Estratégias para promoção da saúde mental de residentes na área da saúde: resumo para políticas (policy brief): Projeto Residências / Estrategias para promover la salud mental de los residentes en el área de la salud: resumen de políticas: Proyecto Residencias / Strategies for promoting mental health in healthcare residents: policy brief: Residency Project

Durante o período da residência em saúde espera-se que os residentes equilibrem aprendizado, atendimento aos pacientes, ensino e gestão de serviços superlotados ao longo das jornadas de trabalho. As demandas dessa modalidade de treinamento têm sido associadas com redução da qualidade do sono, diminuição da frequência de exercícios, distanciamento das relações familiares e sociais, culminando com aumento de diagnósticos de ansiedade, depressão e burnout.

Durante su residencia en el área de la salud, se espera que los residentes equilibren el aprendizaje, la atención al paciente, la enseñanza y la Gestión de servicios saturados a lo largo de sus jornadas laborales. Las exigencias de esta modalidad de entrenamiento se han asociado con una reducción de la calidad del sueño, una menor frecuencia de ejercicio, un distanciamiento de las relaciones familiares y sociales, culminando en un aumento de los diagnósticos de ansiedad, depresión y burnout.

During the healthcare residency program, residents are expected to balance out learning, patient care, teaching, and managing overcrowded services throughout their workdays. The demands of this training modality have been associated with reduced sleep quality, reduced exercise frequency, and distance from family and social relationships, culminating in an increase in diagnoses of anxiety, depression, and burnout.

How junior doctors perceive personalised yoga and group exercise in the management of occupational and traumatic stressors.

OBJECTIVES: Junior doctors are exposed to occupational and traumatic stressors, some of which are inherent to medicine. This can result in burnout, mental ill-health and suicide. Within a crossover pilot study comparing personalised, trauma-informed yoga to group-format exercise, qualitative interviews were conducted to understand the experience of junior doctors and whether such interventions were perceived to help manage these stressors. METHODS: Twenty-one doctors, 76% female, were order-randomised to consecutive 8-week yoga and exercise programmes. Fifty-two interviews were recorded before and after each programme. RESULTS: Many participants reported being time poor, sleep-affected, frequently stressed and occasionally in physical pain/distress. Major stressor themes were workplace incivility, death/human suffering and shift work with minimal support. Both interventions were acceptable for different reasons. Personalised yoga offered a therapeutic alliance, time to check-in and reduced anxiety/rumination. Group exercise provided energy and social connection. One participant found yoga beneficial following an acute workplace trauma: 'It was really eye opening how much I felt my body just needed to detox … I wouldn't have gone to a group fitness the next day … I just wanted to relax and breathe …We still had a big debrief which was great … (but) I almost felt like … I dealt with it physically and emotionally before going into it (P20).' CONCLUSION: Junior doctors found both interventions useful for stress management adjunctive to other organisational programmes though for different and complementary reasons, possibly related to delivery mode. Personalised, trauma-informed yoga provided a confidential therapeutic alliance whereas group exercise offered social connection.

Spirituality of medical students: associations with empathy and attitudes in the doctor-patient relationship / Espiritualidade dos estudantes de Medicina: associações com empatia e atitude na relação médico-paciente

Abstract: Introduction: Currently, the study of the factors that improve interpersonal relationships in patient care and medical education has been considered relevant and necessary. Understanding what precedes empathy and medical interns' and young doctors' attitudes is a relevant topic for health professionals' education and for their academic and professional performance. Although patients and medical students have indicated that spirituality is an important issue, it is not frequently addressed in medical schools. Objective: This study aims to verify the association between (i) well-being related to spirituality, religiosity and the medical interns' and residents' personal beliefs and (ii) empathy and attitudes in the doctor-patient relationship. Methods: This was a quantitative, cross-sectional, observational study. A total of 64 undergraduate students in the last years of medical school and 50 residents answered the following self-administered instruments: WHOQOL-SRPB, Jefferson Scale of Empathy, and Patient-Practitioner Orientation Scale. Descriptive statistics, Pearson's correlation and stepwise linear regressions were used to analyze data. Results: Significant correlations (p<0.05) varying from weak (r=0.10) to moderate (r=0.39) were found. The WHOQOL-SRPB final score affected the global score of empathy (R2 = 0.12; p <0.00; VIF=1.00). The component meaning and purpose in life affected the global score of the patient-centered attitude (R2= 0.14; p <0.00; VIF=1.00). Conclusions: Spirituality, religiosity and personal beliefs are associated with patient-centered attitudes and medical interns' and residents' empathy. In general, well-being related to spirituality preceded empathy, and the component meaning and purpose in life preceded patient-centered attitudes. These results imply the need to consider well-being related to spirituality in interns' and residents' education for a better doctor-patient relationship.

Resumo: Introdução: Na atualidade, considera-se relevante e oportuno estudar os fatores que contribuem para a melhoria das relações interpessoais no contexto da assistência ao paciente e da educação médica. Compreender os preditores em relação à empatia e à atitude do interno de Medicina e do jovem médico é tema em destaque na formação dos profissionais de saúde, no desempenho acadêmico e profissional. A espiritualidade tem sido apontada como tema importante tanto pelos pacientes como pelos estudantes de Medicina, porém ainda pouco abordada nas escolas médicas. Objetivo: O estudo propõe verificar a associação entre o bem-estar relacionado à espiritualidade, à religiosidade e às crenças pessoais do interno e residente de Medicina e a empatia e a atitude na relação médico-paciente. Métodos: Trata-se de um estudo observacional, transversal, de abordagem quantitativa. O questionário WHOQOL-espiritualidade, religiosidade e crenças pessoais, a Escala Jefferson de Empatia e a Escala de Orientação Médico-Paciente foram autoaplicados por 64 estudantes dos últimos anos do curso e 50 residentes de Medicina. Realizaram-se estatística descritiva, correlação de Pearson e regressão linear stepwise para análise dos dados. Resultados: Foram encontradas correlações significativas (p < 0,05), variando de fracas (r = 0,10) a moderadas (r = 0,39). O escore final do WHOQOL-SRPB apresentou efeito sobre o escore global de empatia (R2 = 0,12; p < 0,00; β = 0,35; VIF = 1,00). Sentido da vida apresentou efeito sobre o escore global da atitude centrada no paciente (R2 = 0,14; p < 0,00; β = 0,38; VIF = 1,00). Conclusão: A espiritualidade, a religiosidade e as crenças pessoais foram associadas à atitude centrada no paciente e à empatia dos internos e residentes de Medicina. Em geral, o bem-estar relacionado à espiritualidade foi preditor da empatia, e o sentido da vida, preditor da atitude centrada no paciente. Esses resultados implicam a necessidade de se considerar o bem-estar relacionado à espiritualidade na formação dos internos e residentes para uma melhor qualidade da relação médico-paciente.

Personalised yoga for burnout and traumatic stress in junior doctors.

OBJECTIVES: Junior doctors are frequently exposed to occupational and traumatic stress, sometimes with tragic consequences. Mindfulness-based and fitness interventions are increasingly used to mitigate this, but have not been compared.We conducted a randomised, controlled pilot trial to assess the feasibility, acceptability and effectiveness of these interventions in junior doctors. METHODS: We randomised participants (n=21) to weekly 1-hour sessions of personalised, trauma-informed yoga (n=10), with a 4-hour workshop, and eHealth homework; or group-format fitness (n=8) in an existing wellness programme, MDOK. Burnout, traumatic stress and suicidality were measured at baseline and 8 weeks. RESULTS: Both interventions reduced burnout, and yoga increased compassion satisfaction within group on the Professional Quality of Life scale, without difference between groups on this measure.Personalised yoga significantly reduced depersonalisation (z=-1.99, p=0.05) compared with group fitness on the Maslach Burnout Inventory (MBI-HSS (MP)) and showed greater flexibility changes. Both interventions increased MBI Personal Accomplishment, with no changes in other self-report psychological or physiological metrics, including breath-counting.Participants doing one-to-one yoga rated it more highly overall (p=0.02) than group fitness, and reported it comparatively more beneficial for mental (p=0.01) and physical health (p=0.05). Face-to-face weekly sessions were 100% attended in yoga, but only 45% in fitness. CONCLUSION: In this pilot trial, both yoga and fitness improved burnout, but trauma-informed yoga reduced depersonalisation in junior doctors more than group-format fitness. One-to-one yoga was better adhered than fitness, but was more resource intensive. Junior doctors need larger-scale comparative research of the effectiveness and implementation of individual, organisational and systemic mental health interventions. TRIAL REGISTRATION NUMBER: ANZCTR 12618001467224.

Maternity staff immunization coverage against pertussis and maternal vaccination practices: Results of a 2017 cross-sectional survey in five public maternity hospitals.

OBJECTIVES: To conduct an audit of vaccination practices against pertussis in maternity wards to assess immunization practices targeting women, knowledge and awareness among health professionals and their involvement in the vaccination process, and to estimate their vaccine coverage. MATERIALS AND METHODS: 2017 cross-sectional descriptive survey using a data collection sheet of immunization practices targeting women and an anonymous questionnaire for health professionals whose vaccine coverage had been documented by the occupational health service. RESULTS: Five public maternity wards participated: one had a vaccination policy for women; 426 of 822 health professionals completed the questionnaire, 76% (from 50% of all residents to 83% of nurses) declared their vaccination status as up to date. Staff files in occupational health services showed that 69% of 822 health professionals received at least one vaccine booster during adulthood (57% less than 10 years before the survey); documented vaccination coverage rates ranged from 75% for residents to 91% for senior physicians. Occupational physicians and family physicians respectively performed 41% and 34% of vaccinations. While knowledge regarding vaccines was good, only 47% of health professionals declared prescribing them and 18% declared administering the anti-pertussis vaccine "often" or "very often". CONCLUSIONS: Updated data is needed to confirm the reported increase as participating centers are not representative of all birth centers. The active role of health professionals in vaccination-based pertussis prevention needs to be reinforced.

Feasibility and preliminary effectiveness of a drum circle activity to improve affect in patients, families and staff of a pediatric hospital.

Background: Children, families and staff in pediatric hospitals often experience elevated psychological distress. Art-based initiatives, such as group drumming, have been proposed as strategies to support well-being in this context. Methods: This study evaluated the feasibility and potential benefits of a drum circle activity designed to improve the affective experience of patients, families and staff in a large pediatric hospital. A total of 48 patients, 16 employees and 15 visitors completed questionnaires before and after up to 12 joint drum circle sessions. A total of 12 respondents took part in semi-structured interviews. Results: Quantitative analyses showed significant pre-post-session increases in positive affect (beta = .48; p < .001) and decreases in negative affect (beta = -.29; p < .001). Qualitative results corroborated these findings, in addition to suggesting the safety of the activity as well as other potential benefits. Conclusions: This preliminary study supports the usefulness of group drumming to enhance the well-being of pediatric hospital patients, families and staff.

Junior doctors' experience of interprofessional shadowing in a palliative care setting.

Interprofessional shadowing, whereby medical students take on the role of another profession, is an effective interprofessional education (IPE) method to promote interprofessional teamwork. Palliative care is an ideal setting for IPE as multidisciplinary teams work together to deliver holistic patient care. This brief report explores junior doctors' experiences in shadowing nurses to provide care to patients in a hospice setting in New Zealand. We conducted semi-structured interviews with six participants to find out the impact that this shadowing experience had on their professional development and feasibility of incorporating this activity into the undergraduate medical curriculum. Inductive thematic analysis revealed that shadowing a nurse for two days increased participants' awareness of the nursing role and gave them the opportunity to develop a personal relationship with their patients, both of which made participants actively reflect on the value of IPE and the way they practice medicine. Participants considered the palliative care setting as conducive to IPE and saw the value of incorporating interprofessional shadowing into the undergraduate medical curriculum.

Integrated liaison psychiatry services in England: a qualitative study of the views of liaison practitioners and acute hospital staffs from four distinctly different kinds of liaison service.

BACKGROUND: Liaison psychiatry services provide mental health care for patients in physical healthcare (usually acute hospital) settings including emergency departments. Liaison work involves close collaboration with acute hospital staff so that high quality care can be provided. Services however are patchy, relatively underfunded, heterogeneous and poorly integrated into acute hospital care pathways. METHODS: We carried out in-depth semi-structured interviews with 73 liaison psychiatry and acute hospital staff from 11 different acute hospitals in England. The 11 hospitals were purposively sample to represent hospitals in which four different types of liaison services operated. Staff were identified to ensure diversity according to professional background, sub-specialism within the team, and whether they had a clinical or managerial focus. All interviews were audio-recorded and transcribed. The data were analysed using a best-fit framework analysis. RESULTS: Several key themes emerged in relation to facilitators and barriers to the effective delivery of integrated services. There were problems with continuity of care across the secondary-primary interface; a lack of mental health resources in primary care to support discharge; a lack of shared information systems; a disproportionate length of time spent recording information as opposed to face to face patient contact; and a lack of a shared vision of care. Relatively few facilitators were identified although interviewees reported a focus on patient care. Similar problems were identified across different liaison service types. CONCLUSIONS: The problems that we have identified need to be addressed by both liaison and acute hospital teams, managers and funders, if high quality integrated physical and mental health care is to be provided in the acute hospital setting.

The educational intervention "Focusing" as a strategy to stress reduction among health care workers: a pilot study in an Italian teaching hospital.

BACKGROUND: An educational intervention for stress management of healthcare workers based on a mindfulness approach called Focusing in an Italian teaching hospital. METHODS: In 2017 a pilot mandatory training on stress management targeted to healthcare workers was organized in the 447 bed teaching hospital Sant'Andrea in Rome. We implemented a mindfulness intervention called Focusing. Training with an adult learning approach was adopted. A mixed model using quantitative and qualitative methods was used to evaluate the course's effects on stress reduction. Quantitative data were collected with the Perceived Stress Scale and data were analyzed at two different time points: pre-intervention and post-intervention. Qualitative data were collected via a focus group interview at the end of the course. RESULTS: A total of 20 healthcare workers participated in the course and was divided in 2 groups: 7 physicians and 13 nurses. 15 (75%) were women and ages ranged from 31 to 56 (median age 46,5 years). 5 (25%) were men and ages ranged from 39 to 54 (median age 47 years). Perceived stress decreased with significant change (P=,0195) from 21,4 +/- 4,4 at baseline to 17,5 +/- 6.18 at the end of the course. The major changes the participants noted in their focus group were a greater sense of calmness, enhanced emotional self-regulation, improved coping, increased mental clarity and a sense of empowerment in dealing with the fear, anxiety, and other issues related to their work. CONCLUSIONS: Our initial aim was to investigate whether the course, based on improve of self-empathy by Focusing, could help healthcare workers face the negative effects of stress. There was a significant reduction in perceived stress and qualitative results showed an improvement in reactivity to inner experience and a more attentive perception of internal and external experiences.

Effectiveness of interventions to reduce occupational stress among emergency department staff: a systematic review protocol.

REVIEW QUESTION: The aim of the review is to synthesize the best available evidence on interventions targeting occupational stress and burnout among emergency department (ED) staff. The specific review questions are.

The benefits of an animal-assisted intervention service to patients and staff at a children's hospital.

An online survey of parents and staff was conducted to assess the effect of an animal-assisted intervention (AAI) service at a UK children's university teaching hospital. Three volunteer handlers with five golden retriever dogs provided AAIs across all eight paediatric wards including day, medical, surgical, oncology and intensive care. Interventions ranged from 'meet and greet' to assisting nursing care, physiotherapy and occupational therapy, as well as providing distraction during blood taking and other tests including radiology examinations. Two hundred surveys were completed and there was an overwhelmingly positive response to the service. No concerns were recorded with respect to the presence, cleanliness and behaviour of the dogs. There was a 100% recommendation that similar services should be supported across the UK.

Experiences of women, hospital clinicians and general practitioners with gestational diabetes mellitus postnatal follow-up: A mixed methods approach.

PROBLEM: Postnatal screening rates to detect type two diabetes following gestational diabetes are low. The quality of communication is an important element to consider in developing targeted strategies that support women in completing recommended follow-up care. AIMS: To explore the communication perspectives, practices and preferences of women, hospital clinicians and general practitioners, to determine strategies that may promote completion of recommended postnatal GDM follow-up, in Queensland Australia. METHOD: We used an exploratory, three-phase, mixed-methods approach, interpreted through intergroup communication theory. Phase one: convergent interviews explored perspectives of the communication experience in GDM care among new mothers (n = 13), hospital clinicians (n = 13) and general practitioners (n = 16). Phase two: a retrospective chart audit assessed current practice in postnatal discharge summaries of women (n = 86). Phase three: an online survey identified the preferences of general practitioners and hospital clinicians who provide maternity care in Queensland. Triangulation of the findings from the interviews, audit and surveys was used to clarify results and increase the robustness of the findings. RESULTS: Three themes: Seeking information, Written hospital discharge summary (discharge summary) and Clarity of follow-up requirements, provide direction for pragmatic strategies to promote follow-up. Practical recommendations include continued discussion about care with women from the point of GDM diagnosis into the postnatal period; discharge summaries that give primacy to diagnosis and ongoing treatment; and provision of explicit directions for recommended testing and timing. IMPLICATIONS: This research informs seven practical recommendations to help promote completion of recommended postnatal GDM follow-up.

Do 'physicians in the lead' support a holistic healthcare delivery approach? A qualitative analysis of stakeholders' perspectives.

OBJECTIVES: Value-based healthcare implies that healthcare issues are addressed most effectively with the 'physicians in the lead' (PIL) strategy. This study explores whether PIL also supports a holistic care approach that patients are increasingly demanding. DESIGN: A qualitative research design was used. SETTING: This study was conducted in a general hospital in the Netherlands with an integrated PIL strategy. PARTICIPANTS: Semistructured interviews were conducted with 14 hospital stakeholders: 13 stakeholders of an Obstetrics and Gynaecology department (the hospital's Patient Council (n=1), nurses (n=2), midwives (n=2), physicians (n=2), residents (n=2), the non-medical business managers of the Obstetrics and Gynaecology department (n=2) the Board of Directors (n=2)) and a member of the Dutch National Healthcare Institute's Innovative Healthcare Professions programme. RESULTS: According to diverse stakeholders, PIL does not support a holistic healthcare delivery approach, primarily because of the strong biomedical focus of the physicians. Although physicians can be educated to place more emphasis on the holistic outcome, holistic care delivery requires greater integration and teamwork in the care chain. As different healthcare professions are complementary to each other, a new strategy of a 'team in the lead' was suggested to meet the holistic healthcare demands. Besides this new strategy, there is a need for an extramural care management coordination centre where patients are able to receive support in managing their own care. This centre should also facilitate services similar to the core function of a church or community centre. These services should help patients to deal with different holistic dimensions that are important for their well-being. CONCLUSIONS: The PIL strategy appears to be insufficient for holistic healthcare delivery. A 'team in the lead' approach should be considered to meet the holistic healthcare demands. Further research should focus on observing PIL in different cultures and exploring the effectiveness of the strategy 'team in the lead'.

Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study.

OBJECTIVES: Work-related stress is highly prevalent among physicians working in emergency medicine. Mental health promotion interventions offer the chance to strengthen physicians' health, work ability, and performance. The aim of this study was to implement and evaluate a mental health promotion program for junior physicians working in emergency medicine. METHODS: In total, 70 junior physicians working in emergency medicine were randomized to either the mental health promotion program (n=35) or a waitlist control arm (n=35). The training involved 90-min sessions over a time period of 3 months. The primary outcome was perceived stress. The secondary outcomes included emotional exhaustion, emotion regulation, work engagement, and job satisfaction. Self-report assessments for both groups were scheduled at baseline, after the training, after 12 weeks, and 6 months. RESULTS: The intervention group showed a highly significant reduction in perceived stress and emotional exhaustion from baseline to all follow-up time points, with no similar effects found in the comparison group. The benefit of the mental health promotion program was also evident in terms of improved emotion regulation skills, job satisfaction, and work engagement. Participating physicians evaluated the training with high scores for design, content, received outcome, and overall satisfaction. CONCLUSION: The results suggest that this health promotion program is a promising intervention to strengthen mental health and reduce perceived work stress. It is suitable for implementation as a group training program for junior physicians working in emergency medicine. Comparable interventions should be pursued further as a valuable supportive offer by hospital management.

Encouraging Mindfulness in Medical House Staff via Smartphone App: A Pilot Study.

BACKGROUND: Stress and burnout are increasingly recognized as urgent issues among resident physicians, especially given the concerning implications of burnout on physician well-being and patient care outcomes. OBJECTIVE: The authors assessed how a mindfulness and meditation practice among residents, supported via a self-guided, smartphone-based mindfulness app, affects wellness as measured by prevalidated surveys. METHODS: Residents in the departments of general surgery, anesthesia, and obstetrics and gynecology were recruited for participation in this survey-based, four-week, single-arm study. All participants used the app (Headspace) on a self-guided basis, and took surveys at enrollment, at 2 weeks, and at 4 weeks. The Positive and Negative Affect Schedule (PANAS) assessed mood, and the Freiburg Mindfulness Inventory (FMI) measured mindfulness. RESULTS: Forty-three residents enrolled in this study from April 2015 to August 2016; 30 residents (90% female) completed two or more surveys, and so were included for further analysis. In a comparison of baseline scores to week four scores, there was a significant increase in FMI at week four (36.88 ± 7.00; Cohen's d = 0.77, p = 0.005), a trend toward increase in the positive affect score (PAS) (31.73 ± 6.07; Cohen's d = 0.38, p = 0.08), and no change in negative affect score (NAS) (21.62 ± 7.85; Cohen's d = -0.15, p = NS). In mixed-effect multivariate modeling, both the PAS and the FMI scores showed significant positive change with increasing use of the smartphone app (PAS, 0.31 (95% CI 0.03-0.57); FMI, 0.38 (95% CI 0.11-0.66)), while the NAS did not show significant change. CONCLUSIONS: Study limitations include self-guided app usage, a homogenous study subject population, insufficient study subjects to perform stratified analysis of the impact of specialty on the findings, lack of control group, and possible influence from the Hawthorne effect. This study suggests the feasibility and efficacy of a short mindfulness intervention delivered by a smartphone app to improve mindfulness and associated resident physician wellness parameters.

An exploration of nurse-physician perceptions of collaborative behaviour.

Interprofessional collaboration is a key element in providing safe, holistic patient care in the acute care setting. Trended data at a community hospital indicated opportunities for improvement in collaboration on micro, meso, and macro levels. The aim of this survey study was to assess the current state of collaboration between frontline nurses and physicians at a non-academic acute care hospital. A convenience sample of participants was recruited with a final respondent sample of 355 nurses and 82 physicians. The results indicated that physicians generally perceived greater collaboration than nurses. Physician ratings did not vary by primary practice area, whereas nurse ratings varied by clinical practice area. Nurse ratings were the lowest in the operating room and the highest in the emergency department. Text-based responses to an open-ended question were analysed by role and coded by two independent research teams. Emergent themes emphasised the importance of rounding, roles, respect, and communication. Despite recognition of the need for improved collaboration and relational behaviours, strategies to improve collaborative practice must be fostered at the meso level by organisational leaders and customised to address micro-level values. At the study site, findings have been used to address and improve collaboration towards the goal of becoming a high reliability organisation.

Development and Psychometric Properties of a Scale to Measure Hospital Organizational Culture for Cardiovascular Care.

BACKGROUND: Because organizational culture is increasingly understood as fundamental to achieving high performance in hospital and other healthcare settings, the ability to measure this nuanced concept empirically has gained importance. Aside from measures of patient safety culture, no measure of organizational culture has been widely endorsed in the medical literature, limiting replication of previous findings and broader use in interventional studies. METHODS AND RESULTS: We sought to develop and assess the validity and reliability of a scale for assessing organizational culture in the context of hospitals' efforts to reducing 30-day risk-standardized mortality after acute myocardial infarction. The 31-item scale was completed by 147 individuals representing 10 hospitals during August and September 2014. The resulting organizational culture scale demonstrated high level of construct validity and internal consistency. Factor analyses indicated that the 31 items loaded well (loading values 0.48-0.90), supporting distinguishable domains of (1) learning environment, (2) psychological safety, (3) commitment to the organization, (4) senior management support, and (5) time for improvement efforts. Cronbach α coefficients were 0.94 for the scale and ranged from 0.77 to 0.88 for the subscales. The scale displayed reasonable convergent validity and statistically significant variability across hospitals, with hospital identity accounting for 11.3% of variance in culture scores across respondents. CONCLUSIONS: We developed and validated a relatively easy-to-administer survey that was able to detect substantial variability in organizational culture across different hospitals and may be useful in measuring hospital culture and evaluating changes in culture over time as part performance improvement efforts.