Burnout in nurses during the COVID-19 pandemic in China: New challenges for public health.

During the COVID-19 pandemic, frontline nurses have faced extraordinary personal and professional challenges. These challenges have had mental health consequences, and concerning reports of burnout have emerged globally. We conducted a cross-sectional survey at a designated COVID-19 hospital in Shanghai at the peak of the pandemic, i.e. about 2 months after the onset of the outbreak from February to April 2020. Findings revealed burnout in 6.85% of nurses. Of 336 respondents, 87 (25.89%) had a high level of emotional exhaustion, 61 (18.15%) had a high level of depersonalization, and 100 (29.76%) had a low level of personal accomplishment. Burnout can be prevented by offering more support from families and supervisors, paying attention to health monitoring and personal protection, and creating a rational human resource allocation and shift management system. Specific training on infection control and self-protection, mental health guidance, and stress coping techniques must be implemented. As the current health crisis ultimately abates, moving the focus from mental health issues to public health issues, more attention and support at the national and organizational levels are needed to reduce occupational discrimination, nurse autonomy and status need to be promoted, and public health emergency teams need to be created. A positive and fair working environment is essential to effective healthcare delivery.

A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic.

A large-scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID-19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory-Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID-19 designated hospitals. At the survey's conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12-1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09-1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06-1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12-1.33, P < 0.001) (iii) COVID-19 designated hospital (OR: 1.24, 95% CI 1.11-1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17-1.36; P < 0.001) and (iv) COVID-19-related departments (OR: 1.16, 95% CI 1.04-1.29, P = 0.006, emotional exhaustion only). To date, this is the first large-scale study to report the rates of trauma and burnout for nurses during the COVID-19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID-19 designated hospitals, and departments involved with treating COVID-19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.

Why is change a challenge in acute mental health wards? A cross-sectional investigation of the relationships between burnout, occupational status and nurses' perceptions of barriers to change.

Changes in UK psychiatric wards have been difficult to implement. Specific areas of nursing staff resistance remain unclear. Previous healthcare research suggests that burnout is common and that managers' regard changes more positively than direct care staff. We will therefore examine whether burnout and workforce characteristics influence psychiatric nurses' perceptions of barriers to change. Psychiatric nurses (N = 125) completed perceptions measures of 'barriers to change' (VOCALISE: subscales included 'powerlessness, confidence and demotivation'); and 'burnout' (Maslach Burnout Inventory: subscales included 'emotional exhaustion, personal accomplishment and depersonalization '). Staff characteristics, such as length of employment, occupational status, education, ethnicity, gender and age, were also collected. Correlations between these measures informed random-effects regression models, which were conducted to predict the barriers to change score and to explore differential effects in the subscales of VOCALISE. Perceptions of barriers to change (VOCALISE) were correlated with burnout (r = 0.39), occupational status (r = -0.18) and age (r = 0.22). Burnout (Coef. ß: 10.52; P > 0.001) and occupational status (Coef. ß: -4.58; P = 0.05) predicted VOCALISE. Emotional exhaustion (Coef. ß: 0.18; P < 0.001) and low personal accomplishment (Coef. ß: 0.21; P = 0.001) predicted powerlessness. Emotional exhaustion predicted low motivation regarding changes (Coef. ß: 0.11; P = 0.005). Low confidence predicted high levels of depersonalization (Coef ß: 0.23; P = 0.01). Direct care staff expressed significantly more powerlessness (Coef. ß: -2.60; P = 0.02) and significantly less confidence (Coef. ß: -3.07; P = 0.002) than managers. For changes to be successful in psychiatric wards, burnout will need to be addressed. Future change strategies may consider involving direct care staff to improve perceptions of barriers to change.

Resilience and mental health nursing: An integrative review of international literature.

Mental health nurses work in challenging and potentially high stress settings. Stressors can occur in the context of consumer, family, and/or staff relationships, as well as the work environment and organization. The cumulative effects of stress and professional challenges can lead to harmful impacts for mental health nurses including burnout and poorer physical and mental health. Resilience involves a process of positive adaptation to stress and adversity. The aims of this integrative review were to examine understandings and perspectives on resilience, and explore and synthesize the state of knowledge on resilience in mental health nursing. Following systematic search processes, screening, and data extraction, 12 articles were included. Constant comparative analysis and synthesis of the data resulted in two key categories: Theoretical concepts of resilience and Knowledge on mental health nurses' resilience. In mental health nursing, resilience has been variously constructed as an individual ability, collective capacity, or as an interactive person-environment process. Resilience was most often reported as low-moderate, with positive correlations with hardiness, self-esteem, life and job satisfaction, and negative correlations with depression and burnout. A resilience programme improved mental health nurses' coping self-efficacy and capacity to regulate thoughts and emotions and developed their resilient practice. Use of contemporary resilience definitions will inform more consistent investigation and progressively scaffold knowledge of this emergent construct in mental health nursing. Future research on the implementation of resilience programmes and resilience-building strategies for mental health nurses at the individual, work unit, and organizational levels is needed.

Moral Distress (MD) and burnout in mental health nurses: a multicenter survey.

INTRODUCTION: Moral Distress (MD) is a common experience among nurses and if it is not recognised and treated, it may lead to serious consequences on nurses' health and quality of care. MD has been studied in several healthcare contexts. However, there are only few studies on MD in psychiatry and in Italy there are no data in this field.  Objective: To assess the presence of MD among mental health nurses in Italy and verify whether there is a relationship between MD and burnout. METHODS: We conducted a multicentre survey among nurses of Mental Health services of four hospitals in Milan. The MD Scale for Psychiatric NursesItalianrevised (MDS-PItarev) and the Maslach Burnout Inventory (MBI) were used for data collection. Factor analysis and calculation of content validity index (CVI) and Cronbach's alpha were performed on the Italian version of the MDS-PIta. Three items of the old version of the scale were removed, because judged not relevant in the Italian context. The revised scale maintained excellent CVI (0.89) and Cronbach's alpha (0.93). RESULTS: Of 285 questionnaires distributed, 228 (80%) were returned. The median of MD was 2 (scale range 0-6); MD is correlated with two burnout dimensions: emotional exhaustion (rho(ρ)=0.28, p<0,001) and depersonalization (ρ=0.20, p<0,001). CONCLUSIONS: This is the first study about MD among psychiatric nurses in Italy. We found a medium-low level of MD among nurses who participated in the survey. We also found a modest but significant correlation between MD and two dimensions of MBI. Further studies are needed to confirm these results.

Los factores relacionados con el desarrollo de el estrés y el burnout entre los profesionales de enfermería que trabajan en el cuidado de las personas que viven con el VIH / sida / Fatores relacionados ao desenvolvimento de estresse e burnout entre profissionais de enfermagem que atuam na assistência a pessoas vivendo comHIV/aids / Factors related to the development of stress and burnout among nursing professionals who work in the care of people living with HIV/aids

Objetivo: identificar quais os fatores relacionados ao desenvolvimento de desgaste emocional, estresse e Burnout estão presentes na assistência de enfermagem às pessoas vivendo com HIV/AIDS. Método: Revisão integrativa de literatura, com busca eletrônica de publicações nas bases de dados MEDLINE e LILACS, utilizando-se os descritores: esgotamento profissional, enfermagem, infecções por HIV em português e/ou em suas variações na língua inglesa. Resultados: Somente 9 artigos foram incluídos na seleção por se enquadrarem nos critérios de inclusão e atender a questão norteadora. Ressalta-se que 100% destes artigos são originários de periódicos internacionais, assim como desenvolvidos no continente africano. Conclusão: Estressores como falta de recursos, dificuldades para atender às expectativas da clientela, sobrecarga de trabalho, necessidade de lidar com a morte dos clientes e medo de contaminação estão presentes no cotidiano desses profissionais, podendo culminar na ocorrência de estresse e Burnout, e comprometer a assistência prestada.

Objetivo: identificar factores relacionados con el desarrollo de agotamiento emocional, estrés y burnout presentes en los cuidados de enfermería a personas que viven con el VIH/SIDA. Método: revisión integrativa de literatura con búsqueda electrónica de publicaciones en las bases de datos MEDLINE y LILACS, utilizando los descriptores: burnout, enfermería, infecciones por VIH en portugués y/o variaciones en el idioma Inglés. Resultados: 9 artículos fueran incluídos en la selección porque se ajustan a los criterios de inclusión y responden a pregunta de guía. 100% de estos artículos se originan en revistas internacionales, así como desarrollado en África. Conclusión: Factores de estrés como falta de recursos, dificultades para cumplir con las expectativas del cliente, carga de trabajo, tener que lidiar con la muerte y temor a la contaminación están presentes en la vida diaria de estos profesionales y puede resultar en aparición de estrés, agotamiento y daño a la asistencia prestada.

Objective: to identify factors related to the development of emotional exhaustion, stress and burnout that are present in nursing care to people living with HIV/AIDS. Method: Integrative review of literature with electronic search of publications in the MEDLINE and LILACS databases, using the descriptors: burnout, nursing, HIV infections in Portuguese and/or variations in the English. Results: Only 9 articles were included into the selection because they fit the inclusion criteria and answer the guiding question. It is noteworthy that 100% of these items were originated from international journals, as well as developed in Africa. Conclusion: Stressors such as lack of resources, difficulties to meet the customer’s expectations, workload, need to deal with the death of customers and fear of contamination are present in the daily lives of these professionals and may result in the occurrence of stress and burnout, and compromise the assistance provided.

Serviços de saúde mental: percepção da enfermagem em relação à sobrecarga e condições de trabalho / Servicios de salud mental: percepción de las enfermeras frente a la sobrecarga y condiciones de trabajo / Mental health services: perception of nursing in relation to overload and working conditions

Objective: to identify the perception of nursing professionals about the work overload in hospital psychiatric services. Method: descriptive, analytical and exploratory study analyzed through Bardin referential. Data collection occurred from April to May 2013 with 70 nursing professionals who underwent Labor Impact Assessment Scale Mental Health Services. Once authorized by the Ethics Committee Unicesumar (CAEE n. 13676913.2.0000.5539). Results: thematic categories: The causes of work overload; Aspects that relieve the workload and changes proposed to reduce the workload. Conclusion: The main factor is that overload relates to the lack of human resources and relations between professionals. The management of the work process can be a strategy to reduce the burden of work.

Objetivo: conhecer a percepção dos profissionais de enfermagem em relação à sobrecarga e condições de trabalho em serviços psiquiátricos hospitalares. Método: Estudo descritivo, analítico e exploratório, desenvolvido a partir do referencial de Bardin. A coleta de dados ocorreu no período de abril a maio de 2013 com 70 profissionais de enfermagem, aplicando-se a Escala de Avaliação do Impacto do Trabalho em Serviços de Saúde Mental. Obteve-se o Certificado de Apresentação para Apreciação Ética sob nº 13676913.2.0000.5539. Resultados: Da análise de conteúdo emergiram três categorias: As causas da sobrecarga de trabalho; Aspectos que aliviam a sobrecarga; Mudanças propostas para diminuir a sobrecarga. Considerações finais: Falta de recursos humanos e relações interpessoais conflituosas incrementam a sobrecarga, ao passo que a infraestrutura física do ambiente influencia negativamente nas condições de trabalho.

Objetivo: identificar la percepción de los profesionales de enfermería acerca de la sobrecarga de trabajo em los servicios de psiquiatria del hospital. Método: estúdio descriptivo, analítico y exploratório analizada a través Bardin referencial. Los datos fueron recolectados entre abril y mayo de 2013, con 70 profesionales de enfermería que se sometieron Trabajo de Impacto Escala de Evaluación de Servicios de Salud Mental. Una vez autorizado por el Comité de Ética Unicesumar (CAEE n. 13676913.2.0000.5539). Resultados: categorías temáticas: Las causas de la sobrecarga de trabajo; Aspectos que alivian la carga de trabajo y los câmbios propuestos para reducir la carga de trabajo. Conclusión: El principal factor que la sobrecarga se relaciona com la falta de recursos humanos y las relaciones entre los profesionales. La gestión del proceso de trabajo puede ser una estrategia para reducir la carga de trabajo.

Fatores estressores, de esgotamento profissional e satisfação no trabalho de enfermeiros atuantes na atenção primária à saúde / Factors stressors, of Burnout and job satisfaction of nurses working in primary health care

Introdução: evidências científicas indicam aumento de distúrbios psíquicos entre enfermeiros, sobretudo estresse e esgotamento profissional ou síndrome de Burnout. No entanto, poucas pesquisas têm investigado esse problema nos serviços na Atenção Primária à Saúde. Assim, estudar os processos envolvidos na constituição desses distúrbios torna-se relevante para a tomada de medidas que auxiliem na prevenção de adoecimento pelo trabalho e para a melhoria da qualidade de vida desses profissionais. Objetivo: avaliar os fatores estressores, de esgotamento profissional e de satisfação no trabalho de enfermeiros de Unidades Básica/Distrital de Saúde, enfermeiros de Unidades/Equipes de Saúde da Família e enfermeiros gestores/gerentes. Material e Métodos: pesquisa de campo, descritiva, de caráter exploratório, realizada nas unidades da Atenção Primária à Saúde do município de Ribeirão Preto - São Paulo. A coleta de dados foi realizada mediante aplicação de Questionário para Dados Sociodemográficos, Escala de Estresse no Trabalho (EET), Escala de Caracterização de Burnout (ECB) e Questionário de Satisfação no Trabalho (S20/23), no período de junho a agosto de 2017, após aprovação do Comitê de Ética em Pesquisa (Protocolo CAAE 65353317.8.0000.5393/2017). Os dados das escalas psicométricas foram submetidos à análise de confiabilidade e a avaliação estatística foi dividida em grupos de enfermeiros gestores/supervisores e enfermeiros assistencialistas após realização do teste de normalidade. Resultados: 122 enfermeiros participaram do estudo sendo 58 (47,5%) enfermeiros gestores/supervisores e 64 (62,5%) enfermeiros assistencialistas, média de 45,2 anos, casados (59%) e com filhos (66,4%), há mais de 25 anos na profissão (42,6%), o tempo de trabalho nos serviços primários prevaleceu entre 5 a 9 anos (27,9%), carga horária de 40 horas semanais (64,8%), servidores públicos (86,1%) e com qualificação profissional e títulos de especialistas a doutores. Destes 39 (32%) apresentaram nível de estresse considerável, quanto a exaustão emocional, desumanização e decepção no trabalho apresentou níveis de moderados a altos, enquanto satisfação com as relações hierárquicas e ao ambiente físico de trabalho, com média, respectivamente, de 3,4 e 3,5, apesar de serem satisfeitos intrinsecamente com o trabalho, média 3,8. Conclusão: há uma associação entre os problemas organizacionais e as condições laborais que dificulta o trabalho desse profissional, com perceptível sobrecarga, tempo insuficiente para atender às demandas, poucas oportunidades de evolução na carreira e insatisfação com normas e acordos legais na contratação de benefícios. Entretanto, é significante a satisfação intrínseca por gostar do que fazem. Identificou-se que, quando aumentam os níveis de estresse, exaustão emocional, desumanização e decepção no trabalho, consequentemente, diminui a satisfação do trabalhador

Introduction: Scientific evidence indicates an increase in psychiatric disorders among nurses, especially stress and professional exhaustion or Burnout. However, few researches have investigated this problem in services in Primary Health Care. Therefore, studying the processes involved in the formation of these disturbances becomes relevant to take measures that help in the prevention of illness for work and for the quality of life of these professionals. Objective: to evaluate the factors stressors, Burnout and job satisfaction of nurses from Basic/District Health Units, Nurses from Units/Teams Family Health and nurse managers/administrators. Material and Methods: field research, descriptive, of exploratory character, realized in the units of Primary Health Care of the city of Ribeirão Preto - São Paulo. Data collection was performed using a Questionnaire for Socio-demographic Data, Work Stress Scale (EET), Burnout Characterization Scale (ECB) and Job Satisfaction Questionnaire (S20 / 23), from June to August 2017 after approval of the Research Ethics Committee (Protocol CAAE 65353317.8.0000.5393/2017). The data of psychometric scales were submitted to reliability analysis and the statistical evaluation was divided into groups of nurse managers/supervisors and nurse assistants after the normality test. Results: 122 nurses participated in the study, of whom 58 (47.5%) were nurses who were managers/supervisors and 64 (62,5%) assistant nurses, mean age of 45.2 years, married (59%) and with children (66,4%), with more than 25 years of work (42,6%), working time in the primary services prevailing between 5 and 9 years (27,9%), working hours of 40 hours weekly (64,8%), civil servants (86,1%) and with professional qualification with titles of specialists to doctors. Of these 39 (32%) presented considerable level of stress, emotional exhaustion, dehumanization and disappointment at work presenting moderate to high levels, satisfaction with hierarchical relationships and physical work environment presents average, respectively, 3,4 and 3,5, although they were met intrinsically with the work, average 3,8. Conclusion: there is an association with organizational problems and working conditions that hinder the work of this professional, with perceptible work overload, insufficient time to attend to the demands, few career opportunities, dissatisfaction with norms and legal agreements in contracting benefits. However, it is significant the intrinsic satisfaction for liking what is done. It was identified that, when it increases stress, emotional exhaustion, dehumanization and disappointment at work, consequently decreases job satisfaction

Inpatient-Derived Vital Sign Parameters Implementation: An Initiative to Decrease Alarm Burden.

OBJECTIVES: To implement data-driven vital sign parameters to reduce bedside monitor alarm burden. METHODS: Single-center, quality-improvement initiative with historical controls assessing the impact of age-based, inpatient-derived heart rate (HR) and respiratory rate (RR) parameters on a 20-bed acute care ward that serves primarily pediatric cardiology patients. The primary outcome was the number of alarms per monitored bed day (MBD) with the aim to decrease the alarms per MBD. Balancing measures included the frequency of missed rapid response team activations, acute respiratory code events, and cardiorespiratory arrest events in the unit with the new vital sign parameters. RESULTS: The median number of all cardiorespiratory monitor alarms per MBD decreased by 21% from 52 (baseline period) to 41 (postintervention period) (P < .001). This included a 17% decrease in the median HR alarms (9-7.5 per MBD) and a 53% drop in RR alarms (16.8-8.0 per MBD). There were 57 rapid response team activations, 8 acute respiratory code events, and no cardiorespiratory arrest events after the implementation of the new parameters. An evaluation of HRs and RRs recorded at the time of the event revealed that all patients with HRs and/or RRs out of range per former default parameters would also be out of range with the new parameters. CONCLUSIONS: Implementation of data-driven HR and iteratively derived RR parameters safely decreased the total alarm frequency by 21% in a pediatric acute care unit.

[Therapeutic education for carers, an innovative concept to prevent burnout]. / ETP de l'aidant, un concept innovant pour prévenir l'épuisement.

Some hospital teams have chosen to use therapeutic education with carers in order to prevent their burnout. Nurses trained in therapeutic patient education perform a particularly innovative role by helping to relieve the carer's 'burden'.

[Organizational features influencing health worker's fulfillment in an Alzheimer center and in a nursing home]. / Le caratteristiche organizzative che influenzano il benessere lavorativo degli operatori di un Centro Alzheimer e di una RSA.

OBJECTIVES: The pursuit of the best working conditions and of a rewarding job are pivotal elements in care process cause working satisfaction plays a main role to further the positive treatments outcome. METHODS: Anonymous questionnaires were administered to 59 subjects (10 nurses and 49 health workers) operating in two different institutions, an Alzheimer centre and a nursing home, in order to describe their personal sensation about work's gratification. RESULTS: Our research shows up, in both institutions, a satisfying perception about working conditions, learning and educational opportunities, teamwork and individual skills recognition. CONCLUSIONS: Patients' behavioural disorders and hard relationship with families are source of strain and stress for both groups. The rest home staff complain about the unsuitable environmental conditions which make difficult the managing of particular minor behavioural disorders like wonderings, escapes and falls. Elements as salary and balance between work and free time are relevant for both groups but not adequate to fulfill their expectations if work recognition and individual daily efforts appreciation are lacking.

Burnout e tecnologias em saúde no contexto da enfermagem na Atenção Primária à Saúde / Burnout and health technologies in the context of Primary Health Care nursing

Objetivo: Analisar as relações do Burnout e das tecnologias em saúde no contexto dos enfermeiros da atenção primária à saúde. Métodos: Estudo reflexivo segundo referencial teórico de Hinds, Chaves e Cypress. Resultados: Analisou-se o contexto imediato (enfermagem da atenção primária à saúde e Burnout); o específico (tecnologias em saúde e enfermeiros com Burnout na atenção primária em saúde); no contexto geral (o estresse ocupacional no processo de trabalho dos enfermeiros da atenção primária à saúde); e o metacontexto (o uso de tecnologias na prevenção e enfrentamento do Burnout na Enfermagem da atenção primária à saúde). Conclusão: A utilização das tecnologias em saúde, pelo enfermeiro, possibilita a melhoria do conhecimento, da saúde, do estresse laboral e do adoecimento mental.(AU)

[Maintaining the proper distance for nurses working in the home]. / La juste distance de l'infirmière à domicile.

Health professionals must be able to respond to many different situations which require technical knowledge and self-control. Particularly when working in the patient's home, nurses must know how to maintain a proper distance to protect themselves from burnout. In this respect, the practice analysis constitutes an adapted support tool.