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Caring for a dying child can be an experience full of all kinds of negative emotions, pain and stress for the pediatric nurse. In this study, which was carried out in Turkey, we aimed to determine how nurses working in a pediatric intensive care unit remembered and made sense of their experiences regarding children's deaths. In-depth interviews were held with 13 nurses. The data were analyzed using the content analysis method. Three themes were identified. These were (1) Personal effects of death, (2) Difficulties in care, and (3) Coping with death. It was clear that the nurses were traumatised by their exposure to infant deaths. The findings showed that nurses experienced regret, fatigue and posttraumatic stress disorder. In addition, it was determined that nurses should be supported to cope with child deaths, which is a complicated process involving the child and the family, especially emotionally. Moreover, providing institutional support to nurses and referring them to cognitive-behavioral therapies may make it easier for them to cope with the emotional burden they carry, as well as the burnout they experience.

INTRODUCTION: Protecting health-care provider (HCP) well-being is imperative to preserve health-care workforce capital, performance, and patient care quality. Limited evidence exists for the long-term effectiveness of HCP well-being programs, with less known about physiotherapists specifically. PURPOSE: To review and synthesize qualitative research describing experiences of HCP, generate lessons learned from the greater population of HCP participating in workplace well-being programs, and then to inform programs and policies for optimizing psychological well-being in an understudied population of physiotherapists. METHODS: This qualitative meta-synthesis included a systematic literature search conducted in September 2020; critical appraisal of results; and data reduction, re-categorizing, and thematic extraction (reciprocal translation) with interpretive triangulation. RESULTS: Twenty-five papers met the inclusion criteria. Participants included physicians, nurses, and allied health providers. All programs targeted the individual provider and included psychoeducational offerings, supervision groups, coaching, and complementary therapies. Four themes were constructed: 1) beneficial outcomes across a range of programs; 2) facilitators of program success; 3) barriers to program success; and 4) unmet needs driving recommendations. CONCLUSIONS: The findings enhance our understanding of diverse individual-level programs to address HCP well-being. Beneficial outcomes were achieved across program types with system-level support proving critical; however, HCP described barriers to program success (HCP characteristics, off-site programs, institutional culture) and remaining needs (resources, ethical dissonance) left unaddressed. Organizations should offer individual-level programs to support physiotherapists in the short term while pursuing long-term, system-level change to address drivers of well-being.

[This is an excerpt.] The World Health Organization (WHO) declared 2020 as the Year of the Nurse and Midwife. Originally designated in recognition of Florence Nightingale’s 200th birthday, and intended to draw attention to the critical role of over 28 million nurses and nurse midwives worldwide, the WHO had little foresight into the significance of their declaration when they made their decision in 2019.1 Given the impact of the COVID pandemic, the WHO expanded the Year of the Nurse and Midwife to the Year of Health and Care Workers in 2021.2 The goal of this declaration was an expression of appreciation and gratitude for the unwavering service and dedication of health care workers during the COVID pandemic. Another objective was to engage stakeholders in a dialog focused on the protection of health care workers’ rights and the improvement of work and practice environments. While well intended, progress toward improved nursing workforce conditions has been slow to emerge, with little progress made thus far. [To read more, click View Resource.]

[This is an excerpt.] Despite fireworks, midnight kisses, black-eyed peas, and billions of people tuning into the Times Square ball drop, Jan. 1 is not unlike Dec. 31. We wake up in our same beds, find our same slippers, and fill our same coffee mugs. What distinguishes January is our perspective. It's the time of year for self-awareness and self-imposed change as we reflect on the year we've been through and prepare for the year ahead. The year 2023 was a doozy. We experienced the loss of two of my oldest son's best friends in a car crash just weeks before their high school graduation. Months later, I dropped one son off at college and helped the other son apply to go off to college this fall. Then we finished building and moving into our new home, an empty nester's oasis in the country. Looking back at 2023's dramatic events and milestones, I realize the year dialed up my burnout meter. Since well before COVID, I've been among the ever-growing ranks of burned-out EPs. Now I'm missing my son, and I have two friends who will never see their sons again. I see that the time we have with our kids is precious, and I find myself resenting EM for all the lost holidays, birthdays, and school events. [To read more, click View Resource.]

The COVID-19 pandemic has been distressing to health care professionals, causing significant burnout. Burnout has resulted in notable rates of mental health symptoms and job turnover. Hospitals have incorporated programming to meet the needs of health care professionals. A previously reported intervention at the study institution was a cognitive behavioral narrative writing program to target job-related stress. On the basis of participant feedback, psychoeducational seminars, psychotherapy drop-in sessions, and complementary interventions (mindfulness, yoga, and acupuncture) were also implemented to alleviate stress. This article is an update based on these year 2 augmentations. Participation in brief psychoeducational seminars and acupuncture was high, but engagement in other programming (individual psychotherapy and mindfulness) was poor. Hospitals should consider multimodal approaches to address pandemic-related stress and burnout. In addition to educational seminars, programs that address lasting distress should be offered to health care professionals. Targeting job-related burnout at organizational and systemic levels may ameliorate distress. This article discusses methods of integrating organizational programs into clinics.

In Measuring Trust: Where are we and where do we need to go? Drs. Platt and Taylor set out to address three issues which have fueled the propagation of trust measures:

1. The lack of conceptual clarity across measures
2. A lack of consensus around a single measure or set of measures
3. Trust may operate differently depending on who is trusting whom, and what the context is

The intended readers for this guide are (1) health system leaders, organizational leaders and others interested in adopting measures at their institutions, (2) health services researchers who may not be focused on the issue of trust as a primary area of expertise, but see it as an important variable or outcome of interest in their work, and (3) those interested in assessing measures to support a convergence of methods and/or processes for choosing how, when, and what aspects of trust are to be measured.  

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Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members.

To solve the nursing shortage and sustain a thriving workforce, it’s essential that new nurses transition to practice successfully. For three health systems, nurse residency programs are not only keeping nurses at the bedside but helping them build confidence and find belonging. Read on to learn how health systems from Los Angeles to Connecticut are forging a path forward for nurses at a time when their presence is needed more than ever.

In addition to pressures typical of other medical professions, family physicians face additional challenges such as building long-term relationships with patients, dealing with patients' social problems, and working at a high level of uncertainty. We aimed to assess the rate of burnout and factors associated with it among family medicine residents throughout Israel.

[This is an excerpt.] Physician burnout is a growing problem within the healthcare system and sports medicine physicians are not exempt. Burnout is a job-related, long-term stress reaction manifesting as emotional exhaustion, depersonalisation and feelings of decreased personal achievement which may occur simultaneously with depression. Its impact on the healthcare system is not trivial, contributing to decreased patient satisfaction and clinical productivity, and increased occupational/personal distress, medical errors, unprofessional behaviour and physician turnover. The authors approach this topic as physicians within the American Medical Society for Sports Medicine (AMSSM). Burnout is not unique to American physicians, thus, some of these principles will apply to sport and exercise medicine clinicians worldwide. Despite the emerging priority among healthcare organisations to mitigate burnout, rates are not decreasing. Various strategies for screening and addressing burnout exist, yet significant gaps exist in the current framework when applied to sports medicine. We highlight the need to recognise systemic factors contributing to burnout specific to sports medicine physicians, identify action items to address these factors within the healthcare system and provide resources for affected physicians. Sports medicine physicians are experts in non-surgical sports medicine, specialising in medical, musculoskeletal and biopsychosocial issues affecting physically active individuals, including competitive athletes. AMSSM members represent multiple primary specialties (table 1) and provide care across a range of clinical settings, delivering a variety of athlete care, team/event coverage and procedural expertise. [To read more, click View Resource.]

BACKGROUND: The impact of patient aggression on primary health care employees is underexplored, yet imperative to address, given high rates of burnout. OBJECTIVE: We qualitatively explore perceptions of patient aggression among staff in women's health primary care at the Veterans Health Administration (VA). Our objective is to identify coping strategies that staf devised in response to aggressive behavior. METHODS: We conducted semi-structured interviews with 60 VA women's health primary care employees in 2021 and 2022. Informed by the Job Demands-Resources theoretical model, we used rapid qualitative analysis to identify themes related to patient aggression and employee coping strategies. RESULTS: Disruptive behaviors reported by participants included verbal and physical aggression. Staff cited disruptive patient behavior as emotionally draining and perceived a lack of consequences for low-level aggression. Respondents used coping strategies in response to patient aggression at three time points: before, during, and after a negative interaction. At each point, support from team members emerged as a dominant coping mechanism, as well as rapport-building with patients. CONCLUSION: Patient aggression can negatively impact the work experiences of primary care employees. At VA, women's health primary care staff have devised multiple strategies to cope with these interactions. However, the ability to effectively prevent and manage patient aggression is limited by the lack of meaningful repercussions for aggression at the organizational level, which has important implications for employee well-being and retention. Retention of women's health employees in VA is critical given the need for a highly specialized workforce to address the complex health needs of women veterans.

[This is an excerpt.] What is meant by the term “DEI,” and why is it important? One of the most popular acronyms in modern-day society carries with it not only meaning but also charge to action. Diversity, equity, and inclusion (DEI) are most commonly represented as an acronym, but it is much more than three letters or words. It seeks to represent the importance of ensuring that groups of people working toward a common goal are diverse in identity, thought, and experience. Beyond identity, however, operationalizing principles of DEI requires a commitment to justice, safety, and accountability (Fig. 1). [To read more, click View Resource.]

BACKGROUND: Several studies show that intense work schedules make health care professionals particularly vulnerable to emotional exhaustion and burnout. OBJECTIVE: In this scenario, promoting self-compassion and mindfulness may be beneficial for well-being. Notably, scalable, digital app–based methods may have the potential to enhance self-compassion and mindfulness in health care professionals. METHODS: In this study, we designed and implemented a scalable, digital app–based, brief mindfulness and compassion training program called “WellMind” for health care professionals. A total of 22 adult participants completed up to 60 sessions of WellMind training, 5-10 minutes in duration each, over 3 months. Participants completed behavioral assessments measuring self-compassion and mindfulness at baseline (preintervention), 3 months (postintervention), and 6 months (follow-up). In order to control for practice effects on the repeat assessments and calculate effect sizes, we also studied a no-contact control group of 21 health care professionals who only completed the repeated assessments but were not provided any training. Additionally, we evaluated pre- and postintervention neural activity in core brain networks using electroencephalography source imaging as an objective neurophysiological training outcome. RESULTS: Findings showed a post- versus preintervention increase in self-compassion (Cohen d=0.57; P=.007) and state-mindfulness (d=0.52; P=.02) only in the WellMind training group, with improvements in self-compassion sustained at follow-up (d=0.8; P=.01). Additionally, WellMind training durations correlated with the magnitude of improvement in self-compassion across human participants (ρ=0.52; P=.01). Training-related neurophysiological results revealed plasticity specific to the default mode network (DMN) that is implicated in mind-wandering and rumination, with DMN network suppression selectively observed at the postintervention time point in the WellMind group (d=–0.87; P=.03). We also found that improvement in self-compassion was directly related to the extent of DMN suppression (ρ=–0.368; P=.04). CONCLUSIONS: Overall, promising behavioral and neurophysiological findings from this first study demonstrate the benefits of brief digital mindfulness and compassion training for health care professionals and compel the scale-up of the digital intervention. Clinical Trial: Trial Registration:   International Standard Randomized Controlled Trial Number Registry ISRCTN94766568, https://www.isrctn.com/ISRCTN94766568

IMPORTANCE: Creating an inclusive and equitable learning environment is a national priority. Nevertheless, data reflecting medical students’ perception of the climate of equity and inclusion are limited. OBJECTIVE: To develop and validate an instrument to measure students’ perceptions of the climate of equity and inclusion in medical school using data collected annually by the Association of American Medical Colleges (AAMC). DESIGN, SETTING, AND PARTICIPANTS: The Promoting Diversity, Group Inclusion, and Equity tool was developed in 3 stages. A Delphi panel of 9 members identified survey items from preexisting AAMC data sources. Exploratory and confirmatory factor analysis was performed on student responses to AAMC surveys to construct the tool, which underwent rigorous psychometric validation. Participants were undergraduate medical students at Liaison Committee on Medical Education–accredited medical schools in the US who completed the 2015 to 2019 AAMC Year 2 Questionnaire (Y2Q), the administrations of 2016 to 2020 AAMC Graduation Questionnaire (GQ), or both. Data were analyzed from August 2020 to November 2023. EXPOSURES: Student race and ethnicity, sex, sexual orientation, and socioeconomic status. MAIN OUTCOMES AND MEASURES: Development and psychometric validation of the tool, including construct validity, internal consistency, and criterion validity. RESULTS: Delphi panel members identified 146 survey items from the Y2Q and GQ reflecting students’ perception of the climate of equity and inclusion, and responses to these survey items were obtained from 54 906 students for the Y2Q cohort (median [IQR] age, 24 [23-26] years; 29 208 [52.75%] were female, 11 389 [20.57%] were Asian, 4089 [7.39%] were multiracial, and 33 373 [60.28%] were White) and 61 998 for the GQ cohort (median [IQR] age, 27 [26-28] years; 30 793 [49.67%] were female, 13 049 [21.05%] were Asian, 4136 [6.67%] were multiracial, and 38 215 [61.64%] were White). Exploratory and confirmatory factor analyses of student responses identified 8 factors for the Y2Q model (faculty role modeling; student empowerment; student fellowship; cultural humility; faculty support for students; fostering a collaborative and safe environment; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation) and 5 factors for the GQ model (faculty role modeling; student empowerment; faculty support for students; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation). Confirmatory factor analysis indicated acceptable model fit (root mean square error of approximation of 0.05 [Y2Q] and 0.06 [GQ] and comparative fit indices of 0.95 [Y2Q] and 0.94 [GQ]). Cronbach α for individual factors demonstrated internal consistency ranging from 0.69 to 0.92 (Y2Q) and 0.76 to 0.95 (GQ). CONCLUSIONS AND RELEVANCE: This study found that the new tool is a reliable and psychometrically valid measure of medical students’ perceptions of equity and inclusion in the learning environment.

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BACKGROUND: The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time.

BACKGROUND: To examine the effectiveness of interventions to ameliorate burnout, secondary traumatic stress, and emotional exhaustion in nurses and midwives. The systematic review was completed with all available studies that reported data on the effect of interventions that targeted burnout using the outcome measures of the Professional Quality of Life scale (ProQOL), or the Maslach Burnout Inventory (MBI). METHODS: We used a systematic review methodology, which included a meta-analysis. A total of 2103 articles resulted from the systematic search; 688 were removed as duplicates, and 1415 articles were reviewed by the title and abstract, of which 255 were eligible for full-text screening. Only 66 met the inclusion criteria and were included in the analysis. The final meta-analysis consisted of 33 reports divided into 12 studies for ProQOL and 21 studies for the MBI. RESULTS: The results provide an overall effect in studies using the ProQOL measurement was Z = 2.07 (P = 0.04) and a positive improvement mean difference of 9.32. The overall effect in studies using MBI was Z = 3.13 (P = 0.002) and a positive improvement mean difference of 6.58. CONCLUSIONS: Whilst most studies indicated a positive difference, the most effective interventions included clinical supervision or activities that addressed the personal physical and mental well-being of nurses. Less effective interventions were managerial interventions or ones that used a strictly educational approach.

Initiatives that promote mental well-being are formally recommended for all British workers, with many practices targeting change in individual workers' resources. While the existing evidence is generally positive about these interventions, disagreement is increasing because of concerns that individual-level interventions do not engage with working conditions. Contributing to the debate, this article uses survey data (N = 46,336 workers in 233 organisations) to compare participants and nonparticipants in a range of common individual-level well-being interventions, including resilience training, mindfulness and well-being apps. Across multiple subjective well-being indicators, participants appear no better off. Results are interpreted through the job demands–resources theory and selection bias in cross-sectional results is interrogated. Overall, results suggest interventions are not providing additional or appropriate resources in response to job demands.

Healthcare literature suggests that leadership behavior has a profound impact on nurse work-related well-being. Yet, more research is needed to better conceptualize, measure, and analyse the concepts of leadership and well-being, and to understand the psychological mechanisms underlying this association. Combining Self-Determination and Job Demands-Resources theory, this study aims to investigate the association between engaging leadership and burnout and work engagement among nurses by focusing on two explanatory mechanisms: perceived job characteristics (job demands and resources) and intrinsic motivation.

Ethics ratings of a diverse list of 23 professions are less positive than they have been in recent years, with eight establishing or tying record lows.

Burnout causes decreased job satisfaction, mental health issues, and leads to poor patient care. A large contributor is the electronic health record. Primary care providers from a medical group completed the Professional Fulfillment and Burnout Index survey showing high rates of burnout, and a scribe program was initiated. This quality improvement project evaluated the scribe program and its effects on burnout, documentation burden, and productivity for primary care physicians and nurse practitioners. Most participants had burnout. After using scribes, most had improved work-life balance. The scribe program was an important resource to prevent burnout related to the electronic health record.