Well-Being Among Respiratory Therapists in an Academic Medical Center During the COVID-19 Pandemic

Evaluating Professional Burnout and Psychological Distress Among Intensive Care Unit Healthcare Workers During the COVID-19 Pandemic: A Single-Center Cross-Sectional Study

Aim This study aimed to evaluate burnout, stress, anxiety, and depression among intensive care unit (ICU) healthcare workers (HCWs) in Singapore during the COVID-19 pandemic. It sought to identify risk factors associated with burnout to inform targeted interventions and improve HCWs' well-being and patient care quality. Subject and methods A cross-sectional survey was conducted in December 2021 in the ICU of Sengkang General Hospital, Singapore. Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), stress was assessed with the Cohen Perceived Stress Scale (CPSS), and anxiety and depression were evaluated using the Patient Health Questionnaire-4 (PHQ-4). Physical questionnaires were distributed anonymously to HCWs. Multiple logistic regression analysis was performed to examine associations between burnout and demographic/work-related factors. Results A total of 76 HCWs responded to the survey out of 100 who were eligible. The study found an overall burnout rate of 43/76 (56.6%) among HCWs, with respiratory therapists being the most affected. Emotional exhaustion was reported by 53/76 (69.7%) participants, depersonalization by 35/76 (46.1%), and reduced personal accomplishment by 64/76 (84.2%). Multiple logistic regression demonstrated higher burnout rates associated with respiratory therapists and lower burnout rates associated with Filipino ethnicity. Stress affected 66/76 (86.8%) of HCWs, with physicians reporting the highest levels. Stress showed moderate correlations with emotional exhaustion (0.38) and depersonalization (0.33). Anxiety and depression, which were present in 63/76 (82.9%) participants, were strongly correlated with all burnout dimensions. Conclusion The findings highlight the urgent need for mental health resources and stress management interventions to address burnout among ICU HCWs, particularly in the context of the COVID-19 pandemic. Implementing targeted strategies to mitigate burnout can enhance HCWs' well-being and maintain high standards of patient care. Further longitudinal research is recommended to explore the long-term impacts and effectiveness of interventions.

Respiratory Therapy Leaders' Perceptions of Value of Respiratory Care Services

Background: Respiratory care departments are experiencing an increased need to demonstrate value in the care they deliver. Value efficiency is a concept that incorporates the value of individual treatments into the normal operations of a department. The purpose of this study was to describe respiratory care leaders' attitudes about the value of services provided by respiratory care departments. Methods: An electronic survey was distributed via social media, professional networks, and a manager work group. The survey was targeted to directors, managers, and supervisors of respiratory care departments. We asked questions related to value, services, and barriers to implementation of value efficiency. Data analysis was descriptive. Results: We received 116 responses; 86% were from managers or directors. The 5 most valuable services delivered were invasive mechanical ventilation (82%), noninvasive ventilation or CPAP (71%), protocol-driven care (47%), code team (44%), and rapid response team (41%). The 5 least valuable services delivered by respiratory care departments were electrocardiograms (63%), stress testing (44%), lung expansion therapies (41%), sleep studies staffed by the respiratory care department (36%), and smoking cessation education (36%). The primary barrier to value efficiency was physician prescribing practices (68%). There was general agreement that physicians support respiratory therapy protocols (71%), value should be considered when evaluating respiratory care services (95%), and directing resources to more valuable services if possible (73%). Respondents did not agree that hospital administrators understand respiratory therapy workflow and full-time equivalent needs (35%) nor that hospital administrators would be supportive if we reduced services (18%). Conclusions: In a small sample of respiratory therapy leaders, there was limited consensus on what respiratory care services are the most and least valuable. Lack of consensus on high- and low-value services and physician prescribing practice were the primary barriers to value efficiency. Nearly all respondents felt value should be considered when evaluating respiratory care services.

Quality Assurance and Quality Improvement Research

Quality assurance and quality improvement initiatives are being performed widely across the respiratory care profession. Common goals of quality assurance and quality improvement include the detection and prevention of errors, establishment of standards to improve respiratory care practice, and overall delivery of quality care to the patient. For these reasons, respiratory care departments participate in quality assurance and quality improvement initiatives at multiple levels: (1) interdepartmental (hospital/systemwide/multi-center), (2) intradepartmental (local/respiratory care department), or (3) grassroots approach (bottom-up approach). Utilization of a systematic approach to quality assurance and quality improvement is essential in ensuring the work is germane, and using appropriate research methodology can assure the results can benefit a generalized audience. A description of quality assurance and quality improvement research is presented with considerations and examples from Respiratory Care.

A qualitative study examining stressors among Respiratory Therapists in Ontario amidst the COVID-19 pandemic

Health care systems were subjected to an unprecedented surge of critically ill patients with the coronavirus disease 2019 (COVID-19), which required management by Respiratory Therapists (RTs). Despite the high level of burnout reported in this health care professional group, we have limited knowledge about the lived experience of RTs during the pandemic. This study aims to examine the impact of COVID-19 on RTs in Ontario, Canada. We conducted a qualitative exploratory, descriptive study by conducting virtual semi-structured interviews and focus groups with RTs between March 2023 and June 2023. Two coders analyzed the data using thematic analysis. Twenty-seven RTs participated in the study, with the majority being female (n = 25), averaging 16.4 years of practice (range 4 to 36 years), primarily in acute care settings (n = 23). We identified four themes and lessons learned from the perspective of RTs: (1) Working in the shadow and suffering in silence reflecting varying perceptions of recognition; (2) Flying blind amidst the buzz reflecting the rapid pace of changing policies and practices as COVID-19 gained global attention; (3) Putting out fires in the face of overflowing hospitals reflecting increased workload and staffing issues; and (4) Managing tensions, both external and internal reflecting how RTs coped with distressing workplace situations and their mental well-being. Finally, lessons learned from the RTs include 1) Mobilizing early and consistently during an emergency, which addresses staff concerns; 2) Prioritizing and investing in the mental health and well-being of RTs; 3) Implementing strategies to retain experienced staff in healthcare; and 4) Involving RTs in leadership discussions. The COVID-19 stressors of RTs have illuminated the detrimental impact of the pandemic on this understudied health care profession. With this knowledge, targeted interventions can be developed to address RT recognition and staff retention and provide mental health support.

Prevalence and sociodemographic factors of depression, anxiety and stress in Saudi Arabia: a survey of respiratory therapists

Background

Depression, anxiety and stress are prevalent among healthcare providers but limited data is available regarding respiratory therapists (RTs). This study aimed to assess the prevalence of depression, anxiety and stress, and identify the associated sociodemographic factors among RTs in Saudi Arabia.

Methods

A cross-sectional online survey was distributed to RTs in Saudi Arabia. Data were summarized using frequency and percentages. Stress, anxiety, and depression prevalence rates were expressed as proportions with 95% confidence intervals (CI). The associated factors of stress, anxiety, and depression were subjected to logistic regression.

Results

Overall, 988 (91%) RTs, 661 (66.9%) males, completed the online survey. The prevalence (95% CI) of depression, anxiety and stress among RTs was 81.3% (0.787, 0.837), 89.6% (0.875, 0.914), and 45.5% (0.424, 0.487), respectively. RT staff who were ≥41 years old, divorced, widowed or separated, or had > 10 years of clinical experience were more likely to experience stress. RTs who were (divorced, widowed or separated), did not live with their family, were current smokers, or worked the night shift were more likely to experience anxiety. RTs who were (divorced, widowed or separated), were current smokers, had >10 years of clinical experience were more likely to experience depression.

Conclusion

Stress, anxiety and depression are prevalent among RTs. Several sociodemographic factors are associated with the incidence of stress, anxiety and depression.