Randomized controlled trial of the “WISER” intervention to reduce healthcare worker burnout

Profit, Jochen; Cui, Xin; Mitchell, Briana; Brandon, Debra; Tawfik, Daniel S.; Rigdon, Joseph; Gould, Jeffrey B.; Lee, Henry; Timpson, Wendy; McCaffrey, Martin J.; Davis, Alexis S.; Pammi, Mohan; Matthews, Melissa; Stark, Ann R.; Papile, Lu-Ann; Thomas, Eric J.; Cotten, Michael; Khan, Aman Nawaz

doi:10.1038/s41372-021-01100-y

Cited by 25 publications

(47 citation statements)

References 47 publications

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“…For these reasons, no interventions have been implemented as part of clinical care [ 10 ]. In addition, few interventions for staff burnout exist, and only one resiliency program has been developed for NICU staff [ 11 ]. This web-based resiliency intervention included six positive psychology modules: (1) gratitude; (2) three good things; (3) awe; (4) random acts of kindness; (5) identifying and using signature strengths; and (6) relationship resilience [ 11 ].…”

Section: Current Nicu Psychosocial Programmingmentioning

confidence: 99%

“…In addition, few interventions for staff burnout exist, and only one resiliency program has been developed for NICU staff [ 11 ]. This web-based resiliency intervention included six positive psychology modules: (1) gratitude; (2) three good things; (3) awe; (4) random acts of kindness; (5) identifying and using signature strengths; and (6) relationship resilience [ 11 ]. Tested in a pragmatic randomized clinical trial, this intervention helped reduce staff burnout [ 11 ].…”

Section: Current Nicu Psychosocial Programmingmentioning

confidence: 99%

“…This web-based resiliency intervention included six positive psychology modules: (1) gratitude; (2) three good things; (3) awe; (4) random acts of kindness; (5) identifying and using signature strengths; and (6) relationship resilience [ 11 ]. Tested in a pragmatic randomized clinical trial, this intervention helped reduce staff burnout [ 11 ]. However, 44.3% of eligible staff enrolled [ 11 ], suggesting possible resistance among staff and a need for standardized mental health support.…”

Section: Current Nicu Psychosocial Programmingmentioning

confidence: 99%

“…Tested in a pragmatic randomized clinical trial, this intervention helped reduce staff burnout [ 11 ]. However, 44.3% of eligible staff enrolled [ 11 ], suggesting possible resistance among staff and a need for standardized mental health support. Overall, psychosocial care in the NICU is limited because: (1) current interventions for parents tend to lack post-intervention efficacy and/or effectiveness; (2) few staff programs exist; (3) resources and support for psychosocial programs are limited; and (4) researchers and clinicians are working in silos.…”

Section: Current Nicu Psychosocial Programmingmentioning

confidence: 99%

“…Clinical-research-trainee programs that aim to improve resiliency and relationships are ideal. Focusing on resiliency and relationships within this sensitive unit can positively impact on parental emotional distress, staff burnout and, ultimately, parent–child interactions and quality of care [ 7 , 9 , 11 ]. Figure 1 displays the proposed conceptual model that can help inform innovative services.…”

Section: Future Directionsmentioning

confidence: 99%

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Caring for our caretakers: building resiliency in NICU parents and staff

2022

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The neonatal intensive care unit (NICU) is a high-acuity, stressful unit for both parents and staff. Up to 50% of mothers and partners experience emotional distress (i.e., depression, anxiety, or posttraumatic stress) during NICU hospitalization and 30–60% continue to experience distress after discharge. Similarly, up to 50% of NICU staff report burnout and emotional distress. Although healthcare providers have developed interdisciplinary guidelines to enhance psychosocial resources for parents and staff, standardized psychosocial services are lacking. The purpose of this short communication is to describe: (1) the need for psychosocial interventions for NICU parents and staff; (2) existent psychosocial programs and their gaps and limitations; and (3) future directions for psychosocial care in NICU settings. We reviewed the current literature and propose a new conceptual model to inform psychosocial interventions for the NICU. We argue that brief, evidence-based, resiliency, and relationship-based programs are needed to enhance parent and staff outcomes and, ultimately, child development and the NICU unit culture. Conclusion : Given the lack of standardized psychosocial care, new interventions for NICU families and staff are needed more than ever. Resiliency, relationship-based interventions that leverage multidisciplinary support may be an innovative way to enhance NICU outcomes and care. What is Known: • 40-50% of parents in the NICU report elevated emotional distress and 30-50% of staff report burnout. • Psychosocial interventions for parents and staff are needed, yet lacking. What is New: • Interventions that focus on resiliency and relationships may improve the culture of the NICU. • New multidisciplinary collaborations and approaches are needed to improve implementation.

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Section: Current Nicu Psychosocial Programmingmentioning

confidence: 99%

Section: Current Nicu Psychosocial Programmingmentioning

confidence: 99%

Section: Current Nicu Psychosocial Programmingmentioning

confidence: 99%

Section: Current Nicu Psychosocial Programmingmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

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Caring for our caretakers: building resiliency in NICU parents and staff

2022

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Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers

et al. 2022

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ImportanceHealth care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress.ObjectiveTo assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period.Design, Setting, and ParticipantsThis single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group).InterventionsThe TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources.Main Outcomes and MeasuresThe primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale).ResultsAmong 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (−5.6 points vs −3.8 points; between-group difference, −1.8 points; 95% CI, −4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: −8.0 points vs −2.6 points; between-group difference, −5.4 points; 95% CI, −9.2 to −1.6 points; P = .006), insomnia (Insomnia Severity Scale score: −4.1 points vs −1.9 points; between-group difference, −2.2 points; 95% CI, −4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: −3.1 points vs −0.9 points; between-group difference, −2.2 points; 95% CI, −3.8 to −0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice.Conclusions and RelevanceIn this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs.Trial RegistrationClinicalTrials.gov identifier: NCT04632368

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Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021

Sexton

Adair

Proulx³

et al. 2022

JAMA Netw Open

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111

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ImportanceExtraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being.ObjectiveTo determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point.Design, Setting, and ParticipantsThis survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US.ExposuresSafety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate.Main Outcomes and MeasuresThe percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree); neutral or higher scores were counted as “percent concerning” for exhaustion.ResultsElectronic surveys were returned by 37 187 (of 49 936) HCWs in 2019, 38 460 (of 45 268) in 2020, and 31 475 (of 41 224) in 2021 to 2022 for overall response rates of 74.5%, 85.0%, and 76.4%, respectively. The overall sample comprised 107 122 completed surveys. Nursing was the most frequently reported role (n = 43 918 [40.9%]). A total of 17 786 respondents (16.9%) reported less than 1 year at their facility, 59 226 (56.2%) reported 1 to 10 years, and 28 337 (26.9%) reported 11 years or more. From September 2019 to September 2021 through January 2022, overall %EE increased from 31.8% (95% CI, 30.0%-33.7%) to 40.4% (95% CI, 38.1%-42.8%), with a proportional increase in %EE of 26.9% (95% CI, 22.2%-31.8%). Physicians had a decrease in %EE from 31.8% (95% CI, 29.3%-34.5%) in 2019 to 28.3% (95% CI, 25.9%-31.0%) in 2020 but an increase during the second year of the pandemic to 37.8% (95% CI, 34.7%-41.3%). Nurses had an increase in %EE during the pandemic’s first year, from 40.6% (95% CI, 38.4%-42.9%) in 2019 to 46.5% (95% CI, 44.0%-49.1%) in 2020 and increasing again during the second year of the pandemic to 49.2% (95% CI, 46.5%-51.9%). All other roles showed a similar pattern to nurses but at lower levels. Intraclass correlation coefficients revealed clustering of exhaustion within work settings across the 3 years, with coefficients of 0.15 to 0.17 for emotional exhaustion and 0.22 to 0.24 for emotional exhaustion climate, higher than the .10 coefficient typical of organizational climate (a medium effect for shared variance), suggestive of a social contagion effect of HCW exhaustion.Conclusions and RelevanceThis large-scale survey study of HCWs spanning 3 years offers substantial evidence that emotional exhaustion trajectories varied by role but have increased overall and among most HCW roles since the onset of the pandemic. These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions.

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Randomized controlled trial of the “WISER” intervention to reduce healthcare worker burnout

Cited by 25 publications

References 47 publications

Caring for our caretakers: building resiliency in NICU parents and staff

Caring for our caretakers: building resiliency in NICU parents and staff

Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers

Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021

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