Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study

INTRODUCTION

COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic.

METHODS

We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI).

RESULTS

Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores.

CONCLUSION

We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.

Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries

OBJECTIVES

To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety.

DESIGN

Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians' well-being.

SETTING

Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway.

PARTICIPANTS

Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments.

MAIN OUTCOME MEASURES

Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being.

RESULTS

Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised.

CONCLUSIONS

Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.

Using Serenity Rooms and Similar Tools to Improve the Workplace during COVID-19: A Rapid Review

This manuscript examines using serenity rooms and similar tools to improve the workplace during COVID-19 for nurses and other practitioners. A rapid review of the literature was conducted and completed from four different databases, including PubMed, CINAHL, Science Direct, and Academic Search Complete. The literature review was completed with the use of a single-string Boolean search to maximize the number of articles returned. The resulting 14 germane articles yielded six facilitator themes and four barrier themes. Facilitator themes included: benefits, assistive adjuncts, places of relaxation, leadership required, availability, and other effects. Barrier themes included: lacking leadership, concerns regarding lack of space, holistic concerns, and negative perceptions. There is a significant lack of research in the literature in this area. Most of the literature reviewed showed widely positive results for institutions that utilized serenity rooms or similar tools for decreasing nurse and practitioner stress and burnout. The use of these tools improved nurse and practitioner compassion, retention, and resiliency.

Latent profile analysis of nurses' perceived professional benefits in China: a cross-sectional study

OBJECTIVE

To identify profiles of nurses' perceived professional benefits as well as their predictors.

DESIGN

Cross-sectional study.

SETTING

The study was carried out online in China.

METHODS

From 6 July to 27 July 2022, a total of 1309 registered nurses participated in the survey by convenient sampling. We collected the Nurses' Perceived Professional Benefits Questionnaire and demographic data. Using latent profile analysis (LPA), subgroups of nurses' perceived professional benefits were identified. Moreover, univariate and multinomial logistic regression analyses were conducted to find the factors that were linked with the profiles.

RESULTS

The survey was validly completed by 1309 nurses, with a 92.9% effective return rate. The findings of the LPA demonstrated three unique profiles: low-perceived professional benefits (11.8%), moderate-perceived professional benefits (57.1%) and high-perceived professional benefits (31.1%). There was a correlation between marital status, the number of night shifts per month and leadership role.

CONCLUSIONS

According to our research, registered nurses have three unique professional benefit profiles. In order to sustain the nursing workforce, despite the fact that nurses get a high level of professional benefits, interventions are necessary to increase nurses' perception of their professional value.

How the COVID-19 crisis affected the well-being of nurses working in paediatric critical care: A qualitative study

OBJECTIVES

Evidence shows paediatric critical care (PCC) nurses display high rates of burnout, moral distress, symptoms associated with post-traumatic stress disorder (PTSD) and poor well-being. The COVID-19 pandemic magnified these pressures producing extremely challenging working conditions. The objective was to understand PCC nurses' lived experience of working during COVID-19 to determine the impact it had on their well-being.

DESIGN

A qualitative design was used with individual, semi-structured online interviews analysed using thematic analysis.

RESULTS

Ten nurses from six PCC units in England participated. Five themes were generated: (i) Challenges of working in Personal Protective Equipment (PPE), (ii) Adapting to redeployment to adult intensive care, (iii) Changes to staff working relationships, (iv) Being unable to attain work-life balance and (v) Unprocessed traumatic experiences of working in COVID-19. It was clear COVID-19 presented novel challenges to PCC nurses' well-being. With those came enforced changes in practice; some were temporary, for example use of PPE and redeployment, but others provided insight into the prerequisites for good staff well-being, for example strong professional relationships, work-life balance and managing one's psychological health.

CONCLUSIONS

Findings show authentic connections between peers, verbal and non-verbal communication and a sense of belonging were crucial to nurses' well-being. A dent in PCC nurses' perceived competence significantly affected their well-being. Finally, staff need a psychologically safe space to process distress and trauma experienced during COVID-19. Future research needs to test evidence-based, theoretically-informed well-being interventions to improve and maintain PCC nurses' well-being.

Mapping factors that may influence attrition and retention of midwives: a scoping review protocol

INTRODUCTION

An appropriately staffed midwifery workforce is essential for the provision of safe and high-quality maternity care. However, there is a global and national shortage of midwives. Understaffed maternity services are frequently identified as contributing to unsafe care provision and adverse outcomes for mothers and babies. While there is a need to recruit midwives through pre-registration midwifery programmes, this has significant resource implications, and is counteracted to a large extent by the high number of midwives leaving the workforce. It is increasingly recognised that there is a critical need to attend to retention in midwifery in order to develop and maintain safe staffing levels. The objective of this review is to collate and map factors that have been found to influence attrition and retention in midwifery.

METHODS AND ANALYSIS

Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to guide the review process and reporting of the review. CINAHL, MEDLINE, PsycINFO and Scopus databases will be searched for relevant literature from date of inception to 21 July 2023. Research from high-income countries that explores factors that influence leaving intentions for midwives will be included. Literature from low-income and middle-income countries, and studies where nursing and midwifery data cannot be disaggregated will be excluded. Two reviewers will screen 20% of retrieved citations in duplicate, the first author will screen the remaining results. Data will be extracted using a preformed data extraction tool by the first author. Findings will be presented in narrative, tabular and graphical formats.

ETHICS AND DISSEMINATION

The review will collate data from existing research, therefore ethics approval is not required. Findings will be published in journals, presented at conferences and will be translated into infographics and other formats for online dissemination.

Stats on the desats: alarm fatigue and the implications for patient safety

BACKGROUND

Physiological monitoring systems, like Masimo, used during inpatient hospitalisation, offer a non-invasive approach to capture critical vital signs data. These systems trigger alarms when measurements deviate from preset parameters. However, often non-urgent or potentially false alarms contribute to 'alarm fatigue,' a form of sensory overload that can have adverse effects on both patients and healthcare staff. The Joint Commission, in 2021, announced a target to mitigate alarm fatigue-related fatalities through improved alarm management. Yet, no established guidelines are presently available. This study aims to address alarm fatigue at the Mayo Clinic to safeguard patient safety, curb staff burnout and improve the sensitivity of oxygen saturation monitoring to promptly detect emergencies.

METHODS

A quality improvement project was conducted to combat minimise the false alarm burden, with data collected 2 months prior to intervention commencement. The project's goal was to decrease the total alarm value by 20% from 55%-85% to 35%-75% within 2 months, leveraging quality improvement methodologies.

INTERVENTIONS

February to April 2021, we implemented a two-pronged intervention: (1) instituting a protocol to evaluate patients' continuous monitoring needs and discontinuing it when appropriate, and (2) introducing educational signage for patients and Mayo Clinic staff on monitoring best practices.

RESULTS

Baseline averages of red alarms (158.6), manual snoozes (37.8) and self-resolves (120.7); the first postintervention phase showed reductions in red alarms (125.5), manual snoozes (17.8) and self-resolves (107.8). Second postintervention phase recorded 138 red alarms, 13 manual snoozes and 125 self-resolves. Baseline comparison demonstrated an average of 16.92% reduction of alarms among both interventions (p value: 0.25).

CONCLUSION

Simple interventions like education and communication techniques proved instrumental in lessening the alarm burden for patients and staff. The findings underscore the practical use and efficacy of these methods in any healthcare setting, thus contributing to mitigating the prevalent issue of alarm fatigue.

Burnout: A Call to Action From the AUA Workforce Workgroup

PURPOSE

We hypothesize burnout has failed to improve and certain demographics may be disproportionately affected.

MATERIALS AND METHODS

The AUA Workforce Workgroup examined work from the annual AUA Census over the past several years. Particular to this study, relevant burnout-related data were examined from the past 5 years.

RESULTS

In 2021, 36.7% of urologists reported burnout compared to 36.2% in 2016. Burnout in men decreased from 36.3% to 35.2%, but increased in women from 35.3% to 49.2%. When examined by age, the largest increases in burnout were seen in those <45 years old, increasing from 37.9% to 44.8%, followed by 45-54 years old, increasing from 43.4% to 44.6%. When asked about the effect of COVID-19 on burnout, 54% of urologists didn't feel COVID-19 impacted burnout. Beyond burnout, only 25.0% of men and 4.6% of women reported no conflict between work and personal responsibilities, while 25.7% of men and 44.7% of women resolved these conflicts in favor of work or were unable to resolve them. Of respondents, 22.5% of men and 37.1% of women were "dissatisfied" with work-life balance. Similarly, 33.6% of men reported their work schedule does not leave enough time for personal/family life, compared to 57.5% of women.

CONCLUSIONS

Overall, urologists have higher burnout now when compared to 2016. The gender discrepancy has vastly widened with women experiencing burnout at an increased rate of 14% compared to 2016, while burnout in men decreased by 1%. Burnout has increased the most in those <45 years old. Further action is needed to substantiate the causes of burnout.

Prevalence of Burnout in Healthcare Specialties: A Systematic Review Using Copenhagen and Maslach Burnout Inventories

BACKGROUND This systematic review used the Copenhagen (CBI) and the Maslach (MBI) Burnout Inventories and its scales to assess and compare studies that involved students and workers in all medical specialties. MATERIAL AND METHODS PubMed, ScienceDirect, Scopus, Wiley Library, and Web of Science databases were searched using keywords and Medical Subject Headings. Identified studies were in English, published between 2008 and 2022, measured the burnout of healthcare workers and students by using CBI and MBI, and observed adverse patient outcomes. RESULTS A total of 38 studies were included in the current review. All included studies assessed and evaluated subjects and participants by observing clinical measures, personal and demographic data, countries where the study was conducted, and study type used. Fifty percent of CBI papers were conducted in Saudi Arabia and other Arab countries, whereas the majority of MBI papers (10) were conducted in Europe, followed by 9 studies conducted in Saudi Arabia and other Arab countries and 6 studies conducted in the USA and Canada. The overall percentage of burnout in CBI studies (53%) was higher than that in MBI studies (35%). Also, the types and domains in CBI were marginally higher than those in MBI. CONCLUSIONS Studies that used CBI scales recorded higher burnout compared with studies that used MBI. Females, higher education levels, and marriage status of the tested subjects showed higher CBI and MBI scale scores in comparison to their counterparts. Higher significant differences percentages in burnout types and genders were recorded in CBI than in MBI.

Promoting Organizational Change: A Urology Department-wide Wellness Program to Reduce Burnout

INTRODUCTION

We developed a comprehensive wellness initiative to address burnout with specific interventions targeted at faculty, residents, nurses, administrators, coordinators, and other departmental personnel.

METHODS

A department-wide wellness initiative was implemented in October 2020. General interventions included monthly holiday-themed lunches, weekly pizza lunches, employee recognition events, and initiation of a virtual networking board. Urology residents received financial education workshops, weekly lunches, peer support sessions, and exercise equipment. Faculty were offered personal wellness days to use at their discretion at no penalty to their calculated productivity. Administrative and clinical staff were given weekly lunches and professional development sessions. Pre- and post-intervention surveys included a validated single-item burnout instrument and the Stanford Professional Fulfillment Index. Outcomes were compared using Wilcoxon rank-sum tests and multivariable ordinal logistic regression.

RESULTS

Among 96 department members, 66 (70%) and 53 (55%) participants completed the pre- and post-intervention surveys, respectively. Burnout scores were significantly improved after the wellness initiative (mean 2.06 vs 2.42, mean difference -0.36, P = .012). An improvement was also observed in the sense of community (mean 4.04 vs 3.36, mean difference 0.68, P < .001). Adjusting for role group and gender, completion of the curriculum was associated with decreased burnout (OR 0.44, P = .025), increased professional fulfillment (OR 2.05, P = .038), and increased sense of community (OR 3.97, P < .001). The highest-rated components were monthly gatherings (64%), sponsored lunches (58%), and employee of the month (53%).

CONCLUSIONS

A department-wide wellness initiative with group-specific interventions can help reduce burnout and may improve professional fulfillment and workplace community.

Effectiveness of auriculotherapy for anxiety, stress or burnout in health professionals: a network meta-analysis

OBJECTIVE

to analyze the effectiveness of auriculotherapy, when compared to the control group, placebo or usual treatment for anxiety, stress or burnout in health professionals.

METHOD

a systematic review conducted in nine information sources, being selected experimental or quasi-experimental studies with auriculotherapy intervention in health professionals, compared to control, placebo or usual treatment groups. Descriptive analysis and network meta-analysis by means of direct and indirect comparison. Quality of the outcomes was assessed with the Confidence in Network Meta-analysis.

RESULTS

15 articles were included: 66.6% with Nursing teams and 53.3% with interventions involving semi-permanent needles. The shen men, brainstem, kidney, sympathetic, lung and liver acupoints predominated. There was a reduction in anxiety with semi-permanent needles (CI -8.18, -6.10), magnetic palettes (CI -7.76, -5.54), placebo (CI -5.47, -3.36) and seeds (CI -6.35, -4.05); as well as in stress with semi-permanent needles (CI -37.21, -10.88) and seeds with (CI -28.14, -11.70) and without a closed protocol (CI -36.42, -10.76). Meta-analysis was unfeasible for burnout; however, significant reductions were verified when it was treated with auriculotherapy.

CONCLUSION

Auriculotherapy is effective to reduce anxiety and stress in health professionals; however, this assertion cannot be made in the case of burnout. It was evidenced that workers' health is favored with the use of auriculotherapy.

Professional Burnout of Advanced Practice Providers Based on 2019 American Urological Association Census Data

INTRODUCTION

Burnout has been recognized as an occupational hazard among health care professionals. The objective of this study was to assess the extent and pattern of burnout in advanced practice providers (APPs) in urology by analyzing American Urological Association Census data.

METHODS

The American Urological Association conducts an annual census survey to all providers in the urological care community, including APPs. In the 2019 Census, the Maslach Burnout Inventory questionnaire was included to measure burnout among APPs. Demographic and practice variables were assessed to establish correlating factors to burnout.

RESULTS

A total of 199 APPs (83 physician assistants and 116 nurse practitioners) completed the 2019 Census. Slightly more than 1 in 4 APPs experienced professional burnout (25.3% in physician assistants and 26.7% in nurse practitioners). Observed higher burnout rates were seen in APPs who were aged 45 to 54 (34.3%), women (29.6% vs 10.8% in men, p value <0.05), non-White (33.3% vs 24.9% in White), those who had 4-9 years of practice (32.4%) and those who practiced in academic medical centers (31.7%). Except for gender, none of the above observed differences were statistically significant. Using a multivariate logistic regression model, gender remained the only significant factor associated with burnout (women vs men with an odds ratio of 3.2 [95% confidence interval: 1.1-9.6]).

CONCLUSIONS

Overall, APPs in urological care reported lower levels of burnout than urologists; however, there was a higher chance of female APPs experiencing higher professional burnout in comparison to their male counterparts. Future studies are needed to investigate possible reasons for this finding.

[Burnout among Radiologists in Korea: Prevalence, Risk Factors, and Remedies]

Burnout among radiologists has recently emerged as an issue that poses a threat to patient safety. Burnout adversely effects the quality of patient care and may lead to health problems in physicians. Approximately 84% of board-certified radiologists working in large hospitals in Korea responded that they had experienced burnout at least once. To overcome this, the standardization of physicians' workloads, as well as improvements in the professional workflow are necessary to ensure a healthy lifestyle balance.

Prevalence of burnout among healthcare workers in six public referral hospitals in northeastern Brazil during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has placed considerable psychological stress on frontline healthcare workers (HCWs).

OBJECTIVE

To evaluate the prevalence of burnout syndrome among HCWs facing the COVID-19 outbreak.

DESIGN AND SETTING

Cross-sectional study conducted in six public intensive care units (ICUs) in the city of Fortaleza, Brazil.

METHODS

An online survey was conducted among HCWs to measure the three dimensions of burnout.

RESULTS

A total of 62 physicians (23.4%), 65 nurses (24.5%), 58 nurse technologists (21.9%) and 80 physiotherapists (30.2%) completed the questionnaire. Nearly half of the participants (48.6%) had high levels of emotional exhaustion, and almost one-third of them (29.4%) had high levels of depersonalization. Low levels of professional efficacy were observed in 18.1% of the sample. The independent determinants of depersonalization burnout were age < 33 years (odds ratio, OR 2.03; 95% confidence interval, CI 1.15-3.56; P = 0.01) and female gender (OR 0.33; 95% CI 0.18-0.62; P = 0.01). Increased workload was associated with both depersonalization (OR 2.37; 95% CI 2.02-5.50; P = 0.04) and emotional exhaustion (OR 1.89; 95% CI 1.04-3.58; P = 0.030).

CONCLUSION

The COVID-19 pandemic has had a great impact on the dimensions of depersonalization and emotional exhaustion. Consideration of these dimensions is important when designing future burnout prevention programs for frontline personnel.

Relationship between depressive symptoms, burnout, job satisfaction and patient safety culture among workers at a university hospital in the Brazilian Amazon region: cross-sectional study with structural equation modeling

BACKGROUND

Workplaces can be sources of mental distress. In healthcare services, this can also affect patients.

OBJECTIVE

To assess the prevalence of and factors associated with depressive symptoms, burnout, job satisfaction and patient safety culture and the relationships between these constructs, among healthcare workers.

DESIGN AND SETTING

Cross-sectional study in a university hospital in Manaus, Brazil.

METHODS

Randomly selected workers were interviewed based on Brazilian-validated tools. We calculated the prevalence ratio (PR) and 95% confidence interval (CI) of depressive symptoms and burnout using Poisson regression with robust variance; and the β-coefficient of safety culture and job satisfaction using linear regression. Outcome relationships were assessed using partial least-squares structural equation modeling.

RESULTS

300 professionals were included; 67.3% were women. The prevalence of depressive symptom was 19.0% (95% CI: 14.5; 23.5%) and burnout, 8.7% (95% CI: 5.2; 12.3%). Lack of work stability increased depression (PR = 1.88; 95% CI: 1.17; 3.01) and burnout (PR = 2.17; 95% CI: 1.03; 4.57); and reduced job satisfaction (β = -11.93; 95% CI: -18.79; -5.07). Depressive symptoms and burnout were positively correlated, as also were job satisfaction and safety culture (P < 0.001); job satisfaction was negatively correlated with burnout (P < 0.001) and depression (P = 0.035).

CONCLUSION

Impermanent employment contracts increased depression and burnout and reduced job satisfaction. Job satisfaction reduced poor mental health outcomes and increased safety culture. Job satisfaction and safety culture were directly proportional (one construct increased the other and vice versa), as also were depression and burnout. Better working conditions can provide a virtuous cycle of patient safety and occupational health.

Associated factors of professional burnout among faculty members of graduate stricto sensu programs in language teaching and linguistics: a cross-sectional study

BACKGROUND

The burnout syndrome can be avoided and/or have its signs and symptoms reduced by knowing the five associated factors that help identify the health and working conditions of the professors of graduate programs.

OBJECTIVE

To analyze the factors associated with burnout among faculty members of graduate stricto sensu programs.

DESIGN AND SETTING

A cross-sectional study was conducted among 585 faculty members of Graduate Programs in Language Teaching and Linguistics in Brazil.

METHODS

Data were collected through an online questionnaire. The outcomes were the dimensions of burnout and its related factors identified through multiple templates of logistic regression.

RESULTS

Faculty members with increased chances of emotional exhaustion and depersonalization mentioned the use of medications due to labor activities. The negative influence of pace and intensity of work, thoughts about quitting the program, and having to produce three or more scientific articles were associated with higher chances of emotional exhaustion, while having to achieve nine hours per week in undergraduate programs was related to reduced personal accomplishment. Having a conjugal relationship, satisfaction with health and work, post-doctoral degree, autonomy, and good interpersonal relationships with faculty members of the program reduced the chances of emotional exhaustion. Reduced chances of depersonalization occurred among those who were satisfied with work, had good interpersonal relationships with advisees and faculty members, and received productivity funding.

CONCLUSION

Sociodemographic, health, and occupational factors related to the dimensions of burnout were identified.

Lower Likelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups

PURPOSE

We investigated whether physician race and ethnicity were associated with burnout among a nationally representative sample of family physicians.

METHODS

We undertook a cross-sectional observational study using survey data from 1,510 American Board of Family Medicine recertification applicants in 2017 and 1,586 respondents to the 2017 National Graduate Survey. Of the 3,096 total family physicians, 450 (15%) were from racial and ethnic groups underrepresented in medicine. We used structural equation models to test the effects of underrepresented status on single-item measures of emotional exhaustion and depersonalization.

RESULTS

Family physicians underrepresented in medicine were significantly less likely than their non-underrepresented counterparts to report emotional exhaustion (adjusted odds ratio = 0.82; 95% CI, 0.69-0.99; total effect) and depersonalization (adjusted odds ratio = 0.54; 95% CI, 0.41-0.71; total effect). The underrepresented physicians were more likely than non-underrepresented peers to practice in more racially and ethnically diverse counties and less likely to practice obstetrics, both of which partly mediated the protective effect of underrepresented status on depersonalization.

CONCLUSIONS

Although factors such as racism might be expected to adversely affect the well-being of underrepresented clinicians, underrepresented family physicians reported a lower frequency of emotional exhaustion and depersonalization. The mediating protective effect of working in more racially and ethnically diverse counties is consistent with evidence of the beneficial effect of cultural diversity on health outcomes for minorities. Because physician burnout is a known predictor of job turnover and may also be associated with poorer quality of care, the lower burnout observed among underrepresented family physicians may be an asset for the health care system as a whole.

Prevalence of burnout and predictive factors among oncology nursing professionals: a cross-sectional study

BACKGROUND

Burnout is a syndrome that mostly affects professionals working in contact with patients and their caregivers. In oncology care, nursing professionals are constantly required to provide emotional support for patients and their caregivers, throughout the process of becoming ill, suffering and dying.

OBJECTIVE

To evaluate the prevalence and factors associated with burnout in a sample of nursing professionals at a cancer hospital.

DESIGN AND SETTING

Cross-sectional study conducted at Hospital de Câncer de Barretos.

METHODS

The study population comprised 655 nursing professionals. Burnout syndrome was assessed using the Maslach Burnout Inventory Human Service Survey. Univariate analysis and binary logistic regression models were used to identify independent predictors associated with burnout.

RESULTS

Among 304 nursing professionals included in the study, 27 (8.9%) were classified as presenting burnout according to the two-dimensional criteria, and four (1.3%) were classified based on the three-dimensional criteria. Workplace characteristics were not associated with burnout, while single marital status (odds ratio, OR = 2.695; P = 0.037), perceived workplace stressors, such as impatience with colleagues (OR = 3.996; P = 0.007) and melancholy (OR = 2.840; P = 0.021) were considered to be predictors of burnout. Nursing professionals who would choose the profession again (OR = 0.214; P = 0.001) were least likely to present burnout.

CONCLUSION

Perceived workplace stressors are strongly associated with burnout. Strategies focusing on restructuring of daily work processes and on activities that stimulate positive relationships are important for professionals' health because motivation to continue working in oncology nursing has a protective effect against burnout.

Dental trainees' mental health and intention to leave their programs during the COVID-19 pandemic

Background

Dental trainees (dental students, graduate students, and postdoctoral residents) are at increased risk of experiencing poor mental health, which can lead to intentions to leave their program, especially during the COVID-19 pandemic.

Methods

The authors invited 355 dental trainees at the University of Washington School of Dentistry to complete an 83-item questionnaire in August and September 2020. The outcome analyzed was intention to leave their programs. There were 4 self-reported predictors: anxiety, burnout, depression, and COVID-19 impact on overall mental health. The authors ran multiple variable logistic regression models to evaluate relationships between each predictor and outcome (α = .05) and reported odds ratios (ORs) and 95% CIs.

Results

The survey response rate was 35.5%. Overall, 12.7% of participants reported any intention to leave. In total, 22.2% and 16.7% of participants endorsed clinically significant anxiety or depression symptomatology, respectively; 28.6% reported 1 or more burnout symptoms; and 69.0% reported that COVID-19 affected their overall mental health. Participants reporting anxiety (OR, 8.87; 95% CI, 1.80 to 43.57; P = .007), depression (OR, 11.18; 95% CI, 1.84 to 67.74; P = .009), or burnout (OR, 8.14; 95% CI, 1.73 to 38.23; P = .008) were significantly more likely to report intention to leave than those not reporting mental health problems. All participants reporting that the COVID-19 pandemic impacted their mental health expressed intention to leave.

Conclusions

Poor mental health is common among dental trainees and is associated with intention to leave their program.

Practical Implications

COVID-19 has exacerbated the prevalence and consequences of poor mental health among dental students, highlighting the importance of providing wellness resources.

Effects of Occupational Radiation Exposure on Job Stress and Job Burnout of Medical Staff in Xinjiang, China: A Cross-Sectional Study

BACKGROUND Although the potential effects of long-term and low-dose radiation exposure on physical health have attracted considerable attention, few systematic evaluations have been reported regarding the mental health of occupational groups. This study sought to investigate the effects of occupational radiation exposure on job stress and job burnout of medical radiation staff. MATERIAL AND METHODS Using cluster random sampling, a total of 1573 medical radiation workers were initially selected from 10 hospitals in Xinjiang, China, and 1396 valid questionnaires were finally collected. Job stress and job burnout were assessed using the Effort-Reward Imbalance (ERI) questionnaire and the Chinese Maslach Burnout Inventory (CMBI), respectively. RESULTS The percentages of medical radiation staff experiencing job stress and job burnout were 53.08% and 63.32%, respectively. A statistically significant difference in job stress was observed in association with age, ethnicity, professional title, marital status, radiation work type, radiation working years, family history, hypertension, obesity, smoking, and drinking (P<0.05). A statistically significant difference in job burnout was observed in association with age, sex, ethnicity, professional title, educational level, marital status, job post, radiation work type, radiation working years, family history, hypertension, diabetes, and obesity (P<0.05). Female (odds ratio [OR]=0.75, 95% confidence interval [CI]: 0.58-0.98), senior professional title (OR=0.64, 95% CI: 0.43-0.96), and radiation work types of nuclear medicine (OR=0.15, 95% CI: 0.07-0.33) and radiotherapy (OR=0.54, 95% CI: 0.36-0.79) were protective factors, and job stress (OR=4.57, 95% CI: 3.55-5.91) was the risk factor for job burnout of medical radiation staff. CONCLUSIONS Medical radiation staff experience high levels of job stress and job burnout. The interventions of occupational physical examination, personal dose monitoring, occupational health education, and management optimization are recommended to relieve job stress and job burnout and enhance occupational health of medical radiation staff.

Assessment of the Relationship between Nurses' Perception of Ethical Climate and Job Burnout in Intensive Care Units

OBJECTIVES

To determine the relationship between ethical climate and burnout in nurses working in Intensive Care Units (ICUs).

METHODS

This cross-sectional and multi-center study was conducted among 212 nurses working in adult ICUs of six hospitals affiliated to Shiraz University of Medical Sciences, Iran in 2019. The participants were selected using systematic random sampling technique. Data was collected using valid instruments of Olson's Hospital Ethical Climate Survey (HECS) and Maslach Burnout Inventory (MBI).

RESULTS

Ethical climate was favorable (3.5±0.6). The intensity (32.2±12.4) and frequency (25.5±12.4) of burnout were high. Ethical climate had significant and inverse relationships with frequency of burnout (r =-0.23, p=0.001) and with intensity of burnout (r=-0.186, p=0.007). Ethical climate explained 5.9% of burnout. Statistically significant relationships were also found between these factors: age with ethical climate (p=0.001), work shifts with burnout (p=0.02), and gender and with intensity frequency of burnout in ICU nurses (p=0.038). The results of Spearman correlation coefficient showed significant and inverse relationships between ethical climate and job burnout (r=-0.243, p < 0.001).

CONCLUSIONS

Nurses in ICUs perceived that ethical climate was favorable however, burnout was high. Therefore, burnout can be affected by many factors and it is necessary to support ICU nurses since they undertake difficult and complicated task. It is recommended to assess factors that increase burnout and adopt specific measures and approaches to relieve nursing burnout.

Job satisfaction and burnout among oral healthcare providers within the Unified Health System in Sobral, Ceará, Brazil

Background

The particular characteristics of oral health care might influence job satisfaction and occurrence of burnout among providers, with consequent impact on their quality of life and the quality of care delivery. In the present study, we analyzed job satisfaction among oral healthcare providers affiliated with the public health service in Sobral, Ceará, Brazil, work-related factors and prevalence of burnout.

Methods

Cross-sectional study performed in 2017 with 95 oral healthcare providers allocated to primary and secondary care facilities. We administered a sociodemographic questionnaire, the Occupational Stress Indicator scale and the Maslach Burnout Inventory-Human Services Survey. The data were analyzed by means of the χ² test; the significance level was set to p<0.05.

Results

Job dissatisfaction was associated with precarious working conditions and lack of professional recognition; satisfaction was associated with interpersonal relationships. The overall prevalence of burnout was low (1.05%), however, on subscale analysis 37.9% of the participants exhibited low personal accomplishment and 22.1% high emotional exhaustion.

Conclusion

The results for job dissatisfaction and burnout subscales point to the need for more thorough investigation of the working conditions of oral healthcare providers.

Health-related physical fitness of military police officers in Paraiba, Brazil

Background

An adequate relationship among health-related physical fitness (HRPF) components improve the professional performance of military police officers (MOPs).

Objective

To investigate the correlation among HRPF components for Special Police Operations (BOPE) and Traffic Police (BPTRAN) Battalion MOPs.

Method

The sample comprised 47 male MOPs aged 26 to 49 years old divided in two groups BOPE (N=25) and BPTRAN (n=22). The participants were subjected to a test battery-anthropometric measurements, sit-and-reach test, 1-minute sit-up test, elbow flexion test, and 20-meter shuttle run test-for evaluation of the HRPF morphological, cardiorespiratory and neuromuscular components.

Results

Both groups exhibited moderate-to-strong correlation of waste circumference (WC), body mass index (BMI) and body fat percentage (BFP) with localized muscle resistance (LMR) (r=-0.589; r=-0.404; r=-0.637) and dynamic muscle strength (DMS) (r=0.592; r=-0.416; r=-0.651) (p<0.05). Significant positive and negative correlation was found between maximum oxygen consumption and WC, BMI, BFP and LMR (p<0.05) but not with flexibility for BOPE.

Conclusion

There was strong correlation between the HRPF morphological, cardiorespiratory and neuromuscular components, except for flexibility among BOPE MPOs. The study findings allow inferring that HRPF is a global variable.

Burnout syndrome and sleep quality among military police officers in Piaui

Background

Military police officers are a distinct population group given they deal everyday with violence and crime. For this reason they are more susceptible to develop burnout syndrome, resulting in significant decrease of productivity and changes in the quality of sleep.

Objective

To analyze the correlation between burnout syndrome and sleep quality relative among military police officers.

Method

Cross-sectional, descriptive and quantitative study conducted with 32 military police officers of the military police battalion of Teresina, Piaui, Brazil. Data collection was performed through administration of a questionnaire for sociodemographic data, the Masliach Burnout Inventory and the Pittsburgh Sleep Quality Index. Pearson's correlation was used for statistical analysis.

Results

The sample comprised 32 male military police officers, with average age 44.35±5.63 years old. Sleep duration exhibited highly significant, inverse and moderate correlation with emotional exhaustion (p=0.0003). Emotional exhaustion exhibited significant moderate correlation with sleep quality (p=0.004). Depersonalization exhibited significant, albeit weak correlation with sleep quality (p=0.03).

Conclusion

Burnout syndrome domains emotional exhaustion and depersonalization exhibited significant correlation with sleep quality.

Analysis of the work environment and intention of perioperative nurses to quit work

OBJECTIVE

to investigate how the perioperative work environment affects work dissatisfaction, professional exhaustion and the perception of the quality of care about the intention of abandoning the work of perioperative nurses.

METHOD

cross-sectional study with 130 nurses working in the surgical area of a high-tech Spanish public university hospital. The scale of the nursing practice environment, Maslach's exhaustion inventory, the questions about job satisfaction, the perception of the care quality and intention to abandon work to collect data were used. Descriptive, inferential and logistic regression statistics were made.

RESULTS

in general, 20% of perioperative nurses would want to quit their work. The dimension of the work environment of staff and resources, dissatisfaction and emotional exhaustion in nurses were factors that indicated the intention of perioperative nurses to abandon work.

CONCLUSION

the implementation of strategies for the retention of perioperative nurses should be considered, improving the factors that indicate how the work environment, especially the allocation of personnel and resources, dissatisfaction and emotional exhaustion. Creating positive work environments based on magnetic values can be a key strategy.

Burnout and job satisfaction among emergency and intensive care providers in a public hospital

Background

New technologies and inadequate management of work might have negative impact on the mental health of workers.

Objective

To investigate factors associated with the prevalence of burnout and levels of job satisfaction among emergency department and intensive care providers in a large public hospital.

Methods

Cross-sectional study with 91 healthcare workers, who were administered the self-report questionnaires Maslach Burnout Inventory - Human Services Survey (MBI-HSS) and Job Satisfaction Scale (JSS20/23).

Results

The sample was predominantly composed of women (58.2%), married workers or with a stable partner (52.8%), having attended graduate studies (75.8%) and with average age 37 years old. Twenty-five percent of the participants exhibited emotional exhaustion and dissatisfaction with the work environment and hierarchical relationships, and 66% had already thought of leaving the profession. Allocation to intensive care unit, lack of professional growth opportunities, dissatisfaction with hierarchical relationships, nursing profession, and having thought of leaving the profession explained 55% of the prevalence of emotional exhaustion.

Conclusion

Positive correlation between emotional exhaustion and job dissatisfaction was the earliest identifiable indicator of burnout. Periodic evaluations for early detection and prevention are important to reduce occupational disorders, and consequently improve the quality and safety of care delivery.

Burnout among specialists and trainees in physical medicine and rehabilitation: A systematic review

OBJECTIVE

Burnout, a state of emotional exhaustion related to work or patient-care activities, is prevalent in all stages of medical training and clinical practice. The syndrome has serious consequences, including medical errors, poorer quality of care, substance abuse, and suicide. The aim of this study is to evaluate the prevalence of burnout in Physical Medicine and Rehabilitation (PMandR) specialists and trainees.

METHODS

Systematic literature searches were conducted in MEDLINE, CINAHL and EMBASE for peer-reviewed articles in English before March 2019 about the prevalence of burnout amongst PMandR specialists and trainees.

RESULTS

This systematic review yielded 359 results. Of these, 33 full-text records were reviewed; 5 met the inclusion criteria: 3 surveys of PMandR specialists and 2 of PMandR residents (total n?=?1,886 physicians; year of publication 20122019). Data extracted included prevalence and severity of burnout and, if available, risk or protective factors. Data were analysed using descriptive statistics. Incidence of burnout ranged from 22.2% to 83.3% in trainees and 48% to 62% in specialists. Organizational and system challenges were the primary risk factors for burnout amongst specialists.

CONCLUSION

Emerging evidence positions physicians in PMandR among the most likely to experience burnout. Although there is limited literature regarding PMandR specialists and trainees, the available evidence suggests that more than half of physicians in PMandR experience burnout.

Stress and coping among workers at psychosocial care centers in the interior of the state of Sao Paulo

BACKGROUND

Psychosocial Care Centers (CAPS) are community-based facilities designed as a substitutive model to break with asylum-based care and aligned to the principles underlying the Unified Health System (Sistema Único de Saúde-SUS); thus they promote patient-centered care.

OBJECTIVE

To establish the prevalence of stress and its association with biosocial characteristics and coping strategies within the work process of healthcare providers at CAPS in a city in the interior of the state of Sao Paulo, Brazil.

METHOD

Cross-sectional quantitative study involving administration of three questionnaires: biosocial, Work Stress Scale and a checklist of coping strategies. The sample comprised 193 healthcare providers from 11 different CAPS.

RESULTS

Most participants were female, with average age 35 years old, single and without children. The levels of stress were rated high, with prevalence of 50.2%. The main associations found concern the participants' subjective appraisal of their job, particularly personal recognition and satisfaction. The coping strategies most frequently cited were problem-solving and social support.

CONCLUSION

We found high levels of stress in the analyzed population and association of stress mainly with biosocial characteristics.

Working conditions and high emotional exhaustion among hospital nurses

Background

Healthcare workers are exposed to many different occupational stressors, some of which are related to their working conditions. While the experience of stress seems to depend on individual perceptions, some characteristics of inpatient units might influence the occurrence of emotional exhaustion among nurses.

Objective

The aim of the present study was to identify characteristics of inpatient units which might be associated with high levels of emotional exhaustion among healthcare workers, nurses in this case.

Methods

We conducted the present cross-sectional, exploratory and descriptive study with 108 nurses (83.8% female; average age 33 years old) allocated to inpatients units (wards and intensive care) at a university hospital in Portugal. We administered the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) emotional exhaustion subscale and collected the following data relative to the units to which the participants were allocated: 1) mortality rate; 2) number of deceased patients; 3) shortage of nurses compared to national standards; 4) occupancy rate; 5) proportion of elderly patients (>65 years old).

Results

We found a positive relationship between high levels of emotional exhaustion among nurses and very high number of deceased patients (p=0.012), high fatality rate (p=0.036) and high proportion of elderly patients (p=0.025).

Conclusion

Very high number of deceased patients, high proportion of elderly patients and high fatality rate in inpatients units were associated with high levels of emotional exhaustion among nurses. These findings suggest that characterizing the objective conditions of inpatient units seems to be an important aspect to be considered in psychosocial risk management programs.

Anxiety, depression and stress among employees of a public higher education institution in São Paulo, Brazil

BACKGROUND

Occupational health is increasing in visibility within the scientific community and has become a field of international research and discussions in which occupational stress is described as a possible stressor.

OBJECTIVE

To analyze the relationship between anxiety and depression symptoms and socioeconomic level among technical-administrative employees of a public university in the state of São Paulo, Brazil.

METHODS

The sample comprised 89 participants. Data were obtained through Lipp's Inventory of Stress Symptoms for adults to identify levels of stress and the Hospital Anxiety and Depression scale. An additional questionnaire was administered to gather information on educational and socioeconomic levels.

RESULTS

About 45% of the participants exhibited symptoms of anxiety and 39% of depression, however, without direct relationship with their socioeconomic level. Among the participants with depression 50% were professors, and among those with depression 38.4% were administrative employees. Stress was more frequent among the participants who had attended higher education (29.6%) and graduate studies (33.3%).

CONCLUSION

The study results indicate a high prevalence of anxiety and depression regardless of the socioeconomic level of the participants. Stress was more frequent among the participants with higher educational level.

Impact of participation in continuing medical education small group learning (CME-SGL) on the stress, morale, and professional isolation of rurally-based GPs: a qualitative study in Ireland

BACKGROUND

The pressures of general practice contribute to high levels of stress, low morale, and burnout in some GPs. In addition, rurally-based doctors may experience significant professional isolation. Participation in continuing medical education (CME) appears to reduce stress, and may improve the retention of rural GPs.

AIM

As part of a larger study devised to examine the effectiveness of regular participation in CME small group learning (SGL) on rurally-based Irish GPs, this study explored whether CME-SGL had any impact on GP stress, morale, and professional isolation.

DESIGN & SETTING

This was a qualitative study involving four CME-SGL groups based in rural Ireland.

METHOD

Semi-structured focus group interviews were conducted in established CME-SGL groups in four different rural geographical locations. Interviews were audiorecorded, transcribed verbatim, and analysed thematically.

RESULTS

All members of these CME-SGL groups (n = 43) consented to interview. These GPs reported that regular meetings with an established group of trusted colleagues who are 'in the same boat' provided a 'safe space' for discussion of, and reflection on, both clinical concerns and personal worries. This interaction in a supportive, non-threatening atmosphere helped to relieve stress, lift morale, and boost self-confidence. The social aspect of CME-SGL sustained these rural GPs, and served to alleviate their sense of professional isolation.

CONCLUSION

Delivery of CME through locally-based SGL provides as an important means of supporting GPs working in rural areas. The non-educational benefits of CME-SGL, as described by these Irish GPs, are of relevance for rural doctors in other countries.

Prevalence of burnout syndrome among military physicians at a public hospital in Rio de Janeiro, Brazil

Background

Burnout syndrome is a sociopsychological disorder which develops in response to emotional tension and occupational stress, and is triggered by continuous stressors to which workers are exposed.It comprises three domains: emotional exhaustion, depersonalization and reduced personal accomplishment.

Objectives

To establish the prevalence of physical and emotional stress (burnout) among military physicians at Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil.

Methods

Cross-sectional, exploratory and descriptive study with quantitative approach.Data collection was performed from March through June 2016.Assessment instruments used were Maslach Burnout Inventory and a sociodemographic questionnaire.

Results

Burnout was more prevalent among women (57.1%), the participants who lived with a partner (64.3%), with age under 50 years old (100.0%), income up to 15 times the equivalent of the minimum wage (78.6%), who practiced physical activity (57.1%) and no leisure activities (78.6%).Alcohol consumption and smoking behaved as significant risk factors.Prevalence was higher for the depersonalization domain (44.8%), followed by personal accomplishment (28.4%) and emotional exhaustion (6.6%).

Conclusion

The professionals at the analyzed military hospital exhibited considerable levels of burnout, especially in regard to domain depersonalization.We call the attention to the need to develop preventive programs against burnout, particularly targeting workers exposed to emotional exhaustion, to avoid the occurrence of illness.

Relationship network at a mobile urgent care service unit: analysis of a work team

Introduction

Professionals at the Mobile Urgent Care Service (Serviço de Atendimento Móvel de Urgência - SAMU) face extreme situations which pose high psychological demands.

Objective

To investigate networks of relationships among employees of SAMU-Ceará, in Northeastern Brazil.

Methods

Case study of qualitative nature in which we conducted semi-structured interviews with SAMU-Ceará staff. To draw the relationship network, we first interviewed three professionals including physicians and nurses. Based on their narratives, we interviewed two further employees named by the former. We used program Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (iRaMuTeQ) for textual analysis of the narratives obtained. Structural network characteristics, such as size and density, were analyzed with software UCINET 6.123 and NetDraw 2.38.

Results

The interviewees had worked at the service for one year at least. The connections identified based on the interviews evidenced interrelationship between networks involving the interviewees. The links found were weak and unarticulated, even though two interviewees worked in the same department. Discourse analysis yielded three classes: 1) teamwork characteristics and peculiar ways to execute work; 2) relational and subjective aspects centered on management; and 3) nature of the service delivered.

Conclusions

The social networks at SAMU-Ceará represent a set of workers who establish mutual relationships to satisfy the demands and needs of service users in an integrated manner while attempting to respect the knowledge and autonomy of each member. Nevertheless, the networks evidenced conflict which is a cause of mental suffering at work.

Burnout and workorganization in Nursing

BACKGROUND

Burnout syndrome (BS) consists of a set of symptoms that appear in response to chronic interpersonal stressors at work and involve the perceptions individuals have of themselves and their work environment.

OBJECTIVES

To identify psychosocial risk and work organization factors able to predict mental suffering, and to estimate the prevalence of BS in a sample of nursing professionals from a public hospital in the state of São Paulo, Brazil.

METHODS

Mixed methods research combining quantitative and qualitative approaches conducted at a public university hospital. Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to estimate the prevalence of BS. Thematic content analysis of narratives gathered in focus groups was performed to identify psychosocial risk factors at work (PRFW).

RESULTS

The prevalence of BS at the investigated institution (5.7%) is consistent with the rates reported in the international literature. Analysis of the narratives gathered in focus groups revealed stressors in the organization of work.

CONCLUSION

The present study also points to the need for a broader look into the causes of BS, in which consideration of singular psychosocial risk and work organization factors from the perspective of workers devoted to proving care to human beings has paramount importance.

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

BACKGROUND

GPs are under increasing pressure due to a lack of resources, a diminishing workforce, and rising patient demand. As a result, they may feel stressed, burnt out, anxious, or depressed.

AIM

To establish what might help or hinder GPs experiencing mental distress as they consider seeking help for their symptoms, and to explore potential survival strategies.

DESIGN AND SETTING

The authors recruited 47 GP participants via e-mails to doctors attending a specialist service, adverts to local medical committees (LMCs) nationally and in GP publications, social media, and snowballing. Participants self-identified as either currently living with mental distress, returning to work following treatment, off sick or retired early as a result of mental distress, or without experience of mental distress. Interviews were conducted face to face or over the telephone.

METHOD

Transcripts were uploaded to NVivo 11 and analysed using thematic analysis.

RESULTS

Barriers and facilitators were related to work, stigma, and symptoms. Specifically, GPs discussed feeling a need to attend work, the stigma surrounding mental ill health, and issues around time, confidentiality, and privacy. Participants also reported difficulties accessing good-quality treatment. GPs also talked about cutting down or varying work content, or asserting boundaries to protect themselves.

CONCLUSION

Systemic changes, such as further information about specialist services designed to help GPs, are needed to support individual GPs and protect the profession from further damage.

GPs' perceptions of resilience training: a qualitative study

BACKGROUND

GPs are reporting increasing levels of burnout, stress, and job dissatisfaction, and there is a looming GP shortage. Promoting resilience is a key strategy for enhancing the sustainability of the healthcare workforce and improving patient care.

AIM

To explore GPs' perspectives on the content, context, and acceptability of resilience training programmes in general practice, in order to build more effective GP resilience programmes.

DESIGN AND SETTING

This was a qualitative study of the perspectives of GPs currently practising in England.

METHOD

GPs were recruited through convenience sampling, and data were collected from two focus groups (n = 15) and one-to-one telephone interviews (n = 7). A semi-structured interview approach was used and data were analysed using thematic analysis.

RESULTS

Participants perceived resilience training to be potentially of value in ameliorating workplace stresses. Nevertheless, uncertainty was expressed regarding how best to provide training for stressed GPs who have limited time. Participants suspected that GPs most likely to benefit from resilience training were the least likely to engage, as stress and being busy worked against engagement. Conflicting views were expressed about the most suitable training delivery method for promoting better engagement. Participants also emphasised that training should not only place the focus on the individual, but also focus on organisation issues.

CONCLUSION

A multimodal, flexible approach based on individual needs and learning aims, including resilience workshops within undergraduate training and in individual practices, is likely to be the optimal way to promote resilience.

Mindfulness-based stress reduction for GPs: results of a controlled mixed methods pilot study in Dutch primary care

BACKGROUND

Burnout is highly prevalent in GPs and can have a negative influence on their wellbeing, performance, and patient care. Mindfulness-based stress reduction (MBSR) may be an effective intervention to decrease burnout symptoms and increase wellbeing.

AIM

To gain insight into the feasibility and effectiveness of MBSR on burnout, empathy, and (work-related) wellbeing in GPs.

DESIGN AND SETTING

A mixed methods pilot study, including a waiting list-controlled pre-/post-study and a qualitative study of the experiences of participating GPs in the Netherlands.

METHOD

Participants were sent questionnaires assessing burnout, work engagement, empathy, and mindfulness skills, before and at the end of the MBSR training/waiting period. Qualitative data on how GPs experienced the training were collected during a plenary session and with evaluation forms at the end of the course.

RESULTS

Fifty Dutch GPs participated in this study. The MBSR group reported a greater decrease in depersonalisation than the control group (adjusted difference -1.42, 95% confidence interval [CI] = -2.72 to -0.21, P = 0.03). Dedication increased more significantly in the MBSR group than in the control group (adjusted difference 2.17, 95% CI = 0.51 to 3.83, P = 0.01). Mindfulness skills increased significantly in the MBSR group compared with the control group (adjusted difference 6.90, 95% CI = 1.42 to 12.37, P = 0.01). There was no significant change in empathy. The qualitative data indicated that the MBSR course increased their wellbeing and compassion towards themselves and others, including their patients.

CONCLUSION

The study shows that MBSR for GPs is feasible and might result in fewer burnout symptoms and increased work engagement and wellbeing. However, an adequately powered randomised controlled trial is needed to confirm the study's findings.

Psychosocial factors and prevalence of burnout syndrome among nursing workers in intensive care units

OBJECTIVE

To evaluate the prevalence of burnout syndrome among nursing workers in intensive care units and establish associations with psychosocial factors.

METHODS

This descriptive study evaluated 130 professionals, including nurses, nursing technicians, and nursing assistants, who performed their activities in intensive care and coronary care units in 2 large hospitals in the city of Rio de Janeiro, Brazil. Data were collected in 2011 using a self-reported questionnaire. The Maslach Burnout Inventory was used to evaluate the burnout syndrome dimensions, and the Self Reporting Questionnaire was used to evaluate common mental disorders.

RESULTS

The prevalence of burnout syndrome was 55.3% (n = 72). In the quadrants of the demand-control model, low-strain workers exhibited a prevalence of 64.5% of suspected cases of burnout, whereas high-strain workers exhibited a prevalence of 72.5% of suspected cases (p = 0.006). The prevalence of suspected cases of common mental disorders was 27.7%; of these, 80.6% were associated with burnout syndrome (< 0.0001). The multivariate analysis adjusted for gender, age, educational level, weekly work duration, income, and thoughts about work during free time indicated that the categories associated with intermediate stress levels - active work (OR = 0.26; 95%CI = 0.09 - 0.69) and passive work (OR = 0.22; 95%CI = 0.07 - 0.63) - were protective factors for burnout syndrome.

CONCLUSION

Psychosocial factors were associated with the development of burnout syndrome in this group. These results underscore the need for the development of further studies aimed at intervention and the prevention of the syndrome.

Prevalence and factors of burnout among Australian orthopaedic trainees: a cross-sectional study

PURPOSE

To assess the prevalence and factors of burnout among Australian orthopaedic trainees.

METHODS

236 orthopaedic registrars of the Australian Orthopaedic Association were invited to participate in a 32-item survey by email. The questionnaire assessed potential factors associated with burnout, satisfaction with the choice of orthopaedics as a career and work-life balance, and subjective overall health, as well as 3 subscales of the Maslach Burnout Inventory - Human Services Survey for assessing burnout: emotional exhaustion, depersonalisation, and personal accomplishment. Participants with high levels of either emotional exhaustion or depersonalisation were defined as having burnout. Those with and without burnout were compared.

RESULTS

51 (22%) of the 236 trainees completed the questionnaire. Of whom, 88% were satisfied with their choice of orthopaedics as a career, whereas 27% were satisfied with their work-life balance. 27 (53%) respondents were considered burned out. Compared with those who did not burn out, those who burned out were less satisfied with their careers (p=0.004) and work-life balance (p=0.021).

CONCLUSION

53% of Australian orthopaedic trainees were burned out. Burnout trainees were more likely to be dissatisfied with their career choice and worklife balance. Active interventions to combat burnout and improve work-life balance are needed.

The impact of stress on the health of sugar cane cutters

OBJECTIVE

Evaluate the impact of stress on sugar cane cutters and the prevalence of physical and psychological symptoms before and after harvest.

METHODS

We studied 114 sugarcane cutters and 109 urban workers in the pre-harvest and 102 sugar cane cutters and 81 urban workers in the post-harvest period in the city of Mendonça, SP, Southeastern Brazil, in 2009. Data analysis was based on the frequency and percentage of the assessed symptoms of stress, using the Lipp-ISSL test (Symptoms of Stress for Adults). The data were analyzed using descriptive statistics. The Fisher Test was used to compare the variable of stress between pre- and post-harvest within the sugar cane cutter and urban worker groups. P values below 0.05 were considered significant.

RESULTS

Stress in sugar cane cutters increased after harvesting (34.2% pre-harvest and 46.1% post-harvest); in urban workers, stress decreased from 44.0% pre-harvest to 42.0% post-harvest. There was prevalence of the phase of resistance to stress for both groups with signs more apparent from the near-exhaustion and exhaustion phases for sugar cane cutters. After harvest, there was a tendency for the number of sugar cane cutters with symptoms of near-exhaustion (6.4%) and exhaustion (10.6%) to increase. After harvest there was a trend for the number of sugar cane cutters with physical symptoms (pre-harvest = 20.5%, post-harvest = 25.5%) and psychological symptoms (pre-harvest = 64.1%; post-harvest = 70.2%) to increase. For both groups, predominantly psychological symptoms occurred in both phases (70.2% versus 64.7%).

CONCLUSIONS

The work process of cutting cane can cause stress. Individual factors such as cognitive perception of the experience, self-efficacy beliefs and expectations of the employee regarding their performance can influence the understanding of the reactions in their body in face of the work.

[Burnout and quality of life in medical residents]

BACKGROUND

burnout and quality of life are poorly studied phenomena in postgraduate students, and its effects are unknown. The aim was to investigate the relationship between quality of life and burnout in medical residents.

METHODS

a longitudinal study was performed. We included medical residents who began their postgraduate studies in 2010. The Spanish version of the Quality of Life Profile for the Chronically Ill (PLC, according to its initials in German), and the Maslach Burnout Inventory specific to physicians were applied at the beginning, and six and 12 months later. Descriptive statistics were used for nominal variables. Chi-square and ANOVA were applied to numerical variables.

RESULTS

we included 45 residents, the average age was 26.9 ± 2.93 years, 18 (40 %) were female and 27 (60 %) were male. The PLC survey found significant decrease in four of the six scales assessed in the three measurements. The Maslach Burnout Inventory found high levels of emotional exhaustion in the three tests, low levels of depersonalization and low personal gains at the beginning, rising at six and 12 months. The most affected specialty was Internal Medicine.

CONCLUSIONS

burnout and impaired quality of life for residents exist in postgraduate physicians and it is maintained during the first year of residency.

[Burnout syndrome among family physicians]

BACKGROUND

burnout syndrome is a state of physical and emotional exhaustion that can occur among workers who interact directly with others. This could affect job performance. The objective was to determine the prevalence of this syndrome and its associated factors among family physicians.

METHODS

a cross-sectional survey applying the Maslach Burnout Inventory was conducted in a selected convenience non-probability sampling of family physicians. Central tendency and dispersion measures were used in determining the prevalence of burnout syndrome; the associated factors were analysed by χ(2) test.

RESULTS

there were 59 cases of burnout syndrome, 36 had involvement in a single component, 15 in 2 and 8 were affected in 3 components; we observed that 35 % of positive cases reported doing an average of 10 extra shifts a month (p = 0.013). Having a second job was associated with positive cases of burnout syndrome.

CONCLUSIONS

the results are consistent with similar studies. Working extra shifts or having a second job were the related factors most associated to this syndrome.

Therapy of the burnout syndrome

Background

The prevalence, diagnostics and therapy of the burnout syndrome are increasingly discussed in the public. The unclear definition and diagnostics of the burnout syndrome are scientifically criticized. There are several therapies with unclear evidence for the treatment of burnout in existence.

Objectives

The health technology assessment (HTA) report deals with the question of usage and efficacy of different burnout therapies.

Methods

For the years 2006 to 2011, a systematic literature research was done in 31 electronic databases (e.g. EMBASE, MEDLINE, PsycINFO). Important inclusion criteria are burnout, therapeutic intervention and treatment outcome.

Results

17 studies meet the inclusion criteria and are regarded for the HTA report. The studies are very heterogeneous (sample size, type of intervention, measuring method, level of evidence). Due to their study design (e.g. four reviews, eight randomized controlled trials) the studies have a comparable high evidence: three times 1A, five times 1B, one time 2A, two times 2B and six times 4. 13 of the 17 studies are dealing with the efficacy of psychotherapy and psychosocial interventions for the reduction of burnout (partly in combination with other techniques). Cognitive behaviour therapy leads to the improvement of emotional exhaustion in the majority of the studies. The evidence is inconsistent for the efficacy of stress management and music therapy. Two studies regarding the efficacy of Qigong therapy do not deliver a distinct result. One study proves the efficacy of roots of Rhodiola rosea (evidence level 1B). Physical therapy is only in one study separately examined and does not show a better result than standard therapy.

Discussion

Despite the number of studies with high evidence the results for the efficacy of burnout therapies are preliminary and do have only limited reach. The authors of the studies complain about the low number of skilled studies for the therapy of burnout. Furthermore, they point to the insufficient evaluation of the therapy studies and the need for further research. Some authors report the effects of considerable natural recovering.

Numerous limitations affect the quality of the results. Intervention contents and duration, study design and study size are very diverse and do not permit direct comparison. Most of the samples are small by size with low statistical power, long-term follow-ups are missing. Comorbidities and parallel utilized therapies are insufficient documented or controlled. Most of the studies use the Maslach Burnout Inventory (MBI) as diagnostic or outcome-tool, but with different cut-off-points. It should be noticed that the validity of the MBI as diagnostic tool is not proved. Ethical, juridical and social determining factors are not covered or discussed in the studies.

Conclusion

The efficacy of therapies for the treatment of the burnout syndrome is insufficient investigated. Only for cognitive behavioural therapy (CBT) exists an adequate number of studies which prove its efficacy. Big long-term experimental studies are missing which compare the efficacy of the single therapies and evaluate their evidence. The natural recovering without any therapy needs further research. Additionally, it has to be examined to what extent therapies and their possible effects are thwarted by the conditions of the working place and the working conditions.

What effect does increasing inpatient time have on outpatient-oriented internist satisfaction?

OBJECTIVE

Because career satisfaction among general internists is relatively low, we sought to understand the impact on satisfaction of general internists managing patients both in and outside of the hospital. Using data from a national survey, we asked, "Among outpatient-oriented general internists (i.e., internists who spend less than 50% of their clinical time caring for inpatients), what effect does time spent in the hospital have on physician satisfaction, stress, and burnout?"

DESIGN/PARTICIPANTS

The Physician Worklife Study, in which 5,704 physicians in primary and specialty nonsurgical care selected from the American Medical Association's Masterfile were surveyed (adjusted response rate = 52%), was used. Our analyses focused on clinically active outpatient-oriented general internists (N = 339).

MEASUREMENTS AND MAIN RESULTS

We constructed multivariate linear models to test for statistically significant associations between the amount of time spent seeing inpatients and physician satisfaction as measured by several satisfaction scales. Even after controlling for total hours worked and other possible confounding variables, we found that increased time working in the hospital was significantly associated with decreases in satisfaction with administration, specialty, autonomy, and personal time, and significantly associated with an increase in life stress. There was also a significant association between increased time spent in the hospital and burnout.

CONCLUSIONS

Our findings imply that there may be a tension between the practice of inpatient and outpatient medicine by general internists, and suggest that fewer hospital duties may increase career satisfaction for outpatient-oriented internists. Although additional studies are warranted in order to better understand why these relationships exist, our data suggest that the hospitalist model of inpatient care might be one approach to alleviate stress and improve satisfaction for many general internists.

Measuring and enhancing self-efficacy among professional caregivers of individuals with dementia

Nurses who provide care for individuals with Alzheimer's disease and other dementias are at risk of burnout. Self-efficacy is a psychological construct with the potential to help reduce or prevent the impact of caregiver stress. Evidence supporting a link between higher levels of self-efficacy and lower levels of stress is emerging among lay caregivers. However, concurrent research for professional caregivers lags behind, partly due to a lack of appropriate self-efficacy measures for this population. We developed an intervention to enhance self-efficacy and an inventory to measure its improvements among long-term care nurses. Training resulted in lasting improvements in knowledge and self-efficacy regarding the management of challenging team, resident, and family situations. Short-term reductions in caregiver burnout were also evident. Suggestions for maintaining improvements in caregiver burnout over longer periods are offered.