Stress, burnout and coping strategies in the emergency and intensive care hospital departments

Doctors and nurses working at the accident and emergency (A&E), and intensive care departments are at risk of burnout. They often spend substantial time in intense interactions with other people, centered on patients? health problems (physical, psychological and social) that may lead to feelings of anger, anxiety and frustration, and eventually to burnout. Burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment (Maslach & Jackson, 1981) The purpose of this chapter is to assess work stressors, burnout and stress-coping mechanisms among doctors and nurses at the A&E and intensive care departments. A quantitative design using the survey approach was used to collect data from a sample of 200 participants with a response rate of 71% (n=154) Work stressors were associated with burnout in both doctors and nurses. Workload was the most salient work stressor in the sample. Nurses experienced more stress (M=1.5, SD=0.4) than doctors (M=1.2, SD=0.4) in all the work stressor variables examined. The A&E department was reported as more stressful than the intensive care department. Avoidance-oriented and task-oriented coping were the most and the least frequently reported coping strategies respectively. Additionally, only emotion-oriented coping strategy was significantly different between doctors and nurses, and this strategy was also significantly positively correlated with all the variables in the adapted nursing stress scale, and the three burnout variables. Death and dying was most strongly correlated with emotion-oriented coping. This chapter provides an assessment of stress, burnout and coping experienced by both doctors and nurses within the A&E and intensive care departments. Methods that may mitigate stress in these environments may be adequate staffing, supportive management, stress management programs, as well as improvement in communication strategies between doctors and nurses.

The Effects of Systematic Self-Monitoring, Feedback, and Collaborative Assessment on Stress Reduction

Thesis (Ph.D.)--University of Washington, 2016-08

Management of presenteeism. The effects on productivity of a food processing company

Presenteeism consists in going to work without conditions to produce, which can have a much higher impact than absenteeism on the productivity of an organisation. Presenteeism translates in both physical as psychological perturbations. It is a difficult to quantify reality, as is its translation into direct and indirect costs within the organisation. Our goal was to analyse the effects of presenteeism on the productivity of a company in the food-procession sector through a descriptive and transversal study of exploratory nature. The Stanford Presenteeism Scale SPS-6 (validated by Ferreira et al, 2010) and a semi-structured interview were used. Most of the workers referred having already gone to work feeling ill at least two days in the last year, mentioning that their health condition affected their performance, made them feel desperate and lacking pleasure from work. Management mentioned that presenteeism has a direct impact on productivity without, however, being able to quantify the true costs. Presenteeism is a reality in organisational scenarios, exceling in the educational and health sectors. We underline the importance of making organisations aware of the psychosocial risks and the importance of having healthy leaderships, work stress control and the presence of clinical psychologists and professional coaches.

Gestão do stress em enfermeiros perioperatórios

Os enfermeiros não estão isentos das consequências do stress ocupacional, que embora psicológico, afeta a saúde física, constituindo um risco para a segurança e saúde quando persistente, levando ao aparecimento de Burnout. Avaliar o nível de stress e o nível de Burnout na amostra selecionada; Conhecer a relação entre as estratégias de coping e nível de stress vivenciado pelos enfermeiros. Estudo quantitativo, descritivo, correlacional e transversal. Amostra de 81 enfermeiros perioperatórios, maioritariamente do género feminino (74,1%), 66,6% dos inquiridos exercem funções nos Blocos Operatórios do Centro Hospitalar de Trás‐os‐Montes e Alto Douro, média de idades de 43 anos. A opção de trabalhar no Bloco Operatório, foi para 59,3% dos inquiridos imposta pela instituição. A experiência média neste serviço foi de 15 anos. Aplicados três instrumentos de avaliação: Maslach Burnout Inventory, Nurse Stress Index e Inventário de Resolução de Problemas. A amostra exibe um nível considerável de stress (M=81,25; DP=20,7). Observou‐se uma correlação estatisticamente significativa entre o nível de stress e o nível de Burnout (r=0,43; p<0,001); verificou‐se existir uma relação estatisticamente significativa entre o nível de stress e as estratégias de coping (r=‐0,28; p<0,05), contudo, esta relação traduziu uma relação inversa. Valores elevados de Burnout correspondem a valores elevados de stress; valores elevados nas estratégias de coping, corresponderam a níveis baixos de stress. A gestão do stress tem valorizado mais os indivíduos do que as organizações. Contudo, mais importante que prevenir o stress laboral e os riscos psicossociais, é a organização e a gestão do trabalho que deve ser prioritária.

Diabetes text-message self-management support program (SMS4BG): A pilot study

BACKGROUND: The increasing prevalence of diabetes and costly long-term complications associated with poor glycemic control are issues facing health services worldwide. Diabetes self-management, with the support of health care providers, is critical for successful outcomes, however, frequent clinical contact is costly. Text messages via short message service (SMS) have the advantage of instant transmission at low cost and, given the ubiquity of mobile phones, may be the ideal platform for the delivery of diabetes self-management support. A tailored text message-based diabetes support intervention called Self-Management Support for Blood Glucose (SMS4BG) was developed. The intervention incorporates prompts around diabetes education, management, and lifestyle factors (healthy eating, exercise, and stress management), as well as blood glucose monitoring reminders, and is tailored to patient preferences and clinical characteristics. OBJECTIVE: To determine the usability and acceptability of SMS4BG among adults with poorly controlled diabetes. METHODS: Adults (aged 17 to 69 years) with type 1 (n=12) or type 2 diabetes (n=30), a hemoglobin A1c (HbA1c) over 70 mmol/mol (8.6%), and who owned a mobile phone (n=42) were recruited to take part in a 3-month pilot study of SMS4BG. At registration, participants selected the modules they would like to receive and, where appropriate, the frequency and timing of blood glucose monitoring reminders. Patient satisfaction and perceptions of the usability of the program were obtained via semistructured phone interviews conducted at completion of the pilot study. HbA1c was obtained from patient records at baseline and completion of the pilot study. RESULTS: Participants received on average 109 messages during the 3-month program with 2 participants withdrawing early from the study. Follow-up interviews were completed with 93% of participants with all reporting SMS4BG to be useful and appropriate to their age and culture. Participants reported a range of perceived positive impacts of SMS4BG on their diabetes and health behaviors. HbA1c results indicated a positive impact of the program on glycemic control with a significant decrease in HbA1c from baseline to follow-up. CONCLUSIONS: A tailored text message-based intervention is both acceptable and useful in supporting self-management in people with poorly controlled diabetes. A randomized controlled trial of longer duration is needed to assess the efficacy and sustainability of SMS4BG.

Bifidobacterium longum 1714 as a translational psychobiotic: modulation of stress, electrophysiology and neurocognition in healthy volunteers

The emerging concept of psychobiotics—live microorganisms with a potential mental health benefit—represents a novel approach for the management of stress-related conditions. The majority of studies have focused on animal models. Recent preclinical studies have identified the B. longum 1714 strain as a putative psychobiotic with an impact on stress-related behaviors, physiology and cognitive performance. Whether such preclinical effects could be translated to healthy human volunteers remains unknown. We tested whether psychobiotic consumption could affect the stress response, cognition and brain activity patterns. In a within-participants design, healthy volunteers (N=22) completed cognitive assessments, resting electroencephalography and were exposed to a socially evaluated cold pressor test at baseline, post-placebo and post-psychobiotic. Increases in cortisol output and subjective anxiety in response to the socially evaluated cold pressor test were attenuated. Furthermore, daily reported stress was reduced by psychobiotic consumption. We also observed subtle improvements in hippocampus-dependent visuospatial memory performance, as well as enhanced frontal midline electroencephalographic mobility following psychobiotic consumption. These subtle but clear benefits are in line with the predicted impact from preclinical screening platforms. Our results indicate that consumption of B. longum 1714 is associated with reduced stress and improved memory. Further studies are warranted to evaluate the benefits of this putative psychobiotic in relevant stress-related conditions and to unravel the mechanisms underlying such effects.

Exploring the impact of context-specific job stressors on employee work outcomes

A path model was developed to examine the impact of context-specific job stressors on the work outcomes of 132 customer service employees. Respondents who reported a moderate and high level of context-specific stressors report a higher level of job demand and work family conflict. Respondents who reported a higher level of job control tend to receive more work-related support and are more satisfied with their job. Surprisingly, respondents who experienced a higher level of work family conflict tend to receive less work-related support. We found that respondents who obtained more work-related support tend to report a higher level of job satisfaction. There was also a positive relationship between positive job satisfaction and a lower level of intention to quit.

Does 'fit' matter in nonprofits? Exploring value congruence, role stressors and employee health

The number of employees working in nonprofit organisations has grown significantly. These employees are often motivated to join these organisations by a strong desire to fulfil the particular vision and mission of that nonprofit (such as helping the community). While the effects of employee organisation value congruence on job-related attitudes are reasonably well documented, little consideration has been given to the nonprofit context and also perceptions of work stressors and health outcomes. A sample on nonprofit employees from a human services organisation (N = 181) was surveyed with results suggesting that value congruence was related to lower perceptions of role stressors. The results further revealed that value congruence was related to less favourable employee health in some circumstances. Outcomes are discussed in terms of theoretical and practical importance.

Positive reappraisal improves heart rate variability during stressful work

Recent developments in wearable ECG technology have seen renewed interest in the use of Heart Rate Variability (HRV) feedback for stress management. Yet, little is know about the efficacy of such interventions. Positive reappraisal is an emotion regulation strategy that involves changing the way a situation is construed to decrease emotional impact. We sought to test the effectiveness of an intervention that used feedback on HRV data to prompt positive reappraisal during a stressful work task. Participants (N=122) completed two 20-minute trials of an inbox activity. In-between the first and the second trial participants were assigned to the waitlist control condition, a positive reappraisal via psycho-education condition, or a positive reappraisal via HRV feedback condition. Results revealed that using HRV data to frame a positive reappraisal message is more effective than using psycho-education (or no intervention)–especially for increasing positive mood and reducing arousal.

Time course-dependent changes in the transcriptome of human skeletal muscle during recovery from endurance exercise: From inflammation to adaptive remodeling

Re-programming of gene expression is fundamental for skeletal muscle adaptations in response to endurance exercise. This study investigated the time-course dependent changes in the muscular transcriptome following an endurance exercise trial consisting of 1 h of intense cycling immediately followed by 1 h of intense running. Skeletal muscle samples were taken at baseline, 3 h, 48 h, and 96 h post-exercise from eight healthy, endurance-trained, male individuals. RNA was extracted from muscle. Differential gene expression was evaluated using Illumina microarrays and validated with qPCR. Gene set enrichment analysis identified enriched molecular signatures chosen from the Molecular Signatures Database. Three h post-exercise, 102 gene sets were up-regulated [family wise error rate (FWER), P < 0.05]; including groups of genes related with leukocyte migration, immune and chaperone activation, and cyclic AMP responsive element binding protein (CREB) 1-signaling. Forty-eight h post-exercise, among 19 enriched gene sets (FWER, P < 0.05), two gene sets related to actin cytoskeleton remodeling were up-regulated. Ninety-six h post-exercise, 83 gene sets were enriched (FWER, P < 0.05), 80 of which were up-regulated; including gene groups related to chemokine signaling, cell stress management, and extracellular matrix remodeling. These data provide comprehensive insights into the molecular pathways involved in acute stress, recovery, and adaptive muscular responses to endurance exercise. The novel 96 h post-exercise transcriptome indicates substantial transcriptional activity, potentially associated with the prolonged presence of leukocytes in the muscles. This suggests that muscular recovery, from a transcriptional perspective, is incomplete 96 h after endurance exercise involving muscle damage.

Explaining psychological distress in the legal profession: the role of overcommitment

The purpose of this study was to explain previously reported high levels of psychological distress in lawyers. General demands (i.e., time pressure and emotional demands) and lawyer demands (i.e., emphasis on profits and competitiveness), as well as three resources (i.e., control, pay, and praise) were examined, along with the moderating role of overcommitment. Participants included 448 Australian lawyers who completed an online questionnaire distributed to them by their state or territory law society. Results revealed significant direct relationships between the demands, resources, and overcommitment on depression and anxiety. Significant two-way interactions indicated that the positive relationship of general demands on depression and anxiety were more marked for high overcommitted lawyers, as was the negative relationship of pay on anxiety. Contrary to predictions for the three-way interaction, in the presence of high general demands, there was a trend to suggest that high control was positively related to psychological distress for high overcommitted lawyers. The theoretical and practical implications of these results, including the importance of identifying overcommitted lawyers and developing preventive interventions to reduce overcommitment prior to the development of strain, are discussed.

Emotional intelligence and job-demands resources model

Occupational stress research has consistently demonstrated negative effects for employees. Research also describes potential moderators of this relationship. While research has revealed some positive effects of emotional intelligence (EI) on employee adjustment, it has neglected investigation of their potential stress buffering effects. Based on the Job-Demand Resources model, it was predicted that higher trait emotional intelligence would act as a buffer to the potential negative effects of stressors on employee adjustment. Hierarchical multiple regression analyses with a sample of 306 nurses found no main effects of EI but revealed eight moderating effects. While some interactions support the buffering hypothesis, others revealed buffering for those with low EI. Findings are discussed in terms of theoretical and practical implications.

Integrating AlGaN/GaN high electron mobility transistor with Si: A comparative study of integration schemes

AlGaN/GaN high electron mobility transistor stacks deposited on a single growth platform are used to compare the most common transition, AlN to GaN, schemes used for integrating GaN with Si. The efficiency of these transitions based on linearly graded, step graded, interlayer, and superlattice schemes on dislocation density reduction, stress management, surface roughness, and eventually mobility of the 2D-gas are evaluated. In a 500 nm GaN probe layer deposited, all of these transitions result in total transmission electron microscopy measured dislocations densities of 1 to 3 x 10(9)/cm(2) and <1 nm surface roughness. The 2-D electron gas channels formed at an AlGaN-1 nm AlN/GaN interface deposited on this GaN probe layer all have mobilities of 1600-1900 cm(2)/V s at a carrier concentration of 0.7-0.9 x 10(13)/cm(2). Compressive stress and changes in composition in GaN rich regions of the AlN-GaN transition are the most effective at reducing dislocation density. Amongst all the transitions studied the step graded transition is the one that helps to implement this feature of GaN integration in the simplest and most consistent manner. (C) 2015 AIP Publishing LLC.

Ab Initio MD Simulations of the Bronsted Acidity of Glutathione in Aqueous Solutions: Predicting pK(a) Shifts of the Cysteine Residue

The tripeptide glutathione (GSH) is one of the most abundant peptides and the major repository for nonprotein sulfur in both animal and plant cells. It plays a critical role in intracellular oxidative stress management by the reversible formation of glutathione disulfide with the thiol-disulfide pair acting as a redox buffer. The state of charge of the ionizable groups of GSH can influence the redox couple, and hence the pK(a) value of the cysteine residue of GSH is critical to its functioning. Here we report ab initio Car-Parrinello molecular dynamics simulations of glutathione solvated by 200 water molecules, all of which are considered in the simulation. We show that the free-energy landscape for the protonation-deprotonation reaction of the cysteine residue of GSH computed using metadynamics sampling provides shift in the dissociation constant values as compared with the isolated accurate estimates of the pK(a) and correctly predicts the cysteine amino acid.

GaN-based LEDs grown on 6-inch diameter Si (111) substrates by MOVPE

The issues and challenges of growing GaN-based structures on large area Si substrates have been studied. These include Si slip resulting from large temperature non-uniformities and cracking due to differential thermal expansion. Using an A1N nucleation layer in conjunction with an AlGaN buffer layer for stress management, and together with the interactive use of real time in-situ optical monitoring it was possible to realise flat, crack-free and uniform GaN and LED structures on 6-inch Si (111) substrates. The EL performance of processed LED devices was also studied on-wafer, giving good EL characteristics including a forward bias voltage of ∼3.5 V at 20 mA from a 500 μm × 500 μm device. © 2009 SPIE.