Emotional labor and burnout among nurses in Iran: core self-evaluations as mediator and moderator.

BACKGROUND: This study investigated the mediating and moderating impact of core self-evaluations in the path from emotional labor to burnout. Our hypothesized associations are based on Hobfoll (Rev Gen Psychol 6:307-24, 2002) conservation of resources theory. METHOD: Three hundred nurses from four hospitals in Abadan, Iran, were invited to participate in our study. Of the 300, 255 completed all sections and questions in our survey for an 85% response rate. The posited direct and indirect effects were evaluated with structural equation modeling and the interaction effects were evaluated with hierarchical moderated regression and simple regression slope plots. RESULT: Deep acting has indirect effects on burnout through core self-evaluations. Though unrelated to surface acting, core self-evaluations moderate its impact: under low core self-evaluations, surface acting is strongly related to emotional exhaustion and inversely related to personal accomplishment, whereas, under high core self-evaluations, surface acting is unrelated to these burnout dimensions. CONCLUSION: Our findings reveal the dual functions of CSE as a psychological resource and buffer to offset the interpersonal demands of patient care. Limitations, directions for future research, and practical implications are discussed.

Basal keratinocytes contribute to all strata of the adult zebrafish epidermis.

The epidermis of terrestrial vertebrates is a stratified epithelium and forms an essential protective barrier. It is continually renewed, with dead corneocytes shed from the surface and replaced from a basal keratinocyte stem cell population. Whilst mouse is the prime model system used for epidermal studies, there is increasing employment of the zebrafish to analyse epidermis development and homeostasis, however the architecture and ontogeny of the epidermis in this system are incompletely described. In particular, it is unclear if adult zebrafish epidermis is derived entirely from the basal epidermal stem cell layer, as in the mouse, or if the most superficial keratinocyte layer is a remnant of the embryonic periderm. Furthermore, a relative paucity of cellular markers and genetic reagents to label and manipulate the basal epidermal stem cell compartment has hampered research. Here we show that the type I keratin, krtt1c19e, is a suitable marker of the basal epidermal layer and identify a krtt1c19e promoter fragment able to drive strong and specific expression in this cell type. Use of this promoter to express an inducible Cre recombinase allowed permanent labelling of basal cells during embryogenesis, and demonstrated that these cells do indeed generate keratinocytes of all strata in the adult epidermis. Further deployment of the Cre-Lox system highlighted the transient nature of the embryonic periderm. We thus show that the epidermis of adult zebrafish, as in the mouse, derives from basal stem cells, further expanding the similarities of epidermal ontogeny across vertebrates. Future use of this promoter will assist genetic analysis of basal keratinocyte biology in zebrafish.

Correlates of physician burnout across regions and specialties: a meta-analysis.

BACKGROUND: Health care organizations globally realize the need to address physician burnout due to its close linkages with quality of care, retention and migration. The many functions of health human resources include identifying and managing burnout risk factors for health professionals, while also promoting effective coping. Our study of physician burnout aims to show: (1) which correlates are most strongly associated with emotional exhaustion (EE) and depersonalization (DP), and (2) whether the associations vary across regions and specialties. METHODS: Meta-analysis allowed us to examine a diverse range of correlates. Our search yielded 65 samples of physicians from various regions and specialties. RESULTS: EE was negatively associated with autonomy, positive work attitudes, and quality and safety culture. It was positively associated with workload, constraining organizational structure, incivility/conflicts/violence, low quality and safety standards, negative work attitudes, work-life conflict, and contributors to poor mental health. We found a similar but weaker pattern of associations for DP.Physicians in the Americas experienced lower EE levels than physicians in Europe when quality and safety culture and career development opportunities were both strong, and when they used problem-focused coping. The former experienced higher EE levels when work-life conflict was strong and they used ineffective coping. Physicians in Europe experienced lower EE levels than physicians in the Americas with positive work attitudes. We found a similar but weaker pattern of associations for DP.Outpatient specialties experienced higher EE levels than inpatient specialties when organization structures were constraining and contributors to poor mental health were present. The former experienced lower EE levels when autonomy was present. Inpatient specialties experienced lower EE levels than outpatient specialties with positive work attitudes. As above, we found a similar but weaker pattern of associations for DP. CONCLUSIONS: Although we could not infer causality, our findings suggest: (1) that EE represents the core burnout dimension; (2) that certain individual and organizational-level correlates are associated with reduced physician burnout; (3) the benefits of directing resources where they are most needed to physicians of different regions and specialties; and (4) a call for research to link physician burnout with performance.

Impact of mirabegron extended-release on the treatment of overactive bladder with urge urinary incontinence, urgency, and frequency.

Overactive bladder is a highly prevalent disorder with a significant impact on quality of life. Antimuscarinic agents are commonly used, but persistence is limited due to unsatisfactory efficacy and/or tolerability. Mirabegron is the first beta-3 adrenoceptor agonist approved for the treatment of overactive bladder syndrome. This paper reviews the pharmacology, mechanism of action, efficacy, and safety of mirabegron. A PubMed search of all English articles pertaining to mirabegron was performed. An alternative to antimuscarinics, mirabegron has a unique mechanism, improves overactive bladder symptoms and quality of life, and has limited adverse effects and few contraindications.

Interpersonal factors affecting communication in clinical consultations: Canadian physicians' perspectives.

PURPOSE: This study seeks to determine how process and latent errors in the interpersonal, organizational, health system, and public health domains impact doctor/patient communication and patient safety. DESIGN/METHODOLOGY/APPROACH: There were 278 physicians from Manitoba, Canada who completed a self-report questionnaire during 2006. The largest specialty was family medicine, followed by internal medicine and pediatrics. Mean years of practice was 16, and 60 percent of the respondents were male. Respondents indicated the extent to which difficulties were encountered when communicating with patients. FINDINGS: The study finds that physicians had more difficulties with patients in the 0-20 year age bracket on 12 of the 18 communication statements. Psychiatry and pediatrics reported more difficulties with language interpreters. Pediatrics reported more difficulties with patients using culturally-based alternative medicine. Internal medicine had more difficulty with patients not appearing to trust or participate in treatment decisions. Patients in the 41-60 years age bracket had the highest mean for non-adherence to treatment plans, health maintenance and needed lifestyle change. The female physician-female patient dyad had fewer communication difficulties on all statements. RESEARCH LIMITATIONS/IMPLICATIONS: Further research should examine how family structure influences health-care delivery and health outcomes. Health care organizations can contribute to improving quality of care by seeking out and correcting sources of latent errors, and by supporting professional development and practice interventions. ORIGINALITY/VALUE: Few studies exist that have linked communication difficulties to adverse events. This study provides insight on sources of interpersonal errors in communication that directly impact the physician/patient relationship and which may represent threats to patient safety.

May I long experience the joy of healing: professional and personal wellbeing among physicians from a Canadian province.

BACKGROUND: The development of best practices to promote physician wellbeing at the individual and organisational levels is receiving increased attention. Few studies have documented how physicians perceive their wellbeing in these contexts. The purpose of this qualitative study is to identify and discuss the reported factors that hinder wellbeing, as well as the reported factors that would promote wellbeing among physicians. METHODS: There were 165 physicians from a province of Canada who wrote their open-ended responses to two questions, as part of a larger self-report questionnaire. The questions asked what causes them stress, and what interventions should be implemented at organisational/institutional levels. The largest specialty was family medicine, followed by internal medicine, and surgical disciplines, with 58% of participants male. A general inductive approach was used to analyze the data and themes and sub-themes were discovered using the socio-ecological model as the framework. RESULTS: Reponses were both personal and professional which resulted in the emergence of four major themes to reflect this diversity. These themes were external constraints on the practice of medicine, issues at the professional/institutional levels, issues at the individual practice level, and work/life balance. The work/life balance theme received the highest number of responses followed by external constraints on the practice of medicine. In the major theme of work-life balance, work-life conflict received the most responses, and in the major theme of external constraints on practice of medicine, lack of resources (human and material) and restrictions to autonomy received the most responses. Ideas for interventions in the work/life balance theme were health promotion, and healthy workplace initiatives. In the second largest theme, suggested ideas for interventions were collegiality/professionalism and policy formulation at the health care system. CONCLUSION: Our findings have implications for governance and health policy, health human resources and education. In particular, the socio-ecological framework was a useful framework to analyse physician wellbeing due to its applicability for issues at the structural, organisational, and individual levels. Future research should target interventions at the organisational and institutional levels to address work-life conflict and job dissatisfaction.

Testing a conservation of resources model of the dynamics of emotional labor.

This study uses S. E. Hobfoll's (1989) conservation of resources theory as a means of examining why emotional labor may or may not result in burnout. A model is developed that proposes that workers attempt to cope with role demands by performing surface or deep acting and that the effect of this expenditure of resources on worker burnout depends on the more immediate rewards of the service encounter and the application of internal and external resources specific to the needs at hand. This model is tested and confirmed using cross-sectional survey responses from 236 working adults. Research and practical implications are discussed.