Babarinde, Olufunmilayo Abidemi

Okojie, Paul West

English

Liberty University Digital Commons

1.Maslach C, Leiter MP. Understanding the burnout experience: recentresearch and its implications for psychiatry. World Psychiatry.2016;15(2):103–111. doi:10.1002/wps.20311.Morse G, Salyers MP, Rollins AL, Monroe-DeVita M, Pfahler C. Burnoutin mental health services: a review of the problem and itsremediation. Adm Policy Ment Health. 2012;39(5):341–352.doi:10.1007/s10488-011-0352-1.3. Poper R. Physician burnout in the U.S. and Europe: 19 statistics.Available at: https://www.beckersasc.com/leadership/physician-burnout-in-the-us-europe-19-statistics.html. Accessed 04/03/2020*The literature matrix and literature is extensive and therefore it is notpossible to fit on this specific poster. Paper copies are available or can berequested by email by requesting them from the faculty sponsor atDr Linnaya Graf lgraf@liberty.edu*The authors want to acknowledge the work and time of the many authors who provided the amazing data and contributions that are being used to shape this field.    https://watch.liberty.edu/media/t/1_wziq51wiStress and Resilience among Healthcare Professionals: A synthesized Literature ReviewPaul W. Okojie,  Babarinde O. Abidemi, Linnaya Graf, PhD, CHES, CPSIntroductionStress and burnout among health professions is a serious public health problem, as it contributes to failing to meet the demands of implementing successful prevention and treatment programs for the populace.Methods The research design for this current work begins with empirical, synthesized literature using The Matrix Method of an archived review from 2016. Primary studies investigating the prevalence of burnout, its determinants and resiliency factors across professions in the health field were included. The archived review included over 120,000 articles from 2005-2015 (from an original pool of 800,000 articles). This is compared with a more current literature matrix of 102 targeted articles from 2017-2020.ResultsThe initial search strategy returned 65,000 titles and abstracts, of which 34,500 were removed as duplicates. Titles and abstract screening identified 460 full-text items for review. Of these, 102 met inclusion criteria. Of the included studies, 65 (63.7%) used a cross-sectional study design, 16 (15.7%) systematic reviews, 6 (5.9%) narrative reviews, and cohort studies, respectively. The sample size across all the 102 included studies ranged from 18 to 165,024 participants, with a median of 384 participants. 63.7% of the studies included male and female participants. Emotional exhaustion was associated with burnout (45%) while social support (38.%) was identified as a human resilience factor.Discussion and ConclusionMultiple factors contribute to burnout. Administration must become more versed in the importance of  understanding how to reduce stress and burnout, while increasing resilience to protect against burnout for the field.Abstract▪ The chronic stress that leads to burnout is defined as physical, emotional, or mental withdrawal and is characterized by apathy, physical collapse, and chronic fatigue resulting in termination of a worker’s ability in performing effectively.1▪ Burnout and chronic stress cross health professions in the fields of medicine, mental health, crises medicine, and public health; they continue to result in health complications and absenteeism.2▪ This impacts both the health care work force and the quality of care despite several years of focused efforts in understanding burnout and stress for the field.2▪ Many individuals who work across health professions are engaged inpositions that are classified as high stress, working long shifts (often 10-12-hour) which are physically taxing for the body, mind, and emotionalstate. 21-27% of mental health workers may be experiencing burnout. 3▪ Persistent and chronic burnout reduces the numbers of workers availablefor many health professions.▪ Despite primary intervention studies directly aimed at burnout, manyinstitutions still use no form of burnout intervention or preventionmeasures.This theoretical proposal is aimed to:▪ Synthesize the published literature, prevalent themes of burnout, and thehuman/organizational factors for building resilience.▪ Design tools for future data collection on reduction of stress and burnoutand increasing resiliency among health professionals.Introduction▪ Categories and themes from the results of this study were used to develop empirically based data collection tools,  including a short and long survey, a long-open ended question interview guide, and a guided focus group guide. ▪ Next steps will require field testing by key experts and pilot testing for validity, reliability, creditability, and transferability to determine if the measures are capturing the intended constructs, consistently, across professions. ▪ Long-term future work plans will culminate in a multiple-step Force Field Analysis, grounded by a participatory research approach framework.▪ Future work is being designed to produce data needed in creating tools and services needed for the reduction of stress and burnout and increasing resilience among healthcare professionals. Conclusion & Future WorkReferences and AcknowledgmentsResults: ▪ Overall 102 studies representing 32 countries where included in the matrix; United States 33.3% (n=34), United Kingdom 10.8% (n=11)▪ Of the 102 included studies, 63.7% were cross-sectional design. The largest health care professionals singularly studied the publications were the clinicians (29%) followed by the nurses (21%).▪ A total of  58 stress and burnout themes were identified. ▪ 45% themes were already identified from former study while 69%  themes were identified in the new study. ▪ Emotional exhaustion (44%) and depersonalization (30%) were the most prevalent contributors to stress and burnout.▪ Social support, mindfulness, autonomy were the most observed human resilient factors. Meditation was the least.▪ Organizational support, staff recognition and job satisfaction were the most observed organizational resilient factors.Discussion▪ Overall, a range of new themes were identified in recent literature.▪ This could be attributed to an increase in current research aimed tounderstand the ways in which workplace conditions drive stress and burnout. ▪ The use of the Maslach Burnout Inventory (MBI) in 32% of theliterature may explain the high prevalence of Emotional exhaustion & Depersonalization observed.▪ The proportion of U.S. and U.K. studies may be an indication of the volume of ongoing research to address stress/burnout in these countries. Physician burnout in the U.S & UK have been estimated at 27% and 22%, respectively.▪ Increasing prevalence of stress and burnout among workers coupled with the evolving dimensions by which the conditions manifests point to the need for the development of effective tools tailored at future management of this trend. ▪ Therefore healthcare administration must become more versed in the importance of understanding how to reduce stress and burnout, while increasing resilience to protect against burnout for the field.Results & DiscussionATable 1: Study DemographicsMethodsCharacteristics (n = 102) Percent (%) Study designsCross-sectional 65 63.7Systematic reviews 16 15.7Narrative reviews 6 5.9Cohort studies 6 5.9Exploratory                               5                       4.9Pre- & Post test 2 2.0Comparative/analytic 1 0.9Longitudinal 1 0.9Sample sizeMedian 384RangeToolsMBI scale18-165,02438 37.2ParticipantsMales & Females 65 63.7Database  Google Scholar, Search via LU JF Library   Current study (2017-2020) 2016 study EBSCO, ProQuest, Science Direct Burnout Research, WHO, CDC  Search Terms   Stress, burnout, resilience, work related stress, stress management, health professional Boolean operators ‘AND’, ‘OR’; Truncations * Inclusion criteria Peer-reviewed, limited to stress/burnout, resilience in health profession, 2017 to current, no geographical constraint, publications in English Screening    Full text and abstracts retrieved and reviewed independently by two authors for relevance  Data extraction & Synthesis  Matrix methodology Objective, Study design, methods of recruitment, Sample size, professional group, study location, study instrument, Key finding  Comparison  A hand completed factorial analysis was used to determine the themes and categories which emerged from the literature related to what contributed to burnout among health professionals and what promoted resilience.  Factors were sorted and coded, compared with the review from 2016. A final list was compiled.   Author/Year Professional Group Study DesignSample Size BasicMethodsObjective ResearchQuestionTools ResultsElbarazi, et al2017Physicians,  Nurses, Surgeons, ResidentsSystematic Review4108 Systematic Review with PRISMA GuidelineMindfulness in the context of    Professionals with occupational stressWhat is the prevalence of Burnout in Health Professionals? What are Work-Related Factors in Burnout?The Maslach Burnout Inventory (MBI)High Emotional Exhaustion (20.0–81.0%), High Depersonalization (9.2–80.0%)Table 3: Sample Data MatrixFactors (n = 102) Percent (%) Replicated ThemesEmotional Exhaustion 44 43.1Physical Exhaustion7 7.8Mental Exhaustion 4 4.0Long Working Hours 3 3.0High Work  Demand                  8                       8.0High Work Pace 6 6.0New ThemesDepersonalization 31 30.3Low Personal Accomplishment 24 24.0Effort Reward Imbalance5 5.0Cynicism8 8.0High Workload 19 19.0Compassion Fatigue 4 4.0Inter Role Conflict 4 4.0Low Personal Control    4 4.0Table 2: Table of Factors

Stress and Resilience among Healthcare Professionals: A Synthesized Literature Review

Stress & Resilience among Healthcare Professionals: A Synthesized Literature ReviewbyPaul W. Okojie, Babarinde O. Abidemi, Linnaya Graf, PhD, CHES, CPS IntroductionChronic stress and burnout among healthcare professionals affect workers and the populations they serve.• Benefits of a more experienced workforce. • Chronic stress leads to high rates of burnout and absenteeism• Burnout results in termination of workers’ ability to effectively do their jobs, apathy among worker, compassion fatigue, and departure from the field for seasoned workers. Broad Problem• Chronic stress and burnout is high for workers across many areas of health professions 1• Few organizational systems are designed to provide prevention services to reduce stress/burnout or increase resilience. Poor health outcomes for health professionals =lowered quality of care & increased risk for the populations being served Background• Burnout – Historically defined as a notable lack of control, low performance, low motivation, emotional exhaustion, absenteeism, turnover,  negative attitudes, and poor performance reviews 2– Phenomenon is well documented in the literature among specific healthcare and crises positions – Stress contributes significantly to burnout, while resilience is protective against burnoutSpecific Problem• Chronic stress related to the variety of high-stress positions among various health professions • ( examples include medicine,  mental health, crises and emergency medicine, and various public health professions) 3,4• Contributes to• Low employee retention, absenteeism, high risk behaviors, physical, emotional, and mental withdrawal; apathy, accidents, physical collapse, chronic fatigue, and termination preventing workers to successfully complete their job. 2Methods • Systematic literature review  – Structured evaluation of the literature from 2017-2020 and compared with a previous review from 2016.– Completed using the Matrix Method (Garrad, 2016) to analyze the current body of literature related to stress and burnout among various health professions. – Analyzed using factor/thematic analysis to identify themes contributing to stress and burnout or resilience documented within the literature. Literature Matrix Synthesized • 2016 Review: – 135,496 articles systematic review– 2005-2015• 2020 Review:– 102 articles systematic review– 2017-2020• Sources – Scholarly, peer reviewed sources- e.g. Ebsco, ProQuest, Science Direct. Characteristics of the Current Lit Review• Overall 102 studies representing 32 countries where included in the matrix; United States 33.3% (n=34), United Kingdom 10.8% (n=11) ▪• Of the 102 included studies, 63.7% were cross-sectional design. The largest health care professionals singularly studied the publications were the clinicians (29%) followed by the nurses (21%). Factor & Thematic Analysis • An initial thematic analysis of the studies was completed  with the following resultsA total of 58 stress and burnout themes were identified.– 45% themes were already identified from former study while 69%themes were identified in the new study.– Emotional exhaustion (44%) and depersonalization (30%) were the most prevalent contributors to stress and burnout.– Social support, mindfulness, autonomy were the most observedhuman resilient factors. Meditation was the least.– Organizational support, staff recognition and job satisfaction werethe most observed organizational resilient factors.Application of Results• Themes applied towards Data Collection Tools – Measurements Developed • Long & short survey • Open ended questionnaire & Interview guide• Focus Group Guide • Upon completion and approval of IRB the measurements will be field tested (key experts) and pilot tested (sample populations). Implications of the Analysis• Continually being up to date with literature is essential to work in the field.– This literature review documents a recent synthesized review completed in 2016, with a large bulk of literature (N= 135,496) along with a second, intentional sampling of literature (N=102) and shows a range of new themes were identified in recent literature. – This could be attributed to an increase in current research aimed to understand the ways in which workplace conditions drive stress and burnout. This is also a testament to how important this issue has become to label and understand in the last decade. Discussion• Potential Limitations – Themes need further investigative analysis within this study before making any judgements. For example, the use of the Maslach Burnout Inventory (MBI) in 32% of the literature may explain the high prevalence of Emotional Exhaustion & Depersonalization observed.• Future Research – Increasing prevalence of stress and burnout among workers coupled with the evolving dimensions by which the conditions manifests point to the need for the development of effective tools tailored at future management of this trend.Long Term: Future WorkUpon completion of the testing of instrument development, a large-scale Force Field Analysis will be undertaken. This will include developing from the perspective of those in the Frontline: – Identification of the factors that drive the process – Identification of the factors that hinder the process– Determining which factors are most amenable and most important. – Using those to create Recommendations and an Action plan – Findings drive the development of tools/strategiesReferences and Acknowledgments1. De Paiva LC, Canário ACG, de Paiva China ELC, Gonçalves AK. Burnout syndrome in health-care professionals in a university hospital. Clinics (Sao Paulo). 2017;72(5):305–309. doi:10.6061/clinics/2017(05)082. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103–111. doi:10.1002/wps.20311. 3. Morse G, Salyers MP, Rollins AL, Monroe-DeVita M, Pfahler C. Burnout in mental health services: a review of the problem and its remediation. Adm Policy Ment Health. 2012;39(5):341–352. doi:10.1007/s10488-011-0352-1. 4. Poper R. Physician burnout in the U.S. and Europe: 19 statistics. Available at: https://www.beckersasc.com/leadership/physician-burnoutin-the-us-europe-19-statistics.html. Accessed 04/03/2020 *The literature matrix and literature is extensive and therefore it is not possible to fit on this specific poster. Paper copies are available or can be requested by email by requesting them from the faculty sponsor at Dr Linnaya Graf lgraf@liberty.edu *The authors want to acknowledge the work and time of the many authors who provided the amazing data and contributions that are being used to shape this field. https://watch.liberty.edu/media/t/1_wziq51wi

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Stress and Resilience among Healthcare Professionals: A Synthesized Literature Review

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