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BMC Health Services Research Jul 2017Burnout among healthcare professionals is one of the key challenges affecting health care practice and quality of care. This systematic review aims to (1) estimate the... (Review)
Review
BACKGROUND
Burnout among healthcare professionals is one of the key challenges affecting health care practice and quality of care. This systematic review aims to (1) estimate the prevalence of burnout among health care professionals (HCP) in Arab countries; and (2) explore individual and work-related factors associated with burnout in this population.
METHODS
Multiple electronic databases were searched for studies published in English or Arabic from January 1980 to November 2014 assessing burnout (using the Maslach Burnout Inventory; MBI) amongst health care professionals (HCP) in Arab countries.
RESULTS
Nineteen studies (N = 4108; 49.3% females) conducted on HCP in Bahrain, Egypt, Jordan, Lebanon, Palestine, Saudi Arabia and Yemen were included in this review. There was a wide range of prevalence estimates for the three MBI subscales, high Emotional Exhaustion (20.0-81.0%), high Depersonalization (9.2-80.0%), and low Personal Accomplishment (13.3-85.8%). Gender, nationality, service duration, working hours, and shift patterns were all significantly associated with burnout.
CONCLUSIONS
Within the constraints of the study and the range of quality papers available, our review revealed moderate-to-high estimates of self-reported burnout among HCP in Arab countries that are similar to prevalence estimates in non-Arabic speaking westernized developed countries. In order to develop culturally appropriate interventions, further research using longitudinal designs is needed to confirm the risk factors for burnout in specific HCP settings and specialties in Arab countries.
Topics: Arabs; Burnout, Professional; Depersonalization; Fatigue; Female; Health Personnel; Humans; Male; Middle East; Prevalence; Risk Factors; Self Report
PubMed: 28716142
DOI: 10.1186/s12913-017-2319-8 -
Journal of Graduate Medical Education Jun 2017Studies report high burnout prevalence among resident physicians, with little consensus on methods to effectively reduce it. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies report high burnout prevalence among resident physicians, with little consensus on methods to effectively reduce it.
OBJECTIVE
This systematic literature review explores the efficacy of interventions in reducing resident burnout.
METHODS
PubMed, Embase, and Web of Science were searched using these key words: and , , or . We excluded review articles, editorials, letters, and non-English-language articles. We abstracted data on study characteristics, population, interventions, and outcomes. When appropriate, data were pooled using random effects meta-analysis to account for between-study heterogeneity. Study quality was assessed using Newcastle-Ottawa Scale (cohort studies) and Jadad scale (randomized control trials [RCTs]).
RESULTS
Of 1294 retrieved articles, 19 (6 RCTs, 13 cohort studies) enrolling 2030 residents and examining 12 interventions met criteria, with 9 studying the 2003 and 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour restrictions. Work hour reductions were associated with score decrease (mean difference, -2.73; 95% confidence interval (CI) -4.12 to -1.34; < .001) and lower odds ratio (OR) for residents reporting emotional exhaustion (42%; OR = 0.58; 95% CI 0.43-0.77; < .001); a small, significant decrease in depersonalization score (-1.73; 95% CI -3.00 to -0.46; = .008); and no effect on mean personal accomplishment score (0.93; 95% CI -0.19-2.06; = .10) or for residents with high levels of personal accomplishment (OR = 1.01; 95% CI 0.67-1.54; = .95). Among interventions, self-care workshops showed decreases in depersonalization scores, and a meditation intervention reduced emotional exhaustion.
CONCLUSIONS
The ACGME work hour limits were associated with improvement in emotional exhaustion and burnout.
Topics: Accreditation; Burnout, Professional; Education, Medical, Graduate; Humans; Internship and Residency; Physicians
PubMed: 28638506
DOI: 10.4300/JGME-D-16-00372.1 -
BMC Palliative Care May 2017The practice of continuous deep sedation is a challenging clinical intervention with demanding clinical and ethical decision-making. Though current research indicates... (Review)
Review
BACKGROUND
The practice of continuous deep sedation is a challenging clinical intervention with demanding clinical and ethical decision-making. Though current research indicates that healthcare professionals' involvement in such decisions is associated with emotional stress, little is known about sedation-related emotional burden. This study aims to systematically review the evidence on the impact of the inpatient practice of continuous deep sedation until death on healthcare professionals' emotional well-being.
METHODS
A systematic review of literature published between January 1990 and October 2016 was performed following a predefined protocol. MEDLINE, EMBASE, PubMed, Cochrane Library, CINAHL, Scopus, and PsycINFO were searched using search terms within "end-of-life care", "sedation", and "emotional well-being". Dissertations and reference lists were screened by hand. Two independent reviewers conducted study selection, data extraction and quality assessment. We abstracted measures of psychological outcomes, which were related to the practice of continuous deep sedation until death, including emotional well-being, stress and exhaustion. We used the GRADE approach to rate the quality of evidence.
RESULTS
Three studies remained out of 528 publications identified. A total of 3'900 healthcare professionals (82% nurses, 18% physicians) from Japan (n = 3384) and the Netherlands (n = 16) were included. The prevalence of sedation-related burden in nurses varied from 11 to 26%, depending on outcome measure. Physicians showed medium levels of emotional exhaustion and low levels of depersonalization. Common clinical concerns contributing to professionals' burden were diagnosing refractory symptoms and sedation in the context of possibly life-shortening decisions. Non-clinical challenges included conflicting wishes between patients and families, disagreements within the care team, and insufficient professionals' skills and coping. Due to the limited results and heterogeneity in outcome measure, the GRADE ratings for the quality of evidence were low.
CONCLUSIONS
Current evidence does not suggest that practicing continuous deep sedation is generally associated with lower emotional well-being of healthcare professionals. Higher emotional burden seems more likely when professionals struggled with clinical and ethical justifications for continuous deep sedation. This appeared to be in part a function of clinical experience. Further research is needed to strengthen this evidence, as it is likely that additional studies will change the current evidence base.
Topics: Death; Decision Making; Deep Sedation; Ethics, Medical; Health Personnel; Humans; Inpatients; Netherlands; Patient Care; Stress, Psychological
PubMed: 28482856
DOI: 10.1186/s12904-017-0205-0 -
Atencion Primaria Feb 2017To determine the risk factors and levels of burnout in Primary Care nurses. (Review)
Review
OBJECTIVE
To determine the risk factors and levels of burnout in Primary Care nurses.
METHODS
A systematic review was performed.
DATA SOURCES
CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015.
STUDY SELECTION
The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date.
DATA EXTRACTION
The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level.
RESULTS
Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout.
CONCLUSION
High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors.
Topics: Burnout, Professional; Humans; Primary Care Nursing; Risk Factors
PubMed: 27363394
DOI: 10.1016/j.aprim.2016.05.004 -
Medical Journal of the Islamic Republic... 2015Burnout is currently a major concern among physicians due to their high level of stress at work. There are several reports on various levels of burnout in residency...
BACKGROUND
Burnout is currently a major concern among physicians due to their high level of stress at work. There are several reports on various levels of burnout in residency programs due to several predisposing factors. The aim of this systematic review was to estimate a more precise prevalence of burnout among residents of obstetrics and gynecology.
METHODS
PubMed, Science Direct and Scopus were searched to identify peer-reviewed Englishlanguage studies published from January 1974 to 2005 reporting burnout among residents of obstetrics and gynecology. The key words used in the search were as follows: Residents, gynecology and obstetrics, professional burnout, depersonalization, distress, anxiety, or emotional exhaustion. Relevant additional articles were identified from the lists of the retrieved articles.
RESULTS
We identified 12 studies which met our criteria. A total of 2509 participants were included in this meta-analysis. The overall prevalence rate of burnout on all the three subscales was 44% (95% CI: 30 - 57) in this group of residents.
CONCLUSION
This meta-analysis revealed a high prevalence of burnout syndrome in residents during obstetrics and gynecology residency program. Therefore, it is recommended to consider and address this important issue to develop solutions and interventions which could improve the work condition of the medical residents.
PubMed: 26793673
DOI: No ID Found -
Deutsches Arzteblatt International Nov 2011"Burnout syndrome" is now a common reason for medical excuses from work, and thus an important topic in health-related economics. Much research is still needed, however,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
"Burnout syndrome" is now a common reason for medical excuses from work, and thus an important topic in health-related economics. Much research is still needed, however, to establish the scientific basis for this entity, the criteria by which it might be diagnosed and classified, and how it should be treated.
METHODS
A systematic review of this topic, previously published as an HTA report, is presented here together with a selective overview of pertinent literature.
RESULTS
There currently exists neither an officially accepted definition nor a valid instrument for the differential diagnosis of burnout syndrome. Its manifestations are generally considered to lie along three dimensions: emotional exhaustion, depersonalization, and reduced performance ability and/or motivation. Most of the available studies on its epidemiology and differential diagnosis provide no more than a low level of evidence for their conclusions. There have been no controlled trials of treatments for burnout.
CONCLUSION
High-quality controlled studies on burnout syndrome are lacking. A standardized and internationally accepted diagnostic instrument with a validated rating scale should be developed. There is also a need for epidemiological and health-economic studies on the prevalence, incidence, and cost of burnout. The etiology and pathogenesis of burnout should be studied with special regard to the possible role of neurobiological factors. Treatments for it should be studied systematically so that their effects can be judged at a high level of evidence. In view of the current lack of knowledge about what is called "burnout," the term should not be used as a medical diagnosis or as a basis for decisions regarding disability or other socioeconomic matters.
Topics: Burnout, Professional; Diagnosis, Differential; Humans; Prevalence; Risk Assessment
PubMed: 22163259
DOI: 10.3238/arztebl.2011.0781 -
Scandinavian Journal of Work,... Jun 2008This study evaluated the effectiveness of interventions in reducing stress at work among health care workers. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study evaluated the effectiveness of interventions in reducing stress at work among health care workers.
METHODS
A systematic search was conducted of the literature on reducing stress or burnout in health care workers. The quality of the studies found was then appraised and the results combined. A meta-analysis was performed when appropriate.
RESULTS
Altogether 14 randomized controlled trials, three cluster-randomized trials, and two crossover trials, comprising 2812 participants, were included. Only two trials were of high quality. The following comparisons were possible: person-directed interventions versus no intervention, person-work interface interventions versus no intervention, and organizational interventions versus no intervention. Person-directed interventions can reduce stress [standardized mean difference (SMD) -0.85, 95% confidence interval (95% CI) -1.21 - -0.49] and burnout, measured as emotional exhaustion [weighted mean difference (WMD) -5.82, 95% CI -11.02 - -0.63) and lack of personal accomplishment (WMD -3.61; 95% CI -4.65 - -2.58). They also reduce anxiety, measured as state anxiety (WMD -9.42, 95% CI -16.92 - -1.93) and trait anxiety (WMD -6.91, 95% CI -12.80 - -1.01). Person-work interface interventions can reduce burnout, measured as depersonalization [mean difference (MD) -1.14, 95% CI -2.18 - -0.10]. Organizational interventions can also reduce stress symptoms (MD -0.34; 95% CI -0.62 - -0.06) and general symptoms (MD -2.90, 95% CI -5.16 - -0.64). No harmful effects were reported.
CONCLUSIONS
Limited evidence is available for a small, but probably relevant reduction in stress levels from person-directed, person-work interface, and organizational interventions among health care workers. This finding should lead to a more-active stress management policy in health care institutions. Before large-scale implementation can be advised, larger and better quality trials are needed.
Topics: Burnout, Professional; Health Personnel; Humans; Occupational Diseases; Occupational Health; Stress, Psychological
PubMed: 18728906
DOI: 10.5271/sjweh.1240