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.

Development of a Psychological Scale for Measuring Disruptive Clinician Behavior.

OBJECTIVES: Disruptive clinician behavior worsens communication, information transfer, and teamwork, all of which negatively affect patient safety. Improving safety in medical care requires an accurate assessment of the damage caused by disruptive clinician behavior. Psychometric scales complement case reports, but existing scales have significant limitations. Therefore, this study developed a psychometric scale based on the psychological paradigm to assess disruptive clinician behavior. METHODS: The scale was developed through a sequence of steps. First, we used an open-ended questionnaire targeting 712 nurses, content analysis, and content validity assessment by 5 experts to determine valid items for disruptive clinical behavior. Next, an Internet questionnaire survey targeting 1000 health care staff, exploratory factor analysis, and subfactor analysis was conducted to identify necessary and sufficient factors. Then, we calculated difficulty level and discriminative power. We also conducted a field questionnaire survey targeting 84 staff in a hospital. Finally, we calculated ω coefficients and then used confirmatory factor analysis to verify the fit of the hypothesized model. RESULTS: Our open-ended survey involving 478 nurses identified 47 codes in 9 categories. The questionnaire survey involving hospital 1000 medical staff identified 6 factors, with 1 factor subdivided into 4 subfactors and 1 into 2 subfactors. The goodness of fit of the hypothesized 10-factor models with factor pairs and groups was confirmed. CONCLUSIONS: We developed a psychometric scale measuring subjective assessments of harm covering various disruptive clinician behaviors. The scale complements interviews and case reports by generating valid, reliable scores for various disruptive clinician behaviors in health care institutions.

The Effectiveness of the Multiple-Attending-Physicians System Compared With the Single Attending-Physician System in Inpatient Setting: A Mixed-Method Study.

OBJECTIVES: Medical facilities have been required to effectively utilize insufficient human resources in many countries. Therefore, we qualitatively and quantitively compared physicians' working burden, and assessed advantages and disadvantages of the single- and the multiple-attending physicians systems in inpatient care. METHODS: In this cross-sectional study, we extracted electronic health record of patients from a hospital in Japan from April 2017 to October 2018 to compare anonymous statistical data between the single-attending and multiple-attending-physicians system. Then, we conducted a questionnaire survey for all physicians of single and multiple-attending systems, asking about their physical and psychiatric workload, and their reasons and comments on their working styles. RESULTS: The average length of hospital stay was significantly shorter in the multiple-attending system than in the single-attending system, while patients' age, gender, and diagnoses were similar. From the questionnaire survey, no significant difference was found in all categories although physical burden in multiple-attending system tended to be lower than that in single-attending system. Advantages of multiple-attending system extracted from qualitative analysis are (1) improvement of physicians' quality of life (QOL), (2) lifelong-learning effect, and (3) improving the quality of medical care, while disadvantages were (1) risk of miscommunications, (2) conflicting treatment policies among physicians, and (3) patients' concern. CONCLUSIONS: The multiple-attending physician system in the inpatient setting can reduce the average length of stay for patients and also reduce the physical burden on physicians without compromising their clinical performance.

Implementation of a Behavioral Emergency Response Team in the Emergency Department.

INTRODUCTION: Emergency nurses, physicians, and patients experience occurrences of workplace violence. Having a team to respond to escalating behavioral events provides a consistent approach to reducing occurrences of workplace violence and increasing safety. The purpose of this quality improvement project was to design, implement, and evaluate the effectiveness of a behavioral emergency response team in an emergency department to reduce occurrences of workplace violence and increase the perception of safety. METHODS: A quality improvement design was used. The behavioral emergency response team protocol was created using evidenced-based protocols that have been shown to be effective in reducing the number of occurrences of workplace violence. Emergency nurses, patient support technicians, security personnel, and a behavioral assessment and referral team were trained in the behavioral emergency response team protocol. Data on occurrences of workplace violence were collected from March 2022 to November 2022. Postbehavioral emergency response team debriefings were conducted, and real-time education was provided after implementation. Survey data were collected to evaluate the emergency team members' perceptions of safety and of the effectiveness of the behavioral emergency response team protocol. Descriptive statistics were calculated. RESULTS: The number of reported occurrences of workplace violence decreased by to 0 postimplementation of the behavioral emergency response team protocol. The perception of safety increased 36.5% postimplementation (mean 2.2 preimplementation, mean 3.0 postimplementation). In addition, an increase in awareness about reporting occurrences of workplace violence resulted from education and implementation of the behavioral emergency response team protocol. CONCLUSION: Postimplementation, participants reported an increase in the perception of safety. Implementation of a behavioral emergency response team was effective in reducing assaults toward emergency department team members and increasing the perception of safety.

Evidence-Based Design in the Hospital Environment: A Staff's Burnout Study in the COVID-19 Era.

OBJECTIVE: This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19. BACKGROUND: The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement. METHODS: This cross-sectional study was performed on 406 nurses and physician's burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05. RESULTS: The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff's burnout (p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout (p = .018, odds ratio [OR] = 0.910). CONCLUSION: Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.

Strategies Australian junior doctors use to maintain their mental, physical and social well-being: a qualitative study.

OBJECTIVES: This study aimed to uncover the strategies that junior doctors implement to maintain their mental, physical and social well-being, and the barriers they experience in practising these strategies. PARTICIPANTS: Fifteen junior doctors in their postgraduate year 1 or 2 currently practising in Australia were recruited. OUTCOME MEASURES: Semistructured interviews were conducted, and the transcripts underwent thematic analysis. RESULTS: Three key themes emerged from thematic analysis, namely: well-being strategies, barriers to well-being and and future interventions. Exercise, a healthy and balanced diet, quality sleep, and workplace organisations were frequently reported well-being strategies. High workload, unpredictable routines, lack of familiarity with the healthcare system and ongoing stigma surrounding mental health were seen as barriers to well-being. Suggested interventions included increased control over rosters, subsidised access to facilities such as gyms and increased internship preparedness programmes organised by the medical schools. CONCLUSIONS: The findings from this study may assist in developing more personalised and targeted methods to help junior doctors maintain their mental, physical and social well-being. Future studies may address the structural and systemic changes required to develop a workforce that fosters the well-being of junior doctors and reduces the institutional barriers to practising well-being strategies.

Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic.

OBJECTIVES: This qualitative study aimed to explore the occupational experiences of medical students and junior doctors working during the COVID-19 pandemic. In particular, the research sought to identify factors which mediated work stress, barriers to disclosing mental health problems and levels of support medical students and junior doctors received during the pandemic. DESIGN: This study was a form of thematic analysis and adopted an inductive, 'bottom-up' approach, in which coded categories were derived from rich, descriptive data. SETTING: Semistructured interviews were conducted online with UK-based medical students and junior doctors. Interviews were recorded, and analysis was done by coding salient quotes into themes. PARTICIPANTS: The final sample consisted of seven junior doctors and eight medical students, during the summer of 2021. RESULTS: High levels of occupational stress were identified, which were exacerbated by COVID-19. A number of organisational difficulties associated with the pandemic compounded participants' experiences of work stress. Participants recognised progress towards promoting and managing mental health within the profession but may still be reluctant to access support services. Barriers to disclosure included fear of stigmatisation, concerns about adding to colleagues' workloads, lack of clarity about career implications and mistrust of occupational health services. CONCLUSIONS: While attitudes towards mental health have improved, medical students and junior doctors may avoid seeking help. Given the immense pressures faced by health services, it is imperative that extra measures are implemented to minimise work-stress, encourage help-seeking behaviours and promote supportive work cultures.

Estratégias e dificuldades encontradas na comunicação de notícias difíceis em um hospital universitário / Strategies and difficulties found in communicating difficult news in a university hospital / Estrategias y dificultades encontradas para comunicar noticias difíciles en un hospital universitario

O trabalho teve como objetivo apresentar estratégias e dificuldades que influenciam o processo de Comunicação de Notícias Difíceis por médicos em um hospital universitário. Trata-se de um estudo descritivo-exploratório, de orientação qualitativa, sobre as estratégias e dificuldades encontradas por residentes (R1, R2 ou R3) e staffs, dos quatro programas da área médica: Ginecologia e Obstetrícia (GO), Pediatria, Cirurgia Geral (CG) e Clínica Médica (CM). A partir de uma entrevista semiestruturada para a análise dos dados foi utilizado o método do Discurso do Sujeito Coletivo (DSC), que mostrou como é importante utilizar protocolos para subsidiar a melhor abordagem com o paciente. Além da formação profissional, para realizar a comunicação de notícias difíceis, foi citado o protocolo SPIKES, seus pontos estratégicos e como ele pode auxiliar o profissional a realizar a melhor conduta. No que tange às dificuldades, a falta de preparo foi um dos destaques, bem como a ausência de um local adequado para a comunicação e os aspectos emocionais envolvidos, tanto por parte dos pacientes quanto dos profissionais de saúde. (AU)

The aim of this study was to present the strategies and difficulties that influence the process of communicating difficult news by doctors in a university hospital. This is a descriptive-exploratory study with a qualitative orientation on the strategies and difficulties encountered by residents (R1, R2 or R3) and staff from the four medical programs: Obstetrics and Gynecology (O&G), Pediatrics, General Surgery (GS) and Internal Medicine (IM). Based on a semi-structured interview, the Collective Subject Discourse (CSD) method was used for data analysis, which showed the importance of using protocols to support the best approach to the patient. In addition to professional training for communicating difficult news, the SPIKES protocol and its strategic points were mentioned, as well as how it can help professionals to conduct themselves effectively. The lack of preparation was one of the main difficulties reported, as well as the absence of an appropriate location for communication and the emotional aspects involved for both patients and health professionals. (AU)

El objetivo de este trabajo fue presentar estrategias y dificultades que influyen en el proceso de Comunicación de Noticias Difíciles por parte de médicos en un hospital universitario. Se trata de un estudio descriptivo-exploratorio, con orientación cualitativa, sobre las estrategias y dificultades encontradas por los residentes (R1, R2 o R3) y personal, de los cuatro programas del área médica: Ginecología y Obstetricia (GO), Pediatría, General Cirugía (CG) y Medicina Interna (CM). A partir de una entrevista semiestructurada para el análisis de los datos, se utilizó el método del Discurso del Sujeto Colectivo (CSD), que mostró cuán importante es el uso de protocolos para apoyar el mejor abordaje del paciente. Además de la formación profesional, para comunicar noticias difíciles, se mencionó el protocolo SPIKES, sus puntos estratégicos y cómo puede ayudar a los profesionales a llevar a cabo la mejor conducta. En cuanto a las dificultades, la falta de preparación fue uno de los destaques, así como la ausencia de un lugar adecuado para la comunicación y los aspectos emocionales involucrados, tanto por parte de los pacientes como de los profe-sionales de la salud. (AU)

Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives.

BACKGROUND: Doctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors' working conditions and, thus, their mental health. METHODS: We interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors' working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations. RESULTS: Junior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork. CONCLUSION: We suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.

Efectos de la pandemia COVID-19 en la formación de residentes de cirugía general de la Argentina / Efects of the COVID-19 pandemic on the training of residents in general surgery in Argentina

RESUMEN Antecedentes: los sistemas de salud del mundo se han visto afectados en su lucha contra el COVID-19, generando efectos negativos tanto en la actividad asistencial como en la formación de los residentes. Suspender cirugías electivas, disminuir la participación de residentes en quirófano y otros cambios estructurales de los hospitales determinó que los residentes de cirugía experimenten un marcado déficit educacional en su formación. Material y métodos: modalidad observacional y transversal. Se realizó una encuesta anónima online de 20 preguntas a residentes de cirugía de la Argentina. Se confeccionó una base de datos para el análisis estadístico. Se valoraron variables categóricas y numéricas. Resultados: se recibieron 100 respuestas de la encuesta en la que se identificó predominio de residentes de instituciones públicas. Se calculó un descenso del 63% en la cantidad de cirugías en las que participaron los residentes durante la pandemia. El 77% usó plataformas virtuales para remediar el impacto en las instancias de formación académica. El 57% de los encuestados cuentan con programas de simulación quirúrgica en su hospital. La mayoría experimentó consecuencias negativas en sus habilidades quirúrgicas y en su formación durante la pandemia, pero se identificaron diferencias entre el grupo que dispone de simulación quirúrgica y el que no. Conclusión: para resolver el déficit educativo que generó la pandemia por COVID-19, y como medida para potenciar el aprendizaje de habilidades quirúrgicas en situaciones normales, este estudio recomendaría contar con programas de simulación quirúrgica y fomentar el uso de plataformas virtuales como herramienta de formación académica.

ABSTRACT Background: Health systems worldwide have been affected in their fight against COVID-19, generating negative effects on both healthcare activity and training of residents. Cancellation of elective surgeries, less participation of residents in the operating room and other structural changes in the hospitals resulted in an educational gap in the training of residents in surgery. Material and methods: We conducted an observational and cross-sectional study. A 20-question online survey was conducted among residents in surgery from Argentina. A database was created for statistical analysis of categorical and continuous variables. Results: The survey was responded by 100 residents in surgery; most of them belonged to public institutions. There was a 63% decrease in the number of surgeries in which the residents participated during the pandemic. Seventy-seven percent used virtual platforms to mitigate the impact on academic training and 57% count with surgical simulation programs in their hospitals. Most of them experienced negative consequences on their surgical skills and training during the pandemic, but there were differences identified between the group with and without surgical simulation programs. Conclusion: The availability of surgical simulation programs and the use of virtual platforms as an academic training tool could solve the educational gap generated by the COVID-19 pandemic and enhance the learning of surgical skills under normal conditions.

A qualitative analysis of adding kindness into the ISBAR handover tool.

BACKGROUND: The COVID pandemic has highlighted the stresses experienced by our medical workforce, with worldwide publications attesting to high rates of depression, anxiety and burnout, particularly in junior doctors. Many studies focus on reporting on the prevalence of mental health issues, but not many report on interventional strategies. One of the most stressful interactions in the day of a junior doctor is the medical handover. The incorporation of kindness into clinical handover has coined the term 'KISBAR' to underline the importance of delivering handover in a kind manner. AIM: The aim is to analyse the efficacy of a novel intervention by introducing an emotional support representative to participate in the morning labour ward handover. METHODS: We undertook an ethnographic constructivist qualitative research project in a tertiary hospital in Perth, Western Australia, using focus groups to explore the views of junior medical staff on the KISBAR handover tool in the specific context of labour ward handover. Fifty per cent of the total junior doctors from the hospital participated in this study. RESULTS: Four dominant themes arose from analysis of the focus group discussions: (i) inherent stress experienced by junior doctors during the labour ward handover process, (ii) support strategies for junior doctors during labour ward handover; (iii) role modelling and the hidden curriculum aspects of communication from senior doctors at labour ward handover; and (iv) benefit of having an emotional support person present for labour ward handover. CONCLUSION: Our study confirmed the benefit of having an emotional support person present at labour ward handover: improved perception of safety and an environment that junior doctors found to be supportive. This is a novel and reproducible interventional strategy which is applicable to various obstetric units around Australia.

Vulnerability of Inexperience: A Qualitative Exploration of Physician Grief and Coping after Impactful Pediatric Patient Deaths.

Background: Caring for dying patients can result in burnout, stress, and emotional trauma for some physicians,1,2 particularly among trainees. Research is lacking that focuses on the emotional impact and coping techniques utilized by novice and experienced pediatricians after impactful pediatric patient deaths. Objectives: To define the salient features of an impactful pediatric patient death and physicians' grief and coping responses. As a secondary aim, we explored the cognitive and emotional training physicians described as helpful or would be helpful when coping after impactful patient deaths. Design: We conducted a prospective qualitative study using semistructured interviews and applied descriptive thematic content analysis to the transcribed interviews. Setting/Subjects: We enrolled pediatric intensive care unit trainees and attendings in a single United States institution over a six-month period from January 2021 to June 2021. Results: Both trainee and attending physicians were most impacted by acute or unexpected patient deaths. Trainees were particularly impacted by their first or early career patient deaths. Both groups found talking about the death of a patient the most helpful coping mechanism. Attending physicians coped with positive reframing, whereas novices more frequently utilized avoidance, numbing, and rumination. The importance of experienced physician's role modeling vulnerability and supporting trainee growth rather than "getting it right" were highlighted as trainee coping gaps. Conclusions: Novice physicians are particularly vulnerable to acute stress after the death of a patient and require additional coping resources and supports. Future projects should explore the impact of teaching emotion-focused coping techniques on trainee resiliency and coping after early career patient deaths.

Impact of Bedside Rounding on Attending Teaching Evaluations.

OBJECTIVE: To examine associations between bedside rounding (BSR) and other rounding strategies (ORS) with resident evaluations of teaching attendings and self-reported attending characteristics. METHODS: Faculty from three academic medical centers who attended resident teaching services for ≥4 weeks during the 2018-2019 academic year were invited to complete a survey about personal and rounding characteristics. The survey instrument was iteratively developed to assess rounding strategy as well as factors that could affect choosing one rounding strategy over another. Survey results and teaching evaluation scores were linked, then deidentified and analyzed in aggregate. Included evaluation items assessed resident perceptions of autonomy, time management, professionalism, and teaching effectiveness, as well as a composite score (the numeric average of each attending's scores for all of the items at his or her institution). BSR was defined as spending >50% of rounding time in patients' rooms with the team. Hallway rounding and conference room rounding were combined into the ORS category and defined as >50% of rounding time in these settings. All of the scores were normalized to a 10-point scale to allow aggregation across sites. RESULTS: A total of 105 attendings were invited to participate, and 65 (62%) completed the survey. None of the resident evaluation scores significantly differed based on rounding strategy. Composite scores were similar for BSR and ORS (difference of <0.1 on a 10-point scale). Spearman correlation coefficients identified no statistically significant correlation between rounding strategy and evaluation scores. An exploratory analysis of variance model identified no single factor that was significantly associated with composite teaching scores (P > 0.45 for all) or the domains of teaching efficacy, professionalism, or autonomy (P > 0.13 for all). Having a formal educational role was significantly associated with better evaluation scores for time management, and the number of lectures delivered per year approached statistical significance for the same domain. CONCLUSIONS: Conducting BSR did not significantly affect resident evaluations of teaching attendings. Resident perception of teaching effectiveness based on rounding strategy should be neither a motivator nor a barrier to widespread institution of BSR.

Assessment of anxiety level and sleep quality of medical staff treating patients with COVID-19.

OBJECTIVE: Worldwide transmission of the novel coronavirus (COVID-19) and related morbidity and mortality has presented a global challenge for several reasons. One such underrecognized and unaddressed aspect is the emotional health problems that medical staff have developed during this pandemic. The purpose of this one-month study was to examine anxiety levels and sleep quality of 100 medical staff members who worked in medical clinics treating COVID-19 patients in Saudi hospitals and to investigate the association of both anxiety levels and sleep quality with age, sex, and distinctive demographics. MATERIALS AND METHODS: We investigated anxiety levels and sleep quality of 100 medical staff members (age range 20-60 years) who worked in medical clinics treating COVID-19 patients in Saudi hospitals and the association of both anxiety levels and sleep quality with age, sex, and distinctive demographics. Anxiety levels and sleep quality were measured using the Self-Rating Anxiety Scale and the Pittsburgh Sleep Quality Index (SAS and PSQI, respectively). RESULTS: A significant increment in anxiety and poor sleep quality was found in medical staff caring for COVID-19 patients. Anxiety levels in females were higher than males; however, poor sleep quality was somewhat higher in males vs. females but did not vary between age groups. Age was significantly negatively correlated with anxiety symptoms; individuals < 40 years old vs. ≥ 40 had more significant anxiety levels. We observed that medical staff with top-level salaries demonstrated a significant correlation (p = 0.028) between poor sleep quality and ill effects vs. those who had lower pay rates. A correlation between income and anxiety was not found. CONCLUSIONS: The higher the probability and intensity of exposure to coronavirus patients, the more noteworthy the danger that medical staff will experience the ill effects of mental issues.

Psychological impact of COVID-19 on emergency department healthcare workers in a tertiary care center during a national economic crisis.

BACKGROUND: Since the declaration of the novel Corona Virus Disease (COVID-19) as a global pandemic by the World Health Organization, frontline healthcare workers (HCWs) and staff in the Emergency Departments (ED) started experiencing feelings of anxiety and fear from the projected exponential spread and the potential burden on the healthcare system and infrastructure. In Lebanon, major local factors contributing to this fear were the rapid escalation of COVID-19 cases across the country, the lack of preparedness, and the shortage of personal protective equipment, in addition to the evolving economic crisis and financial restrictions. This study aims to investigate the immediate psychological impact of the COVID-19 outbreak on ED staff working in a hospital environment in relation to their household income. METHODS: Self-reported cross-sectional survey was delivered to the frontline staff working at the Department of Emergency Medicine of AUBMC in Beirut, Lebanon. General demographic characteristics, scores of Generalized Anxiety Disorder 7 (GAD-7), scores of Patient Health Questionnaire 9 (PHQ-9), and scores of Burnout Measure-Short (BMS) version were collected. RESULTS: 74 HCWs (49.6%) participated in the study. The mean age for participants was (31.78 ± 9.49). More than half of the participants were nurses and more than 70% reported a monthly salary of less than 2000 USD. The household income was negatively associated with the participants' scores on the GAD-7 and PHQ-9, but not the BMS. Previous mental health diagnosis was positively associated with the PHQ-9 and BMS scores, while seeking mental health care was negatively associated with the PHQ-9 and BMS scores. CONCLUSION: At our tertiary care center in a low-income, low resource country amidst the COVID-19 pandemic, the HCWs reported marked psychological disturbances on different scales. In particular, the financial burden was associated with increased anxiety and clinical depression, but was not associated with burnout.

COVID-19 pandemic and personal protective equipment: Evaluation of equipment comfort and user attitude.

This study aimed to evaluate the comfort of personal protective equipment (PPE) used during the COVID-19 and attitudes of healthcare professionals regarding the use of PPE. Descriptive research was conducted with 553 healthcare professionals, who work in a pandemic center in Turkey. Findings showed that all participants used masks, 99.3% wore gloves, 89% wore protective glasses, and 89% wore aprons during the COVID-19. The most-reported physical complaints have been dryness, irritation, and wound on the hands. Age and gender, as well as PPE discomfort, has been determined to affect the use of PPE. It might be concluded that age and sex, as well as the discomfort caused by PPE, affected the use of PPE and the attitudes of healthcare professionals.

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.

La seguridad psicológica del personal de salud durante la pandemia por COVID-19: aproximación epistemológica y sociológica / The psychological safety of health personnel during the COVID 19 pandemic: epistemological and sociological approach

La pandemia de COVID-19 pone en evidencia la importancia de los aspectos psicológicos y de salud mental para la prevención y afrontamiento de sus consecuencias. En este contexto se requiere de un modelo de Seguridad Psicológica (SP) que fundamente teórica y metodológicamente su gestión en una situación de emergencia sanitaria. El problema de la SP, visto desde una perspectiva transdisciplinar, intercepta aspectos relacionados con la epistemología y la sociología de la ciencia: análisis crítico del concepto a la luz de los aportes de otras disciplinas; relaciones entre el nivel de acceso al conocimiento y el funcionamiento de los equipos de trabajos; y contradicción entre la gestión neoliberal de la pandemia y la necesidad de un afrontamiento humanista. El objetivo del artículo es analizar, desde la perspectiva sociológica y epistemológica, la SP del personal de la salud en emergencias sanitarias, para lo cual se desarrolló una revisión narrativa. Como resultado, se presentan las reflexiones desarrolladas acerca del tema estructuradas en dos momentos: la aproximación crítica a la epistemología del concepto de SP y el impacto de la SP en los equipos de trabajo visto desde la concepción de la sociedad del conocimiento. Se enfoca la SP como un campo transdisciplinario y se valoran los antecedentes y aportes de otras disciplinas para su empleo en situaciones de emergencia y desastres. También se contrasta el afrontamiento a la COVID-19 desde la gestión neoliberal con su afrontamiento humanista. Finalmente, se presenta una nueva perspectiva de la SP para la gestión de la salud mental del personal de la salud involucrado en la respuesta a emergencias y desastres

The COVID-19 pandemic highlights the importance of psychological and mental health aspects for preventing and coping with its consequences. In this context, a model of Psychological Safety (PS) is required that theoretically and methodologically bases its management in a health emergency situation. The problem of PS, seen from a transdisciplinary perspective, intercepts aspects related to the epistemology and sociology of science: the critical analysis of the concept in light of the contributions of other disciplines; the relationships between the level of access to knowledge and the functioning of work teams and the contradiction between the neoliberal management of the pandemic and the need for a humanistic approach. The objective of the article is to analyze, from the sociological and epistemological perspective, the PS of health personnel in health emergencies, for which a narrative review was developed. As a result, the reflections developed on the subject structured in various moments are presented: the critical approach to the epistemology of the concept of PS; the impact of PS on work teams seen from the conception of the knowledge society. PS is approached as a transdisciplinary field and the antecedents and contributions of other disciplines are valued for its use in emergency situations and disasters. The coping with COVID-19 is also contrasted from that of neoliberal management with its humanistic coping. Finally, a new perspective of the PS is presented for the management of the mental health of the health personnel involved in the response to emergencies and disasters

Effect of Operating Room Personnel Generation on Perceptions and Responses to Surgeon Behavior.

BACKGROUND: Little is known regarding the impact of operating room (OR) personnel generation on their perceptions to various surgeon behaviors. We aimed to characterize these relationships by evaluating their responses to 5 realistic intraoperative scenarios. METHODS: Operating room personnel were asked to assess surgeon OR behavior across a standardized set of 5 scenarios via an online survey. For each scenario, respondents were asked to identify the behavior as either acceptable, unacceptable but would ignore, unacceptable and would confront the surgeon, or unacceptable and would report to management. Chi-squared analyses were used to compare responses to surgeon behavior with respondent generation. RESULTS: There were 3101 respondents, of which 41% of respondents were baby boomers (n = 1280), 31% were generation (Gen) X (n = 955), and 28% were Gen Y (n = 866). Overall, when compared to Gen X or Gen Y, baby boomers were significantly more likely to find surgeon behaviors of impatience (P < .001), being late for a case (P < .001), swearing in the OR (P < .001), and shouting with a bleeding patient (P = .001) to be inappropriate and would talk to the surgeon. Alternatively, Gen Y respondents were more likely to find fault with surgeon behaviors that deviate from rules and regulations, such as forgetting a time-out (P = .001), when compared to baby boomers and Gen X respondents. DISCUSSION: Results of our study demonstrate that OR personnel generation affects their perceptions and response to surgeon behavior. Understanding these tendencies can guide efforts to improve OR interactions among team members.