Combatting professional burnout through creative writing.

Physician burnout is becoming an increasing problem. In fact, nearly half of all physicians feel completely depleted, to the point where one in seven has contemplated suicide. Causes for burnout development include: administrative overload, regulatory restrictions, loss of autonomy or control, workplace issues, decreased access to medicines for patients, and electronic medical records. On the opposite end of this spectrum is physician fulfillment. Creative writing can be a therapeutic method of self-fulfillment. This may provide not only focused relief from burnout but also another possible avenue for success for multitalented people such as physicians.

The impact of program-driven wellness initiatives on burnout and depression among surgical trainees.

BACKGROUND: The prevalence of burnout and depression are high among surgical trainees. This study examined the impact of program-driven initiatives to improve surgical trainee wellness. METHODS: A survey was administered to residents and fellows at all surgical training programs across an urban academic health system. The survey measured burnout, depressive symptoms, and perceptions of program-driven wellness initiatives. RESULTS: The response rate was 44% among 369 residents. Of these, 63.2% screened positively for burnout, and 36.7% for depression. Residents who were burned out were more likely to work >80 h per week, have greater clerical duties, and miss educational activities more frequently. Conversely, having opportunities for wellness activities, dedicated faculty and housestaff wellness champions, and assistance with clerical burden were all associated with lower rates of burnout and depression. CONCLUSION: The presence of wellness support was associated with better outcomes, suggesting the value of initiatives to manage workload and support the well-being of surgical resident physicians.

[Residential multimodal job focused rehabilitation for teachers increases return to work]. / Internatbehandling hjälper lärare med utmattningssyndrom tillbaka i arbete - En kontrollerad studie av rehabilitering i internatform.

Stress induced exhaustion disorder is the disease that caused most sickleavedays in Sweden during the last 10 years. Teachers have the highest percentage of sick leave, and is the group where the number on sick leave increases most. No previous studies have achieved a statistically significant increased return to work after any specific treatment for exhaustion disorder. The current  multimodal occupational specific treatment for exhaustion disorder among teachers showed statistically significant return to work at follow-up 1-1.5 years after treatment. The treatment focus was reflective peer support group sessions which ended with a recommended an individualised course of action to deal with job stressors for each participant. The treatment model works well for teachers. Continued research is needed to test other occupational groups.

Musculoskeletal Pain and Interest in Meditation and Yoga in Home Health Aides: Evidence From the Home Health Occupations Musculoskeletal Examinations (HHOME) Study.

Home healthcare aides (HHAs) are a growing U.S. workforce highly susceptible to workplace stressors and musculoskeletal pain. In the present study we: 1) examine the association of musculoskeletal pain to life satisfaction and emotional exhaustion; and 2) characterize interest in meditation and yoga in a sample of HHAs. A nonprobabilistic sample of HHAs employed at home healthcare agencies in Florida, Massachusetts, and Oregon (n = 285 total) completed a self-administered questionnaire with standard survey measures on musculoskeletal pain location, duration, and severity; life satisfaction; emotional exhaustion; and interest in meditation techniques and yoga. Among HHAs responding, 48.4% reported pain in the last 7 days and 46.6% reported pain in the last 3 months. Home healthcare aides who reported current pain and chronic pain had a significant (P < .05) decrease in satisfaction with life score and a significant increase in emotional exhaustion score. The majority of HHAs reported an interest in learning about the benefits (65.6%) and practice (66.4%) of meditation and a willingness to participate in a yoga class (59.2%) or stress management meeting (59.1%). The HHAs reported both acute and chronic musculoskeletal pain that was correlated with lower life satisfaction and greater emotional exhaustion. More efforts are needed to reduce the sources of injury and emotional exhaustion.

Subtypes in clinical burnout patients enrolled in an employee rehabilitation program: differences in burnout profiles, depression, and recovery/resources-stress balance.

BACKGROUND: Burnout is generally perceived a unified disorder with homogeneous symptomatology across people (exhaustion, cynicism, and reduced professional efficacy). However, increasing evidence points to intra-individual patterns of burnout symptoms in non-clinical samples such as students, athletes, healthy, and burned-out employees. Different burnout subtypes might therefore exist. Yet, burnout subtypes based on burnout profiles have hardly been explored in clinical patients, and the samples investigated in previous studies were rather heterogeneous including patients with various physical, psychological, and social limitations, symptoms, and disabilities. Therefore, the aim of this study is to explore burnout subtypes based on burnout profiles in clinically diagnosed burnout patients enrolled in an employee rehabilitation program, and to investigate whether the subtypes differ in depression, recovery/resources-stress balance, and sociodemographic characteristics. METHODS: One hundred three patients (66 women, 37 men) with a clinical burnout diagnosis, who were enrolled in a 5 week employee rehabilitation program in two specialized psychosomatic clinics in Austria, completed a series of questionnaires including the Maslach Burnout Inventory - General Survey (MBI-GS), the Beck Depression Inventory, and the Recovery-Stress-Questionnaire for Work. Cluster analyses with the three MBI-GS subscales as clustering variables were used to identify the burnout subtypes. Subsequent multivariate/univariate analysis of variance and Pearson chi-square tests were performed to investigate differences in depression, recovery/resources-stress balance, and sociodemographic characteristics. RESULTS: Three different burnout subtypes were discovered: the exhausted subtype, the exhausted/cynical subtype, and the burned-out subtype. The burned-out subtype and the exhausted/cynical subtype showed both more severe depression symptoms and a worse recovery/resources-stress balance than the exhausted subtype. Furthermore, the burned-out subtype was more depressed than the exhausted/cynical subtype, but no difference was observed between these two subtypes with regard to perceived stress, recovery, and resources. Sociodemographic characteristics were not associated with the subtypes. CONCLUSIONS: The present study indicates that there are different subtypes in clinical burnout patients (exhausted, exhausted/cynical, and burned-out), which might represent patients at different developmental stages in the burnout cycle. Future studies need to replicate the current findings, investigate the stability of the symptom patterns, and examine the efficacy of rehabilitation interventions in different subtypes.

Systematic review: Factors associated with return to work in burnout.

BACKGROUND: Professional burnout predicts sick leave and even permanent withdrawal from the labour force. However, knowledge of the barriers to and facilitators of return to work (RTW) in such burnout is limited. AIMS: To identify factors associated with RTW of burned-out individuals to inform occupational health care (OHC) RTW policy. METHODS: A systematic search of peer-reviewed quantitative and mixed-method studies published from January 2005 to July 2016 in English and Finnish in ARTO, CINAHL (EBSCO), Medic, PsycINFO (ProQuest), PubMed, Scopus and Web of Science databases, followed by a manual search. We included studies that identify burnout with valid burnout measures and measure the degree of RTW or sick leave as outcomes. We excluded studies with heterogeneous samples without subgroup analyses of RTW in burnout cases. RESULTS: We included 10 studies (three experimental and seven observational) of the initial 1345 identified. The studies reported work-related factors; enhanced communication (positive association) and low control at work (negative association) and individual-related factors; male gender (positive association), covert coping (negative association), high over-commitment to work (positive association) and burnout-related factors; unimpaired sleep (positive association), duration of sick leave over 6 months (negative association) and part-time sick leave (positive association) associated with RTW in burnout. Associations between burnout rehabilitation and RTW, and the level of symptoms and cognitive impairment and RTW remained unclear. CONCLUSIONS: Few quantitative studies, of varied methodological quality, explore factors associated with RTW in burnout. Further research is needed to build an evidence base and develop guidelines for supportive OHC actions.

Getting back on track: a systematic review of the outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns.

OBJECTIVE: To provide an overview of the evidence regarding outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns, and to explore if outcomes differ for specific concerns and professions. METHODS: A search in four databases (Medline, Embase, PsycINFO and CINAHL) was conducted from 1 January 1990 to 7 May 2017. Studies reporting on outcomes of nationwide and state-wide programmes aimed at remediation and rehabilitating healthcare professionals with performance concerns (ie, dentists, midwives, nurses, pharmacists, physicians, physiotherapists, psychologists and psychotherapists) were included. RESULTS: We included a total of 38 studies. More than half of the studies included programmes in the USA (57.9%), and a majority of studies focused on outcomes for physicians (78.9%) and on outcomes for substance use disorders (SUDs, 63.2%). Programme completion rates for SUDs were positive and approximately 80%-90% of participants were employed after treatment. Studies that reported on remediation outcomes for dyscompetence, almost all from Canada (7/8), showed varying results. One study compared outcomes for performance concerns in the same programme (ie, SUD and other mental and behavioural problems) and showed comparably successful results. No study specifically compared outcomes between professions. CONCLUSION: The literature is dominated by outcomes for physicians in North American programmes, with positive outcomes for SUD and varying outcomes for dyscompetence. Based on our findings we cannot make valid comparisons in outcomes between professions and specific performance concerns, and we call for other programmes to report on outcomes for different professions and concerns. Because of the positive outcomes of physician health programmes, other countries should consider introducing similar programmes to support healthcare professionals getting back on track.

The impaired and/or disabled anesthesiologist.

PURPOSE OF REVIEW: Impairment and/or disability resulting from any of a number of etiologies will afflict a significant number of anesthesiologists at some point during their career. The impaired anesthesiologist can be difficult to identify and challenging to manage. Questions will arise as to if, how, and when colleagues, family members, or friends should intercede if significant impairment is suspected.This review will examine the common sources of impairment among anesthesiologists and the professional implications of these conditions. We will discuss the obligations of an anesthesiologist and his/her colleagues when there is sufficient suspicion that he/she might be impaired. RECENT FINDINGS: Substance use disorder remains one of the commonest sources of impairment among both resident and attending anesthesiologists. Other common etiologies of impairment include various physical ailments, major psychiatric disorders, especially depression and burnout, and age related dementia. Many regulatory organizations, healthcare systems, and state licensing agencies have developed programmes and protocols with which to identify and direct into treatment those suspected of significant impairment. SUMMARY: Some degree of impairment will occur to one-third of anesthesiologists during the course of their career. It is important to understand how such impairments might impact the safe practice of anesthesiology.

[Changes and differences of heart rate variability of patients in a psychiatric rehabilitation clinic]. / Veränderungen und Unterschiede in der Herzratenvariabilität (HRV) von Patienten einer psychiatrischen Rehabilitationsklinik.

BACKGROUND: A reduced heart rate variability (HRV) has been associated with various different pathological physical and psychological conditions and illnesses. The present study is focused on investigating HRV in respect to psychological disorders (depressive disorders anxiety disorders, Burn-out-Syndrome). METHODS: The results from an investigation with patients from a psychiatric Rehabilitation clinic following a six week in-patient treatment are presented. RESULTS: The results show relevant changes in HRV in the course of the rehabilitative treatment for patients with depressive disorders, anxiety disorders or Burn-out-Syndrome. Simultaneously changes in HRV were linked with improvements in patient's psychological symptoms. Changes in HRV (i. e. an increase of relevant HRV-parameters) were accompanied by a reduction of psychological strain as well as psychological and physical health problems, which typically occur in Burnout-Syndrome. Furthermore, changes in relevant HRV-parameters were predictive of changes in psychological symptoms (depression, anxiety, phobia, Burnout symptoms). CONCLUSIONS: The present study did show, that in respect to the investigation of the relationship between HRV and subjective data, primarily those HRV-parameters are important (in terms of significant results) which are based on parasympathetic activity. These results are interesting in the context of theories, which view vagal mediated HRV as positively connected with self-regulation, adaptability and positive interpersonal interaction of individuals.

Physician Burnout: Improving Treatment Efficacy with Virtual Reality.

Creating a significant negative impact on both their quality of life and the quality of patient care with an evident economical burden for the healthcare system, there is a growing concern over physician burnout. The range of interventions and treatments that have been used to address this problem, however, appear quite fragmented and lack compelling efficacy. We describe the main factors known to contribute to the development of physician burnout as well as currently available treatments. Studies seem to indicate that both specialisation area as well as personality traits may contribute to the manifestation. The highest risk specialties appear to be critical care physicians, emergency physicians, oncologists and internal medicine physicians, while the highest risk personality attributes are high neuroticism, low agreeableness, introversion, and negative affectivity. In addition, being exceedingly enthusiastic about one's work and having high aspirations at work, with an idealistic approach, also serve as factors which contribute to increased risk of burnout, and in particular for those who are new to the occupation.

[Effectiveness of an inpatient multimodal psychiatric-psychotherapeutic program for the treatment of job burnout]. / Einmal Burnout ist nicht immer Burnout: Eine stationäre multimodale Psychotherapie ist eine effektive Burnout-Behandlung.

We studied the clinical course and long-term effects of inpatient treatment in 723 patients with job burnout referred with an ICD-10 F diagnosis and Z73.0 code («overwhelming exhaustion¼) to a Swiss hospital specialized in the treatment of job stress-related disorders. Patients were characterized in terms of age, gender, socioeconomic status. Self-rated psychological measures related to general and burnout-specific symptoms (i. e., emotional exhaustion, depersonalization, and diminished personal accomplishments) were applied before and after a six-week treatment program, as well as at 15 months after hospital discharge in 232 patients. The results show that the multimodal inpatient psychiatric-psychotherapeutic treatment was successful with a sustainable effect on psychological well-being (>90 %), including improvements regarding emotional exhaustion, depersonalization and personal accomplishments as well as professional reintegration in 71 % of cases.

Yoga for Self-Care and Burnout Prevention Among Nurses.

The promotion of self-care and the prevention of burnout among nurses is a public health priority. Evidence supports the efficacy of yoga to improve physical and mental health outcomes, but few studies have examined the influence of yoga on nurse-specific outcomes. The purpose of this pilot-level randomized controlled trial was to examine the efficacy of yoga to improve self-care and reduce burnout among nurses. Compared with controls (n = 20), yoga participants (n = 20) reported significantly higher self-care as well as less emotional exhaustion and depersonalization upon completion of an 8-week yoga intervention. Although the control group demonstrated no change throughout the course of the study, the yoga group showed a significant improvement in scores from pre- to post-intervention for self-care (p < .001), mindfulness (p = .028), emotional exhaustion (p = .008), and depersonalization (p = .007) outcomes. Implications for practice are discussed.

My Well-Being in My Own Hands: Experiences of Beneficial Recovery During Burnout Rehabilitation.

PURPOSE: To explore how burnout rehabilitation clients experienced their recovery from burnout and what they found beneficial in rehabilitation. SUBJECTS: Twelve clients whose burnout levels had declined during rehabilitation were interviewed at the end of the second period of the rehabilitation course. METHODS: Semi-structured interviews comprised the main material of the study and were analysed by content analysis. In addition, the Bergen Burnout Indicator (BBI-15) was used to measure the reduction in burnout levels. RESULTS: The analysis yielded a single overarching theme, My well-being in my own hands, and four categories. The overarching theme describes the overall process of recovery and the revelation experienced by clients that they are in charge of their own well-being. The process starts with Support from rehabilitation professionals, the client group and family or friends. The categories Awareness and Approval refer to specific changes in the attitude towards and recognition of one's needs and limits. The category Regained joy describes the culmination of the recovery process manifested in different spheres of life. CONCLUSIONS: The rehabilitation course proved particularly beneficial for individuals suffering from burnout. The accumulation of support, awareness and approval led to a revival of joy in life and greater perceived control over one's well-being.

Reading fiction during sick leave, a multidimensional occupation.

BACKGROUND: In bibliotherapy, the therapeutic gains of reading fiction are ascribed to the literature. Viewing reading fiction as an occupation may give other explanations of its therapeutic function. AIM: The aim of this qualitative study was to explore the experiences of reading fiction among women during a period of sick leave. MATERIAL AND METHODS: A qualitative approach was applied. Eight women who had been reading fiction during sick leave were interviewed. RESULTS: An overarching theme: Supporting one's active self, comprised five categories of experiences: a prospect of ordinary life, a place of refuge, a life together with others, a source of power, and as supporting an active life. CONCLUSION AND SIGNIFICANCE: Based on the categories, reading fiction is seen to comprise intentional, functional, mental, relational, and personal dimensions. A tentative model of supporting one's active self is proposed, which may be helpful in clarifying the mechanisms of the process of change. The health-related dimensions of reading fiction suggest that reading fiction should be regarded as a significant occupation comparable with other, more highlighted ones. Understood in this way, it is argued that the results add to the knowledge base in occupational therapy focusing on how meaningful occupations connect to occupational life trajectories.

[Stress Management Interventions at the Workplace Improve Perceived Stress Reactivity of Men at Higher Risk]. / Prävention stressbedingter Gesundheitsschäden in einem Industriebetrieb bei Männern mit erhöhtem Risiko.

A randomised controlled trial was conducted in a metal working plant. The primary endpoint was perceived stress reactivity (Stress Reactivity Scale, SRS). 174 participants were randomly assigned to a stress-management intervention (SMI) (IG) or a waiting control group (CG). N=174 participants (171 male) were recruited at t0, 154 (89%) were still taking part after one year (t1), 131 (76%) after 2 years. The SRS score decreased in both groups. The conducted SMI proved to be effective over both a 1- and a 2-year period.