Burnout and areas of work-life among anaesthetists in South Africa Part 1 : Burnout

Burnout among veterinary anaesthesia specialists: The impact of different areas of worklife (Part 2)

OBJECTIVE

To identify worklife areas predictive of American and European Veterinary Anaesthesia Diplomate burnout.

STUDY DESIGN

Cross-sectional online anonymous, voluntary survey.

SAMPLE POPULATION

A total of 530 American and/or European Veterinary Anaesthesia and Analgesia College (ACVAA and ECVAA) Diplomates were canvassed, 286 responded.

METHODS

Self-administered electronic questionnaire, incorporating a sociodemographic questionnaire, the Maslach Burnout Inventory-Human Service for Medical Personnel (results reported in Part 1), and the Areas of Worklife Survey (AWS). The AWS uses 28 questions to evaluate six key worklife areas in an organization. Scores ≥ 3.0 indicate better alignment between the workplace and the respondent, scores < 3.0 indicate poor alignment. Data were analysed with descriptive statistical tests and univariate and multivariate linear regression analyses (p < 0.05).

RESULTS

The six AWS areas demonstrated a strong significant collective effect for the emotional exhaustion (EE) and personal accomplishment (PA) burnout domains (p < 0.001) and moderate for the depersonalization (DP) domain (p < 0.001). Workload and reward accounted for 36.6% and 17% of responders' EE scores, respectively, with EE increasing by 9.1 for each one-point rise in workload and decreasing by 7.4 for every one-point increase in feeling of reward. PA declined by 3.7 and 4.2 points, respectively, for every one-point reduction in perceived lack of fairness, and alignment with organizational values. The DP domain of burnout was influenced by the perceived lack of control, which was opposed by the sense of community, whereby for each one-point drop in level of control, DP increased by 3.0, while for each one-point gain in the sense of community, DP decreased by 3.5.

CONCLUSIONS AND CLINICAL RELEVANCE

The drivers of burnout include modifiable workplace factors, many of which lend themselves to easy change. It is time for employers to consider instigating measures to reduce the risk of burnout in veterinary anaesthesia Diplomates.

Cross-Sectional Survey to Assess Hospital System Readiness for Hemorrhage During and After Cesarean Delivery in Africa

BACKGROUND

Mothers in Africa are 50 times more likely to die after cesarean delivery (CD) than in high-income countries, largely due to hemorrhage. It is unclear whether countries across Africa are adequately equipped to prevent and treat postpartum hemorrhage (PPH) during and after CD.

METHODS

This was a cross-sectional survey of anesthesiologists and obstetricians across the African Perioperative Research Group (APORG). The primary objective was to determine readiness of the hospital system to implement the World Health Organization (WHO) recommendations for prevention and treatment of PPH during and after CD. The secondary objectives were to evaluate the availability of blood products, skilled human resources and establish available postoperative care after CD. Survey question format was close-ended or Likert scale, with options "always," "sometimes," or "never."

RESULTS

Responses were analyzed from 1 respondent from each of 140 hospitals from 29 low- and middle-income countries across Africa. Most respondents completed every data field on the case report form. Regarding WHO recommendations on prevention of PPH, oxytocin and misoprostol were available in 130/139 (93.5%) and 101/138 (73.2%) hospitals, respectively. There was limited access to heat-stable carbetocin (12/138 [8.7%]) and ergometrine (35/135, [25.9%]). Controlled cord traction for removal of placenta was always performed in 133/135 (98.5%) hospitals. Delayed cord clamping when neonatal resuscitation was not indicated, was not performed universally (86/134 [64.2%]). Regarding the treatment of PPH, crystalloids were always available in 133/139 (95.7%) hospitals, and the preferred initial resuscitation fluid (125/138 [90.6%]). Uterine massage was always performed in 117/139 (84.2%) hospitals. Tranexamic acid was always available in 97/139 (69.8%) hospitals. The availability of intrauterine balloon tamponade devices was limited. Most had immediate access to theater (126/139 [90.6%]). Responses concerning organizational recommendations showed that 113/136 (83.1%) hospitals had written protocols for the treatment of PPH. Protocols for patient referral and simulation training were limited. Most hospitals had access to emergency blood (102/139 [73.4%]). There was limited access to blood component therapy, with platelets available at 32/138 (23.2%), cryoprecipitate at 21/138 (15.2%) and fibrinogen at 11/139 (7.9%) hospitals. In-person specialist cover was reduced after-hours.

CONCLUSIONS

Important WHO-recommended measures to reduce hemorrhage during and after CD, are not currently available in many hospitals across Africa. It is likely that the lack of a combination of factors leads to failure to rescue mothers in Africa from postoperative complications. These findings should facilitate codesign of quality improvement initiatives to reduce hemorrhage related to CD.

The psychological impact of COVID-19 on frontline doctors in Tshwane public hospitals

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic placed immense pressure on frontline doctors. Burnout is a psychological syndrome that develops in response to chronic work stress. It consists of emotional exhaustion (EE), depersonalisation (DP) and reduced personal accomplishment (PA). Burnout is associated with personal dysfunction and compromises the work profession and patient safety. International studies suggest burnout is exacerbated during a pandemic.

METHODS

We conducted a descriptive cross-sectional observational study. Respondents included frontline doctors working in emergency medicine, family medicine and internal medicine during COVID-19 in Tshwane public hospitals. The survey included two validated questionnaires, the Maslach Burnout Inventory and the Depression, Anxiety, Stress Scale-21. The aim was to determine the prevalence and severity of burnout, psychological and somatic symptoms in frontline doctors.

RESULTS

Of the 163 participants, we found clinical burnout to be present in 58.9% (n = 96) and extreme burnout in 19.6% (n = 32). Moderate to extremely severe levels of stress, anxiety and depression were present in 55.1% (n = 90), 43.6% (n = 71) and 22.1% (n = 36) of participants, respectively. We found significant correlations between burnout and psychological symptoms. Increased levels of burnout, anxiety, depression and stress were found to be meaningfully associated with adverse somatic symptoms.

CONCLUSION

Our study demonstrated an insufferably high prevalence of burnout and psychosomatic symptoms in frontline doctors during COVID-19. In the event of future pandemics, more measures should be taken to support frontline doctors.Contribution: Pandemic-associated burnout and its psychophysical consequences have not been studied in frontline doctors in South Africa.

Study of burnout and depressive symptoms in doctors at a central level, state hospital

Background

Doctors are at high risk of burnout, which has far-reaching consequences on an individual and organisational level. Several studies have shown an association between burnout and depression.

Aim

This study aimed to determine the rate of burnout and depressive symptoms among doctors, as well as factors associated with both conditions.

Setting

Charlotte Maxeke Johannesburg Academic Hospital.

Methods

Burnout was measured using the Maslach Burnout Inventory-Human Services Survey and defined as the total score of high emotional exhaustion (≥ 27 points) + high depersonalisation (≥ 13 points). Individual subscales were analysed separately. Depressive symptoms were screened using the Patient-Health Questionnaire-9 (PHQ-9) and a score of ≥ 8 was deemed indicative of depression.

Results

Of the respondents (n = 327 for burnout and n = 335 for depression), 46.2% screened positive for burnout, whilst 53.73% screened positive for depression. Factors associated with increased burnout risk were younger age; Caucasian race; internship and/or registrarship; the discipline of emergency medicine; and having a prior psychiatric diagnosis of depressive and/or anxiety disorder. Factors associated with increased risk of depressive symptoms were females; younger age; being an intern, medical officer or registrar; disciplines of anaesthetics and obstetrics and gynaecology; having a prior psychiatric diagnosis of depressive and/or anxiety disorder; and family history of psychiatric disorder.

Conclusion

A high rate of burnout and depressive symptoms was determined. Although there is an overlap between the two conditions in terms of both symptomatology and risk factors, specific risk factors were determined for each in this population.

Contribution

This study highlighted the rate of burnout and depressive symptoms experienced by doctors at the state level hospital necessitating individual and institutional interventions to address this.

Nurses' Priorities for Perioperative Research in Africa

BACKGROUND

Mortality rates among surgical patients in Africa are double those of surgical patients in high-income countries. Internationally, there is a call to improve access to and safety of surgical and perioperative care. Perioperative research needs to be coordinated across Africa to positively impact perioperative mortality.

METHODS

The aim of this study was to determine the top 10 perioperative research priorities for perioperative nurses in Africa, using a research priority-setting process. A Delphi technique with 4 rounds was used to establish consensus on the top 10 perioperative research priorities. In the first round, respondents submitted research priorities. Similar research priorities were amalgamated into single priorities when possible. In round 2, respondents ranked the priorities using a scale from 1 to 10 (of which 1 is the first/highest priority, and 10 is the last/lowest priority). The top 20 (of 31) were determined after round 2. In round 3, respondents ranked their top 10 priorities. The final round was an online discussion to reach consensus on the top 10 perioperative research priorities.

RESULTS

A total of 17 perioperative nurses representing 12 African countries determined the top research priorities, which were: (1) strategies to translate and implement perioperative research into clinical practice in Africa, (2) creating a perioperative research culture and the tools, resources, and funding needed to conduct perioperative nursing research in Africa, (3) optimizing nurse-led postoperative pain management, (4) survey of operating theater and critical care resources, (5) perception of, and adherence to sterile field and aseptic techniques among surgeons in Africa (6) surgical staff burnout, (7) broad principles of infection control in surgical wards, (8) the role of interprofessional communication to promote clinical teamwork when caring for surgical patients, (9) effective implementation of the surgical safety checklist and measures of its impact, and (10) constituents of quality nursing care.

CONCLUSIONS

These research priorities provide the structure for an intermediate-term research agenda for perioperative research in Africa.

Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Protocol for a Scoping Review

BACKGROUND

Burnout syndrome is a chronic response to stressors in the workplace. It is characterized by emotional exhaustion and physical and mental burnout and may lead to high employee turnover, work absenteeism, and increased occupational accidents. Most studies use the Maslach Burnout Inventory (MBI) to identify burnout and implement preventive actions and treatments.

OBJECTIVE

This study presents a scoping review protocol to identify and map studies that used MBI to assess burnout syndrome in health care professionals working in public health services.

METHODS

This scoping review protocol follows the Joanna Briggs Institute reviewers' manual, and this protocol consists of 6 stages: identifying the research question, identifying relevant studies, study selection, data extraction and coding, analysis and interpretation of results, and consultation with stakeholders. We will conduct searches in Embase, LILACS, PubMed/MEDLINE, PsycINFO, Scopus, Web of Science databases, and gray literature. The main research question is as follows: how is MBI used to identify burnout syndrome in health care professionals working in public health services? Inclusion criteria will comprise qualitative and quantitative studies using MBI to identify burnout syndrome in health care professionals working in public health services and no restrictions in language and publication dates. Data will be extracted using a spreadsheet adapted from the Joanna Briggs Institute model. Quantitative and qualitative data will be analyzed using descriptive statistics and thematic analysis, respectively. The consultation with stakeholders will be essential for increasing the knowledge about MBI, identifying new evidence, and developing future strategies to guide public policies preventing burnout syndrome in health care professionals working in public services.

RESULTS

This protocol will guide a scoping review to identify and map studies that used MBI to identify burnout syndrome in health care professionals working in public health services. The results of this review may be useful to public health care professionals, managers, policymakers, and the general population because these findings will help understand the validated, translated, and adapted versions of MBI and domains, number of items, Likert scales, and cutoff points or the latent profile analysis most used in the literature. Furthermore, possible research gaps may be identified to guide future studies. All information regarding the stages of the scoping review favor its transparency and allow it to be methodologically replicated according to the principles of open science, thereby reducing the risk of bias and data duplication.

CONCLUSIONS

This study may reveal the multiplicity of scales described in the literature and the different forms of assessing burnout syndrome in health care professionals. This study may help to standardize the assessment of burnout syndrome in health care professionals working in public health services and contribute to the discussion and knowledge dissemination about burnout syndrome and mental health in this population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42338.