Staying in bounds: A framework for setting workplace boundaries to promote physician wellness

Journal of Hospital Medicine, Journal Year: 2023, Volume and Issue: 18(12), P. 1139 - 1143

Published: April 10, 2023

Physician burnout and compassion fatigue are on the rise.1, 2 Many factors have contributed to this phenomenon, including COVID-19 pandemic, staffing shortages, increased patient acuity.3-7 These complex require broad systemic reform target root causes, such as job demands resource allocation.2-7 Effectively addressing these system failures requires significant time resources. Individual strategies can occur in tandem with organizational level changes may be implemented more quickly mitigate some aspects of burnout.1, 2, 7-9 Advice clinicians often focuses need do more, emphasizing self-care activities outside work, exercise, quality family time, mindfulness.8 This expectation create stress by implying that nonwork should dedicated enhance capacity manage stressors workplace. The primary message is antidote doing work work. However, an alternative approach at clinician-level establishing healthier workplace boundaries. Boundaries provide a way directly address risk factors, which include overcommitting (e.g., providing emotional support peers beyond one's capacity, attending meetings hours), limiting work-life balance, or difficulty managing boundary violations.1, A “psychological demarcation protects integrity individual” helps “set realistic limits participation relationship activity.”10 Delineation blurred line falls differently depending individual context. Individuals varying levels comfort boundaries context, power dynamics scope also relevant. differ how porous they allow their personal professional lives be, differences influenced conceptualize who define relationships. For example, one hospitalist view completely separate, rarely sharing information about colleagues feel each aspect identity has specific focus. Another identify inextricably intertwined, using stories families connect colleagues. Boundary-setting field Hospital Medicine uniquely difficult due its variable clinical, academic, administrative Often, clinical role dictated edges subspecialists—hospitalists what subspecialists not, differs based hospital, resources, clinician-specific practices. Thus, for flexible inherent career choice. Although proceeding examples within article primarily focus defining boundaries, presented framework applies unique practicing hospitalist. Beyond various contextual affect setting across lifespan career. Relative privilege change throughout development. During training early career, physicians finding voice hospital medicine. goals developmental stage capitalize building connections engage new opportunities aim identifying interests areas expertise. lead compulsion say “yes” opportunities, out excitement but sometimes fear tarnishing relationships missing later opportunities.7 balance desire advancement niche fits aspirations creates challenges when “no” thus establish boundaries.9 Conversely, mid-career recognized experts established point person lectures topics). expertise recognition frequent requests talks, mentoring, writing pile not crucial own goals. challenge letting go responsibilities no longer serve make space better align current trajectory. differential changed it still firmly reputation Having deep understanding evolving discussing trusted mentors assist phase. innate please others, empathetic, team player. While attributes beneficial busy, stressful, health system, repeatedly overextending oneself places physician high burnout.2, 9, 11 development around energy challenging, especially many self-sacrificing behaviors become habits over time. Root causes deeply entrenched counterintuitive. In settings, been functional rewarded behavior. Additionally, medical programs offer limited develop practice culture systems normed having very few reactive people try enact Despite challenges, healthy essential psychological well-being, clinician satisfaction, prevention amelioration burnout.8, developing promotes cohesion indirectly benefit patients.11 Because context relationship, challenging maintain we value most.9 Therefore, our incorporates while protecting from overextension. We created three-step process (i.e., assessment confidence, skill development, maintenance) improve competence maintaining informed available literature.2, Before approach, must decide yes request where set limits. Engagement self-reflection critical before deciding whether accept opportunity. Self-reflection consider opportunity fit priorities capacity. Table 1 provides questions prompt reflection. It helpful review mentor, peer, friend member making decision.11, 12 There situations answer simple no. offered once lifetime situation, question could commitments other modified. arise cannot accepted alone presents junior partner form team. Does my top priorities? Is responsibility? Will bring me joy? What will I take away this? How decision day? month? year? easy you boundaries? When hard Settings? People? Internal factors? Role? your values? Personal? Professional? supervisor colleague. Recognizing being present home help boost confidence scheduling any 9 a.m. after 5 p.m. Develop hierarchy—easiest hardest set. Practice easiest competence. Share values colleague asking them adhere language aligns likely effective. After boundary, check yourself. did today? week? does give trade-off something else value? If worried perceived responded boundary: Use sentence summarize wish/need is, communicates heard connected you. Briefly state (less explanation better!). share ensuring gets highest care admitted most appropriate service line). Strategies others transgress boundaries: possible, acknowledge possible benevolent cause transgression know were really getting accomplished quickly). remind already Indicate hold minimal justification. explain weaker become. Below by: Time: Thank considering me. Unfortunately, bandwidth related XX (an activity values) arises future, let because would interested participating. Emotional energy: (Make brief reflection communicate understand communicated.) sounds challenging. I'm glad trust enough And want sure get need. (You then either talk limit much offer, discuss formal informal resources need.) Advice: feedback. wish position this, think someone might suited advise matter. (It suggest if mind.) noticed since themes setting? Are there certain categories easier/harder set? Do worries/distress Once decided propose process: (1) assess baseline enacting (2) skills, (3) reflect values, reassessing revising needed ensure maintained. overview steps guide 1. Assessing honest barriers associated past experiences, was discouraged punished. They relate personality, stressors, lack practice. Setting easier than authorities, colleagues, patients, families). Shifting reasons why important generate strength required and/or boundary. Specifically, keeping life taking tasks interests/goals, colleagues) honor implementing Inherent explicit invisible trade-offs continually making. choice commit committee meets evening typical hours additional trade off Informed reflections, implement degree category person(s) involved, Given mentorship underdeveloped scaffolding. sample use jumpstart process. Starting reflective statement achieves dual aims: acknowledging understands asked desired connection between person(s). Effective brief, justification, reflects underlying values. respond challenged violated. Establishing and, like all Boundary confidence. Reflection impacted critical. impact initially feelings discomfort.8, Over expect competent asserting experience lower stress.5 occurs alongside realization less cognitive integrated into interactions. Finally, examined regarding alignment clinician's reassessment revision change. Burnout largely driven mitigation comprehensive approach; however, institutional changes.2, 7 Developing represents key strategy promote well-being protect against 7, hospitalists environment ill-defined navigate. sustainable, long-term solution intentional, nonreactive approach. Our offers structure follow individualized appreciates factors. By conceptualizing skill, practical problems broader system. recommend that, peer mentor. Mentors only mentees decisions avoid react downstream effects setting, backlash feelings. core components applicable healthcare workers. Broader implementation decrease entire team.9 authors declare conflict interest.

Language: Английский

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Progression of the COVID-19 pandemic, Brazilian healthcare workers’ emotional burden and the effects on professional fulfillment at the end of the third wave: a longitudinal study

Frontiers in Psychiatry, Journal Year: 2023, Volume and Issue: 14

Published: Nov. 3, 2023

Introduction Even though the long-term effects of COVID-19 pandemic on healthcare workers’ mental health remain unknown, such might negatively impact services and patient safety, especially in countries like Brazil, where there is little investment public policies. Objectives To assess how indicators Brazilian workers progressed between beginning 2 years after (at end third wave when was a significant decrease number new cases deaths). Methods The sample comprised whose have been monitored since Brazil. potential participants were addressed via social media contacted through class councils institutions across A total 165 answered instruments at baseline pandemic. Data collected online using Redcap platform symptoms anxiety, depression, post-traumatic stress, insomnia, burnout (emotional exhaustion, depersonalization, professional fulfillment). Results faced three periods intensified incidence deaths due to for years. Approximately one-third still experiences high levels stress. Insomnia remained most prevalent compared assessment, while stress ( p = 0.04) fulfillment 0.005) decreased. Conclusion lack positive changes coupled with decreased over time highlights pandemic’s chronic need organizations monitor these health, developing demand policies are poorly structured unstable.

Language: Английский

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Does Burnout Due to COVID-19 Affect Resilience? The Sample of Doctors in Turkiye

Genel Tıp Dergisi, Journal Year: 2024, Volume and Issue: 34(2), P. 212 - 217

Published: April 26, 2024

Objective: The consequences of the coronavirus pandemic on doctors are significant. This study was conducted to determine resilience or burnout status physicians, characteristics that make a difference them and whether predicts resilience. Method: with quantitative method general survey model. 246 physicians were reached in descriptive cross-sectional study. volunteers ethical permission ensured be able answer all questions before collecting data obtained principle voluntary participation. Results: It has been determined age range, income perception, they like their profession not, satisfied unit work variables levels physicians. Self-efficacy, family social network, coping, adaptation scores above average terms Personal achievement satisfaction predict Conclusion: In order increase extraordinary conditions such as pandemics, ensuring workplace supporting personal success should created.

Language: Английский

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Arbeitsbelastung und psychische Gesundheit von Pflegekräften in Deutschland während der COVID-19-Pandemie – Ein Scoping-Review

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 3, 2024

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Self-Compassion in Qualified and Student Social Workers: A Systematic Literature Review and Meta-Analysis

Journal of Evidence-Based Social Work, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 28

Published: Dec. 18, 2024

Purpose Social work is an intrinsically challenging profession, with high levels of distress and burnout reported amongst professionals. Self-compassion has been suggested as a coping resource that may benefit social workers reduce distress. There reason to believe low self-compassion confer vulnerability in workers, particularly student workers. The current review aimed examine how compare the general population they between qualified Additionally, this explored relationship age, sex/gender, psychological distress, work-related wellbeing within

Language: Английский

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A study on differences about the influencing factors of depressive symptoms between medical staff and residents during 2022 city-wide temporary static management period to fighting against COVID-19 pandemic in Shanghai

Frontiers in Public Health, Journal Year: 2023, Volume and Issue: 10

Published: Jan. 9, 2023

Objectives Our study aimed to identify the latent class of depressive symptoms in Shanghai population during city-wide temporary static management period and compare differences factors influencing between medical staff residents. Methods An online cross-sectional survey was conducted with 840 participants using questionnaires, including Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), self-compiled questionnaire (demographic characteristics internet usage time). Latent analysis (LCA) performed based on participants' symptoms. The subgroups were compared chi-square test t- test. Logistic regression used our analyze within group residents then their differences. Results Two distinct identified LCA: low-depressive high-depressive There significant two groups ( P < 0.05) age, education level, marital status, time, identity (medical or residents), family income living style, overall quality sleep, anxiety levels. Furthermore, logistic results showed that group, “increasing time” “daytime dysfunction” would have nearly times possibility getting serious Conclusions are depression 2022 fighting against COVID-19 pandemic Shanghai. We should pay special attention those increasing time daytime dysfunction working a environment such as pandemic.

Language: Английский

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Burnout, emotional distress and sleep quality among Chinese psychiatric healthcare workers during the COVID-19 pandemic: a follow-up study

Frontiers in Public Health, Journal Year: 2023, Volume and Issue: 11

Published: Dec. 21, 2023

Background Different from the very early stages of COVID-19 pandemic, burnout and chronic mental health problems among care workers (HCWs) has become a challenge. Research is lacking on relationship between burnout, stress, emotional distress sleep quality. Methods The Chinese center been involved in Cope-Corona project since second survey (T2). Named after project, total three cross-sectional surveys were distributed: T2 (February 16–20, 2021), T3 (May 10–14, 2022), T4 (December 20–24, 2022). Burnout, depression, anxiety, quality, workplace factors individual resources measured. Using data, we conducted structural equation model (SEM) to examine mediating role predicting Results 96, 124, 270 HCWs enrolled at T2, T3, T4, respectively. In line with epidemic trends, level perceived related risks was significantly higher while feeling safety decreased significantly. At percentages participants clinically significant levels depression anxiety symptoms 18.9% (51/270) 9.3% (25/270), respectively, 30.4% (82/270) them reported poor or According SEM, mainly had an indirect effect via burnout. However, neither nor stress mediator predictor Instead, resources, positive factors, younger age direct good Conclusion Measures designed enhance should be implemented improve psychosomatic wellbeing HCWs.

Language: Английский

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Changes in hospital staff’ mental health during the Covid-19 pandemic: longitudinal results from the international COPE-CORONA study

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2023, Volume and Issue: unknown

Published: April 24, 2023

Abstract This longitudinal study aimed to explore anxiety and depressive symptoms, individual resources, job demands in a multi-country sample of 612 healthcare workers (HCWs) during the COVID-19 pandemic. Two online surveys were distributed HCWs seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) first (May-October 2020, T1) second (February-April 2021, T2) phase pandemic, assessing sociodemographic characteristics, contact with patients, self-compassion, sense coherence, social support, risk perception, health safety at workplace. reported significant increase symptoms. high or symptoms T1 T2 history mental illness lower self-compassion coherence over time. Risk support strong independent predictors T2, even after controlling for baseline variables. These findings pointed out that outbreak experienced burden psychological distress. The resilience should be supported disease outbreaks by instituting workplace interventions support.

Language: Английский

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Risk Mapping of the Management of a Dyspneic Parturient Suffering from COVID-19-Related Pneumopathy During Delivery in a Hospital in Morocco

Journal of Obstetrics Gynecology and Cancer Research, Journal Year: 2023, Volume and Issue: 8(6), P. 587 - 598

Published: Nov. 11, 2023

Background & Objective: The safety of women during childbirth and personnel working in maternity care amidst the COVID-19 pandemic is a priority for health system. Hence, good risk management practices need to be implemented reduce spread infection between healthcare workers pregnant who have contracted COVID-19. Therefore, this study aimed establish map managing dyspneic parturients suffering from COVID-19-related pneumopathy delivery.Materials Methods: This focuses on examining potential risks beforehand context parturient delivery, executed using method FMECA (Failure Mode, Effects Criticality Analysis); was conducted September December 2021 service Hospital Center ElJadida, Morocco.Results: analysis delivery revealed thirteen failure modes. Proposed are corrective measures at addressing modes criticality class C3 whose vital linked level reanimation neonatal intensive unit.Conclusion: Employing mapping fundamental instrument ongoing enhancement quality maximize process by changing organizational culture reactive preventive approach.

Language: Английский

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