Staff Stress

STAFF STRESS

Background

In the last ten years the extent of burnout and other forms of work-related distress, including PTSD1,2  has been increasingly acknowledged as an issue for health professionals working in critical care settings. A recent Call for Action3 has emphasised the need for more research in this field.

Research on prevalence of distress in ICU staff

A series of surveys were completed by n=377 staff at Great Ormond St Hospital (2 paediatric units) and St George's Hospital (3 adult units and 2 paediatric units) between 2012 and 2014. Questionnaires included an abbreviated form4 of the Maslach Burnout Inventory (MBI)5; the Trauma Screening Questionnaire (TSQ)6, which assesses post-traumatic stress symptoms; the Brief Resilience Scale (BRS)7 and for a subset of the sample, the Hospital Anxiety and Depression Scale (HADS)8.

All forms of distress were positively correlated. Prevalence of distress found was as follows9,10 :  

  • Burnout =37% (defined as high risk score for emotional exhaustion or depersonalisation prorated from the aMBI)
  • Post-traumatic stress = 13% (score>=6 on TSQ)
  • Anxiety = 13% (score >=11 on HADS)
  • Depression = 3% (score >=11 on HADS)

Research on associations with burnout and post-traumatic stress

Multiple regression analysis indicated that resilience was negatively associated with both burnout and post-traumatic stress and that doctors were more likely to report burnout than nurses even when other factors were controlled for.  In addition, particular coping strategies were associated with better functioning.  Attending debriefing was associated  with lower burnout and talking to senior staff and having hobbies were associated with lower rates of post-traumatic stress. Venting emotion and using alcohol to cope with stress were associated with worse psychological functioning.9,10  There was also some evidence at one site that use of exercise was associated with worse post-traumatic stress - possibly indicating that distraction is an ineffective coping strategy for this sort of symptom.11

Qualitative analysis of work situations giving rise to post-traumatic stress symptoms

Analysis of a subset of respondents' examples of the worst incident they had experienced at work revealed that the main themes found most traumatic were end of life care; managing patient and family distress; concerns about quality of care and staff conflict.12 

Methodological issue re scoring burnout


Although most researchers in this field use the MBI, in full or shortened form, to assess burnout, there is a lack of consensus on how to interpret scores.13 Post-hoc analyses of the data above showed that prevalence of burnout varied widely between 6% and 60%, depending on scoring method adopted.9


Ideas for future research

1. Do these cross-sectional associations hold in prospective studies?
2. In the offer of increased opportunity for reflection associated with lower rates of burnout and post-traumatic stress?
3. What other proactive methods of improving resilience in teams are associated with the prevention and/or reduction of distress?
4. What is the association between moral distress, burnout and other forms of work-related distress?

References
1. Mealer et al Am J Resp Crit Care Med 2007

2. de Boer et al Soc Sci Med 2011
3. Moss et al Crit Care Med 2016
4. McManus et al  Qual Health Care 2000
5. Maslach et al 1996
6. Brewin et al Br J Psychiatry 2002
7. Smith et al J Behav Med 2008
8. Zigmond & Snaith Acta Psychiatr Scand 1983
9. Colville et al Pediatr Crit Care Med 2017
10. Colville Presentation at SCCM 2017 ppt
11. Colville et al Intensive Care Med 2015
12. Colville et al ISICEM poster 2015 poster
13. van Mol et al PLoS One 2015

 

 

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