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This chapter focuses on resilience and compassion, starting by examining the relevance of resilience in healthcare, especially during the Covid-19 pandemic. The chapter notes that while a certain amount of resilience is helpful and even essential, resilience depends on not only the personal characteristics of each healthcare worker, but also the conditions in which they work. Relevant factors include the structure and function of teams, models of organisation, quality of leadership, and resources. These matters have an enormous influence on individual experiences, attitudes, and behaviour, and on the levels of resilience that are required and accessible in the workplace, as well as compassion. This chapter considers the concepts of ‘compassion fatigue’ and ‘burnout’, and outlines barriers to, and facilitators of, compassionate care. Systemic challenges include competing system demands, time constraints, inadequate resources, communication issues, poor emotional connections with the broader healthcare system, and the perception and/or reality of staff not being valued for the care they provide. These are themes that resonate with many people who work in large healthcare systems where organisational challenges loom large, often distracting focus from day-to-day patient care. This chapter also examines the roles of mindfulness and meditation in navigating these challenges.
Early career researchers have unique demands, many of which contribute to increased stress, decreased professional fulfillment, and burnout. Consequently, academic institutions and government organizations, such as the National Institutes of Health, are beginning to embrace structured coaching as a tool to support physician wellbeing. To date, such coaching programs have demonstrated promising results, but little is known about whether early career research faculty find coaching feasible, accessible, or helpful. To explore this question further, we developed a novel group coaching intervention for clinician researchers and scientific faculty at the University of Texas Southwestern Medical Center based on the concept of appreciative inquiry, grounding the program in a positive and hopeful approach to the challenges faced by clinicians and researchers. Results from our program indicate this intervention is feasible, satisfactory, and helpful, with participants reporting enhanced self-reflection and empowerment. Effective for a wide array of research faculty, our program brought together diverse faculty, fostered connections, and encouraged future collaborations among this translational group. This suggests that our program provides a foundational blueprint that can be used by other academic medical centers who aim to develop group coaching efforts.
from
Section 4
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Walking the Walk (and Talking the Talk)
William Fawcett, Royal Surrey County Hospital, Guildford and University of Surrey,Olivia Dow, Guy's and St Thomas' NHS Foundation Trust, London,Judith Dinsmore, St George's Hospital, London
Training as an anaesthetist can be very demanding and self-care and the wellbeing of the anaesthetist are of essence. Demanding work schedules include night shifts which can be particularly difficult to adjust to for some. Practical advice is stated on how to overcome and adapt to these. Green anaesthesia has gained large importance in ensuring sustainability in healthcare. In the UK anaesthetic cases and Nitrous Oxide contribute around 2% of all NHS greenhouse gas emissions. Steps to reduce the individual anaesthetists’ carbon footprint are discussed.
An overview of the anaesthetic training program is stated in addition to practical advice on enhancing portfolio work. Departments are required to run morbidity and mortality meetings which can be a good opportunity for the anaesthetic trainee. These meetings focus on a specific patient case and may lead to an action plan within the department. This chapter focuses on ways to make the most out of anaesthetic training and offers guidance to the training structure and requirements.
Objective. Witnessing existential suffering in patients is associated with increased risks of compassion fatigue and burnout in palliative care physicians. Finding meaning is a protective factor for burnout and is associated with increased job satisfaction and a sense of purpose.
While the significance of finding meaning through the doctor-patient relationship is widely recognized, less is known about the subjective experience of palliative care physicians, how they ascribe meaning, and how meaning sustains them. The aim of this study was to describe and interpret how palliative care physicians experience meaning when caring for patients.
Method. Hermeneutic-phenomenology, inspired by the philosophy of Heidegger and Gadamer, informed the methodological approach. Ten palliative care physicians, caring for adult patients, completed semi-structured interviews. Van Manen’s “lifeworld existentials” supported our reflexive hermeneutic analysis to interpret participants’ moments of meaning-making.
Results. Our analysis identified two interpretive concepts for meaning-making: moments of connection and moments of transformation. Meaningful connection occurred when physicians and patients together acknowledged existential suffering in death and dying and experienced it on a personal, human level. Often, experiences were fleeting but had a lasting impact. Experiences of connection had a transformational effect on physicians and were associated with a sense of reward and purpose in palliative care work.
Significance of results. Findings are discussed in relation to philosophical literature on the experience of time, contrasting man-made time with the existential experience of time. Moments of connection and transformation experienced by palliative care physicians fueled their commitment to their profession. At a time when burn-out is rife, identifying, describing, and understanding moments of meaning may offer protective benefits for physicians working in palliative care.
COVID-19 saw many career health officials retire early and seasoned health practitioners simply quit due to burnout. This chapter explores various qualities that leaders can utilize to provide and receive support when faced with stressors and challenges in both their work and personal lives. Personal assessments like Myers–Briggs, DISC, the Gallup Strengths Finder, and the Enneagram offer practical tools for members of leadership to identify their strengths and areas for growth. Identifying stressors and engaging in self-regulation ensure public health leaders can mitigate burnout. Leadership qualities are outlined and described. By cultivating leadership qualities, crisis leaders can stay focused and grounded during health emergencies. Transformation leadership theory is described. A student case study uses the Crisis and Emergency Risk Communication framework to analyze former Prime Minister of New Zealand Jacinda Ardern’s communication during the COVID-19 outbreak. End-of-chapter reflection questions and activities are included.
The study objective was to identify the specific challenges experienced by nurses, assess the mental health impacts, and evaluate their role adaptation in response to the ongoing conflict.
Methods
A quantitative, descriptive study was conducted involving 202 nurses from 3 hospitals in the South West Bank. Data were collected through a structured questionnaire addressing socio-demographic information, psychological challenges, and role adaptation during the conflict.
Results
The study surveyed 300 nurses, revealing critical findings regarding their psychological well-being and professional challenges. Approximately 65% of respondents reported experiencing symptoms consistent with PTSD, indicating a significant psychological toll due to their work conditions. In terms of workload, 78% of nurses reported an increased patient influx, leading to higher stress levels and burnout. The analysis indicated that nurses faced severe resource shortages, with 60% reporting inadequate medical supplies and 55% citing insufficient staffing.
Conclusions
The findings underscore the urgent need for enhanced training programs, mental health support, and improved disaster management protocols. Educational background and marital status significantly influence nurses’ resilience and adaptability in conflict zones. Addressing these challenges is essential to improving the well-being of nurses and enhancing the quality of care in conflict-affected areas.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Healthy clinicians are more likely to provide better care for their patients.
However, they often face serious health challenges themselves, which often stem from both personal lifestyle behaviours and work-related factors. Some of the common problems include burnout, stress, fatigue, musculoskeletal disorders, and cardiovascular diseases. To address these issues, interventions need to adopt a comprehensive approach that incorporates Lifestyle Medicine principles, such as nutrition, physical activity, stress management, and social support. These principles can help healthcare workers improve their health behaviours and cope with the demands of their work. However, personal interventions are not enough. There is also a need for organisational support and policy changes that create a healthier work environment for healthcare workers. This includes supportive leadership, flexible work schedules, adequate staffing, and access to wellness programmes. By improving the health of healthcare workers, interventions can also have positive impacts on patient care and healthcare costs.
This study assessed compassion satisfaction, compassion fatigue, and burnout in health care providers from public health care institutions in Ecuador during the COVID-19 pandemic.
Methods
A cross-sectional survey was conducted in 2022, involving 111 different public health care institutions in 23 provinces in Ecuador, with 2873 participants recruited via convenience sampling. The survey instrument was the revised Stamm’s Professional Quality of Life Scale Version-5 tool, designed to measure self-reported compassion fatigue, work satisfaction, and burnout among providers. Kruskall-Wallis test assessed subscale score differences by gender, professional role, region, and health care facility level. Dunn’s test was then applied to determine whether groups differed from each other.
Results
On average, health care providers from all facilities had a high rate of compassion satisfaction (84.9%). However, the majority presented moderate levels of burnout (57.1%), and moderate levels of secondary traumatic stress (59.6%). Higher burnout levels were observed in the Amazon regions compared to Coastal regions.
Conclusions
Despite high compassion satisfaction, most surveyed health care providers from Ecuador’s public health institutions experienced moderate burnout and secondary traumatic stress, with higher burnout levels in the Amazon region. Ecuador, similarly to other LMICs, requires mental health policy and legislation targeted to the mental health workforce and these needs. More research is needed on burnout factors among health care providers in resource-challenged low- and middle-income countries.
While research on leadership and employee physical ill-being is burgeoning, the short- and long-term mechanisms through which leadership influences employee physical ill-being remain underexplored. This research, grounded in leadership theories and the Job Demand-Resource (JD-R) theory, examines how transformational and abusive leadership behaviors influence employee physical ill-being through two conflict-related negative motivational mechanisms (negative work–home interactions and job role conflict) and two negative affective mechanisms representing short-term (negative affect) and long-term (burnout) mechanisms. Employing a three-wave longitudinal design over 6 months (N = 234), our findings from a multilevel path analysis revealed that transformational and abusive leadership had respectful, negative and positive effects on employee physical ill-being via conflict-related negative motivational mechanisms and short- and long-term affective mechanisms. Notably, the influence of leadership behaviors on employee physical ill-being was more pronounced through the short-term affective mechanism (negative affect) than the long-term affective mechanism (burnout). Our findings provide a nuanced understanding of how leadership behaviors affect employee physical ill-being over time, shedding light on the dynamic interplay of motivational and affective pathways in this relationship.
In academia, as in any profession, one of the toughest decisions facing an autistic person is whether and when to disclose their diagnosis. On the one hand, disclosure can bring awareness, understanding, and support. On the other, it can bring misunderstanding, stigma, and discrimination. In this chapter participants reflect on their decisions to disclose (or not to disclose) to employers, colleagues, staff, and students – and the impacts of these decisions. This chapter also addresses the issue of masking (hiding their autistic characteristics), including when and why participants feel the need to mask and the impact this has on them.
Previous research has focused on the significance of occupational burnout and the role of emotional intelligence and poor coping abilities among physicians.
Our study aimed to assess the prevalence of occupational burnout among first-year medical residents in Oman, exploring the relationship between trait emotional intelligence subscales and the three dimensions of burnout syndrome, and examining the association between sociodemographic covariates and the three dimensions of burnout syndrome.
The outcome measures included various indices of the abbreviated Maslach Burnout Inventory. The Trait Emotional Intelligence Questionnaire (TEI) and its subscales were examined.
The data showed a high burnout rate of 25.8%. Specifically, among the residents, 57.5% reported high levels of emotional exhaustion, 50.8% reported high depersonalisation and 49.2% reported a low sense of personal achievement. Age was significantly associated with depersonalisation (P < 0.003) and personal achievement (P < 0.0001). Marital status was the only variable significantly associated with emotional exhaustion (P = 0.001). Single residents had considerably lower emotional exhaustion than married residents (P = 0.001). The global mean score for the TEI was 4.77 (±0.64). A statistically significant relationship was found between personal achievement and emotional intelligence (r = 0.203, P = 0.026).
Medical dramas such as Grey's Anatomy influence young people's career aspirations, creating unrealistic expectations. This article examines the gap between these portrayals and the reality of medical practice, highlighting challenges such as rigorous training and high stress. Using Italy's ‘numero chiuso’ (‘closed number’) system as a case study, it addresses the global issue of intense competition in medical school admissions. The article advocates for realistic education and better support to prepare future healthcare professionals.
This article analyses burnout in governmental psychosocial and community programmes considering training/knowledge, the technical-professional field, the institutional framework, and networking, based on the experience of the intervention teams of three Chilean programmes. A qualitative methodology was used. Fifty people, most of them psychologists, participated in interviews and focus groups. The data were analysed according to Grounded Theory. Results indicate that burnout is a corrosive process in governmental psychosocial and community programmes. The causes of burnout are related to three gaps: between academic training and professional performance, between formulation and implementation, and between the obligation to work as part of a network and the limitations of this approach. Furthermore, we observed manifestations consequences and effects of burnout, and guidelines for improving the programmes. We discuss the institutional dimension of burnout in governmental psychosocial and community programmes and reflect on aspects that may improve team well-being and the quality of social policies.
Palliative care (PC) faces a workforce crisis. Seriously ill patients surpass the supply of PC cliniciansin their work clinicians face repeated loss and extreme suffering which can have deleterious consequences, such as burnout and attrition. We urgently need interventions that foster thriving communities in this emotionally complex environment. Storytelling represents a promising path forward. In response to widespread loneliness and moral distress among PC clinicians before, during, and after the early months of the COVID-19 pandemic, we created the Palliative Story Exchange (PSE), a storytelling intervention to build community, decrease isolation, and help clinicians rediscover the shared meaning in their work. This paper discusses this novel intervention and initial program evaluation data demonstrating the PSE’s impact thus far.
Methods
Participants voluntarily complete a post-then-pre wellness survey reflecting on their experience.
Results
Thus far, over 1,000 participants have attended a PSE. In the fall of 2022, we began distributing a post-then-pre-evaluation survey. To date, 130 interprofessional participants from practice locations across 10 different countries completed the survey. Responses demonstrate an increase in the connection that participants felt toward their work and the larger palliative care community after attending a PSE. Further, more than half of all free-text responses include terms such as, “meaningful,” “healing,” “powerful,” and “universal,” to describe their participation.
Significance of Results
Training programs and healthcare organizations use the humanities to support clinician wellness and improve patient care. The PSE builds upon this work through a novel combination of storytelling, community co-creation using reflection, and shared meaning making. Initial survey data demonstrates that after attending a PSE, participants feel increased meaning in their work, in the significance of their own stories, and connection with the PC community. Moving forward, we seek to expand our community of practice, host a facilitator leadership course, and rigorously study the PSE’s impact on clinician wellness outcomes.
A surge of pediatric respiratory illnesses beset the United States in late 2022 and early 2023. This study evaluated within-surge hospital acute and critical care resource availability and utilization. The study aimed to determine pediatric hospital acute and critical care resource use during a respiratory illness surge.
Methods
Between January and February 2023, an online survey was sent to the sections of hospital medicine and critical care of the American Academy of Pediatrics, community discussion forums of the Children’s Hospital Association, and PedSCCM—a pediatric critical care website. Data were summarized with median values and interquartile range.
Results
Across 35 hospitals with pediatric intensive care units (PICU), increase in critical care resource use was significant. In the month preceding the survey, 26 (74%) hospitals diverted patients away from their emergency department (ED) to other hospitals, with 46% diverting 1-5 patients, 23% diverting 6-10 patients, and 31% diverting more than 10 patients. One in 5 hospitals reported moving patients on mechanical ventilation from the PICU to other settings, including the ED (n = 2), intermediate care unit (n = 2), cardiac ICU (n = 1), ward converted to an ICU (n = 1), and a ward (n = 1). Utilization of human critical care resources was high, with PICU faculty, nurses, and respiratory therapists working at 100% capacity.
Conclusions
The respiratory illness surge triggered significant hospital resource use and diversion of patients away from hospitals. Pediatric public health emergency-preparedness should innovate around resource capacity.
This chapter by Jennifer Uchendu and Elizabeth Haase is dedicated to children and youth-led activism, with a focus on Jennifer’s journey as a youth climate activist leading work at SustyVibes in Nigeria. SustyVibes is a youth-led and youth-focused organization making sustainability actionable and relatable for young people through community-led projects. The chapter chronicles aspects of Jennifer’s journey that may be significant for young people and researchers of youth activism. We also discuss the main types of activism and highlight principles that have been adopted by youth climate activist groups to help them be most inclusive and effective, preventing burnout and group devolution. Drawing from Jennifer’s experience with eco-anxiety and related stress, we review the literature on the risks and benefits of activism – for youth mental health and for youth climate activists in particular – in hopes that her story can be generalizable and empowering to others.
The ongoing Russian–Ukrainian war has been linked to mental health problems in the Ukrainian general population. To date, however, scarce research has examined the mental health of psychosocial support workers (PSWs) in Ukraine who have a burdensome workload in the context of ongoing conflict. This study aimed to examine the prevalence and correlates of burnout, posttraumatic stress disorder (PTSD), and suicidal ideation (SI) in PSWs in Ukraine during the Russian–Ukrainian war.
Methods:
One hundred seventy-eight PSWs in Ukraine completed a survey assessing war exposure, mental health, and psychosocial characteristics.
Results:
A total 59.6% of PSWs screened positive for burnout, 38.2% for PTSD, and 10.7% for current SI. Lower optimism was associated with greater odds of burnout. Greater distress from witnessing war-related destruction, lower optimism, lower presence of meaning in life, and lower levels of close social relationships were associated with greater odds of burnout. Lower presence of meaning in life was associated with greater odds of SI.
Conclusions:
Results of this study highlight the mental health challenges faced by PSWs in Ukraine during the ongoing Russian–Ukrainian war. They further suggest that interventions to foster meaning in life and promote social connectedness may “help the helpers” during this ongoing conflict.
The research aimed to test the job demands-resources (JD-R) model on a sample of Italian oncology workers, and the role of perceived organizational support (POS) as a moderator of the effects of JD on outcomes (job satisfaction and burnout [BO]).
Methods
Based on the JD-R model, a correlational study was designed to investigate the relationships between JD, POS as a job resource, self-esteem (as a personal resource), and job outcomes (BO and job satisfaction); the research involved a sample of oncology nurses (N = 235) from an Italian public hospital, who completed a questionnaire during working hours. Relationships between variables were investigated with multiple regressions and moderation analysis.
Results
Results confirmed that JD predict both BO and job satisfaction; POS is a weak predictor of job outcomes, but its mediator role in the JD-outcomes relationship was confirmed: the more the nurses perceive a supportive organization, the weaker the positive relationship between JD and BO.
Significance of results
Findings are consistent with other contributions that highlighted that organizational job resources may attenuate the adverse effect of JD on positive and negative outcomes: POS may play a central role in employee well-being and health, acting as a possible moderator, and somehow defusing the positive association between JD and outcomes.
Lawyer leaders can transform cultures that feature chronic stress, overwork, and lawyer impairment into neuro-intelligent cultures that make cognitive well-being a priority, reaping benefit at both the individual and institutional levels. Neuro-intelligent cultures promote brain health and mental strength, and they develop environments rich with cognitive power. Neuroscience and psychology research reveals what a culture of concern and respect can mean to individual lawyers. It also supports moving away from grind culture and toward a healthier and more productive neuro-intelligent culture. The American and International Bar Associations have called for action that improves the well-being of individual lawyers. They have also challenged legal organizations to make the legal profession more sustainable. Transformation of the lawyering culture will involve detoxing from overwork, minimizing burnout, leveraging the energy of both introvert and extrovert lawyers, cultivating neurosignature diversity, facilitating psychological safety, reducing hierarchy, limiting competition, and embracing the Maverick lawyer leader professional identity.
Chinese nurses working with immense stress may have issues with burnout during COVID-19 regular prevention and control. There were a few studies investigating status of burnout and associated factors among Chinese nurses. However, the relationships remained unclear.
Objectives
To investigate status and associated factors of nurses’ burnout during COVID-19 regular prevention and control.
Methods
784 nurses completed questionnaires including demographics, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Insomnia Severity Index, Impact of Event Scale-revised, Perceived Social Support Scale, Connor–Davidson Resilience Scale, General Self-efficacy Scale and Maslach Burnout Inventory.
Results
310 (39.5%), 393 (50.1%) and 576 (73.5%) of respondents were at high risk of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). The risk of EE, DP and reduced PA were moderate, high and high. Nurses with intermediate and senior professional rank and title and worked >40 h every week had lower scores in EE. Those worked in low-risk department reported lower scores in PA. Anxiety, post-traumatic stress disorder (PTSD), self-efficacy and social support were influencing factors of EE and DP, while social support and resilience were associated factors of PA.
Conclusion
Chinese nurses’ burnout during COVID-19 regular prevention and control was serious. Professional rank and title, working unit, weekly working hours, anxiety, PTSD, self-efficacy, social support and resilience were associated factors of burnout.