotropic medication, reassurance, routine care practices, offering of beverages, repositioning, and rarely analgesia. A 24-h case analysis highlighted how staff utilised redirection and multiple doses of a PRN benzodiazepine with limited effectiveness.

CONCLUSION

This study reveals current mitigation strategies employed by RACF staff in response to acute changed behaviours often associated with dementia. Agitation and wandering are prevalent and are difficult for staff to manage effectively.

RELEVANCE TO CLINICAL PRACTICE

This study highlights that careful consideration should be taken to avoid overuse of PRN benzodiazepines in management of changed behaviours. Short-term mitigation strategies, such as redirection, may not be effective if underlying causes such as pain, physiological, mental, emotional, or social needs are not met.

PATIENT AND PUBLIC CONTRIBUTION

A RACF participated in project design and review.

A pilot observational study of a psychotherapy incorporating equines resiliency intervention for staff at a large medical center

BACKGROUND

and purpose: Stress and burnout among healthcare workers are significant public health concerns. The primary aim of this pilot study was to conduct preliminary assessments of safety, feasibility, and participant satisfaction with a psychotherapy incorporating equines (PIE)-based resiliency intervention for healthcare workers. The overarching goal was to lay the groundwork for future, more rigorous investigations. Lastly, a very preliminary assessment of using the Acceptance and Action Questionnaire II (AAQII) to assess for changes in psychological flexibility (PF) associated with PIE was conducted.

MATERIALS AND METHODS

Thirty-seven staff members from a medical center participated in a 4-h PIE-based resiliency retreat. Pre- and post-intervention instruments were utilized to assess participants' self-perception of physical and psychological health (PROMIS Global Short Form) and enjoyment of (Physical Activity Enjoyment Scale) and satisfaction with (Client Satisfaction Questionnaire) the intervention, as well as changes in PF (AAQII).

RESULTS

There were no adverse effects on participants, staff, or equines. Preliminary results suggested that the intervention was perceived as enjoyable by participants. However, the intervention was not fully utilized. Finally, there was a significant (p = 0.02) pre-to post-intervention change in AAQII scores.

CONCLUSION

This study provides a foundation for future rigorous studies of PIE-based resiliency interventions for medical staff. Given the limitations of this pilot work, firm conclusions cannot be drawn regarding safety and feasibility. However, the preliminary results suggest that future studies of this intervention are warranted and that the AAQII may be a useful instrument to assess for possible changes in PF.

The Silent Cry of Healthcare Workers: A Cross-Sectional Study on Levels and Determinants of Burnout among Healthcare Workers after First Year of the Pandemic in Turkey

Background

Although the acute phase of the pandemic is over, healthcare workers continue to face challenges. The aim of this study was to determine burnout levels and possible related psychological processes such as psychological flexibility, moral injury, and values among healthcare workers after the first year of coronavirus disease 2019 (COVID-19) pandemic.

Methods

A cross-sectional study was performed using an online survey distributed through social networks. A sample of 124 front line healthcare workers working during the pandemic, between January and April 2021, were included in the study. Multiple linear regression was used to identify predictors of all 3 burnout dimensions (emotional exhaustion, depersonalization, and lack of personal accomplishment).

Results

While 51.6% of healthcare workers experienced high levels of emotional exhaustion, 75.8% of them were found to have experienced high levels of lack of personal accomplishment. On the contrary, 81.5% of the participants reported low levels of depersonalization. Emotional exhaustion was predicted by total Depression Anxiety Stress Scale score (P = .004) and total Moral Injury Events Scale score was the only predictor of depersonalization (P = .051). Predictors of lack of personal accomplishment were the number of days worked in COVID-19 (P = .001), total Moral Injury Events Scale (P=0.004), Valuing Questionnaire (VQ)-Obstruction (P = .009), and total Depression Anxiety Stress Scale score (P = .002). On the other hand, psychological flexibility did not predict any sub-dimension of burnout.

Conclusion

Healthcare workers had high levels of burnout after 1 year with the pandemic. Our findings highlight the importance of factors such as moral injury, values, and emotional distress which need to be taken into consideration to develop future interventions to treat and prevent burnout in healthcare workers.

Burnout: A Review of Theory and Measurement

A growing body of empirical evidence shows that occupational health is now more relevant than ever due to the COVID-19 pandemic. This review focuses on burnout, an occupational phenomenon that results from chronic stress in the workplace. After analyzing how burnout occurs and its different dimensions, the following aspects are discussed: (1) Description of the factors that can trigger burnout and the individual factors that have been proposed to modulate it, (2) identification of the effects that burnout generates at both individual and organizational levels, (3) presentation of the main actions that can be used to prevent and/or reduce burnout, and (4) recapitulation of the main tools that have been developed so far to measure burnout, both from a generic perspective or applied to specific occupations. Furthermore, this review summarizes the main contributions of the papers that comprise the Special Issue on "Occupational Stress and Health: Psychological Burden and Burnout", which represent an advance in the theoretical and practical understanding of burnout.

Evaluation of a Fast Test Based on Biometric Signals to Assess Mental Fatigue at the Workplace-A Pilot Study

Non-pathological mental fatigue is a recurring, but undesirable condition among people in the fields of office work, industry, and education. This type of mental fatigue can often lead to negative outcomes, such as performance reduction and cognitive impairment in education; loss of focus and burnout syndrome in office work; and accidents leading to injuries or death in the transportation and manufacturing industries. Reliable mental fatigue assessment tools are promising in the improvement of performance, mental health and safety of students and workers, and at the same time, in the reduction of risks, accidents and the associated economic loss (e.g., medical fees and equipment reparations). The analysis of biometric (brain, cardiac, skin conductance) signals has proven to be effective in discerning different stages of mental fatigue; however, many of the reported studies in the literature involve the use of long fatigue-inducing tests and subject-specific models in their methodologies. Recent trends in the modeling of mental fatigue suggest the usage of non subject-specific (general) classifiers and a time reduction of calibration procedures and experimental setups. In this study, the evaluation of a fast and short-calibration mental fatigue assessment tool based on biometric signals and inter-subject modeling, using multiple linear regression, is presented. The proposed tool does not require fatigue-inducing tests, which allows fast setup and implementation. Electroencephalography, photopletismography, electrodermal activity, and skin temperature from 17 subjects were recorded, using an OpenBCI helmet and an Empatica E4 wristband. Correlations to self-reported mental fatigue levels (using the fatigue assessment scale) were calculated to find the best mental fatigue predictors. Three-class mental fatigue models were evaluated, and the best model obtained an accuracy of 88% using three features, β/θ (C3), and the α/θ (O2 and C3) ratios, from one minute of electroencephalography measurements. The results from this pilot study show the feasibility and potential of short-calibration procedures and inter-subject classifiers in mental fatigue modeling, and will contribute to the use of wearable devices for the development of tools oriented to the well-being of workers and students, and also in daily living activities.