9
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Prevalence and drivers of nurse and physician distress in cardiovascular and oncology programmes at a Canadian quaternary hospital network during the COVID-19 pandemic: a quality improvement initiative

      research-article

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objectives

          To assess the prevalence and drivers of distress, a composite of burnout, decreased meaning in work, severe fatigue, poor work–life integration and quality of life, and suicidal ideation, among nurses and physicians during the COVID-19 pandemic.

          Design

          Cross-sectional design to evaluate distress levels of nurses and physicians during the COVID-19 pandemic between June and August 2021.

          Setting

          Cardiovascular and oncology care settings at a Canadian quaternary hospital network.

          Participants

          261 nurses and 167 physicians working in cardiovascular or oncology care. Response rate was 29% (428 of 1480).

          Outcome measures

          Survey tool to measure clinician distress using the Well-Being Index (WBI) and additional questions about workplace-related and COVID-19 pandemic-related factors.

          Results

          Among 428 respondents, nurses (82%, 214 of 261) and physicians (62%, 104 of 167) reported high distress on the WBI survey. Higher WBI scores (≥2) in nurses were associated with perceived inadequate staffing (174 (86%) vs 28 (64%), p=0.003), unfair treatment, (105 (52%) vs 11 (25%), p=0.005), and pandemic-related impact at work (162 (80%) vs 22 (50%), p<0.001) and in their personal life (135 (67%) vs 11 (25%), p<0.001), interfering with job performance. Higher WBI scores (≥3) in physicians were associated with perceived inadequate staffing (81 (79%) vs 32 (52%), p=0.001), unfair treatment (44 (43%) vs 13 (21%), p=0.02), professional dissatisfaction (29 (28%) vs 5 (8%), p=0.008), and pandemic-related impact at work (84 (82%) vs 35 (56%), p=0.001) and in their personal life (56 (54%) vs 24 (39%), p=0.014), interfering with job performance.

          Conclusion

          High distress was common among nurses and physicians working in cardiovascular and oncology care settings during the pandemic and linked to factors within and beyond the workplace. These results underscore the complex and contextual aspects of clinician distress, and the need to develop targeted approaches to effectively address this problem.

          Related collections

          Most cited references35

          • Record: found
          • Abstract: found
          • Article: found

          Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Physician burnout: contributors, consequences and solutions

            Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients and healthcare organizations and systems. Drivers of this epidemic are largely rooted within healthcare organizations and systems and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually focused solutions such as mindfulness-based stress reduction and small-group programmes to promote community, connectedness and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfil its mission for patients and for public health, all stakeholders in healthcare delivery must work together to develop and implement effective remedies for physician burnout.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              The consequences of the COVID-19 pandemic on mental health and implications for clinical practice

              There is a wide consensus that the COVID-19 pandemic not only affects physical health, but also mental health and well-being [1,2]. The current pandemic is changing priorities for the general population, but it is also challenging the agenda of health professionals, including that of psychiatrists and other mental health professionals [3]. Everywhere in the world, psychiatric clinics are modifying their practice in order to guarantee care and support to persons with mental health problems, but also to those who are not mentally ill and are suffering from the psychosocial consequences of the pandemic. The number of those who will need psychiatric help is going to increase in the next weeks or months, requiring a reconsideration of our current practices. From a psychopathological viewpoint, the current pandemic is a relatively new form of stressor or trauma for mental health professionals [4]. It has been compared with natural disasters, such as earthquakes or tsunamis [5]. But in those cases, the emergencies are usually localized, limited to a specific area and to a given time; people know that they can escape, if they want to or if they have the possibility to do so [6]. It has also been compared with wars and international mass conflicts. But in those circumstances, the enemy is easily recognizable, while in pandemic the “threat” can be everywhere and it can be carried by the person next to us [7]. We consider that the mental health and psychosocial consequences of the COVID-19 pandemic may be particularly serious for at least four groups of people: (a) those who have been directly or indirectly in contact with the virus; (b) those who are already vulnerable to biological or psychosocial stressors (including people affected by mental health problems); (c) health professionals (because of higher level of exposure); and (d) even people who are following the news through numerous media channels. The pandemic and the related containment measures—namely quarantine, social distancing, and self-isolation—can have a detrimental impact on mental health. In particular, the increased loneliness and reduced social interactions are well-known risk factors for several mental disorders, including schizophrenia and major depression. Concerns about one’s own health and that of their beloved ones (particularly elderly or suffering from any physical illness), as well as uncertainty about the future, can generate or exacerbate fear, depression, and anxiety. If these concerns are prolonged, they may increase the risk of serious and disabling mental health conditions among adult males and females, including anxious disorders including panic, obsessive–compulsive, stress, and trauma-related disorders. A group at a particularly high risk is represented by infected people, physicians, and nurses working in emergency units and resuscitation departments. It is likely that in the next months—when the pandemic is over—we may have a shortage of health professionals due to burnout and mental exhaustion [8]. Another aspect which should be considered is related to stigma and discrimination toward infected people and their family members. Fighting social stigma toward those treating and caring for people with COVID-19 should be another priority for mental health professionals in the next months. Finally, Internet is spreading very rapidly a large amount of uncontrolled news. This information overload has been defined “infodemic,” with the risk of fake news running faster than the virus itself, and creating uncertainties and worries. This should be regulated by a continuous interaction with media and also by national regulations. Another consequence of the pandemic on mental health practice may be that psychiatric problems will be considered less important than physical ones. We should continue to advocate for our patients and their caregivers; our patients often need long-term treatment, continuous support and advices, personal meetings with their physicians or therapists. Their rights to be treated, also in a period of social distancing, should be preserved even though mental health services may be overloaded by a considerable number of requests for psychiatric consultations. Many of these psychosocial and mental health consequences of the pandemic will have to be addressed by psychiatrists and mental health professionals in the months to come. Most probably we will face an increase of mental health problems, behavioral disturbances, and substance-use disorders, as extreme stressors may exacerbate or induce psychiatric problems. In order to reduce the risk of developing mental health problems, simple advices may be provided to the general population: 1. Limit the sources of stress: to rely on a limited amount of official information sources only and to limit the time of the day devoted to this activity, disregarding those which come from unofficial channels and uncontrolled sources. 2. Break the isolation: to increase the communication with friends, family members, and loved ones, even if at a distance. Video-chat or group calls with family members may help to reduce loneliness and precariousness. In case of insufficient social network, professional helplines are particularly useful, if managed by qualified trained professionals. 3. Maintain your usual rhythm: keep a regular routine, by having regular sleep–wake rhythms and diet patterns. Addictive behaviors might be particularly at risk of rebound or relapses, therefore intellectual, physical, and social (even if virtual) activities will be useful. 4. Focus on the benefit of the isolation: we should indeed be conscious that this is a transient period and that this isolated time is needed as we are not only saving our health, but also protecting all others by stopping the epidemic, and therefore shaping our own future. 5. Ask for professional help: getting a psychiatric help or consultation, if the effects of stress is becoming too invasive, is always possible, even if with different modalities. Almost all psychiatric clinics are now equipped for providing support, emotional defusing, problem-solving strategies, and psychiatric consultations—also at a distance. The pandemic will be over, but its effects on mental health and well-being of the general population, health professionals, and vulnerable people will remain for a long time. We hope that all of the mental health community will have very quickly the opportunity to take care of patients in more conventional and personalized ways. Crises also reveal resilience skills and quality of links, the solidarity observed between European countries for severe cases (exchanging patients, material, and competencies) is a nice example to follow.
                Bookmark

                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2024
                12 February 2024
                : 14
                : 2
                : e079106
                Affiliations
                [1 ]departmentPeter Munk Cardiac Centre , Ringgold_7989University Health Network , Toronto, Ontario, Canada
                [2 ]departmentDepartment of Supportive Care, Princess Margaret Cancer Centre , University Health Network , Toronto, Ontario, Canada
                [3 ]departmentOffice of Professional Practice & Policy, Toronto General Hospital , Ringgold_7989University Health Network , Toronto, Ontario, Canada
                [4 ]Goldfarb Intelligence Marketing , Toronto, Ontario, Canada
                [5 ]departmentQuantitative Health Sciences , Mayo Clinic , Rochester, New York, USA
                [6 ]departmentDivision of Medical Oncology & Hematology, Princess Margaret Cancer Centre , Ringgold_7989University Health Network , Toronto, Ontario, Canada
                [7 ]departmentDivision of Vascular Surgery, Peter Munk Cardiac Centre , Ringgold_7989University Health Network , Toronto, Ontario, Canada
                Author notes
                [Correspondence to ] Ahlexxi Jelen; ahlexxi.jelen@ 123456uhn.ca
                Author information
                http://orcid.org/0009-0007-6185-8261
                http://orcid.org/0000-0002-6626-6974
                http://orcid.org/0000-0002-5397-957X
                Article
                bmjopen-2023-079106
                10.1136/bmjopen-2023-079106
                10862283
                38346886
                1201f396-b7ea-4bee-9149-0c48277191a7
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 21 August 2023
                : 16 January 2024
                Funding
                Funded by: Peter Munk Cardiac Centre Innovation Committee;
                Award ID: N/A
                Funded by: Princess Margaret Cancer Centre Foundation;
                Award ID: N/A
                Categories
                Health Services Research
                1506
                2474
                1704
                Original research
                Custom metadata
                unlocked

                Medicine
                burnout, professional,nurses,physicians,occupational stress,covid-19
                Medicine
                burnout, professional, nurses, physicians, occupational stress, covid-19

                Comments

                Comment on this article