Burnout and stress in group of psychiatrists: workload and non-professional-social predictors.

OBJECTIVES: The aim of this research is to present the search for psychosocial predictors explaining the strength of perceived stress in psychiatrists and the search for associations between stress and occupational burnout in psychiatrists. The authors also searched for associations between organizational, workload, family and non-professional - social factors and the intensity of occupational stress. MATERIAL AND METHODS: The group of 131 doctors - specialists in psychiatry, aged 27-86 years - took part in the study. The participants completed 3 questionnaires, i.e., the Sociodemographic Questionnaire, the Link Burnout Questionnaire (LBQ) and the Perceived Stress Scale (PSS-10). RESULTS: The results indicated that significant predictors of the development of occupational stress for psychiatrists were psychophysical exhaustion and lack of a sense of professional efficacy. Taking holidays (several times a year, pursuing the passions and interests), and having a stable family relationship (marriage or civil partnership) were also prominent among the predictors of stress. CONCLUSIONS: Occupational stress and burnout in the work of the surveyed psychiatrists appeared to be a high intensity phenomenon. These results indicate the need to spread preventive health care also in the work of psychiatrists. Mainly in terms of maintaining the right balance between work and rest, which can help to reduce stress levels and protect against further development of burnout syndrome. Family resources such as a stable marriage or partnership may also be a protective factor against the build-up of stress and burnout in psychiatrists (mainly female). In addition, professional resources (work experience measured by number of years of work) is also important in explaining stress levels in psychiatrists. Int J Occup Med Environ Health. 2023;36(3):379-95.

Association of workplace bullying and burnout with nurses' suicidal ideation in Bangladesh.

Suicidal ideation is a complex phenomenon influenced by several predisposing, contextual, and mediating factors that seem more common among healthcare workers, especially nurses. We investigated the association of bullying and burnout with suicidal ideation among Bangladeshi nurses and identified the associated factors. We conducted a cross-sectional study among 1264 nurses in Bangladesh between February 2021 and July 2021. We applied a modified Poisson regression model with robust error variance to determine the association of bullying and burnout with suicidal ideation. Among 1264 nurses, the female was 882 (70.02%), and the mean age was 28.41 (SD = 5.54) years. The prevalence of high levels of suicidal ideation was 13.26%. In the Poison regression model, high risk bullying (RR = 6.22, 95% CI 3.13-12.38), targeted to bullying (RR = 7.61, 95% CI 3.53-16.38), and burnout (RR = 8.95, 95% CI 2.84-28.20) were found to be significantly associated with suicidal ideation. Furthermore, we found significant interaction between workplace bullying and burnout with suicidal ideation (p < 0.05). The high prevalence of bullying, burnout, suicidal ideation, and their association indicate an unsafe workplace for the nurses. Initiatives are needed to make a favorable work environment to improve nurses' overall mental health and reduce suicide ideation.

Effect of an online Workplace Vocal Health and Low Stress Levels Promotion Program implemented in a Colombian university during COVID-19 pandemic.

PURPOSE: To determine the effect of an online Workplace Vocal Health and Low Stress Levels (WVHLS) Promotion Program implemented in a Colombian university during COVID-19 pandemic. METHODS: This research was a quasi-experimental study. Twenty-nine professors participated in this study within two groups: (1) intervention group (n=17) or (2) non-intervention group (n=12). Participants in the intervention group took part in four virtual sessions about how to improve vocal health and strategies to reduce stress levels during their homeworking and online classes. Teachers filled in a questionnaire including questions about working conditions, work-related stress, and the voice functioning (including the Vocal Fatigue Index-VFI). They also recorded a voice sample of a sustained vowel on two separate occasions (before and after the follow-up). RESULTS: At the end of the follow-up, there was a tendency to reduce Factor 1 of VFI in the intervention group. Although, all participants had a longer MPT at the end of the study compared with the baseline measures, males in the intervention group had longer MPT compared with other participants. CONCLUSION: Our results suggest a positive effect of a WVHLS promotion program on reducing vocal fatigue perception measured by means of the Vocal Fatigue Index and improving coordination and control of breathing speech measured MPT. These changes at the end of the follow-up may indicate that holistic programs that include voice care recommendations, breathing exercises, vocal warm-up, cold-down and laryngeal relaxation vocal exercises, and stress management may be beneficial for reducing work-related stress and voice symptoms among professors.

Job burnout among workers with different shift regularity: interactive factors between sleep, depression, and work environment.

Object: We investigated burnout and associated factors in non-shift workers (NSWs), shift workers with regular rotating shifts (RRSWs), and shift workers with irregular or unpredictable rotating shifts (IRSWs). Methods: In total, 5,125 adult workers (1,966 NSWs, 1,936 RRSWs, and 1,223 IRSWs) participated in an online self-reported survey. Job burnout and three dimensions thereof (exhaustion, cynicism, and professional efficacy) were assessed using the Maslach Burnout Inventory-General Survey (MBI-GS). The Center for Epidemiological Studies Depression Scale (CES-D) (depressive symptoms), Pittsburgh Sleep Quality Index (PSQI) (subjective sleep quality), and Korean Occupational Stress Scale (KOSS) (stressful job environment) were also used. Results: Both types of shift workers scored higher in terms of exhaustion, cynicism, and poor professional efficacy on the MBI-GS compared with NSWs after controlling for age and gender. IRSWs exhibited higher scores on the exhaustion and professional efficacy dimensions of the MBI-GS compared with RRSWs. After controlling for the CES-D and PSQI scores, we found no significant difference in cynicism among the groups. After controlling for the KOSS score, we found no significant difference in professional efficacy. All MBI-GS dimensional scores were correlated significantly with the CES-D, PSQI, and KOSS scores in all three groups. Conclusion: The job burnout level of rotating shift workers, especially those with irregular shifts, was higher than that of other workers. Cynicism in shift workers may be largely attributable to poor sleep or depression; the poor efficacy of shift workers may be explained by their stressful work environment.

Mental stress objective screening for workers using urinary neurotransmitters.

BACKGROUND: Almost 10% of the population develop depression or anxiety disorder during their lifetime. Considering that people who are exposed to high stress are more likely to develop mental disorders, it is important to detect and remove mental stress before depression or anxiety disorder develops. We aimed to develop an objective screening test that quantifies mental stress in workers so that they can recognize and remove it before the disorder develops. METHODS: We obtained urine specimens from 100 healthy volunteers (49 men and 51 women; age = 48.2 ± 10.8 years) after they received medical checks and answered the Brief Job Stress Questionnaire (BJSQ). Participants were divided into high- and low- stress groups according to their total BJSQ scores. We further analyzed six urinary neurotransmitters (dopamine, serotonin, 5-hydoroxyindoleacetic acid, gamma-aminobutyric acid, homovanillic acid, and vanillylmandelic acid) using liquid chromatography-mass spectrometry to compare their levels between the two groups. RESULTS: We obtained the concentrations of the six analytes from 100 examinees and revealed that the levels of urinary dopamine (p = 0.0042) and homovanillic acid (p = 0.020) were significantly lower in the high-stress group than those in the low-stress group. No biases were observed between the two groups in 36 laboratory items. The stress index generated from the six neurotransmitter concentrations recognized high-stress group significantly. Moreover, we discovered that the level of each urinary neurotransmitter changed depending on various stress factors, such as dissatisfaction, physical fatigue, stomach and intestine problems, poor appetite, poor working environments, sleep disturbance, isolation, worry, or insecurity. CONCLUSION: We revealed that urinary neurotransmitters could be a promising indicator to determine underlying mental stress. This study provides clues for scientists to develop a screening test not only for workers but also for patients with depression.

Measurement of work-related psychological injury with depressive symptoms.

OBJECTIVE: This study aimed to measure the level of psychological injury caused by work-related stress as well as the severity of depression among workers. METHOD: First, we conducted an online survey and recruited 500 workers diagnosed with depression or adjustment disorder to investigate what type of stress they experienced within six months before onset. Second, we conducted another online survey and recruited 767 participants who experienced some form of work-related stress. All the participants were classified into four groups by whether or not they were diagnosed with depression and whether or not they quit their jobs due to work-related stress. We used the Impact of Event Scale-Revised (IES-R) to measure psychological injury caused by work-related stressful events and the Patient Health Questionnaire (PHQ)-9 to assess the severity of depression. RESULTS: In study 1, 62.4% of workers diagnosed with depression or adjustment disorder experienced work-related stress within six months before onset. In study 2, the IES-R mean scores were 40.7 (SD = 23.1) for Group A (workers with depression and quit their jobs) and 36.67 (SD = 23.4) for Group B (workers with depression but stayed at their jobs), with both exceeding the cut-off point (24/25) of PTSD (Post-Traumatic Stress Disorder), while the mean score of Group C (workers who did not have depression but quit their jobs because of work-related stress) was 20.74 (SD = 21.2), and it was 13.89 (SD = 17.4) for Group D (workers who had work-related stress but stayed at their jobs), with both of them below the cut-off point of PTSD. The total scores of IES-R of Group A and Group B were significantly higher than those of Group C and Group D(p < 0.001). There was a significant positive correlation between the scores of IES-R and PHQ-9 for all four groups (r = 0.708). CONCLUSIONS: This study suggests that it is necessary to measure not only depressive symptoms but also the level of psychological injury resulting from stressful events in the workplace to assess workers with depression.

Determining the relative salience of recognised push variables on health professional decisions to leave the UK National Health Service (NHS) using the method of paired comparisons.

OBJECTIVE: The primary and secondary impacts from the COVID-19 pandemic are claimed to have had a detrimental impact on health professional retention within the UK National Health Service (NHS). This study set out to identify priorities for intervention by scaling the relative importance of widely cited push (leave) influences. DESIGN: During Summer/Autumn 2021, a UK-wide opportunity sample (n=1958) of NHS health professionals completed an online paired-comparisons exercise to determine the relative salience of work-related stress, workload intensity, time pressure, staffing levels, working hours, work-homelife balance, recognition of effort and pay as reasons why health professionals leave NHS employment. SETTING: The study is believed to be the first large-scale systematic assessment of factors driving staff exits from the NHS since the COVID-19 pandemic. RESULTS: All professions gave primacy to work-related stress, workload intensity and staffing levels. Pay was typically located around the midpoint of the respective scales; recognition of effort and working hours were ranked lowest. However, differences were apparent in the rank order and relative weighting of push variables between health professions and care delivery functions. Ambulance paramedics present as an outlier, notably with respect to staffing level (F-stat 4.47, p=0.004) and the primacy of work-homelife balance. Relative to staffing level, other push variables exert a stronger influence on paramedics than nurses or doctors (f 4.29, p=0.006). CONCLUSION: Findings are relevant to future NHS health professional retention intervention strategy. Excepting paramedics/ambulance services, rankings of leave variables across the different health professional families and organisation types exhibit strong alignment at the ordinal level. However, demographic differences in the weightings and rankings, ascribed to push factors by professional family and organisation type, suggests that, in addition to signposting universal (all-staff) priorities for intervention, bespoke solutions for different professions and functions may be needed.

Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs ('Resilience Hubs') using normalisation process theory.

OBJECTIVES: Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic. DESIGN: Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach. SETTING: Three Resilience Hubs in the North of England. PARTICIPANTS: Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63). RESULTS: Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs. CONCLUSIONS: Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context.

Paramedic perspectives of job stress: Qualitative analysis of high-stress, high-stakes emergency medical situations.

The time from when an ambulance paramedic receives the 911 alarm notification until they have determined the differential diagnosis of a patient is highly stressful. During this time, there is a high demand placed on the paramedic, and they have a low level of control. Recent advances in prehospital care that place more responsibility on paramedics have exacerbated this high-stress phenomenon. Twenty paramedics from across the United States were interviewed and evaluated using descriptive phenomenology to better understand one of the most stressful moments of high-stakes decision-making that paramedics regularly face. Using descriptive phenomenology, we identified six categories in the paramedics' interview responses: pressure, overwhelm, emotional extremes (with sub-categories of adrenaline rush and time-dilation), dissociation, multi-tasking, and disconnect. This analysis of the paramedic's lived experience of this high-stress, high-stakes phenomenon provides insight into how paramedics experience the unique stress of this phenomenon. This understanding is key to elucidating the effects of this acute stress that may impact the judgment and, ultimately, the care performed by the paramedic. Both early- and late-career paramedics from thirteen different states in all regions of the United States were interviewed. Further qualitative data from paramedics from a diverse range of regions and backgrounds are essential to identify ways in which to ameliorate the negative effects of acute stress experienced by paramedics. Addressing such issues will reduce turnover and burnout among paramedics.

The mediating role of job satisfaction and presenteeism on the relationship between job stress and turnover intention among primary health care workers.

BACKGROUND: Turnover problems among primary health care workers are a significant contributor to the shortage of health human resources. This study aims to determine the relationship between job stress and turnover intention among primary health care workers, as well as to examine the mediating effects of job satisfaction and presenteeism on this relationship. METHODS: Stratified random sampling and quota sampling were used to select 703 primary health care workers in Jilin Province, China in January 2020. Validated scales were used to measure turnover intention, job stress, job satisfaction, and presenteeism among primary health care workers. The study utilized a partial least squares structural equation modeling (PLS-SEM) approach to test the research hypotheses. RESULTS: The turnover intention score of primary health care workers in Jilin Province was 2.15 ± 1.03, and 19.5% of respondents reported a higher turnover intention. Significant sex and occupation differences were found, with a higher rate of turnover intention for male and doctor groups among primary health care workers. This study also revealed a positive correlation between job stress and turnover intention (ß = 0.235, P < 0.001), a significant negative correlation between job satisfaction and turnover intention (ß= -0.347, P < 0.001), and a significant positive correlation between presenteeism and turnover intention (ß = 0.153, P < 0.001). Moreover, the study revealed a significant indirect effect of job stress on turnover intention which was mediated by job satisfaction (ß = 0.183, P < 0.001) and presenteeism (ß = 0.078, P < 0.001). CONCLUSION: We confirmed the positive association between job stress and presenteeism with turnover intention, as well as the negative association between job satisfaction and turnover intention. Moreover, our study confirmed the mediating role of job satisfaction and presenteeism in the relationship between job stress and turnover intention. This study provides scientific evidence to address the turnover problem among primary health care workers.

Work-related factors and hair cortisol concentrations among men and women in emergency medical services in Sweden.

Ambulance personnel in emergency medical services are exposed to physical demands and stress during work, and an increased prevalence of ill health has been observed in this group. The aim was to compare hair cortisol concentration (HCC) among Swedish ambulance personnel with HCC in a population-based reference sample, to analyse differences between women and men, and differences due to work-related factors. Samples of hair 1 cm closest to the skin (5-10 mg) were collected and analysed for cortisol by radioimmunoassay. Moreover, the participants responded to a questionnaire regarding their work environment. The HCC among the ambulance personnel did not differ from the HCC in the population-based reference sample (median 19.2 vs. 22.2 pg/mg, p = 0.319), nor were there statistically significant differences between women and men. Furthermore, no associations were found between HCC and physical and psychosocial work demands, work stress, or rest and recovery from work. However, occupational balance was positively correlated with HCC (rp = 0.240; p = 0.044). The association remained statistically significant after adjustment for sex, age, hair bleaching, and corticosteroid treatment in a linear regression model. This study adds knowledge regarding HCC among ambulance personnel, and thus contributes to the overall picture of work environment and health for this group.

Work Intensification and Its Effects on Mental Health: The Role of Workplace Curiosity.

Work intensification is a psychosocial risk that has been increasing in recent decades and may have been accentuated after the COVID-19 pandemic. Its effects on health are negative, but they can be moderated by contextual and personal factors. The aim of this study was twofold: to analyze the effect of work intensification on workers' stress, anxiety, and depression and to explore the role of workplace curiosity in these relationships. The study design was cross-sectional, and a total of 766 Spanish workers (58.9% female) with different occupations completed the survey. The results showed that work intensification was associated with the symptomatology of stress, anxiety, and depression, with a medium effect size. Women workers showed higher work intensification, but its association with mental health was equally strong for both genders. Workers with higher levels of the workplace curiosity dimension "stress tolerance" showed less impaired mental health in the presence of work intensification. However, workers with higher levels of the workplace curiosity dimension "deprivation sensitivity" showed more symptoms of stress, anxiety, and depression when faced with high work intensification. The results were discussed in terms of their contributions to the field of study of work intensification, the future research they could inspire, and the prevention and intervention measures they could motivate.

Application of the 6S management strategies.

AIM: To explore the value of the 6S management strategies in COVID-19 wards. DESIGN: Nurses from the first Fujian medical team in aiding Hubei Province at Wuhan Jinyintan Hospital (2 February, 2020-24 March, 2020) were recruited and instructed to adopt the 6S management strategies for nursing management. METHODS: The paired-sample t-test was performed to compare the nursing quality, core capabilities of nurses, nursing preparation time, and nursing error rates before and after implementation. RESULTS: After implementation of the 6S management strategies, a total of 93 nurses experienced significant improvements in nursing quality, especially in workplace stress, material preparation, and medication management (p < .001). Adoption of the 6S model for nursing management in COVID-19 wards effectively improves nursing quality, enhances the core capabilities of nurses, reduces nursing preparation time, and lowers nursing error rates.

Attitudes of Employees in Unaccompanied Children's Shelters and Work-Related Stress During the COVID-19 Pandemic.

Data related to the stress of employees in shelters for unaccompanied minors are scarce, especially when considering the escalation of the refugee issue. This study analyzed aspects of this issue as it was carried out in child protection organizations in Greece, which is a country where a huge number of immigrants and refugees pass through and thousands of professionals are employed in this field.More specifically, the aim of this study was to examine the stress (general, perceived, work-related) and burnout symptoms of a specific group of employees exposed to the COVID-19 quarantine restrictions, employees at the 'front line' of care in shelters that host unaccompanied minors and teenagers.The study was carried out from March 2020 to December 2021, when social restrictions and other preventive measures were imposed. The study sample was recruited from non-governmental organizations and shelters for unaccompanied minors, in the urban area of the center of Athens, i.e. the International Organization for Migration, The Home Project, Arsis, Iliachtida, and Zeuxis. The sample consisted of employees at the 'front line' of care in shelters that hosted unaccompanied minors and teenagers. Participants were professionals whose duty was to deal with and respond to the needs of children and adolescents within the shelters they lived in. Participants completed the following questionaires before and after the pandemic restrictions: the Job Stress Measure (JSM), the Maslach Burnout Inventory (MBI), the Perceived Stress Scale (PSS), the Stress in General Scale (SiGS) and a questionnaire of 11-items regarding COVID-19, focusing on the professionals' perceived stress, working conditions, working demands and the impact of COVID-19 on all the aforementioned.The study sample consisted of 50 employees (40 females, 10 males; mean age ± SD 31.46 ± 7.91 years) in hostels for unaccompanied minors. A statistically significant difference was found only in SiGS, with increased stress after COVID-19 (p = 0.001). In terms of sex, significant differences were found at baseline in PSS and Emotional Exhaustion (p = 0.036 and p = 0.028, respectively) (females revealed higher levels than males). Age and educational level were factors that interacted with the increased levels in SiGS after COVID-19 (p = 0.015 and p = 0.006, respectively). Moreover, significant differences were found at baseline in PSS (p = 0.004), with higher levels observed in employees with higher education. Workers who did not work remotely had lower levels in Personal Accomplishment after COVID-19 compared to employees who worked remotely (p = 0.050). Interestingly, the JSM showed a tendency for decreased stress levels after the implementation of the quarantine, suggesting that the employees' work-related stress remained approximately at the same levels. On the other hand, perceived stress increased as the job demands remained the same, while social and personal outlet was in appeasement.The necessity for more research to be held among health professionals is evident and is also imperative to carry out interventional studies to manage stress and thus, provide better mental health services to unaccompanied minors. There is also need for further research in similar populations of professionals outside the urban context of Athens, i.e. in the Greek islands near the sea borders, where the refugees' entries are higher in number and more frequent.

A comparative study on patient safety culture among high-risk hospital staff in the context of the COVID-19 and non-COVID-19 pandemic: a cross-sectional study in Taiwan.

The study aimed to compare the evolution of patient safety culture perceived by high-risk hospital staff in the context of the COVID-19 pandemic and non-COVID-19 pandemic and to examine the variations in patient safety culture across demographic variables. The study found that the COVID-19 pandemic has significantly impacted patient safety culture in healthcare settings, with an increased focus on safety climate, job satisfaction, teamwork climate, stress recognition, and emotional exhaustion. Safety culture and work stress vary among medical professionals of different age groups. To reduce stress, workload should be minimized, work efficiency improved, and physical and mental health promoted. Strengthening safety culture can reduce work-related stress, improve job satisfaction, and increase dedication towards work. The study recommends interventions such as psychological and social support, along with emotional management training, to reduce emotional exhaustion. Healthcare institutions can set up psychological counseling hotlines or support groups to help medical professionals reduce stress and emotional burden.

Association between work stress and mental health in Chinese public health workers during the COVID-19 epidemic: mediating role of social support and self-efficacy.

Background: Little is known about the mediating mechanisms underlying the association between work stress and mental health, especially among primary public health workers (PHWs). We aimed to evaluated the association between work stress and mental health among PHWs, and explore the mediating roles of social support and self-efficacy. Methods: A large-scale cross-sectional survey was conducted among 3,809 PHWs from all 249 community health centers in 16 administrative districts throughout Shanghai, China. Pearson correlation and hierarchical linear regression were used to explore the associations among work stress, social support, self-efficacy and mental health. Structural equation modeling (SEM) was conducted to examine the mediation effects. Results: The prevalence of depression and anxiety symptoms among primary PHWs was 67.3 and 55.5%, respectively. There is a significant positive direct effect of work stress on mental health (ß = 0.325, p < 0.001). Social support and self-efficacy partially mediated the relationship between work stress and mental health, respectively. Meanwhile, the chained mediating effects of social support and self-efficacy also buffered the predictive effects of work stress on anxiety and depression symptoms (ß = 0.372, p < 0.001). Conclusion: Work stress has significant direct and indirect effects on mental health among primary PHWs. Enhancing social support and self-efficacy may be effective psychological interventions to mitigate the effects of work-related stress on mental health. These findings highlight the severity of mental health problems among primary public health workers and provide new evidence for early prevention and effective intervention strategies.

The prevalence of effort-reward imbalance and its associations with working conditions, psychosocial resources and burden among health care workers during the COVID-19 pandemic: Results of the egePan-Voice study.

OBJECTIVE: The association between a measure of effort-reward imbalance (ERI) and profession as well as gender in a sample of health care workers (HCW) during the first wave of the COVID-19 pandemic in Germany using the egePan-Voice study. In addition, we examined, which factors are associated with an effort-reward imbalance ratio (ERI ratio) >1. METHODS: In a large sample of HCW (N = 6174) we assessed occupational stress with the short version of the effort-reward imbalance (ERI) questionnaire, working conditions, COVID-19-related problems and psychosocial resources (ENRICHD Social Support Inventory, ESSI; Sense of Coherence Scale, SOC-3 and optimism, SOP2). RESULTS: The prevalence of a ERI ratio >1 among HCW was 50.9%. The prevalence's of an ERI ratio >1 were statistically significant different between gender as well as the occupational profession. The proportion of women (51.8%) with ERI ratio >1 was significantly higher than among men (47.8%). The highest ERI imbalance was found among nurses (62.8%), followed by medical technical assistants (MTA) (58.8%), while psychologists/psychotherapists revealed the lowest value (37.8%), followed by physicians (41.8%). In the total sample, most essential factors reported at this time for increased ERI ratio were: insufficient staff for the current work load, insufficient recovery, feeling insufficiently protected by measures taken by the hospital/the employer, high occupancy rate of the wards, insufficient trust in colleagues and being a nurse as compared with being a physician. CONCLUSION: The findings indicate a high proportion of HCW with effort-reward imbalance and substantial profession-related differences. Preventive interventions should be offered to vulnerable groups among the HCW to decrease the imbalance measured by work stress.

Occupational heat stress, heat-related effects and the related social and economic loss: a scoping literature review.

Introduction: While there is consistent evidence on the effects of heat on workers' health and safety, the evidence on the resulting social and economic impacts is still limited. A scoping literature review was carried out to update the knowledge about social and economic impacts related to workplace heat exposure. Methods: The literature search was conducted in two bibliographic databases (Web of Science and PubMed), to select publications from 2010 to April 2022. Results: A total of 89 studies were included in the qualitative synthesis (32 field studies, 8 studies estimating healthcare-related costs, and 49 economic studies). Overall, consistent evidence of the socioeconomic impacts of heat exposure in the workplace emerges. Actual productivity losses at the global level are nearly 10% and are expected to increase up to 30-40% under the worst climate change scenario by the end of the century. Vulnerable regions are mainly low-latitude and low- and middle-income countries with a greater proportion of outdoor workers but include also areas from developed countries such as southern Europe. The most affected sectors are agriculture and construction. There is limited evidence regarding the role of cooling measures and changes in the work/rest schedule in mitigating heat-related productivity loss. Conclusion: The available evidence highlights the need for strengthening prevention efforts to enhance workers' awareness and resilience toward occupational heat exposure, particularly in low- and middle-income countries but also in some areas of developed countries where an increase in frequency and intensity of heat waves is expected under future climate change scenarios.

The Mediating Role of Job Stress Between Organizational Climate and Work Alienation Among Nurses in Emergency Departments: A Cross-sectional Study.

BACKGROUND: Nurses suffer a certain degree of work alienation (a psychological state in which employees feel separated from their jobs because the jobs do not meet the needs of employees or do not match their expectations). It is necessary to identify predictors of work alienation and find effective interventions. OBJECTIVE: To explore the influence of organizational climate and job stress on work alienation among nurses in emergency departments. METHODS: This was a cross-sectional study conducted from June to August 2022. A convenience sampling method was adopted to invite 342 nurses from emergency departments in 12 tertiary public hospitals in 4 cities in China. Data were collected using self-reported questionnaires on organizational climate, job stress, and work alienation. Path analysis implemented by IBM AMOS 21.0 was used to explore the associations among organizational climate, job stress, and work alienation. RESULTS: Job stress can positively affect work alienation among nurses in emergency departments (ß = 0.44, P < .01). Organizational climate can directly and negatively affect work alienation (ß = -0.33, P < .01); it can also negatively and indirectly affect work alienation through job stress (ß = -0.20, 95% confidence interval: -0.252 to -0.146). CONCLUSIONS: Job stress partially mediated the effect of organizational climate on work alienation among nurses in emergency departments. The findings provided a valuable perspective on predictors of work alienation among emergency department nurses.

Reflections from the frontline of nursing on acute patient deterioration.

AIMS: To describe medical-surgical nurses' reflections on their experiences with patient deterioration. BACKGROUND: An extensive body of knowledge exists regarding optimal responses to acute patient deterioration within a hospital environment. Much less attention has focused on the profound psychological and emotional impact these experiences of unexpected deterioration can have on nurses who provided the supportive or rescue care. A triggering event, such as patient deterioration, or direct questioning about these experiences, can lead nurses to reflect further on the situation. Engaging in reflection is believed to enhance learning and improve clinical judgement when future complex situations arise. Findings related to nurses' reflective practice when recalling previous situations with deteriorating patients are limited. This gap in the literature provided the basis for the current project. DESIGN: A qualitative descriptive design. METHODS: Twenty medical-surgical nurses were interviewed in 2018. The nurses were recruited through purposive sampling. Semi-structured telephone interviews explored nurses' experiences of a patient deterioration. Conventional content analysis with iterative coding and categorising and theme development was used for data analysis. FINDINGS: Three themes emerged as participants reflected on their experiences. The themes were, Enduring frustration and regret, Feeling deeply responsible for and to the patient and Making sense of what happened. CONCLUSIONS: Medical-surgical nurses who care for acutely deteriorating patients can experience lasting emotional, psychological and physical concerns that often go unrecognised and untreated. Furthermore, nurses with this background commonly reported their perceived increased risk for workplace distress. RELEVANCE TO CLINICAL PRACTICE: Findings from this study are important for nurses, healthcare administrators and leaders, and patients. Participating in a rescue attempt often has a negative impact on nurses' perception of workplace stress and on persistent concerns about nurses' mental and physical health. The findings can be useful in informing additional studies about the phenomenon. Findings also can inform the exploration of workplace design. Organisations should assess for factors influencing workplace stress, develop strategies to mitigate the presence of workplace stress and foster nurses' well-being so they can respond to future scenarios of patient deterioration, while maintaining their physical and mental health. PATIENT OR PUBLIC CONTRIBUTION: This study did not include any patient or public input.