What helps hospital staff in times of crisis: qualitative results of a survey on psychosocial resources and stressors in German hospitals during the COVID-19 pandemic

BackgroundEven before the COVID-19 pandemic, hospital workers faced a tremendous workload. The pandemic led to different and additional strain that negatively affected the well-being of employees. This study aims to explore psychosocial resources and strategies that were used by hospital staff.MethodsIn the context of an intervention study, employees of three German hospitals were questioned in writing in summer and fall 2020. Five open-ended questions about the pandemic were asked to capture corresponding effects on daily work routine. Answers of 303 participants were evaluated using structuring qualitative content analysis.ResultsSignificant stressors and resources were identified in the areas of work content and task, social relations at work, organization of work, work environment and individual aspects. Stressors included, for example, emotional demands, conflicts, an increased workload, time and performance pressure. Important resources mentioned were, among others, the exchange with colleagues and mutual support. Sound information exchange, clear processes and guidelines and a positive work atmosphere were also important. In addition, the private environment and a positive mindset were perceived as helpful.ConclusionThis study contributes to a differentiated understanding of existing psychosocial resources of hospital staff in times of crisis. Identifying and strengthening these resources could reduce stress and improve well-being, making hospital staff better prepared for both normal operations and further crisis situations

Feasibility, psychological outcomes and practical use of a stress-preventive leadership intervention in the workplace hospital:The results of a mixed-method phase-II study

OBJECTIVES: Hospitals are psychologically demanding workplaces with a need for context-specific stress-preventive leadership interventions. A stress-preventive interprofessional leadership intervention for middle management has been developed. This phase-II study investigates its feasibility and outcomes, including work-related stress, well-being and transformational leadership. DESIGN: This is a mixed-methods study with three measure points (T0: baseline, T1: after the last training session, T2: 3-month follow-up). Additionally, focus groups were conducted to assess participants’ change in everyday work. SETTING: A tertiary hospital in Germany. PARTICIPANTS: N=93 leaders of different professions. INTERVENTION: An interactive group setting intervention divided in five separate sessions ((1) self-care as a leader, (2) leadership attitudes and behaviour, (3) motives, needs and stressors of employees, (4) strengthen the resource ‘team’, (5) reflection and focus groups). The intervention was conducted between June 2018 and March 2020 in k=5 runs of the intervention. OUTCOME MEASURES: Feasibility and acceptance were measured with a self-developed intervention specific questionnaire. Psychological outcomes were assessed with the following scales: work-related strain with the Irritation Scale, well-being with the WHO-5 Well-being Index and transformational leadership with the Questionnaire of Integrative Leadership. RESULTS: After the intervention at T2, over 90% of participants reported that they would recommend the intervention to another coworker (92.1%, n=59) and all participants (n=64) were satisfied with the intervention and rated the intervention as practical relevant for their everyday work. Participants’ self-rated cognitive irritation was reduced, whereas their well-being and transformational leadership behaviour were improved over time. Focus group discussions revealed that participants implemented intervention contents successfully in their everyday work. CONCLUSIONS: This intervention was feasible and showed first promising intraindividual changes in psychological outcomes. Participants confirmed its practical relevance. As a next step, the intervention will be evaluated as part of a multicentre—randomised controlled trial within the project SEEGEN (SEElische GEsundheit am Arbeitsplatz KrankeNhaus)

Predictors of cancer patients' utilization of psychooncological support: Examining patient´s attitude and physician´s recommendation

Purpose Patients with cancer suffer from a wide range of psychological distress. Nevertheless, in the literature low utilization rates of psychooncological services are reported. Various factors may influence the utilization of professional support during inpatient care. Up to now it is unclear to what extent patients’ attitude towards psychooncological support and physicians’ recommendation for psychooncological care may influence the utilization. Methods In a multicenter longitudinal observational study in Comprehensive Cancer Centers Germany, 1398 patients with mixed cancer diagnoses were assessed at baseline during their hospital stay with respect to psychooncological distress and the need for and use of psychooncological services. Results Psychooncological support was used by almost 28.4% of patients up to this time. A positive attitude towards psychooncological support was reported by 41.6%. A recommendation of psychooncological support by a physician was received by 16.2%. These patients reported a significant higher level of distress compared to patients who did not received a recommendation. Multivariable logistic regression detected that the utilization rate was 3.79 times higher among patients with positive attitude towards psychooncological support (OR, 3.79; 95% CI 2.51–5.73, p < 0.001). Utilization was 4.21 times more likely among patients who received a physician´s recommendation (OR, 4.21; 95% CI 2.98–5.95, p < 0.001). Conclusion The results of the study provide evidence of the relevance of giving more attention to psychooncological distress and attitudes towards psychooncological care. To reduce reservations, patients need low-threshold information about the psychooncological services offered.Open Access funding enabled and organized by Projekt DEAL.Charité - Universitätsmedizin Berlin (3093

Bone Morphogenetic Protein (BMP)-7 expression is decreased in human hypertensive nephrosclerosis

Background: Bone Morphogenetic Protein (BMP)-7 is protective in different animal models of acute and chronic kidney disease. Its role in human kidneys, and in particular hypertensive nephrosclerosis, has thus far not been described. Methods: BMP-7 mRNA was quantified using real-time PCR and localised by immunostaining in tissue samples from normal and nephrosclerotic human kidneys. The impact of angiotensin (AT)-II and the AT-II receptor antagonist telmisartan on BMP-7 mRNA levels and phosphorylated Smad 1/5/8 (pSmad 1/5/8) expression was quantified in proximal tubular cells (HK-2). Functional characteristics of BMP-7 were evaluated by testing its influence on TGF-b induced epithelial-to-mesenchymal transition (EMT), expression of TGF-b receptor type I (TGF-bRI) and phosphorylated Smad 2 (pSmad 2) as well as on TNF-a induced apoptosis of proximal tubular cells. Results: BMP-7 was predominantly found in the epithelia of the distal tubule and the collecting duct and was less abundant in proximal tubular cells. In sclerotic kidneys, BMP-7 was significantly decreased as demonstrated by real-time PCR and immunostaining. AT-II stimulation in HK-2 cells led to a significant decrease of BMP-7 and pSmad 1/5/8, which was partially ameliorated upon co-incubation with telmisartan. Only high concentrations of BMP-7 (100 ng/ml) were able to reverse TNF-a-induced apoptosis and TGF-b-induced EMT in human proximal tubule cells possibly due to a decreased expression of TGF-bRI. In addition, BMP-7 was able to reverse TGF-b-induced phosphorylation of Smad 2. Conclusions: The findings suggest a protective role for BMP-7 by counteracting the TGF-b and TNF-a-induced negative effects. The reduced expression of BMP-7 in patients with hypertensive nephrosclerosis may imply loss of protection and regenerative potential necessary to counter the disease

The WERA cancer center matrix: strategic management of patient access to precision oncology in a large and mostly rural area of Germany

Purpose Providing Patient Access to Precision Oncology (PO) is a major challenge of clinical oncologists. Here, we provide an easily transferable model from strategic management science to assess the outreach of a cancer center. Methods As members of the German WERA alliance, the cancer centers in Würzburg, Erlangen, Regensburg and Augsburg merged care data regarding their geographical impact. Specifically, we examined the provenance of patients from WERA´s molecular tumor boards (MTBs) between 2020 and 2022 (n = 2,243). As second dimension, we added the provenance of patients receiving general cancer care by WERA. Clustering our catchment area along these two dimensions set up a four-quadrant matrix consisting of postal code areas with referrals towards WERA. These areas were re-identified on a map of the Federal State of Bavaria. Results The WERA Matrix overlooked an active screening area of 821 postal code areas – representing about 50% of Bavaria´s spatial expansion and more than six million inhabitants. The WERA Matrix identified regions successfully connected to our outreach structures in terms of subsidiarity – with general cancer care mainly performed locally but PO performed in collaboration with WERA. We also detected postal code areas with a potential PO backlog – characterized by high levels of cancer care performed by WERA and low levels or no MTB representation. Conclusions The WERA Matrix provided a transparent portfolio of postal code areas, which helped assessing the geographical impact of our PO program. We believe that its intuitive principle can easily be transferred to other cancer centers

The role of Bone Morphogenetic Protein 4 and 7 in hypertensive nephrosclerosis

Bone Morphogenetic Proteins (BMP) bilden eine Subfamilie der transforming growth factor (TGF-β) Superfamilie. BMP-7 hat in verschiedenen tierexperimentellen Studien zur chronischen Niereninsuffizienz protektive Effekte gezeigt. BMP-4 spielt eine progressive Rolle bei der Atherosklerose. Über die Funktion in der Nephrosklerose ist zu diesem Molekül sehr wenig bekannt. Die Hypothese dieser Arbeit war, dass BMP-4 und BMP-7 einen wesentlichen Einfluss auf die Pathogenese der adulten humanen Nephrosklerose ausüben. Hierbei sollten die folgenden Fragen beantwortet werden: A) Werden die beiden BMPs in der adulten humanen Niere exprimiert und ist die Expression vergleichbar zu den Ergebnissen in Tiermodellen? B) Zeigt sich eine veränderte Expression bei der hypertensiven Nephrosklerose? C) Werden die Faktoren durch das Angiotensin II, das eine wesentliche Rolle bei der Hypertonie spielt, beeinflusst? D) Sind die protektiven Funktionen, wie beispielsweise die Hemmung der Proliferation von Fibroblasten, auf menschliche Zellen übertragbar? In der vorliegenden Arbeit konnte die Expression von BMP-4 und BMP-7 im gesunden humanen Nierengewebe und bei der Nephrosklerose nachgewiesen werden. In der Immunhistochemie konnte dargestellt werden, dass eine Expression von BMP-4 und BMP-7 vornehmlich in den distalen Tubuli und den Sammelrohren stattfindet. Es wurde gezeigt, dass es bei der humanen Nephrosklerose zu einer verminderten Expression von BMP-7 kommt, während für BMP-4 keine quantitativ veränderte Expression stattfindet. Eine mögliche Ursache für die verminderte Expression von BMP-7 kann die durch erhöhte AT-II-Spiegel verminderte Expression in proximalen Tubuluszellen sein, wie sie in unseren Stimulationsversuchen mittels RT-PCR nachgewiesen werden konnte. Die Expression von BMP-4 wurde durch Angiotensin II nicht wesentlich beeinflusst. Es konnten keine signifikanten Einflüsse von BMP-4 und BMP-7 auf die Proliferationsraten von proximalen Tubuluszellen und Fibroblasten gezeigt werden

Älterwerden im Beruf – Darstellung einer Gruppenintervention bei mittelalten Pflegekräften

ZusammenfassungDer Pflegeberuf unterliegt durch den demografischen Wandel starken Veränderungen, sowohl in der Alterszusammensetzung von Belegschaften, als auch in der Zunahme von multimorbiden, älteren Patienten. Die Prävalenz psychischer Belastung ist bei den Mitarbeitern im Gesundheitswesen bereits heute relativ hoch. Im Zuge der Veränderungen kommt es zu vermehrter psychischer und körperlicher Belastung. Es besteht ein Zusammenhang zwischen zunehmender Belastung und Gedanken an das Ausscheiden aus dem Beruf (intention to leave). Ziel der hier vorgestellten Gruppenintervention war es, eine verhaltenspräventive Maßnahme zur Förderung des gesunden Alterns im Pflegeberuf zur Verfügung zu stellen.</jats:p