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Journal of Advanced Nursing Aug 2021To examine the nurses' burnout and associated risk factors during the COVID-19 pandemic. (Meta-Analysis)
Meta-Analysis Review
AIMS
To examine the nurses' burnout and associated risk factors during the COVID-19 pandemic.
DESIGN
We followed the Cochrane criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review and meta-analysis.
DATA SOURCES
PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, CINAHL and pre-print services (medRχiv and PsyArXiv) were searched from January 1 to November 15, 2020 and we removed duplicates.
REVIEW METHODS
We applied a random effect model to estimate pooled effects since the heterogeneity between results was very high.
RESULTS
Sixteen studies, including 18,935 nurses met the inclusion criteria. The overall prevalence of emotional exhaustion was 34.1%, of depersonalization was 12.6% and of lack of personal accomplishment was 15.2%. The main risk factors that increased nurses' burnout were the following: younger age, decreased social support, low family and colleagues readiness to cope with COVID-19 outbreak, increased perceived threat of Covid-19, longer working time in quarantine areas, working in a high-risk environment, working in hospitals with inadequate and insufficient material and human resources, increased workload and lower level of specialized training regarding COVID-19.
CONCLUSION
Nurses experience high levels of burnout during the COVID-19 pandemic, while several sociodemographic, social and occupational factors affect this burnout.
IMPACT
We found that burnout among nurses is a crucial issue during the COVID-19 pandemic. There is an urgent need to prepare nurses to cope better with COVID-19 pandemic. Identification of risk factors for burnout could be a significant weapon giving nurses and health care systems the ability to response in a better way against the following COVID-19 waves in the near future.
Topics: Burnout, Professional; Burnout, Psychological; COVID-19; Humans; Nurses; Pandemics; Risk Factors; SARS-CoV-2
PubMed: 33764561
DOI: 10.1111/jan.14839 -
International Journal of Environmental... Oct 2021Nursing is considered to be an at-risk profession of burnout due to daily exposure to difficult situations such as death and pain care. In addition, some units such as... (Meta-Analysis)
Meta-Analysis Review
Nursing is considered to be an at-risk profession of burnout due to daily exposure to difficult situations such as death and pain care. In addition, some units such as the intensive care unit (ICU), can be stressful due to high levels of morbidity and mortality and ethical dilemmas. Burnout causes a deterioration in quality of care, increasing the risk of mortality in patients due to poor performance and errors in the healthcare environment. The aim of this study was to analyse the levels, prevalence and related factors of burnout in ICU nurses. A systematic review and meta-analysis were carried out in the Medline, Scopus and CINAHL databases. Fifteen articles were found for the systematic review and four for the meta-analysis. With a sample of = 1986 nurses, the meta-analytic estimate prevalence for high emotional exhaustion was 31% (95% CI, 8-59%), for high depersonalization was 18% (95% CI, 8-30%), and for low personal accomplishment was 46% (95% CI, 20-74%). Within the dimensions of burnout, emotional exhaustion had a significant relationship with depression and personality factors. Both sociodemographic factors (being younger, single marital status, and having less professional experience in ICU) and working conditions (workload and working longer hours) influence the risk of burnout syndrome.
Topics: Burnout, Professional; Burnout, Psychological; Humans; Intensive Care Units; Nurses; Prevalence; Risk Factors
PubMed: 34769948
DOI: 10.3390/ijerph182111432 -
JAMA Sep 2018Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout... (Review)
Review
IMPORTANCE
Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.
OBJECTIVE
To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout.
DATA SOURCES AND STUDY SELECTION
Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018.
DATA EXTRACTION AND SYNTHESIS
Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively.
MAIN OUTCOMES AND MEASURES
Point or period prevalence of burnout assessed by questionnaire.
RESULTS
Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.
CONCLUSIONS AND RELEVANCE
In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
Topics: Burnout, Professional; Compassion Fatigue; Depersonalization; Humans; Job Satisfaction; Physicians; Prevalence; Surveys and Questionnaires
PubMed: 30326495
DOI: 10.1001/jama.2018.12777 -
JAMA Psychiatry Dec 2022Whether ketamine is as effective as electroconvulsive therapy (ECT) among patients with major depressive episode remains unknown. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Whether ketamine is as effective as electroconvulsive therapy (ECT) among patients with major depressive episode remains unknown.
OBJECTIVE
To systematically review and meta-analyze data about clinical efficacy and safety for ketamine and ECT in patients with major depressive episode.
DATA SOURCES
PubMed, MEDLINE, Cochrane Library, and Embase were systematically searched using Medical Subject Headings (MeSH) terms and text keywords from database inception through April 19, 2022, with no language limits. Two authors also manually and independently searched all relevant studies in US and European clinical trial registries and Google Scholar.
STUDY SELECTION
Included were studies that involved (1) a diagnosis of depression using standardized diagnostic criteria, (2) intervention/comparator groups consisting of ECT and ketamine, and (3) depressive symptoms as an efficacy outcome using standardized measures.
DATA EXTRACTION AND SYNTHESIS
Data extraction was completed independently by 2 extractors and cross-checked for errors. Hedges g standardized mean differences (SMDs) were used for improvement in depressive symptoms. SMDs with corresponding 95% CIs were estimated using fixed- or random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed.
MAIN OUTCOMES AND MEASURES
Efficacy outcomes included depression severity, cognition, and memory performance. Safety outcomes included serious adverse events (eg, suicide attempts and deaths) and other adverse events.
RESULTS
Six clinical trials comprising 340 patients (n = 162 for ECT and n = 178 for ketamine) were included in the review. Six of 6 studies enrolled patients who were eligible to receive ECT, 6 studies were conducted in inpatient settings, and 5 studies were randomized clinical trials. The overall pooled SMD for depression symptoms for ECT when compared with ketamine was -0.69 (95% CI, -0.89 to -0.48; Cochran Q, P = .15; I2 = 39%), suggesting an efficacy advantage for ECT compared with ketamine for depression severity. Significant differences were not observed between groups for studies that assessed cognition/memory or serious adverse events. Both ketamine and ECT had unique adverse effect profiles (ie, ketamine: lower risks for headache and muscle pain; ECT: lower risks for blurred vision, vertigo, diplopia/nystagmus, and transient dissociative/depersonalization symptoms). Limitations included low to moderate methodological quality and underpowered study designs.
CONCLUSIONS AND RELEVANCE
Findings from this systematic review and meta-analysis suggest that ECT may be superior to ketamine for improving depression severity in the acute phase, but treatment options should be individualized and patient-centered.
Topics: Humans; Electroconvulsive Therapy; Ketamine; Depressive Disorder, Major; Suicide, Attempted; Randomized Controlled Trials as Topic
PubMed: 36260324
DOI: 10.1001/jamapsychiatry.2022.3352 -
PloS One 2018Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA).
OBJECTIVE
To estimate burnout among different medical residency specialties.
METHODS
A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018. The following databases were accessed: Embase, PubMed, Web of Science, Google Scholar and Scopus, and 3,575 studies were found. Methodological quality was evaluated by Agency for Healthcare Research and Quality Methodology Checklist for Cross-Sectional/Prevalence Study. In the final analysis, 26 papers were included. Their references were checked for additional studies, but none were included.
RESULTS
4,664 medical residents were included. High DP, EE and low PA proportions were compared. Specialties were distributed into three groups of different levels of burnout prevalence: general surgery, anesthesiology, obstetrics/gynecology and orthopedics (40.8%); internal medicine, plastic surgery and pediatrics (30.0%); and otolaryngology and neurology (15.4%). Overall burnout prevalence found for all specialties was 35.7%.
CONCLUSION
The prevalence of burnout syndrome was significantly higher among surgical/urgency residencies than in clinical specialties.
PROSPERO REGISTRATION
CRD42018090270.
Topics: Burnout, Psychological; Depersonalization; Humans; Internal Medicine; Internship and Residency; Physicians; Prevalence; Specialties, Surgical
PubMed: 30418984
DOI: 10.1371/journal.pone.0206840 -
BMJ (Clinical Research Ed.) Sep 2022To examine the association of physician burnout with the career engagement and the quality of patient care globally. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To examine the association of physician burnout with the career engagement and the quality of patient care globally.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10.
RESULTS
4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08).
CONCLUSIONS
This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO number CRD42021249492.
Topics: Burnout, Professional; Burnout, Psychological; Emergency Medicine; Humans; Patient Care; Physicians; Surveys and Questionnaires
PubMed: 36104064
DOI: 10.1136/bmj-2022-070442 -
Scientific Reports Jul 2023Sporadic evidence exists for burnout interventions in terms of types, dosage, duration, and assessment of burnout among clinical nurses. This study aimed to evaluate... (Meta-Analysis)
Meta-Analysis
Sporadic evidence exists for burnout interventions in terms of types, dosage, duration, and assessment of burnout among clinical nurses. This study aimed to evaluate burnout interventions for clinical nurses. Seven English databases and two Korean databases were searched to retrieve intervention studies on burnout and its dimensions between 2011 and 2020.check Thirty articles were included in the systematic review, 24 of them for meta-analysis. Face-to-face mindfulness group intervention was the most common intervention approach. When burnout was measured as a single concept, interventions were found to alleviate burnout when measured by the ProQoL (n = 8, standardized mean difference [SMD] = - 0.654, confidence interval [CI] = - 1.584, 0.277, p < 0.01, I = 94.8%) and the MBI (n = 5, SMD = - 0.707, CI = - 1.829, 0.414, p < 0.01, I = 87.5%). The meta-analysis of 11 articles that viewed burnout as three dimensions revealed that interventions could reduce emotional exhaustion (SMD = - 0.752, CI = - 1.044, - 0.460, p < 0.01, I = 68.3%) and depersonalization (SMD = - 0.822, CI = - 1.088, - 0.557, p < 0.01, I = 60.0%) but could not improve low personal accomplishment. Clinical nurses' burnout can be alleviated through interventions. Evidence supported reducing emotional exhaustion and depersonalization but did not support low personal accomplishment.
Topics: Humans; Burnout, Professional; Emotions; Mindfulness; Achievement; Nurses
PubMed: 37414811
DOI: 10.1038/s41598-023-38169-8 -
International Journal of Environmental... Oct 2021Physician's burnout has been recognized as an increasing and significant work-related syndrome, described by the combination of emotional exhaustion (EE) and... (Review)
Review
Physician's burnout has been recognized as an increasing and significant work-related syndrome, described by the combination of emotional exhaustion (EE) and depersonalization (D), together with low personal accomplishment (PA). It has many negative consequences on personal, organizational, and patient care levels. This systematic review aimed to analyze research articles where psychological interventions with elements of mindfulness (PIMs) were used to support physicians in order to reduce burnout and foster empathy and well-being. Systematic searches were conducted in May 2019, within six electronic databases PubMed, EBSCOhost MEDLINE, PsycArticles, Cochrane Library, JSTOR, and Slovenian national library information system. Different combinations of boolean operators were used-mindfulness, empathy, medicine/family medicine/general practice/primary care, burnout, doctors/physicians, intervention, and support group. Additional articles were manually searched from the reference list of the included articles. Studies with other healthcare professionals (not physicians and residents) and/or medical students, and those where PIMs were applied for educational or patient's treatment purposes were excluded. Of 1194 studies identified, 786 screened and 139 assessed for eligibility, there were 18 studies included in this review. Regardless of a specific type of PIMs applied, results, in general, demonstrate a positive impact on empathy, well-being, and reduction in burnout in participating physicians. Compared with other recent systematic reviews, this is unique due to a broader selection of psychological interventions and emphasis on a sustained effect measurement. Given the pandemic of COVID-19, it is of utmost importance that this review includes also interventions based on modern information technologies (mobile apps) and can be used as an awareness-raising material for physicians providing information about feasible and easily accessible interventions for effective burnout prevention and/or reduction. Future research should upgrade self-reported data with objective psychological measures and address the question of which intervention offers more benefits to physicians.
Topics: Burnout, Professional; Burnout, Psychological; COVID-19; Empathy; Humans; Mindfulness; Physicians; Psychosocial Intervention; SARS-CoV-2
PubMed: 34769700
DOI: 10.3390/ijerph182111181 -
International Journal of Environmental... Oct 2020Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development.... (Meta-Analysis)
Meta-Analysis
Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development. Thus, it is important to analyze the prevalence and risk factors of burnout in palliative care nurses and estimate its prevalence. A systematic review and meta-analysis was done with quantitative primary studies. = 15 studies were included with = 6 studies including information for the meta-analysis. The meta-analytic prevalence estimation of emotional exhaustion was 24% (95% CI 16-34%), for depersonalization was 30% (95% CI 18-44%) and for low personal accomplishment was 28% with a sample of = 693 palliative care nurses. The main variables related with burnout are occupational variables followed by psychological variables. Some interventions to improve working conditions of palliative care nurses should be implemented to reduce burnout.
Topics: Adult; Burnout, Professional; Female; Humans; Male; Middle Aged; Nurses; Palliative Care; Prevalence; Quality of Life
PubMed: 33096682
DOI: 10.3390/ijerph17207672 -
Frontiers in Psychiatry 2023Stress in the healthcare environment causes negative effects in nurses such as burnout, anxiety, and depression. The COVID-19 pandemic has resulted in increased pressure...
BACKGROUND
Stress in the healthcare environment causes negative effects in nurses such as burnout, anxiety, and depression. The COVID-19 pandemic has resulted in increased pressure on medical staff globally, highlighting the potential benefits of mindfulness-based interventions in reducing nurses' stress levels. Despite numerous studies exploring the effect of mindfulness-based training on nurses, the results remain inconclusive.
OBJECTIVE
To systematically evaluate the impact of mindfulness training on nurse's performance and increase the certainty of existing evidence.
METHODS
This study searched various databases, including EBSCO, Embase, Web of Science, PubMed, ProQuest, Scopus, Cochrane Online Library, Wanfang, SinoMed, CNKI, and VIP, for randomized controlled trials on the impact of mindfulness-based interventions for nurses up until 02 December 2022. Two investigators independently screened and extracted data from the articles, while also assessing the risk of bias. The data was analyzed using RevMan 5.4 software.
RESULTS
This review identified 15 studies out of the 2,171 records retrieved, consisting of a total of 1,165 participants who were randomized. Post-intervention analysis provided very-low certainty evidence of moderate effectiveness of mindfulness-based training in reducing stress [standardized mean difference (SMD) = -0.81; 95% confidence interval (CI) = -1.11 to -0.52], with no significant effect on anxiety (SMD = -0.30; 95% CI = -0.72 to 0.13) or depression (SMD = -0.24; 95% CI = -0.55 to 0.07). However, the training was effective in reducing burnout, as demonstrated by the lower scores for emotional exhaustion (SMD = -4.27; 95% CI = -5.94 to -2.59) and depersonalization (SMD = -2.89; 95% CI = -4.24 to -1.54) and higher scores for personal accomplishment (SMD = 2.81; 95% CI = 0.12 to 5.50). There was a sustained improvement in stress levels in the short-term (≤3 months), with delayed benefits for burnout. However, only two studies were available for later follow-ups, and there was no significant evidence of long-term effects.
CONCLUSION
Mindfulness-based training may be a viable intervention for improving the psychological wellbeing of nurses, including reducing stress, burnout.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023387081.
PubMed: 37599884
DOI: 10.3389/fpsyt.2023.1218340