An Evaluation of the Performance of Five Burnout Screening Tools: A Multicentre Study in Anaesthesiology, Intensive Care, and Ancillary Staff

Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic

PURPOSE

The purpose of this concept delineation was to differentiate similar concepts impacting nurse well-being during the COVID-19 pandemic, including: compassion fatigue, burnout, moral injury, secondary traumatic stress, and second victim.

METHODS

A total of 63 articles were reviewed for concept delineation. Morse's (1995) approach to concept delineation was utilized to analyse the articles.

RESULTS

Concepts were described interchangeably but were found to present themselves in a sequence. A nurse may experience moral injury, leading to a second victim experience, synonymous with secondary traumatic stress, then compassion fatigue and/or burnout that can be acute or chronic in nature. An Occupational Trauma Conceptual Model was created to depict how these concepts interact based on concept delineation findings.

CONCLUSION

Nurses are experiencing long-lasting occupational trauma and future intervention research should centre on optimizing nurse well-being to ensure the sustainability of nursing profession.

A Systematic Review of the Single-Item Burnout Question: Its Reliability Depends on Your Purpose

BACKGROUND

Surveillance of burnout by the gold-standard Maslach Burnout Inventory (MBI) is hindered by cost and length. The validity and benchmarking of the commonly recommended and used single-item burnout question (SIBOQ) are unknown. We sought to (1) derive an equation for predicting the gold standard MBI from the SIBOQ and (2) measure the correlation of the SIBOQ with the full MBI and its subscales.

METHODS

We sought studies in PubMed along with citations by and to included studies. We included studies that either correlated the SIBOQ and the MBI or reported the rates of burnout measured by both instruments. Two reviewers extracted data and CLARITY risk of bias. We used generalized linear mixed regression to separately quantify the predictive (benchmarking) and explanatory (hot-spotting) capabilities of the SIBOQ. We created a regression equation for converting SIBOQ scores to MBI scores. We meta-analyzed correlation coefficients (r) for the SIBOQ and MBI subscales. For all analyses, we considered an r of 0.7 as acceptable reliability for group-level comparisons.

RESULTS

We included 17 studies reporting 6788 respondents. All studies had a high risk of bias, as no study had a response rate over 75% and no study was able to examine non-responders. The correlations (r) of the SIBOQ with the overall MBI were explanatory r = 0.82 and predictive r = 0.56. Regarding MBI subscales, the correlations of the SIBOQ with emotional exhaustion were adequate with r = 0.71 (95% CI 0.67-0.74; I2 = 89%), and depersonalization was r = 0.44 (95% CI 0.34-0.52; I2 = 90%). However, in 8 of 15 comparisons, the r was less than 0.70.

DISCUSSION

The SIBOQ's usually adequate explanatory abilities allow "hot-spotting" to identify subgroups with high or low burnout within a single, homogenous survey fielding. However, the predictive ability of the SIBOQ indicates insufficient reliability in comparing local results to external benchmarks.

Identification of Surgeon Burnout via a Single-Item Measure

BACKGROUND

Burnout is endemic in surgeons in the UK and linked with poor patient safety and quality of care, mental health problems, and workforce sustainability. Mechanisms are required to facilitate the efficient identification of burnout in this population. Multi-item measures of burnout may be unsuitable for this purpose owing to assessment burden, expertise required for analysis, and cost.

AIMS

To determine whether surgeons in the UK reporting burnout on the 22-item Maslach Burnout Inventory (MBI) can be reliably identified by a single-item measure of burnout.

METHODS

Consultant (n = 333) and trainee (n = 217) surgeons completed the MBI and a single-item measure of burnout. We applied tests of discriminatory power to assess whether a report of high burnout on the single-item measure correctly classified MBI cases and non-cases.

RESULTS

The single-item measure demonstrated high discriminatory power on the emotional exhaustion burnout domain: the area under the curve was excellent for consultants and trainees (0.86 and 0.80), indicating high sensitivity and specificity. On the depersonalisation domain, discrimination was acceptable for consultants (0.76) and poor for trainees (0.69). In contrast, discrimination was acceptable for trainees (0.71) and poor for consultants (0.62) on the personal accomplishment domain.

CONCLUSIONS

A single-item measure of burnout is suitable for the efficient assessment of emotional exhaustion in consultant and trainee surgeons in the UK. Administered regularly, such a measure would facilitate the early identification of at-risk surgeons and swift intervention, as well as the monitoring of group-level temporal trends to inform resource allocation to coincide with peak periods.

Cav-1 Protein Levels in Serum and Infarcted Brain Correlate with Hemorrhagic Volume in a Mouse Model of Thromboembolic Stroke, Independently of rt-PA Administration

Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is currently the only FDA-approved drug for acute ischemic stroke. However, its administration is still limited due to the associated increased risk of hemorrhagic transformation (HT). rt-PA may exacerbate blood-brain barrier (BBB) injury by several mechanisms that have not been fully elucidated. Caveolin-1 (Cav-1), a major structural protein of caveolae, has been linked to the endothelial barrier function. The effects of rt-PA on Cav-1 expression remain largely unknown. Here, Cav-1 protein expression after ischemic conditions, with or without rt-PA administration, was analyzed in a murine thromboembolic middle cerebral artery occlusion (MCAO) and in brain microvascular endothelial bEnd.3 cells subjected to oxygen/glucose deprivation (OGD). Our results show that Cav-1 is overexpressed in endothelial cells of infarcted area and in bEnd.3 cell line after ischemia but there is disagreement regarding rt-PA effects on Cav-1 expression between both experimental models. Delayed rt-PA administration significantly reduced Cav-1 total levels from 24 to 72 h after reoxygenation and increased pCav-1/Cav-1 at 72 h in the bEnd.3 cells while it did not modify Cav-1 immunoreactivity in the infarcted area at 24 h post-MCAO. Importantly, tissue Cav-1 positively correlated with Cav-1 serum levels at 24 h post-MCAO and negatively correlated with the volume of hemorrhage after infarction, the latter supporting a protective role of Cav-1 in cerebral ischemia. In addition, the negative association between baseline serum Cav-1 levels and hemorrhagic volume points to a potential usefulness of baseline serum Cav-1 levels to predict hemorrhagic volume, independently of rt-PA administration.