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Interventions on reducing burnout in physicians and nurses: A systematic review

Interventions on reducing burnout in physicians and nurses: A systematic review Background d: Burnout is one of the m main factors in n reducing the e performance quality amon ng hospital sta aff. Appropriate interventions can reduce burn nout among phy ysicians and nur rses and result i in promotion of f the quality of f services provid ded at hospitals s. The present stu udy aimed to p provide a more comprehensive e understanding g of the interve entions on burn nout reduction among hospita al physicians and nurses. Methods: St tudies were sea arched from Jan nuary 2000 to June 2017 in P PubMed, Emba ase, Scopus, Co ochrane, and W Web of Science e. Randomized cl linical trials (R RCTs) and prete est-posttest stud dies that had in nterventions to reduce the bur rnout of physic cians and nurse es were included.. However, stu udies conducted d on medical a and nursing stu udents and nonmedical provid ders or beyond d hospitals wer re excluded. Results: Bas sed on the stud dy inclusion cri iteria, 12 RCTs and 6 pretest t-posttest studie es were includ ded in the revie ew. Most of the included studie es were from N Netherlands, th he United State es, and Englan nd. The interventions included d team-based p program, EMH H- approach, and coping and co ommunication skills training. Most of the interventions had a positive e effect on bur rnout reduction n. Nevertheless, s some studies ha ad no significan nt impact. Conclusion: The results sh howed that the e most interven ntions used to o improve burn nout were imp proving commu unication skills s, teamwork, par rticipatory prog grams, and psychological in nterventions (Y Yoga, meditatio on, and mindf fu u lness). The impact of these interventions c can increase me ental health in the long term m. Burnout is a complicated problem and sh hould be treated d by combining g interventions. Keywords: Bu urnout, Mental h health, Nurses, Physicians, Ho ospital, Systema atic review Conflicts of Interes st: None declared Funding: None *This work has bee en published under r CC BY-NC-SA 1.0 liicense. Copyright© Iran University of Medi ical Sciences Cite this articl le as: Aryankhes sal A, Mohamma adibakhsh R, Ham midi Y, Alidoost S, Behzadifar M M, Sohrabi R, Farrhadi Z. Interven ntions on reducing burnout in physic cians and nurses: A systematic rev view. Med J Islam m Repub Iran. 2019 (31 Jul);33:77 7. https://doi.org/1 10.34171/mjiri.33 3.77 Introduction Health is a a right and an n important ne eed for all hu uman One e of the mostt important S SDH is the so ocial status o of beings, and it ts role in prom moting human n developmen nt in- peop ple in exposu ure to unhealtth hy and stress sful living and d dicators is u undeniable. S Social determ minants of h health work king condition ns (1). Burno out is one of the factors af f- (SDH) are co onsidered as the most im mportant facto ors in fecti ing the qualitty of staff and d worker's pe erformance (2 2, achieving hea alth goals and d establishing g equity in he ealth. 3). T This phenome enon counts a as a particular r type of occu u- _______________ ________________ _ Co orresponding autho or: Dr Roghayeh Mo ohammadibakhsh, m mohamadibakhsh.r r@ @ tak.iums.ac.ir ↑What is “a already known ” in this topic: 1. Burnout is an important p problem for he ealth workforce e, Health Manageme ent and Economics Research Center, Iran University of M Medical Sciences, with a stro ong impact on n their quality y of life and a Tehran, Iran Department of H Health Services M Management, School of Health M Management and correspondiing decrease in n the quality o of care with an n Information Scienc ces, Iran University of Medical Sciences, Tehran, Iran evident economic burden f for the health care system. Department of He ealth Management and Economics, Sc chool of Public Hea alth and Research Center for Public H Health, Hamadan University of Medical Sciences, Hamada an, Iran. →What this article adds: : Social Determinan nts of Health Resea arch Center, Lorestan University of M Medical Sciences, This was tthe first system matic review t to compare th he Khorramabad, Iran n intervention ns on physician ns and nurses’ burnout. Thes se Iranian Social Secu urity Organization, Z Zanjan Province Hea alth Administration n, Zanjan, Iran intervention ns can be used d by policymakers, managers s, researchers, and all th hose who are e interested in n improving m mental health o of physicians an nd nurses. Burnout in ph hysicians and nurses pational react tion among pr rofessions res sulted from m mutual not conducted at hospitals, stu udies conducted on medica al emotional relationships b between servi ice providers and and nursing stude ents, review s studies, the ab bstracts of the e their recipien nts. It is also a a syndrome th hat causes phy ysical conf ferences, book k chapters, an nd letters writ tten to the edi i- and emotiona al exhaustion n, depersonali ization, feelin ng of tors were excluded in this stu udy. Any disa agreement be e- failure, reduc ction in the po ower of adapt tation to stres ssors, twee en the researc chers was res solved through consultation n negative attitu ude towards job, and low s self-efficacy ( (4-6). with h a third resear rcher. Hospital staff fs, especially physicians an nd nurses, are e par- ticularly expo osed to burnout due to th he nature of their Da ata extraction n work, their in nteraction wit th patients, an nd observing their Da ata for the leading authors s’ name, coun ntry, period o of suffering (7, 8 8). research, study d design, year o of publication n, participants s, The effects of burnout ca an be investiga ated from pers sonal samp ple size, type of interventio on, interventio on effects, and d and organizat tional aspects and they ma ay lead to neg gative othe er findings of the study we ere extracted b by 2 member rs impacts on p patients care, their dissatis sfaction, incre eased of t the research team. Disag gr reements bet tween the re e- medical error rs, reduced w working hours, and lack of f sus- searchers were res solved throug gh negotiation or referring to o tainability in health care s systems due t to reduction iin at- a thi ird person as a a referee. tempts, work commitment,, and job term mination, espec cially among nurses s (9, 10). The erefore, recogn nition and pre even- Qu uality assessm ment tion of burno out can play a a key role in improving m mental Th he methodolo ogical quality of studies in ncluded in the e health, and th hus improving g the quality o of services pro ovid- pres sent systematic c review was assessed usin ng the “Critica al ed at hospita als. Accordin ngly, appropri iate interventtions, App praisal Skills P Programme” (C CASP) check klist (14). both at indiv vidual and or rganizational levels, shoulld be In n this study, th he CASP chec cklist was used d for RCT and d performed to reduce burno out among ho ospital staff, e espe- time e series studie es and the JBI I critical appr raisal checklis st cially in phys sicians and nur rses. for p pretest-posttest studies. Th hen, studies t that earned an n Many studi ies have been n done to redu uce the burno out of inter rmediate and h high score enttered the study y (15). physicians an nd nurses. In th hese studies, i interventions, such Sc cores below 7 7 were consid dered as “low w quality”, 7-8 8 as yoga and communicat tion skills tra aining, have been “inte ermediate qua ality”, and 9-1 0 “high qualit ty”. identified as i interventions that have imp proved the bur rnout of physicians s and nurses ( (11, 12). Anot ther systematiic re- Re esults view article e examined the interventions for reducing phy- Th he electronic s search of the databases led d to identifying g sician burnou ut in 2015 (1 13). However,, the present s study 2506 6 studies, and d 5 studies we ere identified through hand d reviewed thes se interventio ons over a lon nger period (u up to searching of the llast issues of jjournals, with h the most pa a- 2017) and se earched more databases. It also compare ed the pers s identified thr rough electron nic database searching. Af f- interventions that were pe erformed to r reduce burnou ut in ter r removing the duplicate stud dies, the titles s and abstract ts physicians an nd nurses. of 1 1965 studies were examin ned by 2 rese earchers inde e- Thus, this s systematic rev view examined d various inter rven- pend dently for relevance, and f finally 18 stu udies were in n- tions that redu uced burnout in physicians and nurses. T These clud ded for the fina al analysis. Th he process of study identifi i- interventions can be used d by policym makers, mana agers, catio on and selectiion, based on n the PRISMA A, is presented d researchers, a and all those w who are intere ested in impro oving in Figure 1. mental health h of physicians s and nurses. Th he findings of f this study in ndicated that o only few stud d- ies h have been con nducted on oc ccupational bu urnout of phy y- Methods sicia ans and nurse es. Selected s studies in thi is paper were e Literature s search inter rventional studies, RCTs, a an nd pretest- po osttest studies.. Five interna ational academ mic databases s (ISI/Web of f Sci- M Most included s studies were f from Netherla ands, the Unit t- ences, PubM Med, Embase, Scopus, and d Cochrane C CEN- ed S States, and En ngland and we ere concluded d during 2010 0- TRAL) were searched fro om January 2000 to June 2017 2017 7. Also, 50% of interventio ons had a positive impact on n using the fol llowing string g of keyword ds: (“Nurses” ” OR phys sicians’ burno out and 67% a a positive imp pact on nurses s’ “Physicians”) ) AND (“Bu urnout” OR “Depression” ” OR burn nout. Most in nterventions w were similar in physician ns “Mental healt th”) AND (“R Randomized co ontrolled trial” ” OR and nurses, but tthe interventiions perform med on nurses “Time series s” OR “Prete est posttest” OR “Before- -after were e more divers se and sometim mes the effects of the same e study”) AND “Hospital”. In this study y, Google Sch holar inter rvention varie ed in different target groups s. was used to search gray l literature. The e reference liist of Th he interventions in the inclu uded studies t that were con n- included stud dies was also h hand-searched d to ensure th hat all duct ted to reduce burnout and tto improve mental health o of relevant studi ies were consi idered. The re esults of the se earch phys sicians and nu urses are as fo ollow: are included i in the EndNot te X8 software e. EM MH and OP Inclusion an nd exclusion c criteria E- -mental healtth interventio ons are aimed to reduce e In the first stage, the title es and the abs stracts of the stud- spec cific mental h health compllaints or to e enhance well l- ies were indep pendently exa amined by 2 re esearchers thr rough bein ng. In the OP- -care group w who were scre eened positive e which interve entional stud dies on physic cians and nu urses’ on im mpaired work k functioning a and/or on any y mental health h burnout were e included. No onintervention nal studies, stu udies com mplaints, the pe ersonalized fe eedback was f followed by an n http://m mjiri.iums.ac.ir Med J Is slam Repub Ira an. 2019 (31 Jul l); 33:77. A. Arya ankhesal, et al l. Fig. 1. Study se election process invitation for r a face-to-fac ce preventive consultation with stres ss, and burnoutt among physiicians and nurs ses. their own occ cupational ph hysician (OP).. Both groups s im- proved over time, and no significant d difference was s ob- On nline program ms and interne et-based inte erventions served betwe een intervention groups with EMH and d OP On nline interven ntion program ms significan ntly improved d approaches. men ntal health and d reduced the symptoms of f depression in n the s staff. Team-base ed interventions and partic cipatory progr rams In all inclu uded studies,, team-based and participa atory Pr rofessional ide entity develop pment progra am programs had d a non-signi ificant effect. In this study y, no A professional identity deve elopment prog gram can also o significant re elationship wa as observed b between super riors’ redu uce burnout of f the nurses. support and improvement t in mental st tatus of the staff, which indica ates that impr rovement in m mental health h and Co oping interven ntions symptoms of depression ca an be due to proper commu unica- Co oping interve entions led tto a reductio on in burnou ut tion and parti icipation of nu urses on the same level, and d not amo ong nurses, bu ut the effect wa as no significa ant. merely on the e relationship with their sup periors. Th hankful event ts Psychosocia al training int tervention W Workplace app preciation had d a significan nt effect in in n- Psychosocial training intervention significantly im- crea asing performa ance and redu ucing depress sion and burn n- proved burno out rates. Nur rse training, w with broader r range out a among nurses and physicia an ns. of interventio ons, helps the e nurses to ha ave more pos sitive attitudes towa ards the patien nts. M Mix methods Th he use of integ grated method ds was shown n to have a sig g- Psychiatric interventions s nific cant effect on reducing phys sicians and nu urses’ burnout t. Psychiatric interventions,, such as Yog ga and medita ation, Ov verall, most iinterventions intended to i investigate the e and mindfulne ess interventio ons led to a sig gnificant increa ase in impa act of trainin ng communic cation skills o on burnout o of self-care and a a significant re eduction in em motional exhaus stion, phys sicians and n nurses. In two o thirds of th he studies, the e http:/ //mjiri.iums.ac.ir i Med J J Islam Repub I Iran. 2019 (31 J Jul); 33.77. Burnout in ph hysicians and nurses interventions had a positive e impact on re educing burno out. copi ing skills train ning had no siignificant effe ect on burnout t. In 50% of t the cases, com mmunication s skills training with Nev vertheless, mix methods h had a signific cant effect on n EMH approa ach had a sig gnificant effect on burnou ut. In burn nout in all stud dies. 75% of studie es, psychiatric c interventions had a signif ficant Ch haracteristics of the includ ded studies on n the interven n- effect on burn nout. Also, in all studies, on nline interven ntions tions s of physician ns' burnout are e presented in n Tables 1 and d and professio onal identity d development p programs had d sig- 2. nificant effec cts on burno out. However, team-based d and In nterventions an nd effects on n burnout of p physicians and d Table 1. Characteristics of the included studies on the intterventions of ph hysicians' burnout t Author o C Country Participant Interventiion Effe fect of the Main n finding Qu uality inte ervention Asse essment Contr ratto Computerized p physician Fou ur months afterr the intervention, im- 9 2017 order entry, ele ectronic P Positive provements were fo ound in physician ns’ burn- (16) 7 physi- health reco ords out. This study supp ports the use of ph hysician UK cians ord der entry clerical l personnel as a simple, cost-effective interv vention to impr rove the wor rk lives of physic cians. The ere were no sig gnificant differe ences in 9 Butow w Australia/New Zealand 95 physi- Consultation n skills Nons significant bur rnout scores bettween the experimental 2016 Swiss/Germany/Austria cians training g and d control groups. (17) The ere were no signiificant differences in pre- and d postrandomizattion scores betw ween the exp perimental and c control groups o on other stre ess and burnout su ubscales. EMH-approach h consul- A s significant improv vement in work fu function- 9 Noben n tation with an o occupa- P Positive ing occurred in the participating phy ysicians. 2014 617 physi- tional physicia an (OP) The e median increm mental cost-effec ctiveness (18) Ne etherlands cians ratio for the occupa ational physician n condi- tion n versus the conttrol condition wa as domi- nan nt. Improved comm munica- Mo ore intervention sh howed significan nt effects 9 tion; changes in n work- on reducing burnou ut t . All 3 of the fo ollowing Linzer 166 physi- flow, and tar rgeted types of interventio ons led to improvements 2015 cians quality improv vement P Positive in s some staff outcom mes: workflow, redesign, (19) USA (QI) proje ects and d improved com mmunication, es specially amo ong physicians an nd staff. Eight-point pr rogram A b beneficial treatme ent effects were o observed 9 Oman n 58 physi- (EPP), a mediitation- Nons significant on stress and menttal health. Treatm ment ef- 2006 USA cians based interve ention fectts on stress were e mediated by ad dherence (20) to p practices. Eviden nc ce suggests this p program reduces stress and d may enhance mental hea alth. No significant difffe e rences were found be- 9 twe een program partticipants and non npartici- Weight h 628 physi- Team-based, in ncentiv- Nons significant pan nts. Burnout wa as lower in partticipants 2013 USA cians ized exercise p program than n in nonparticipa ants, although the e differ- (21) enc ce was not statis stically significan nt. Resi- den nts and fellows m may be much more seden- tary y than previously y reported. Table 2. Characteristics of the included studies with interventions for redu ucing burnout in nurses Auth hor Countr ry Participan nt Interven ntion Eff fect of the Main finding g Quality inte ervention Asses ssment Th he result shows a decrease in sy ymptoms of depr ression. 8 Che eng China a 102 nurses s Thankful e events P Positive However, this rate e became less prronounced as tim me pro- 2015(22) gr ressed. At follow w-up, the gratitud de group reported d lower de epressive symptom ms than control g group. Electronic-mental Th he OP-care appro oach trended tow wards better performance 9 Ketelaar health care (EMH- in n targeting work f functioning, but fi findings showed tthat the 2013(23) Netherlan nds 1140 approac ch) Non- -significant EM MH care approach was noninferrior. However, th he high nurses Consultatio on with dr ropout rate and low compliance to EMH interv ventions an occupa ational sh hould be consider red. physic-cian n (OP) It was not demonstrated that an EM MH approach to W WHS is 9 Ketelaar Netherlan nds 1170 (EMH-approach) Non- -significant m more effective to iimprove WF and d MH. The effectt found 2014(11) nurses with an ( (OP) in n the complete sample of participa ants could not be e easily in nterpreted. Reportted results may be e useful for future meta- an nalytic work. Uchiy yama It is suggested tha at a 6-month inte ervention is effec ctive in 8 2013(24) Japan n 434 nurses s Participator ry pro- Non- -significant im mproving psychosocial work env vironment, but itt is not gram m ef ffective in improv ving mental health h of the nurses. http://m mjiri.iums.ac.ir Med J Is slam Repub Ira an. 2019 (31 Jul l); 33:77. A. Arya ankhesal, et al l. Tab ble 2. Ctd Aut thor Country Pa articipant Intervention Effect t of the Main ffinding Quali ity interv vention Assessm ment Yoga a participants rep ported high significant 8 Ale exander self-c care as well as lless depressive s symp- 201 15 (12) USA 40 0 nurses Yoga Pos sitive toms upon completio on of an 8-week yoga interv vention compare ed to control g group. Altho ough the controll group demonstrated no change of the sttudy, the yoga g group show wed a significant iimprovement in s scores from pre- to postinterv vention. Onliine intervention g group The iintervention was capable of enha ancing 8 Bol lier N Netherlands 1140 (O OI) or the wait listted Pos sitive positiive mental health h. However, due e to a 201 14 (25) nurses c control group (WL L) high attrition rate, tthis result shoulld be consiidered with cautio on. Burnout in the interve ention group improved 8 Dar rban Co ommunication sk kills Pos sitive after the intervention n. These changes s sug- 201 16 (26) Iran 60 0 nurses training gest a significant dec creasing trend. O On the other r hand, the mean n scores of burno out in the c control group sh howed no significant differ rence. Durin ng the research p period, burnout s symp- 9 Sab banciogullari Pro ofessional identity y de- toms significantly dec clined in the inte erven- 201 15 (27) Turkey 63 3 nurses v velopment progra am Pos sitive tion g group while thos se of the control g group increased. This progrram should be im mple- mented in different h hospitals and diff f erent samples of nurses. Inttervention: cognittive, 8 soma atic, dynamic, em motive Sallon Israel 16 64 nurses and h hands-on (Yoga, medi- Pos sitive These e results encoun ntered work stre essors 201 15 (28) tatiion, relaxation, to ouch impacts positively on health and well-being the erapy, energy hea aling and s significantly redu uces stress and bu urnout (Reiki) amon ng the nurses. Staff in the interve ention group sh howed 9 Ew wers Ps sychosocial trainiing signif ficant improvem me ents in burnout rates, 201 10 (29) UK 33 3 nurses intervention (PSI I) Pos sitive while e staff in the c control group sh howed increase in burnout. The findings ind dicate that n nurse training, w with broader ran nge of interv ventions, helps th hem to be more posi- tive in their attitudes s towards the c clients that they work with. Co oping skills trainin ng a Perso on-directed interv ventions can dec crease 9 support group Nonsig gnificant depre ession level. Th he fact that bu urnout Gun nus Turkey 10 08 nurses reduc ces after the inttervention and a an in- 201 10 (30) crease is observed in n 6 months is an n im- portant point. Thus, Itt is recommended that the nu umber of interven ntion studies to re educe burno out be increased d and that long g-term outco omes be evaluated d. Min ndfulness training g is a In this study, the find dings indicate siignifi- 9 pr romising method for cant improvements in n burnout symp ptoms. Ma ackenzie Canada 30 0 nurses help ping those in the n nurs- The r results of this piilot study sugges st that 200 06 (31) ing p profession; it man nages Pos sitive mindfulness training iis a promising m method stress, even when pro ovided for helping those in tthe nursing profe ession in a brief formatt. to ma anage their stress.. nurses are dem monstrated in Table 3. sicia ans and nurses s’ burnout. Th he identified interventions s to reduce burnout and to o impr rove mental health of phy ysicians and nurses are a as Discussion n follo ow: motivatio onal program ms, communic cation training g Burnout sy yndrome is an n important h health problem m af- skill ls, electronic m methods, psyc chiatric progra ams, and com m- fecting many people, espec cially physicia ans and nurses s and bine ed methods. O Overall, most o of studied inte erventions had d should be add dressed global lly with interv ventions at or rg gani- repo orted positive impacts on reducing bur rnout and im m- zational and i individual levels (32). App propriate strattegies prov ving mental he ealth. to control bu urnout can be found in a r range of identtified M Motivational pr rograms, such h as gratitude e and thankfu ul interventions.. The aim of f this systema atic review w was to even nts, for physic cians and nur rses as well a as professiona al investigate th he impact of c conducted inte erventions on phy- http:/ //mjiri.iums.ac.ir i Med J J Islam Repub I Iran. 2019 (31 J Jul); 33.77. Burnout in ph hysicians and nurses Table 3. Interv ventions and their r effect on burnou ut of physicians an nd nurses Interventions Physiciians Effect Nurses s Effect Gratitude and t thankful events * Positive Professional id dentity developme ent program * Positive Communicatio on skills training * Positive Positive Participatory program * No on-significant Team-based pr rogram * N Nonsignificant Consultation sk kills training * N Nonsignificant EMH approach h and OP approac ch * Positive * No on-significant Online program ms and internet-ba ased intervention ns * Positive * Positive Psychosocial tr raining interventi ion (PSI) * Positive Coping skills tr raining * No on-significant Mindfulness tra aining, Yoga, me editation, relaxatio on, touch therapy, energy healing (R Reiki) * N Nonsignificant * Positive Combination o of above methods * N Nonsignificant * Positive identity deve elopment prog grams can in ncrease motiv vation Also o, as burnout is a complex x subject, it is s better to use e and interest in n caring for patients and ca an improve de epres- mult tiple methods to improve iit. In Sallon s study, with the e sion, burnout t, and well-b being. A stud dy by Ziaei et al aim of reducing b burnout and iimproving me ental health o of showed that p proper human n resource man nagement, suc ch as nurs ses, mix interventions were e used which h resulted in a a new approach hes to encou uragement and d motivation,, can redu uction in burn nout among nurses (28). On the othe er reduce burnou ut in nurses a and improve t their mental h health hand d, various stud dies have sho own that burnout is affected d (33). The stud dy of Ebrahim mzadehpezeshki showed tha at the by s several factors s that can act as facilitators s or barriers o of use of motiva ational methods can be eff fective in redu ucing inter rventions to iimprove burn nout, which sh hould be con n- the burnout o of nurses, wh hich is consist tent with the find- sidered. Age, sex x, work expe erience, work environment t, ings of the pr resent study (3 34). The role of communic cation type e of specializa ation, and inco ome can affect the severity y skills training g is importan nt in reducin ng specific m mental and weakness of jjob burnout. I In this regard d, some studies health compla aints or enhan ncing well-bei ing (26). The find- were e shown that higher burnou ut levels could d be increased d ings of the present stud dy revealed t that strengthe ening due to the high de emands, long working hour rs, insufficien nt communicatio on skills is m more effective in reducing b burn- inco ome, a perceiv ved mismatch between effo ort and reward d, out in physici ians than in nu urses. In this c context, Penberthy and poor organizational adm ministration (3 36,37). Work k- study is consistent with the present stud dy which aim med at plac ce appreciation n can also be effective in increasing per r- improving th he communica ation skills of physicians (35). form mance, reducin ng depression n, and improvi ing burnout o of Team-based a and participat tory programs can help re educe nurs ses and physic cians. Further rm more, the study of Viotti e et symptoms of f depression a and improve mental healtth. A al showed no sta atistically sig gnificant diffe erences in the e study conduc cted by Uchiy yama suggested that the sy ymp- emo otional exhaus stion value be etween Intens sive Care Uni it toms of depre ession and me ental health ca an be improved in (ICU U) and non-intensive care e unit (non-ICU) workers s, the hospitals where the p possibility of f visiting patiients, altho ough the aver rage score is h higher for non n-ICU worker rs receiving req quired informa ation, and par rticipation is h high. (38) ). The survey y conducted b by Medscape e showed tha at Nevertheless,, this finding should be interpreted with h cau- spec cialties with the highest p percentage of burnout are e tion. The sym mptoms of de epression app pear in high s stress thos se that deal wiith severely illl patients (em mergency medi i- conditions, so o if milder sy ymptoms, such h as irritation n, an- cine e and critical care register r 55% burnou uts), and thei ir ger, and anxi iety, are also examined, thi is intervention n can phys sicians also r reported a gre eater degree of severity in n have positive e effects (24). In another st tudy by Weig ght et their r burnout (39, 40). al, the sympt toms of burno out were mild der in interven ntion Ad dditionally, th he results of th his study indicated that var r- group, using teamwork, co ompared to control group (21). ious s interventions s can be used d to improve t the burnout o of Psychiatric pr rograms (Yog ga, meditation n, and mindfu ulness phys sicians and nurses, and th heir applicatio on should take e programs) ca an help reduce burnout and improve m mental into account the iindividual, or rganizational, specialty, and d health. Yoga practice may y be an effecti ive strategy to o im- relev vant aspects o of the program m. Therefore, these findings prove the hea alth of nurses (12). Coping g interventions s can are not universall and their ef ffect on burnout should be e also lead to a reduction i in burnout am mong nurses (30). follo owed-up acros ss other health h care personnel and in dif f- Moreover, in ndividual inter rventions can reduce emottional feren nt contexts ov ver a longer pe eriod of time. exhaustion. T These findings s were confirm med in a stud dy by Lee et al, in w which the role e of copying s strategies in re educ- Lim mitations ing burnout of the nurse es was exam mined. Lee's s study Th he number of studies using the same inte erventions wa as showed that using copyi ing interventi ions for 6 to o 12 too small, so gene eralizing the r results should d be done with h months can l lead to a redu uction in emo otional exhaus stion, caut tion. The num mber of partic cipants in som me studies wa as depression, an nd ultimately burnout amon ng nurses (9). too low, which h has led to a r reduction in t their statistica al However, f further researc ch is required d to confirm tthese stren ngth and an increase in iin nconsistency,, reducing the e results. Using g larger sam mple sizes, mo ore active co ontrol effec cts of interven ntion. Howeve er, in some stu udies in which h groups, dedic cating more t time to interv vention, and u using the s sample size w was large, no s significant rel lationship wa as other interven ntions and co omparing them m with mentiioned obse erved betwee en interventio on and burno out reduction n. interventions,, can make th he study resu ults more reliiable. Dem mographic cha aracteristics of f the participa ants and heter r- http://m mjiri.iums.ac.ir Med J Is slam Repub Ira an. 2019 (31 Jul l); 33:77. A. Arya ankhesal, et al l. Eu urope and the United States. BMJ.. 2012;344:e1717 7. ogeneity of t the groups ca an also affect the outcome es. In 11. K Ketelaar SM, Nieuwenhuijsen K,, Gärtner FR, Bo olier L, Smeets O O, some cases, improving und desirable work k conditions ( (staff Sl luiter JK. Mentall Vitality@ Worrk: The effective eness of a menta al shortage and insufficient salaries and be enefits) were m more module for worker rs’ health surveilllance for nurses and allied healt th effective in reducing the symptoms o of depression n and pr rofessionals, com mparing two app proaches in a cluster-randomised co ontrolled trial. Int Arch Occup Env viron Health. 2014;87(5):527-38. burnout than n improving psychological conditions. The 12. A Alexander GK, R Rollins K, Walkerr D, Wong L, Pen nnings J. Yoga fo or dispersion an nd multiplicity y of mental he ealth indices c could se elf-care and burn nout prevention a among nurses. W Workplace Healt th also affect the e outcomes of f the study. Sa af. 2015;63(10):462-70. 13. Wiederhold BK, Cipresso P, Piz zzioli D, Wieder rhold M, Riva G G. In ntervention for p physician burno out: A systematic review. Open Conclusion n M Medicine. 2018;13(1):253-63. Different s strategies, suc ch as trainin ng and impro oving 14. C CASP U. Critical Appraisal Skillls Programme (CASP). Qualitativ ve communicatio on skills, yoga, and spiritual programs b based research checklist. 2017;31(13):449 9. 15. JBI Critical Appraisal Checklistt for Quasi-Experimental Studie es on meditation n, teamwork, c computer prog grams, staff ap ppre- (n non-randomized experimental stud dies), (2017). ciation, and copying stra ategies can be used to re educe 16. C Contratto E, Rom mp K, Estrada CA A, Agne A, Willlett LL. Physician burnout amon ng physicians s and nurses. Training and d im- Or rder Entry Clerical Support Imp proves Physician n Satisfaction and proving com mmunication s skills were th he most effe ective Pr roductivity. South h Med J. 2017;11 0(5):363-8. 17. B Butow P, Brown R, Aldridge J, Ju uraskova I, Zoller r P, Boyle F, et al. interventions to improve bu urnout in nurs ses and physic cians. Ca an consultation skills training cha ange doctors' behaviour to increas se Undoubtedly,, the results o of intervention ns to reduce b burn- involvement of pattients in making d decisions about s standard treatmen nt out and the in ndices related d to mental he ealth improve ement an nd clinical trials: a randomized controlled triall. Health Expect t. will appear in n the long run,, and more fol llow-up studie es are 20 015;18(6):2570-83. 18. N Noben C, Smit F F, Nieuwenhuijse en K, Ketelaar S,, Gärtner F, Boon needed to trac ce the durabil lity of the cha anges. Also, b burn- B,, et al. Comparative cost effec cttiveness of two o interventions t to out in physic cians and nur rses is a complex problem m that pr romote work fun nctioning by tarrgeting mental h health complaint ts should be tak ken into consi ideration in in nterventions a and if am mong nurses: Pr ragmatic clusterr randomized tr rial. Investing in possible, com mbined and m multidimensio onal interven ntions em mployability inter rventions? Int J N Nurs Stud. 2014;5 51:1321–1331 19. L Linzer M, Poplau u S, Grossman E,, Varkey A, Yale e S, Williams E, e et should be use ed. On the oth her hand, full implementatio on of al. A cluster rand domized trial off interventions tto improve wor rk these interven ntions can be costly and providing the neces- co onditions and cliinician burnout iin primary care: results from th he sary conditions, such as c commitment o of key individ duals He ealthy Work Place (HWP) study. J Ge en Intern Med d. and preparing g participants before the int tervention, is h high- 20 015;30(8):1105-11. 20. Oman D, Hedbe erg J, Thoresen CE. Passage m meditation reduce es ly important. Therefore, tim me, space, and d feasibility lim mita- pe erceived stress in n health profess siionals: A randomized, controlled tions are the p priority issues s in applying s such interventtions. tri ial. J Consult Clin n Psychol. 2006;7 74(4):714 –719. 21. W Weight CJ, Sello on JL, Lessard-A Anderson CR, Sha anafelt TD, Olsen Conflict of I Interests KD D, Laskowski E ER, editors. Phys sical activity, qu uality of life, and bu urnout among p physician trainee es: the effect o of a team-based d, The authors d declare that they have no co ompeting inter rests. incentivized exercise program. Ma ayo Clin Proc. 2 2013;88(12):1435 5- 42 2. 22. C Cheng ST, Tsui P PK, Lam JH. Imp prroving mental he ealth in health car re pr ractitioners: Rand domized controlle ed trial of a gratiitude intervention n. Reference es J C Consult Clin Psyc chol. 2015;83(1)::177-86. 1. MoH. The he ealth and its social determinants. The main soluttion to 23. K Ketelaar SM, Nieuwenhuijsen K,, Gärtner FR, Bo olier L, Smeets O O, expand justice in health and create a fair opp portunity for eve eryone. Sl luiter JK. Effect of an e-mental h health approach tto workers' healt th Tehran: Moaf fagh; 2008. su urveillance versus control group on work functioning of hospita al 2. Asuero AM, Q Queraltó JM, Puj jol‐Ribera E, Ber renguera A, Rodr riguez‐ em mployees: a cluster e -RCT. PLoS On ne. 2013;8(9):e72 2546. Blanco T, Ep pstein RM. Effe ectiveness of a m mindfulness edu ucation 24. U Uchiyama A, Oda agiri Y, Ohya Y, Takamiya T, Ino oue S, Shimomitsu program in pr rimary health car re professionals: a pragmatic conttrolled T.. Effect on menta al health of a parrticipatory intervention to improv ve trial. J Contin n Educ Health Pro of. 2014;34(1):4-1 12. ps sychosocial work environment: a c cluster randomized controlled tria al 3. Ding Y, Yan ng Y, Yang X, Zhang T, Qiu X, He X, et all. The am mong nurses. J Oc ccup Health. 2013 3;55(3):173-83. mediating ro ole of coping style in the relationship be etween 25. B Bolier L, Ketelaa ar SM, Nieuwenh huijsen K, Smeets O, Gärtner FR R, psychological l capital and burn nout among Chin nese nurses. PLoS S One. Sl luiter JK. Workp place mental hea alth promotion o online to enhanc ce 2015;10(4):e0 0122128. we ell-being of nur rses and allied health professio onals: A cluster r- 4. Hamidi Y.Str rategic leadership p for effectivenes ss of quality man nagers randomized controlled trial. Internett Interv. 2014;1(4 4):196-204. in medical sc ciences universit ties: What skills s is necessary. A Aust J 26. Darban F, Balou uchi A, Narouip pour A, Safarzaei E, Shahdadi H H. Basic Appl Sc ci. 2009; 3(3):256 63-2569. Ef ffect of communication skills tra aiining on the bur rnout of nurses: a 5. Hamidi Y, Najafi L, Vata ankhah S, Afka ar A. The effe ect of cr ross-sectional stud dy. J Clin Diagn R Res. 2016;10(4):IC01-IC04. performance appraisal results on the personne els motivation an nd job 27. Sabancıogullari S, Dogan S. Efffects of the pro ofessional identit ty promotion. Au ust J Basic Appl Sci. 2010;4(9):41 178-83. de evelopment progr ramme on the pro ofessional identitty, job satisfaction 6. Leiter MP, M Maslach C. Nurse t turnover: the med diating role of bu urnout. an nd burnout levels of nurses: A A pilot study. In nt J Nurs Pract t. J Nurs Manag g. 2009;17(3):331 1-9. 20 015;21(6):847-57. 7. Chou LP, L Li CY, Hu SC. Job stress and d burnout in ho ospital 28. S Sallon S, Katz-Eisner D, Yaffe H H, Bdolah-Abram T. Caring for th he employees: co omparisons of dif fferent medical pr rofessions in a re egional ca aregivers: results of an extended d, five-componen nt stress-reduction hospital in Ta aiwan. BMJ Open n.2014;4(2):e0041 185. intervention for hospital staff. Int J B Behav Med. 2017 7;43(1):47-60. 8. Poghosyan L,, Clarke SP, Finla ayson M, Aiken L LH. Nurse burno out and 29. Ewers P, Bradsh haw T, McGove ern J, Ewers B. Does training in quality of care e: Cross‐national investigation in six countries. Res s Nurs ps sychosocial interv ventions reduce b burnout rates in f forensic nurses? J Health.2010;3 33(4):288-98. Ad dv Nurs. 2010;37 7(5):470-6. 9. Lee HF, Kuo o CC, Chien TW W, Wang YR. A A meta-analysis of the 30. Günüşen N, Üsttün B. An RCT of coping and s support groups t to effects of cop ping strategies o on reducing nurs se burnout. Appll Nurs reduce burnout among nurses. INT N Nurs Rev. 2010;5 57(4):485-92. Res. 2016;31: :100-10. 31. Mackenzie CS S, Poulin PA, Seidman-Carlso on R. A brie ef 10. Aiken LH, Sermeus W, Van n den Heede K, Sloane DM, Bu usse R, mindfulness-based stress reduction intervention for nurses and nurs se McKee M, et t al. Patient safet ty, satisfaction, a and quality of ho ospital aid des. Appl Nurs R Res. 2006;19(2):10 05-9. care: cross sectional surveys o of nurses and patiients in 12 counttries in http:/ //mjiri.iums.ac.ir i Med J J Islam Repub I Iran. 2019 (31 J Jul); 33.77. Burnout in ph hysicians and nurses 32. West CP, Shanafelt TD, Kolars JC. Qua ality of life, bu urnout, educational d debt, and medica al knowledge am mong internal me edicine residents. JAM MA. 2011;306(9) ):952-60. 33. Ziaei M, Y Yarmohammadi H H, Karamimatin B, Yarmohamm madi S, Nazari Z, Gha aragozlou F. Prev valence and risk factors of occupa ational burnout amon ng nurses of a h hospital in Kerma anshah in 2013. Iran J Ergon. 2014;2 2(2):67-74. 34. Ebrahimzad dehpezeshki R. Jo ob burnout in nu urses and its impact on their negligen nce. J Urmia Nurs s. Midwifery Fac.. 2017;15(2):86-9 94. 35. Penberthy JK, Chhabra D,, Ducar DM, Avitabile N, Lync ch M, Khanna S, e et al. Impact of f Coping and C Communication Skills Program on Physician Burn nout, Quality of Life, and Emo otional Flooding. Saf f Health Work. 20 018;9:381-387. 36. Mohammed d K, Ali EG, Yo oussef IM, Fahm my MT, Haggag WEL. Burnout and d Personality a among Egyptian n Residents. A Ar rab J Psychiatry. 20 013;24(2):148-60 0. 37. Hamidi Y, Mohammadibak khsh R, Soltanian A, Behzadif far M. Relationship between organi izational culture and commitme ent of employees in health care centers in west of Ira an. Electron Phys sician. 2017;9(1):364 46-3652. 38. Viotti S, Co onverso D, Loera a B. Soddisfazion ne lavorativa e bu urnout in relazione a alle caratteristiche e del lavoro e alla a tipologia dell’u utenza: un confronto tra servizi di cur ra intensivi (ICU U) e non intensivii (non- ICU). G Ital M Med Lav Ergon. 2 2012;34(2 Suppl B):52-60. 39. Gnerre P, R Rivetti C, Rossi A AP, Tesei L, Mo ontemurro D, Na ardi R. Work stress a and burnout amon ng physicians and d nurses in Intern nal and Emergency D Departments. Ital J J Med. 2017;11(2 2):151-8. 40. Shanafelt TD D, Hasan O, Dyrb rbye LN, Sinsky C C, Satele D, Sloa an J, et al., editors. Changes in bur rnout and satisf faction with wo ork-life balance in phy ysicians and the g general US workiing population be etween 2011 and 2014. Mayo Clin Pro oc. 2015;90(12):1 1600-13. http://m mjiri.iums.ac.ir Med J Is slam Repub Ira an. 2019 (31 Jul l); 33:77. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Medical Journal of the Islamic Republic of Iran Pubmed Central

Interventions on reducing burnout in physicians and nurses: A systematic review

Medical Journal of the Islamic Republic of Iran , Volume 33 – Jul 31, 2019

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Pubmed Central
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© 2019 Iran University of Medical Sciences
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1016-1430
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2251-6840
DOI
10.34171/mjiri.33.77
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Abstract

Background d: Burnout is one of the m main factors in n reducing the e performance quality amon ng hospital sta aff. Appropriate interventions can reduce burn nout among phy ysicians and nur rses and result i in promotion of f the quality of f services provid ded at hospitals s. The present stu udy aimed to p provide a more comprehensive e understanding g of the interve entions on burn nout reduction among hospita al physicians and nurses. Methods: St tudies were sea arched from Jan nuary 2000 to June 2017 in P PubMed, Emba ase, Scopus, Co ochrane, and W Web of Science e. Randomized cl linical trials (R RCTs) and prete est-posttest stud dies that had in nterventions to reduce the bur rnout of physic cians and nurse es were included.. However, stu udies conducted d on medical a and nursing stu udents and nonmedical provid ders or beyond d hospitals wer re excluded. Results: Bas sed on the stud dy inclusion cri iteria, 12 RCTs and 6 pretest t-posttest studie es were includ ded in the revie ew. Most of the included studie es were from N Netherlands, th he United State es, and Englan nd. The interventions included d team-based p program, EMH H- approach, and coping and co ommunication skills training. Most of the interventions had a positive e effect on bur rnout reduction n. Nevertheless, s some studies ha ad no significan nt impact. Conclusion: The results sh howed that the e most interven ntions used to o improve burn nout were imp proving commu unication skills s, teamwork, par rticipatory prog grams, and psychological in nterventions (Y Yoga, meditatio on, and mindf fu u lness). The impact of these interventions c can increase me ental health in the long term m. Burnout is a complicated problem and sh hould be treated d by combining g interventions. Keywords: Bu urnout, Mental h health, Nurses, Physicians, Ho ospital, Systema atic review Conflicts of Interes st: None declared Funding: None *This work has bee en published under r CC BY-NC-SA 1.0 liicense. Copyright© Iran University of Medi ical Sciences Cite this articl le as: Aryankhes sal A, Mohamma adibakhsh R, Ham midi Y, Alidoost S, Behzadifar M M, Sohrabi R, Farrhadi Z. Interven ntions on reducing burnout in physic cians and nurses: A systematic rev view. Med J Islam m Repub Iran. 2019 (31 Jul);33:77 7. https://doi.org/1 10.34171/mjiri.33 3.77 Introduction Health is a a right and an n important ne eed for all hu uman One e of the mostt important S SDH is the so ocial status o of beings, and it ts role in prom moting human n developmen nt in- peop ple in exposu ure to unhealtth hy and stress sful living and d dicators is u undeniable. S Social determ minants of h health work king condition ns (1). Burno out is one of the factors af f- (SDH) are co onsidered as the most im mportant facto ors in fecti ing the qualitty of staff and d worker's pe erformance (2 2, achieving hea alth goals and d establishing g equity in he ealth. 3). T This phenome enon counts a as a particular r type of occu u- _______________ ________________ _ Co orresponding autho or: Dr Roghayeh Mo ohammadibakhsh, m mohamadibakhsh.r r@ @ tak.iums.ac.ir ↑What is “a already known ” in this topic: 1. Burnout is an important p problem for he ealth workforce e, Health Manageme ent and Economics Research Center, Iran University of M Medical Sciences, with a stro ong impact on n their quality y of life and a Tehran, Iran Department of H Health Services M Management, School of Health M Management and correspondiing decrease in n the quality o of care with an n Information Scienc ces, Iran University of Medical Sciences, Tehran, Iran evident economic burden f for the health care system. Department of He ealth Management and Economics, Sc chool of Public Hea alth and Research Center for Public H Health, Hamadan University of Medical Sciences, Hamada an, Iran. →What this article adds: : Social Determinan nts of Health Resea arch Center, Lorestan University of M Medical Sciences, This was tthe first system matic review t to compare th he Khorramabad, Iran n intervention ns on physician ns and nurses’ burnout. Thes se Iranian Social Secu urity Organization, Z Zanjan Province Hea alth Administration n, Zanjan, Iran intervention ns can be used d by policymakers, managers s, researchers, and all th hose who are e interested in n improving m mental health o of physicians an nd nurses. Burnout in ph hysicians and nurses pational react tion among pr rofessions res sulted from m mutual not conducted at hospitals, stu udies conducted on medica al emotional relationships b between servi ice providers and and nursing stude ents, review s studies, the ab bstracts of the e their recipien nts. It is also a a syndrome th hat causes phy ysical conf ferences, book k chapters, an nd letters writ tten to the edi i- and emotiona al exhaustion n, depersonali ization, feelin ng of tors were excluded in this stu udy. Any disa agreement be e- failure, reduc ction in the po ower of adapt tation to stres ssors, twee en the researc chers was res solved through consultation n negative attitu ude towards job, and low s self-efficacy ( (4-6). with h a third resear rcher. Hospital staff fs, especially physicians an nd nurses, are e par- ticularly expo osed to burnout due to th he nature of their Da ata extraction n work, their in nteraction wit th patients, an nd observing their Da ata for the leading authors s’ name, coun ntry, period o of suffering (7, 8 8). research, study d design, year o of publication n, participants s, The effects of burnout ca an be investiga ated from pers sonal samp ple size, type of interventio on, interventio on effects, and d and organizat tional aspects and they ma ay lead to neg gative othe er findings of the study we ere extracted b by 2 member rs impacts on p patients care, their dissatis sfaction, incre eased of t the research team. Disag gr reements bet tween the re e- medical error rs, reduced w working hours, and lack of f sus- searchers were res solved throug gh negotiation or referring to o tainability in health care s systems due t to reduction iin at- a thi ird person as a a referee. tempts, work commitment,, and job term mination, espec cially among nurses s (9, 10). The erefore, recogn nition and pre even- Qu uality assessm ment tion of burno out can play a a key role in improving m mental Th he methodolo ogical quality of studies in ncluded in the e health, and th hus improving g the quality o of services pro ovid- pres sent systematic c review was assessed usin ng the “Critica al ed at hospita als. Accordin ngly, appropri iate interventtions, App praisal Skills P Programme” (C CASP) check klist (14). both at indiv vidual and or rganizational levels, shoulld be In n this study, th he CASP chec cklist was used d for RCT and d performed to reduce burno out among ho ospital staff, e espe- time e series studie es and the JBI I critical appr raisal checklis st cially in phys sicians and nur rses. for p pretest-posttest studies. Th hen, studies t that earned an n Many studi ies have been n done to redu uce the burno out of inter rmediate and h high score enttered the study y (15). physicians an nd nurses. In th hese studies, i interventions, such Sc cores below 7 7 were consid dered as “low w quality”, 7-8 8 as yoga and communicat tion skills tra aining, have been “inte ermediate qua ality”, and 9-1 0 “high qualit ty”. identified as i interventions that have imp proved the bur rnout of physicians s and nurses ( (11, 12). Anot ther systematiic re- Re esults view article e examined the interventions for reducing phy- Th he electronic s search of the databases led d to identifying g sician burnou ut in 2015 (1 13). However,, the present s study 2506 6 studies, and d 5 studies we ere identified through hand d reviewed thes se interventio ons over a lon nger period (u up to searching of the llast issues of jjournals, with h the most pa a- 2017) and se earched more databases. It also compare ed the pers s identified thr rough electron nic database searching. Af f- interventions that were pe erformed to r reduce burnou ut in ter r removing the duplicate stud dies, the titles s and abstract ts physicians an nd nurses. of 1 1965 studies were examin ned by 2 rese earchers inde e- Thus, this s systematic rev view examined d various inter rven- pend dently for relevance, and f finally 18 stu udies were in n- tions that redu uced burnout in physicians and nurses. T These clud ded for the fina al analysis. Th he process of study identifi i- interventions can be used d by policym makers, mana agers, catio on and selectiion, based on n the PRISMA A, is presented d researchers, a and all those w who are intere ested in impro oving in Figure 1. mental health h of physicians s and nurses. Th he findings of f this study in ndicated that o only few stud d- ies h have been con nducted on oc ccupational bu urnout of phy y- Methods sicia ans and nurse es. Selected s studies in thi is paper were e Literature s search inter rventional studies, RCTs, a an nd pretest- po osttest studies.. Five interna ational academ mic databases s (ISI/Web of f Sci- M Most included s studies were f from Netherla ands, the Unit t- ences, PubM Med, Embase, Scopus, and d Cochrane C CEN- ed S States, and En ngland and we ere concluded d during 2010 0- TRAL) were searched fro om January 2000 to June 2017 2017 7. Also, 50% of interventio ons had a positive impact on n using the fol llowing string g of keyword ds: (“Nurses” ” OR phys sicians’ burno out and 67% a a positive imp pact on nurses s’ “Physicians”) ) AND (“Bu urnout” OR “Depression” ” OR burn nout. Most in nterventions w were similar in physician ns “Mental healt th”) AND (“R Randomized co ontrolled trial” ” OR and nurses, but tthe interventiions perform med on nurses “Time series s” OR “Prete est posttest” OR “Before- -after were e more divers se and sometim mes the effects of the same e study”) AND “Hospital”. In this study y, Google Sch holar inter rvention varie ed in different target groups s. was used to search gray l literature. The e reference liist of Th he interventions in the inclu uded studies t that were con n- included stud dies was also h hand-searched d to ensure th hat all duct ted to reduce burnout and tto improve mental health o of relevant studi ies were consi idered. The re esults of the se earch phys sicians and nu urses are as fo ollow: are included i in the EndNot te X8 software e. EM MH and OP Inclusion an nd exclusion c criteria E- -mental healtth interventio ons are aimed to reduce e In the first stage, the title es and the abs stracts of the stud- spec cific mental h health compllaints or to e enhance well l- ies were indep pendently exa amined by 2 re esearchers thr rough bein ng. In the OP- -care group w who were scre eened positive e which interve entional stud dies on physic cians and nu urses’ on im mpaired work k functioning a and/or on any y mental health h burnout were e included. No onintervention nal studies, stu udies com mplaints, the pe ersonalized fe eedback was f followed by an n http://m mjiri.iums.ac.ir Med J Is slam Repub Ira an. 2019 (31 Jul l); 33:77. A. Arya ankhesal, et al l. Fig. 1. Study se election process invitation for r a face-to-fac ce preventive consultation with stres ss, and burnoutt among physiicians and nurs ses. their own occ cupational ph hysician (OP).. Both groups s im- proved over time, and no significant d difference was s ob- On nline program ms and interne et-based inte erventions served betwe een intervention groups with EMH and d OP On nline interven ntion program ms significan ntly improved d approaches. men ntal health and d reduced the symptoms of f depression in n the s staff. Team-base ed interventions and partic cipatory progr rams In all inclu uded studies,, team-based and participa atory Pr rofessional ide entity develop pment progra am programs had d a non-signi ificant effect. In this study y, no A professional identity deve elopment prog gram can also o significant re elationship wa as observed b between super riors’ redu uce burnout of f the nurses. support and improvement t in mental st tatus of the staff, which indica ates that impr rovement in m mental health h and Co oping interven ntions symptoms of depression ca an be due to proper commu unica- Co oping interve entions led tto a reductio on in burnou ut tion and parti icipation of nu urses on the same level, and d not amo ong nurses, bu ut the effect wa as no significa ant. merely on the e relationship with their sup periors. Th hankful event ts Psychosocia al training int tervention W Workplace app preciation had d a significan nt effect in in n- Psychosocial training intervention significantly im- crea asing performa ance and redu ucing depress sion and burn n- proved burno out rates. Nur rse training, w with broader r range out a among nurses and physicia an ns. of interventio ons, helps the e nurses to ha ave more pos sitive attitudes towa ards the patien nts. M Mix methods Th he use of integ grated method ds was shown n to have a sig g- Psychiatric interventions s nific cant effect on reducing phys sicians and nu urses’ burnout t. Psychiatric interventions,, such as Yog ga and medita ation, Ov verall, most iinterventions intended to i investigate the e and mindfulne ess interventio ons led to a sig gnificant increa ase in impa act of trainin ng communic cation skills o on burnout o of self-care and a a significant re eduction in em motional exhaus stion, phys sicians and n nurses. In two o thirds of th he studies, the e http:/ //mjiri.iums.ac.ir i Med J J Islam Repub I Iran. 2019 (31 J Jul); 33.77. Burnout in ph hysicians and nurses interventions had a positive e impact on re educing burno out. copi ing skills train ning had no siignificant effe ect on burnout t. In 50% of t the cases, com mmunication s skills training with Nev vertheless, mix methods h had a signific cant effect on n EMH approa ach had a sig gnificant effect on burnou ut. In burn nout in all stud dies. 75% of studie es, psychiatric c interventions had a signif ficant Ch haracteristics of the includ ded studies on n the interven n- effect on burn nout. Also, in all studies, on nline interven ntions tions s of physician ns' burnout are e presented in n Tables 1 and d and professio onal identity d development p programs had d sig- 2. nificant effec cts on burno out. However, team-based d and In nterventions an nd effects on n burnout of p physicians and d Table 1. Characteristics of the included studies on the intterventions of ph hysicians' burnout t Author o C Country Participant Interventiion Effe fect of the Main n finding Qu uality inte ervention Asse essment Contr ratto Computerized p physician Fou ur months afterr the intervention, im- 9 2017 order entry, ele ectronic P Positive provements were fo ound in physician ns’ burn- (16) 7 physi- health reco ords out. This study supp ports the use of ph hysician UK cians ord der entry clerical l personnel as a simple, cost-effective interv vention to impr rove the wor rk lives of physic cians. The ere were no sig gnificant differe ences in 9 Butow w Australia/New Zealand 95 physi- Consultation n skills Nons significant bur rnout scores bettween the experimental 2016 Swiss/Germany/Austria cians training g and d control groups. (17) The ere were no signiificant differences in pre- and d postrandomizattion scores betw ween the exp perimental and c control groups o on other stre ess and burnout su ubscales. EMH-approach h consul- A s significant improv vement in work fu function- 9 Noben n tation with an o occupa- P Positive ing occurred in the participating phy ysicians. 2014 617 physi- tional physicia an (OP) The e median increm mental cost-effec ctiveness (18) Ne etherlands cians ratio for the occupa ational physician n condi- tion n versus the conttrol condition wa as domi- nan nt. Improved comm munica- Mo ore intervention sh howed significan nt effects 9 tion; changes in n work- on reducing burnou ut t . All 3 of the fo ollowing Linzer 166 physi- flow, and tar rgeted types of interventio ons led to improvements 2015 cians quality improv vement P Positive in s some staff outcom mes: workflow, redesign, (19) USA (QI) proje ects and d improved com mmunication, es specially amo ong physicians an nd staff. Eight-point pr rogram A b beneficial treatme ent effects were o observed 9 Oman n 58 physi- (EPP), a mediitation- Nons significant on stress and menttal health. Treatm ment ef- 2006 USA cians based interve ention fectts on stress were e mediated by ad dherence (20) to p practices. Eviden nc ce suggests this p program reduces stress and d may enhance mental hea alth. No significant difffe e rences were found be- 9 twe een program partticipants and non npartici- Weight h 628 physi- Team-based, in ncentiv- Nons significant pan nts. Burnout wa as lower in partticipants 2013 USA cians ized exercise p program than n in nonparticipa ants, although the e differ- (21) enc ce was not statis stically significan nt. Resi- den nts and fellows m may be much more seden- tary y than previously y reported. Table 2. Characteristics of the included studies with interventions for redu ucing burnout in nurses Auth hor Countr ry Participan nt Interven ntion Eff fect of the Main finding g Quality inte ervention Asses ssment Th he result shows a decrease in sy ymptoms of depr ression. 8 Che eng China a 102 nurses s Thankful e events P Positive However, this rate e became less prronounced as tim me pro- 2015(22) gr ressed. At follow w-up, the gratitud de group reported d lower de epressive symptom ms than control g group. Electronic-mental Th he OP-care appro oach trended tow wards better performance 9 Ketelaar health care (EMH- in n targeting work f functioning, but fi findings showed tthat the 2013(23) Netherlan nds 1140 approac ch) Non- -significant EM MH care approach was noninferrior. However, th he high nurses Consultatio on with dr ropout rate and low compliance to EMH interv ventions an occupa ational sh hould be consider red. physic-cian n (OP) It was not demonstrated that an EM MH approach to W WHS is 9 Ketelaar Netherlan nds 1170 (EMH-approach) Non- -significant m more effective to iimprove WF and d MH. The effectt found 2014(11) nurses with an ( (OP) in n the complete sample of participa ants could not be e easily in nterpreted. Reportted results may be e useful for future meta- an nalytic work. Uchiy yama It is suggested tha at a 6-month inte ervention is effec ctive in 8 2013(24) Japan n 434 nurses s Participator ry pro- Non- -significant im mproving psychosocial work env vironment, but itt is not gram m ef ffective in improv ving mental health h of the nurses. http://m mjiri.iums.ac.ir Med J Is slam Repub Ira an. 2019 (31 Jul l); 33:77. A. Arya ankhesal, et al l. Tab ble 2. Ctd Aut thor Country Pa articipant Intervention Effect t of the Main ffinding Quali ity interv vention Assessm ment Yoga a participants rep ported high significant 8 Ale exander self-c care as well as lless depressive s symp- 201 15 (12) USA 40 0 nurses Yoga Pos sitive toms upon completio on of an 8-week yoga interv vention compare ed to control g group. Altho ough the controll group demonstrated no change of the sttudy, the yoga g group show wed a significant iimprovement in s scores from pre- to postinterv vention. Onliine intervention g group The iintervention was capable of enha ancing 8 Bol lier N Netherlands 1140 (O OI) or the wait listted Pos sitive positiive mental health h. However, due e to a 201 14 (25) nurses c control group (WL L) high attrition rate, tthis result shoulld be consiidered with cautio on. Burnout in the interve ention group improved 8 Dar rban Co ommunication sk kills Pos sitive after the intervention n. These changes s sug- 201 16 (26) Iran 60 0 nurses training gest a significant dec creasing trend. O On the other r hand, the mean n scores of burno out in the c control group sh howed no significant differ rence. Durin ng the research p period, burnout s symp- 9 Sab banciogullari Pro ofessional identity y de- toms significantly dec clined in the inte erven- 201 15 (27) Turkey 63 3 nurses v velopment progra am Pos sitive tion g group while thos se of the control g group increased. This progrram should be im mple- mented in different h hospitals and diff f erent samples of nurses. Inttervention: cognittive, 8 soma atic, dynamic, em motive Sallon Israel 16 64 nurses and h hands-on (Yoga, medi- Pos sitive These e results encoun ntered work stre essors 201 15 (28) tatiion, relaxation, to ouch impacts positively on health and well-being the erapy, energy hea aling and s significantly redu uces stress and bu urnout (Reiki) amon ng the nurses. Staff in the interve ention group sh howed 9 Ew wers Ps sychosocial trainiing signif ficant improvem me ents in burnout rates, 201 10 (29) UK 33 3 nurses intervention (PSI I) Pos sitive while e staff in the c control group sh howed increase in burnout. The findings ind dicate that n nurse training, w with broader ran nge of interv ventions, helps th hem to be more posi- tive in their attitudes s towards the c clients that they work with. Co oping skills trainin ng a Perso on-directed interv ventions can dec crease 9 support group Nonsig gnificant depre ession level. Th he fact that bu urnout Gun nus Turkey 10 08 nurses reduc ces after the inttervention and a an in- 201 10 (30) crease is observed in n 6 months is an n im- portant point. Thus, Itt is recommended that the nu umber of interven ntion studies to re educe burno out be increased d and that long g-term outco omes be evaluated d. Min ndfulness training g is a In this study, the find dings indicate siignifi- 9 pr romising method for cant improvements in n burnout symp ptoms. Ma ackenzie Canada 30 0 nurses help ping those in the n nurs- The r results of this piilot study sugges st that 200 06 (31) ing p profession; it man nages Pos sitive mindfulness training iis a promising m method stress, even when pro ovided for helping those in tthe nursing profe ession in a brief formatt. to ma anage their stress.. nurses are dem monstrated in Table 3. sicia ans and nurses s’ burnout. Th he identified interventions s to reduce burnout and to o impr rove mental health of phy ysicians and nurses are a as Discussion n follo ow: motivatio onal program ms, communic cation training g Burnout sy yndrome is an n important h health problem m af- skill ls, electronic m methods, psyc chiatric progra ams, and com m- fecting many people, espec cially physicia ans and nurses s and bine ed methods. O Overall, most o of studied inte erventions had d should be add dressed global lly with interv ventions at or rg gani- repo orted positive impacts on reducing bur rnout and im m- zational and i individual levels (32). App propriate strattegies prov ving mental he ealth. to control bu urnout can be found in a r range of identtified M Motivational pr rograms, such h as gratitude e and thankfu ul interventions.. The aim of f this systema atic review w was to even nts, for physic cians and nur rses as well a as professiona al investigate th he impact of c conducted inte erventions on phy- http:/ //mjiri.iums.ac.ir i Med J J Islam Repub I Iran. 2019 (31 J Jul); 33.77. Burnout in ph hysicians and nurses Table 3. Interv ventions and their r effect on burnou ut of physicians an nd nurses Interventions Physiciians Effect Nurses s Effect Gratitude and t thankful events * Positive Professional id dentity developme ent program * Positive Communicatio on skills training * Positive Positive Participatory program * No on-significant Team-based pr rogram * N Nonsignificant Consultation sk kills training * N Nonsignificant EMH approach h and OP approac ch * Positive * No on-significant Online program ms and internet-ba ased intervention ns * Positive * Positive Psychosocial tr raining interventi ion (PSI) * Positive Coping skills tr raining * No on-significant Mindfulness tra aining, Yoga, me editation, relaxatio on, touch therapy, energy healing (R Reiki) * N Nonsignificant * Positive Combination o of above methods * N Nonsignificant * Positive identity deve elopment prog grams can in ncrease motiv vation Also o, as burnout is a complex x subject, it is s better to use e and interest in n caring for patients and ca an improve de epres- mult tiple methods to improve iit. In Sallon s study, with the e sion, burnout t, and well-b being. A stud dy by Ziaei et al aim of reducing b burnout and iimproving me ental health o of showed that p proper human n resource man nagement, suc ch as nurs ses, mix interventions were e used which h resulted in a a new approach hes to encou uragement and d motivation,, can redu uction in burn nout among nurses (28). On the othe er reduce burnou ut in nurses a and improve t their mental h health hand d, various stud dies have sho own that burnout is affected d (33). The stud dy of Ebrahim mzadehpezeshki showed tha at the by s several factors s that can act as facilitators s or barriers o of use of motiva ational methods can be eff fective in redu ucing inter rventions to iimprove burn nout, which sh hould be con n- the burnout o of nurses, wh hich is consist tent with the find- sidered. Age, sex x, work expe erience, work environment t, ings of the pr resent study (3 34). The role of communic cation type e of specializa ation, and inco ome can affect the severity y skills training g is importan nt in reducin ng specific m mental and weakness of jjob burnout. I In this regard d, some studies health compla aints or enhan ncing well-bei ing (26). The find- were e shown that higher burnou ut levels could d be increased d ings of the present stud dy revealed t that strengthe ening due to the high de emands, long working hour rs, insufficien nt communicatio on skills is m more effective in reducing b burn- inco ome, a perceiv ved mismatch between effo ort and reward d, out in physici ians than in nu urses. In this c context, Penberthy and poor organizational adm ministration (3 36,37). Work k- study is consistent with the present stud dy which aim med at plac ce appreciation n can also be effective in increasing per r- improving th he communica ation skills of physicians (35). form mance, reducin ng depression n, and improvi ing burnout o of Team-based a and participat tory programs can help re educe nurs ses and physic cians. Further rm more, the study of Viotti e et symptoms of f depression a and improve mental healtth. A al showed no sta atistically sig gnificant diffe erences in the e study conduc cted by Uchiy yama suggested that the sy ymp- emo otional exhaus stion value be etween Intens sive Care Uni it toms of depre ession and me ental health ca an be improved in (ICU U) and non-intensive care e unit (non-ICU) workers s, the hospitals where the p possibility of f visiting patiients, altho ough the aver rage score is h higher for non n-ICU worker rs receiving req quired informa ation, and par rticipation is h high. (38) ). The survey y conducted b by Medscape e showed tha at Nevertheless,, this finding should be interpreted with h cau- spec cialties with the highest p percentage of burnout are e tion. The sym mptoms of de epression app pear in high s stress thos se that deal wiith severely illl patients (em mergency medi i- conditions, so o if milder sy ymptoms, such h as irritation n, an- cine e and critical care register r 55% burnou uts), and thei ir ger, and anxi iety, are also examined, thi is intervention n can phys sicians also r reported a gre eater degree of severity in n have positive e effects (24). In another st tudy by Weig ght et their r burnout (39, 40). al, the sympt toms of burno out were mild der in interven ntion Ad dditionally, th he results of th his study indicated that var r- group, using teamwork, co ompared to control group (21). ious s interventions s can be used d to improve t the burnout o of Psychiatric pr rograms (Yog ga, meditation n, and mindfu ulness phys sicians and nurses, and th heir applicatio on should take e programs) ca an help reduce burnout and improve m mental into account the iindividual, or rganizational, specialty, and d health. Yoga practice may y be an effecti ive strategy to o im- relev vant aspects o of the program m. Therefore, these findings prove the hea alth of nurses (12). Coping g interventions s can are not universall and their ef ffect on burnout should be e also lead to a reduction i in burnout am mong nurses (30). follo owed-up acros ss other health h care personnel and in dif f- Moreover, in ndividual inter rventions can reduce emottional feren nt contexts ov ver a longer pe eriod of time. exhaustion. T These findings s were confirm med in a stud dy by Lee et al, in w which the role e of copying s strategies in re educ- Lim mitations ing burnout of the nurse es was exam mined. Lee's s study Th he number of studies using the same inte erventions wa as showed that using copyi ing interventi ions for 6 to o 12 too small, so gene eralizing the r results should d be done with h months can l lead to a redu uction in emo otional exhaus stion, caut tion. The num mber of partic cipants in som me studies wa as depression, an nd ultimately burnout amon ng nurses (9). too low, which h has led to a r reduction in t their statistica al However, f further researc ch is required d to confirm tthese stren ngth and an increase in iin nconsistency,, reducing the e results. Using g larger sam mple sizes, mo ore active co ontrol effec cts of interven ntion. Howeve er, in some stu udies in which h groups, dedic cating more t time to interv vention, and u using the s sample size w was large, no s significant rel lationship wa as other interven ntions and co omparing them m with mentiioned obse erved betwee en interventio on and burno out reduction n. interventions,, can make th he study resu ults more reliiable. Dem mographic cha aracteristics of f the participa ants and heter r- http://m mjiri.iums.ac.ir Med J Is slam Repub Ira an. 2019 (31 Jul l); 33:77. A. Arya ankhesal, et al l. Eu urope and the United States. BMJ.. 2012;344:e1717 7. ogeneity of t the groups ca an also affect the outcome es. In 11. K Ketelaar SM, Nieuwenhuijsen K,, Gärtner FR, Bo olier L, Smeets O O, some cases, improving und desirable work k conditions ( (staff Sl luiter JK. Mentall Vitality@ Worrk: The effective eness of a menta al shortage and insufficient salaries and be enefits) were m more module for worker rs’ health surveilllance for nurses and allied healt th effective in reducing the symptoms o of depression n and pr rofessionals, com mparing two app proaches in a cluster-randomised co ontrolled trial. Int Arch Occup Env viron Health. 2014;87(5):527-38. burnout than n improving psychological conditions. The 12. A Alexander GK, R Rollins K, Walkerr D, Wong L, Pen nnings J. Yoga fo or dispersion an nd multiplicity y of mental he ealth indices c could se elf-care and burn nout prevention a among nurses. W Workplace Healt th also affect the e outcomes of f the study. Sa af. 2015;63(10):462-70. 13. Wiederhold BK, Cipresso P, Piz zzioli D, Wieder rhold M, Riva G G. In ntervention for p physician burno out: A systematic review. Open Conclusion n M Medicine. 2018;13(1):253-63. Different s strategies, suc ch as trainin ng and impro oving 14. C CASP U. Critical Appraisal Skillls Programme (CASP). Qualitativ ve communicatio on skills, yoga, and spiritual programs b based research checklist. 2017;31(13):449 9. 15. JBI Critical Appraisal Checklistt for Quasi-Experimental Studie es on meditation n, teamwork, c computer prog grams, staff ap ppre- (n non-randomized experimental stud dies), (2017). ciation, and copying stra ategies can be used to re educe 16. C Contratto E, Rom mp K, Estrada CA A, Agne A, Willlett LL. Physician burnout amon ng physicians s and nurses. Training and d im- Or rder Entry Clerical Support Imp proves Physician n Satisfaction and proving com mmunication s skills were th he most effe ective Pr roductivity. South h Med J. 2017;11 0(5):363-8. 17. B Butow P, Brown R, Aldridge J, Ju uraskova I, Zoller r P, Boyle F, et al. interventions to improve bu urnout in nurs ses and physic cians. Ca an consultation skills training cha ange doctors' behaviour to increas se Undoubtedly,, the results o of intervention ns to reduce b burn- involvement of pattients in making d decisions about s standard treatmen nt out and the in ndices related d to mental he ealth improve ement an nd clinical trials: a randomized controlled triall. Health Expect t. will appear in n the long run,, and more fol llow-up studie es are 20 015;18(6):2570-83. 18. N Noben C, Smit F F, Nieuwenhuijse en K, Ketelaar S,, Gärtner F, Boon needed to trac ce the durabil lity of the cha anges. Also, b burn- B,, et al. Comparative cost effec cttiveness of two o interventions t to out in physic cians and nur rses is a complex problem m that pr romote work fun nctioning by tarrgeting mental h health complaint ts should be tak ken into consi ideration in in nterventions a and if am mong nurses: Pr ragmatic clusterr randomized tr rial. Investing in possible, com mbined and m multidimensio onal interven ntions em mployability inter rventions? Int J N Nurs Stud. 2014;5 51:1321–1331 19. L Linzer M, Poplau u S, Grossman E,, Varkey A, Yale e S, Williams E, e et should be use ed. On the oth her hand, full implementatio on of al. A cluster rand domized trial off interventions tto improve wor rk these interven ntions can be costly and providing the neces- co onditions and cliinician burnout iin primary care: results from th he sary conditions, such as c commitment o of key individ duals He ealthy Work Place (HWP) study. J Ge en Intern Med d. and preparing g participants before the int tervention, is h high- 20 015;30(8):1105-11. 20. Oman D, Hedbe erg J, Thoresen CE. Passage m meditation reduce es ly important. Therefore, tim me, space, and d feasibility lim mita- pe erceived stress in n health profess siionals: A randomized, controlled tions are the p priority issues s in applying s such interventtions. tri ial. J Consult Clin n Psychol. 2006;7 74(4):714 –719. 21. W Weight CJ, Sello on JL, Lessard-A Anderson CR, Sha anafelt TD, Olsen Conflict of I Interests KD D, Laskowski E ER, editors. Phys sical activity, qu uality of life, and bu urnout among p physician trainee es: the effect o of a team-based d, The authors d declare that they have no co ompeting inter rests. incentivized exercise program. Ma ayo Clin Proc. 2 2013;88(12):1435 5- 42 2. 22. C Cheng ST, Tsui P PK, Lam JH. Imp prroving mental he ealth in health car re pr ractitioners: Rand domized controlle ed trial of a gratiitude intervention n. 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Medical Journal of the Islamic Republic of IranPubmed Central

Published: Jul 31, 2019

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