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Public safety personnel (PSP) are required to make decisions that can violate their moral standards, and they and are also disproportionately exposed to other morally challenging events that may increase their vulnerability to experiencing moral injury (MI). Yet, there is little research exploring moral pain in PSP and no existing instruments to identify MI in PSP. Here, the Moral Injury Assessment for PSP was developed and piloted with 270 Canadian and American PSP. Factor analytic results revealed 3 distinct factors related to the experience of MI for PSP: Perpetrations, Betrayals, and Emotional sequelae. The emergence of these factors replicates the perpetration and betrayal dimensions of MI established in other populations and adds to the emerging body of literature seeking to identify a consistent symptom profile of MI. Our results preliminarily suggest strong reliability (i.e., internal consistency and item–total correlation) and excellent construct validity when compared with other measures of psychological stress. This work advances our understanding of MI and the unique challenges experienced by PSP and highlights the need for future work aimed at assessing and treating MI in PSP populations.

OBJECTIVE: To decrease the electronic health record (EHR) clerical burden and improve patient/clinician satisfaction, allied health staff were trained as visit facilitators (VFs) to assist the physician in clinical and administrative tasks. PATIENTS AND METHODS: From December 7, 2020, to October 11, 2021, patients with complex medical conditions were evaluated by an internal medicine physician in an outpatient general internal medicine (GIM) consultative practice at a tertiary care institution. A VF assisted with specific tasks before, during, and after the clinical visit. Presurvey and postsurvey assessments were performed to understand the effect of the VF on clinical tasks as perceived by the physician. RESULTS: A total of 57 GIM physicians used a VF, and 41 (82%) physicians and 39 (79%) physicians completed the pre-VF and post-VF surveys, respectively. Physicians reported a significant reduction in time reviewing outside materials, updating pertinent information, and creating/modifying EHR orders (P<.05). Clinicians reported improved interactions with patients and on-time completion of clinical documentation. In the pre-VF survey, “too much time spent” was the most common response for reviewing outside material, placing/modifying orders, completing documentation/clinical notes, resolving in-baskets, completing dismissal letters, and completing tasks outside of work hours. In the post-VF survey, “too much time spent” was not the most common answer to any question. Satisfaction improved in all areas (P<.05). CONCLUSION: VFs significantly reduced the EHR clinical burden and improved GIM physician practice satisfaction. This model can potentially be used in a wide range of medical practices.

Racial and ethnic disparities are well described in paediatric cardiac critical care outcomes. However, understanding the mechanisms behind these outcomes and implementing interventions to reduce and eliminate disparities remain a gap in the field of paediatric cardiac critical care. The Pediatric Cardiac Critical Care Consortium (PC4) established the Equity, Diversity, and Inclusion (EDI) Committee in 2020 to promote an equity lens to its aim of improving paediatric cardiac critical care quality and outcomes across North America. The PC4 EDI Committee is working to increase research, quality improvement, and programming efforts to work towards health equity. It also aims to promote health equity considerations in PC4 research. In addition to a focus on patient outcomes and research, the committee aims to increase the inclusion of Black, Indigenous, and People of Color (BIPOC) members in the PC4 collaborative. The following manuscript outlines the development, structure, and aims of the PC4 EDI Committee and describes an analysis of social determinants of health in published PC4 research.

PURPOSE: Burnout has been well examined among physicians and other high-wage, high-autonomy healthcare positions. However, lower-wage healthcare workers with less workplace autonomy (e.g., medical assistants, nurses’ aides) represent a substantial proportion of the workforce, but remain understudied. We aimed to examine the effects of burnout on psychotropic medication use and misuse and whether these effects differed by occupational level. METHODS: In March 2022, we collected data from a diverse sample of US healthcare workers (N = 200) and examined the cross-sectional relationship between burnout and changes in prescribed psychotropic medication (i.e., starting, stopping, and/ or having a change in the dose/frequency) during the COVID-19 pandemic. We also separately examined the relationship between burnout and psychotropic medication misuse (i.e., without a prescription, in greater amounts, more often, longer than prescribed, and/or for a reason other than prescribed). We stratified models by occupational level (prescribers/healthcare administrators vs. other healthcare workers). RESULTS: Greater burnout was associated with higher odds of changes in prescribed psychotropic medication among prescribers/healthcare administrators (aOR = 1.23, 95% CI 1.01, 1.48), but not among other healthcare workers (aOR = 1.04, 95% CI 0.98, 1.10). Greater burnout was not associated with psychotropic medication misuse among prescribers/healthcare administrators (aOR = 0.96, 95% CI 0.82, 1.12) but was associated with increased odds of psychotropic medication misuse among other healthcare workers (aOR = 1.07, 95% CI 1.01, 1.14). CONCLUSIONS: Potential disparities in help-seeking and healthcare access might manifest in non-medical use of prescription drugs among some healthcare workers, which has implications for worker safety and well-being.

Digital tools play a big part in making the experience of being a clinician overwhelming. Digital minimalism may offer a remedy.

Victim support entails one of the most intense stress- and trauma-laden interactions faced by law enforcement professionals, and this function or role frequently triggers long-lasting negative effects on officers’ psychological health and wellbeing. As police officers interact daily with victims, but also with other officers, social services, and institutions, the limits between tasks and needs may directly affect how they manage stress, trauma, and notions of individual and organisational responsibility. As such, boundary work may be a useful framework to understand and even improve how victim support police officers interact with other individuals and organisations. Drawing from a ground-breaking qualitative, in-depth research with police officers that provide support to victims of gender-based and domestic violence, this paper analyses conscious and unconscious boundaries as key elements in the officers’ wellbeing. Informed by the empirical findings of a case study of Catalonia's Mossos d’Esquadra police corps, this paper explores how victim support officers negotiate their individual and organisational boundaries as they interact with other agents and institutions, and how these negotiations affect them. This paper argues for the relevance of an officer's agency and discretion for distinguishing between conscious and unconscious boundaries, as their limits may be blurred throughout the wide range of interactions.

BACKGROUND: The aim was to determine what factors drive and enhance compassionate care behaviors in the ICU setting and which factors drain and negate such caring attitudes and behaviors. METHODS: Qualitative, focus group discussions using video vignettes. 20 participants agreed to be part of 3 separate focus groups facilitated by the authors. RESULTS: Thematic analysis revealed emphasis on behavior and nonverbal cues, clinical decision making, communication and sensitivity, and building humane relations. The results show that physicians feel driven by the humanity and sensitivity felt in ICU work, however, there exists structural incompetence, as well as the stress and personal -systemic imbalances of ICU work, which leads to burnout and erosion of such motivations, draining compassion. CONCLUSIONS: Regulatory and scheduling practices must be examined to foster the growth of compassionate behaviors and attitudes in healthcare, and these should be treated as essential patient centered metrics.

BACKGROUND: With more than 50% of anesthesiology residents reporting burnout, many residency programs have begun creating wellness programs to address burnout and promote well-being. However, to date, many wellness initiatives have focused on individual strategies rather than systems approaches to improve the learning environment. Individual-focused interventions in the absence of systematic efforts can lead to resentment, resistance, and worsening burnout and precipitate a loss of trust in leadership and the organization. Here, we describe a process to engage anesthesiology residents, who are key stakeholders, by exploring their perspectives on burnout and well-being to better inform systematic interventions to improve the clinical work and learning environments. METHODS: We conducted semistructured interviews with second- and third-year clinical anesthesia residents at the University of California, San Francisco, using the areas of worklife model as sensitizing concepts. We conducted a thematic analysis on transcribed interviews grounded in constructivist orientation. RESULTS: We identified the following 3 major categories of themes based on interviews with 10 residents: (1) definition of well-being, (2) challenges to well-being, and (3) strategies for coping with challenges and burnout. Challenges described by anesthesiology residents align with the areas of the worklife model, with the coronavirus disease 2019 pandemic precipitating additional threats in the domains of workload and community. CONCLUSIONS: Anesthesiology residents’ definition of well-being includes both individual (resilience) and systemic (meaning in work, job autonomy, and control) factors, reaffirming that positive work and learning environments are critical to professional well-being.

In response to a high turnover rate and staggering orientation costs for new nurses in the cardiothoracic ICU, leaders at one organization developed a dual-role initiative that decreased overall turnover and nurses' desire to leave and increased overall job satisfaction.

BACKGROUND: As the practice of cardiothoracic surgery continues to evolve, the optimal training model represents an area of uncertainty. We sought to describe and to compare the early career experiences of cardiothoracic surgery graduates from the 3 training models. METHODS: An anonymous survey with questions pertaining to an individual's demographic characteristics, training model, first employment experience, experience as junior faculty, career satisfaction, and personal reflection was sent to graduates from US cardiothoracic surgery training programs between 2012 and 2020. Respondents completed a traditional fellowship (2-3 years), a 4+3 model, or an integrated 6-year (I-6) residency. RESULTS: Of the 670 graduates who received the survey, there were 267 (40%) respondents. Of these, 209 (78%) respondents graduated from a traditional fellowship, 27 (10%) respondents graduated from a 4+3 pathway, and 31 (12%) respondents graduated from an I-6 residency. There was no difference in overall satisfaction, major case volume, operative autonomy, burnout, and lifestyle satisfaction between the models (P>.05). When respondents were asked about the ideal model, the 4+3 and I-6 models were favored by its graduates, regardless of the surgeons’ field of practice. CONCLUSIONS: Important early career outcomes were not different between graduates of traditional, 4+3, or I-6 models. Most graduates of the 4+3 and I-6 models believe these are the ideal training models, regardless of their field of practice.

PURPOSE: A successful surgical residency program prepares graduates not only in technical skills and patient care, but also in teamwork and communication. The daily demands on faculty and residents create challenges in making time for discussion and reflection, to enhance and improve residency training and work culture. Organized departmental retreats provide a forum to address different facets of training. METHODS: To provide time to cultivate discussion and longitudinally improve the surgery residency experience, the authors’ program created an annual half-day education retreat for surgical residents and faculty. Clinical activities were limited during this time to allow for attendance. Each retreat focused on a particular topic and consisted of a guest speaker lecture, breakout discussion sessions, and final debriefing as a department. Surgical education retreat objectives and content focus on core pillars of professional development including but not limited to technical skills, building knowledge base, feedback, and teamwork. RESULTS: Since 2003, annual surgical education retreats have been organized at the authors’ institution. In particular, the retreat focusing on wellness in 2016 resulted in the establishment of a formal wellness program consisting of a variety of departmental efforts to mitigate resident burnout and promote wellness. CONCLUSION: Structured retreats support discussions within the department to promote education and collaboration. The positive impact of these events can provide long-term improvements in surgery residency programs, and can be applied to any training specialty.

BACKGROUND: Physician burnout impacts all levels of medical education and has a relatively unknown impact on those responsible for medical student education, particularly in paediatrics. This study examines the prevalence of burnout among paediatric undergraduate medical educators and explores the impact of roles in medical education on medical educator burnout. METHODS: This cross-sectional mixed-methods study utilised a binational survey of paediatricians involved in undergraduate medical education. Respondents answered demographics, standardised questions about burnout and attitudes towards students, and an open-ended probe about interactions between medical student education and wellness. FINDINGS: Of 445 possible, 120 (26.9%) responded to demographic and burnout questions. Of these, 23.3% endorsed burnout, 21.7% high emotional exhaustion (EE) and 10.8% high depersonalisation (DP). High levels of student-related burnout symptoms were reported by fewer than 5% of respondents and were correlated with overall EE and DP. Content analysis revealed four emergent themes: positive effect of student-related role, need to balance medical education and clinical roles, impact of protected time and medical education-related autonomy on educator well-being, and the burden of the administrative portion of educational roles. DISCUSSION: Participating paediatric educators had low rates of burnout compared with paediatricians as a whole in prior studies. The vast majority found working with students rewarding and described the overall positive impact of their medical education role on wellness. CONCLUSION: Physician involvement in rewarding non-clinical activities may improve their overall well-being. Providing dedicated time for these activities may ameliorate the difficulty that many medical educators described in balancing their clinical and educational roles. Future studies should continue to explore how we can better support medical educators and the impact of this support on burnout.

We examine how the Affordable Care Act Medicaid expansion affected the insurance coverage and the sources of coverage among low-income nursing home aides using the 2010–2019 American Community Survey data. Insurance coverage for low-income nursing home aides increased from about 60% to nearly 90% in expansion states but rose to only about 80% in nonexpansion states. Using a difference-in-differences regression design, we find that Medicaid expansion was associated with a 5.1 percentage-point increase in overall insurance coverage. Expansion states had a 12.2 percentage-point gain in Medicaid that was partially offset by a 6.4 percentage-point reduction in private insurance coverage. Our results show that ACA Medicaid expansion increased insurance coverage for low-income nursing home aides; however, there was substantial crowd-out of private insurance coverage in this population. Policymakers should consider expanding Medicaid while incentivizing affordable private health insurance options for low-income nursing home aides to improve insurance coverage.

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Strengthen Worker Compensation and Benefits).

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BACKGROUND: Nursing students experience higher stress and burnout compared to students in other health professions, with a prevalence rate of as high as 20%. More recently, they have been affected by changes in nursing education due to the COVID-19 pandemic, such as requirements for social isolation and distance learning. Although there are existing studies on interventions that address academic burnout among nursing students, there is no synthesis of randomized trials on this topic. Aim This study aimed to systematically synthesize studies of interventions for academic burnout among nursing students. METHODS: A systematic search for randomized controlled trials was performed in PubMed, CINAHL, CENTRAL, Web of Science, and Scopus. Eligibility criteria were based on study directness in relation to the Patient, Intervention, Comparison, and Outcome (PICO) question. Two review authors independently screened articles for inclusion, collected data from the included studies, and performed risk of bias assessments using the Cochrane Risk of Bias Tool 2.0. A narrative synthesis was performed. This review was registered a priori in PROSPERO (CRD42022350196). RESULTS: Six papers were included in this review. Various interventions were studied: Qigong exercises, progressive muscle relaxation, autogenic therapy and laughter therapy, didactic behavioral sessions focusing on personal and professional development, and coping skills enhancement. The effects of these interventions on academic burnout, depression, and stress among nursing students were short term and their benefits over time remain uncertain. LINKING EVIDENCE TO ACTION: Progressive muscle relaxation and cognitive behavioral interventions demonstrated short-term positive effects on academic burnout, depression, and stress among nursing students. These findings may support the development of individual-level and organizational-level initiatives for nursing students aimed to lessen or prevent academic burnout. Large-scale, high-quality studies on the effect of interventions on academic burden in various settings and cultures are needed.

OBJECTIVES: Professional burnout has been a significant problem for the US healthcare workforce for years, and particularly during the COVID-19 pandemic. It is known that mindfulness-based interventions (MBIs) can reduce stress and symptoms of burnout in healthcare workers. We aimed to assess the effectiveness of group mindfulness-based interventions on individuals who attended prior to the COVID-19 pandemic, and those who attended intra-pandemic. METHODS: Validated survey instruments were administered to participants before and after the courses to assess stress, mindfulness and burnout. Mean scores were compared between groups at baseline. Pre- and post-course responses were gathered and compared within both the pre-pandemic and intra-pandemic cohorts, and within-group effect sizes were calculated. Finally, the change in effect size was calculated between the pre-pandemic and intra-pandemic conditions. RESULTS: Mindfulness groups were associated with significant score changes on specific mindfulness skills (Observe, Act with Awareness, Non-Judge) within both the pre-pandemic and intra-pandemic time periods. The effectiveness of mindfulness skill acquisition varied between these conditions. Mindfulness courses were more effective at reducing stress and burnout during COVID-19, compared with the pre-pandemic time. CONCLUSIONS: Our results demonstrate the adaptability and effectiveness of mindfulness-based interventions in reducing symptoms of stress and burnout among healthcare workers during adverse circumstances.

AIMS AND OBJECTIVES: The aim of this study was to investigate the effectiveness of mindfulness-based interventions on psychological well-being, burnout and post-traumatic stress disorder symptoms among working registered nurses. BACKGROUND: Nurses account for nearly half of the global healthcare workforce and are considered significant contributors in multi-disciplinary healthcare teams. Yet, nurses face high levels of psychological distress, leading to burnout and post-traumatic stress disorder. Mindfulness-based training is a strategy that has been introduced to foster a state of awareness of present physical, emotional and cognitive experiences to regulate behaviour. DESIGN: This systematic review of randomised controlled trials was designed according to PRISMA guidelines. Eligible studies were screened and extracted. Methodological quality was evaluated by two researchers, independently. RevMan 5.4 was used to conduct the meta-analysis. Results: Fourteen studies including a total of 1077 nurses were included, of which only eleven were included in the meta-analysis as the remaining had missing or incomplete data. Meta-analysis revealed that MBI was more effective than passive comparators in reducing psychological distress, stress, depression and burnout—personal accomplishment. When compared to active comparators, MBI was also found to be more effective in reducing psychological distress and was as effective in reducing stress, anxiety, depression and burnout. Evidence on the effects of MBIs on PTSD was scarce. CONCLUSION: Mindfulness-based interventions can effectively reduce psychological distress, stress, depression and some dimensions of burnout. However, evidence remains scarce in the literature. There is a need for more methodologically sound research on mindfulness-based training among nurses. Relevance for clinical practice An important aspect that relates to the success of mindfulness-based interventions is the continued and dedicated individual practice of the skills taught during mindfulness training amidst demanding clinical work environments. Therefore, relevant support for nurses must be accounted for in the planning, design and implementation of future mindfulness-based interventions.

Behavioral technicians (BT) within the field of applied behavior analysis may be at greater risk for experiencing burnout and stress due to the nature of their clients, job demands, and work environments. Burnout and stress may negatively impact BT’s work performances, more specifically, their treatment integrity. Acceptance and Commitment Training (ACT) may be a useful tool to address the private events as well as the covert and overt behaviors associated with burnout and stress. The purpose of this study was to investigate the effects of an ACT intervention on improving treatment integrity and reducing work-related burnout and stress amongst BTs. Four BTs participated in an ACT workshop, and their treatment integrity as well as their burnout and stress levels were measured prior to and following the ACT workshop. Treatment integrity increased for all participants, suggesting that ACT-based interventions may be an effective approach to improving work performance (i.e., treatment integrity) amongst BTs who may experience workplace burnout and stress.

PURPOSE: The aim of this study was to examine the effects of death anxiety and perceived end-of-life care competencies on the fear of terminal care among clinical nurses. METHODS: This correlational study was conducted from June to July 2021. The study included 149 clinical nurses employed at a tertiary hospital and seven other hospitals. The measurement tools used in this study were the Thanatophobia Scale (Cronbach’s α=0.87), the Death Anxiety Scale (Cronbach’s α=0.80), and the Scale of End-of-life Care Competencies (Cronbach’s α=0.94). These instruments were chosen to assess the levels of fear of terminal care, death-related anxiety, and competencies in end-of-life care. RESULTS: The mean score for fear of terminal care was 3.32±1.32. Differences in fear of terminal care were observed based on the working unit, position, number of patients requiring terminal care, and experience with end-of-life care education. Fear of terminal care was significantly positively correlated with death anxiety and significantly negatively correlated with end-of-life care competencies. In multiple regression analysis, the factors influencing fear of terminal care were attitudes toward end-of-life care competencies (β=-0.39, P<0.001), death anxiety (β=0.24, P<0.001), knowledge of end-of-life care competencies (β=-0.22, P=0.005), and behaviors related to end-of-life care competencies (β=-0.16, P=0.021). These factors explained 64.6% of the total variance (F=25.54, P<0.001). CONCLUSION: This study suggests that developing nurses’ end-of-life care competencies and reducing death anxiety are crucial for managing the fear of terminal care. Therefore, providing end-of-life care education and psychological support programs is important.

BACKGROUND: There is extensive literature on physician burnout showing that it correlates with individual mental and physical illness, leads to adverse patient outcomes, and is financially costly to health systems. Further, understanding physician burnout is a step towards improving physician wellness. Investments in physician wellness nationwide have occurred in a broad assortment of ways; however the literature does not present wellness funds to residents as a previously studied approach. OBJECTIVE: Our goal was to study the impact of wellness credits on resident burnout and assess residents’ overall perspective of the intervention on their daily wellness. We hypothesize a decrease in burnout and an overall positive assessment of the program by involved residents. METHODS: In the Fall of 2021, the University of Chicago EM Residency program began to give financial stipends during the most difficult rotations as a novel approach to mitigating resident burnout. This was a quasi-experimental, prospective study investigating the impact of stipends on EM resident burnout. Following the intervention, a post-intervention survey was sent to residents to assess perspectives on the initiative. RESULTS: 36/49 residents (73%) responded to the survey. Over half of residents “often” or “always” (42%, 8%, respectively) had difficulty completing daily chores, and 72% of residents used more than half or all of the gift cards for such chores. In turn, 74% of residents “agree” or “strongly agree” that the initiative benefits their overall wellness.” Finally, 100% of respondents would like to see the initiative continue. CONCLUSIONS: All respondents felt that the gift card initiative should continue; the majority of residents used this help with daily chores that they had difficulty fulfilling. Further, residents reported an increase in wellness after this initiative. We plan on investigating this intervention in relation to individuals’ Maslach Burnout Inventory.

INTRODUCTION: Use of the electronic health record (EHR) has become increasingly widespread. Higher EHR burden is associated with burnout, but this has not been specifically investigated among gastroenterology (GI) providers. METHODS: We retrospectively collected measures of EHR use for outpatient GI providers during a 6-month period. We compared metrics across provider sex, sub-specialty, and training (physicians vs non-physician providers [NPPs]). RESULTS: Data collected represented over 16,000 appointments from 41 providers across the Division of Gastroenterology and Hepatology. Inflammatory bowel disease (IBD) and hepatology specialists spent more time per appointment in the EHR, clinical review, and outside regular hours compared to other sub-specialists. NPPs spent more EHR time than physicians. CONCLUSION: IBD and hepatology specialists and NPPs may have disproportionally high EHR burden. More work is needed to understand differences in provider workload to combat burnout.