Work-related Psychological Distress Research Articles

Becoming futile: the emotional pain of treating COVID-19 patients.

The COVID-19 pandemic has had a profoundly detrimental impact on the emotional wellbeing of health care workers. Numerous studies have shown that their rates of the various forms of work-related distress, which were already high before the pandemic, have worsened as the demands on health care workers intensified. Yet much less is known about the specific social processes that have generated these outcomes. This study adds to our collective knowledge by focusing on how one specific social process, the act of treating critically ill COVID-19 patients, contributed to emotional pain among health care workers. This article draws from 40 interviews conducted with intensive care unit (ICU) staff in units that were overwhelmed with COVID-19 patients. The study participants were recruited from two suburban community hospitals in Massachusetts and the interviews were conducted between January and May 2021. The results show that the uncertainty over how to treat critically ill COVID-19 patients, given the absence of standard protocols combined with ineffective treatments that led to an unprecedented number of deaths caused significant emotional pain, characterized by a visceral, embodied experience that signaled moral distress, emotional exhaustion, depersonalization, and burnout. Furthermore, ICU workers' occupational identities were undermined as they confronted the limits of their own abilities and the limits of medicine more generally. The inability to save incurable COVID-19 patients while giving maximal care to such individuals caused health care workers in the ICU an immense amount of emotional pain, contributing to our understanding of the social processes that generated the well-documented increase in moral distress and related measures of work-related psychological distress. While recent studies of emotional socialization among health care workers have portrayed clinical empathy as a performed interactional strategy, the results here show empathy to be more than dramaturgical and, in this context, entailed considerable risk to workers' emotional wellbeing.

Burnout or anxiety?! A medical trial regarding resident doctors in a first line University Hospital during COVID 19 pandemic

IntroductionCoronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported as a worldwide emergency. Due to the extensiveness of spread and death, it has been declared as a pandemic.ObjectivesTo highlight how COVID-19 pandemic psycho-emotional affects the medical staff of a frontline University Hospital in the “battle” with new coronavirus.MethodsWe employed a cross-sectional survey of 71 resident doctors from a frontline Hospital after a one-year pandemic and analyzed the prevalence and associated factors with work-related psychological distress among our study group.ResultsOut of the hospital resident doctors, 71 participated and completed the questionnaire, offering an overall response rate of 100%. The majority of participants were women (86% - 61). The average age was 29 years. Most respondents were unmarried. A total of 67% of participants were non-smokers, 5% stated that they occasionally consumed alcohol, none of them used drugs. As a result of the qualitative and quantitative analysis of the data, aspects related to anxiety (21.12% - 15), exhaustion (15.49% - 11), and depression (11.26% - 8) are highlighted. In our study, no people were identified who would reach extreme exhaustion in the work process, due to good resilience and due to a well thought out program of work and rest during the pandemic.ConclusionsThe psychological pressure at work, as well as the one felt after limiting and restricting mobility for shorter or longer periods, had an impact on the psycho-emotional state of health care workers, requiring further psychological reassessments and psychological support.DisclosureNo significant relationships.

MO921: Pandemic Experiences, Perceptions and Burnout Among Haemodialysis Units Personnel in the COVID-19 Era

BACKGROUND AND AIMSThe coronavirus disease 2019 (COVID-19) pandemic is one of the greatest challenges facing healthcare systems worldwide in recent years. Burnout was found to be an important factor in the professional landscape of nephrology already prior to the COVID-19 outbreak and is expected to worsen during the pandemic due to increased workload and changes in the work environment. As a life-saving procedure, haemodialysis (HD) delivery could not undergo profound organizational adjustments, what was the case of out-patient settings, which largely turned towards telemedicine services. Poor COVID-19 outcomes of maintenance HD patients with mortality rate exceeding 20% may be also considered among personnel's aggravating factors. The aim of our study was to assess pandemic experiences, perceptions and burnout among Polish dialysis unit professionals in the COVID-19 era.METHODA web-based survey was distributed via e-mail to Polish dialysis units and was shared via social media channels gathering nephrology professionals, the survey was open between the 1 September 2021 and the 31 December 2021. The study survey consisted of two validated questionnaires––Pandemic Experiences and Perceptions Survey and Maslach Burnout Inventory––Human Services Survey for Medical Personnel, as well as self-created questions about experiences with SARS-CoV-2 infection. The study group comprised 215 nurses (208 F, 5 M, median age 50 years, IQR 10), 148 physicians (77 F, 70 M, mean age) and 16 respondents of other medical professions. 35.3% of the study group confirmed that they suffered from SARS-CoV-2 infection.RESULTSAccording to 40% of nurses and 43.9% of physicians, the pandemic largely affected the work of dialysis units, 19% of nurses and 12% of physicians stated that it completely dominated the work. A total of 54.8% of nurses and 52.7% of physicians agreed that personal protective equipment was completely or mostly adequate. Information about safety procedures received from the dialysis unit management staff was evaluated as adequate by 53.5% of nurses and 59.5% of physicians. A total of 8.8% and 54.4% of nurses perceived life-threatening and serious risk at work during the pandemic, respectively; similar risk ratios were reported by physicians (9.45% and 55.4%, respectively). Importantly, 58.6% of nurses and 54.4% of physicians stated that their work is associated with at least serious risk for their family members. A total of 44.2% of nurses and 49.2% of physicians confirmed that they feel burned out. Out of these, 85.7% of nurses and 76.2% of physicians stated that the feeling of burnout was aggravated during the pandemic. Emotional exhaustion did not differ between nurses and physicians, while depersonalization was significantly lower (P = 0.0001) and the feeling of personal accomplishments was significantly higher (P = 0.035) among nurses than physicians. The level of burnout in three dimensions perceived by dialysis nurses and physicians during the COVID-19 is provided in Table 1. Burnout was lower among those who assessed their personal protection equipment as adequate. Also, participants who felt that the training, equipment and support provided them with a good control over their contact with the virus were found to be less burned out.CONCLUSIONThe COVID-19 pandemic has largely affected work in dialysis units, contributing to an increased risk of work-related psychological distress and burnout in this vulnerable population of healthcare professionals. Providing proper training, equipment and support during these unprecedented times of the COVID-19 outbreak may decrease burnout among dialysis nurses and physicians.Table 1.Prevalence of high, moderate and low levels of burnout in particular dimensions and of the overall burnout among dialysis nurses and physicians in the COVID-19 era

Psychological Distress of Healthcare Workers in Québec (Canada) During the Second and the Third Pandemic Waves.

We aimed to measure the prevalence of psychological distress among Quebec healthcare workers (HCWs) during the second and third pandemic waves and to assess the effect of psychosocial risk factors (PSRs) on work-related psychological distress among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected (cases) and non-infected (controls) HCWs. A self-administered survey was used to measure validated indicators of psychological distress (K6 scale) and PSR (questions based on Karasek and Siegrist models, value conflicts, and work-life balance). Adjusted robust Poisson models were used to estimate prevalence ratios. Four thousand sixty eight cases and 4152 controls completed the survey. Prevalence of high work-related psychological distress was 42%; it was associated with PSRs (mainly work-life balance, value conflicts, and high psychological demands) but not with SARS-CoV-2 infection. Primary prevention measures targeting PSRs are needed to reduce mental health risks of HCWs.

Sources of work-related psychological distress experienced by UK-wide foundation and junior doctors: a qualitative study

ObjectivesThis paper reports findings exploring work cultures, contexts and conditions associated with psychological distress in foundation and junior doctors.DesignQualitative study using in-depth interviews with 21 junior doctor participants. The interviews...

Health care workers' protection and psychological safety during the COVID-19 pandemic in Spain.

AimsTo analyse the relationship between work engagement, sense of coherence and psychological distress levels in Spanish health professionals who were active during the COVID‐19 pandemic lockdown.BackgroundWork engagement and sense of coherence can help professionals to cope with work‐related psychological distress due to the harsh conditions of the COVID‐19 working environment.MethodsCross‐sectional observational study of 1,459 health care professionals. The Utrecht Work Engagement Scale, the Sense of Coherence Scale and Goldberg's General Health Questionnaire were distributed and analysed with descriptive and multiple linear regression methods.ResultsHigh levels of work engagement, especially in the dedication dimension, of sense of coherence, in particular in the meaningfulness dimension, and psychological distress were obtained. Significant correlations (p < .001) were identified between all the variables.ConclusionsWork engagement and sense of coherence correlated positively with each other and both negatively with psychological distress. So, health care professionals, despite presenting psychological distress, perceive their work satisfactorily and positively despite the severity of the situation and the harsh conditions.Implications for Nursing ManagementSense of coherence and work engagement are protective factors against psychological distress. Preventive measures for professionals should go through the dimensionalization of the problem and the adaptation of practical measures for daily management.

A Mindfulness-Based Cognitive Therapy (MBCT) Intervention to Improve Resilience and Mitigate Symptoms of Burnout Syndrome in Critical Care Nurses: Results of a Randomized Trial

Objective: Critical care nurses work in a challenging intensive care (ICU) environment that results in work-related psychological distress. Our objective was to pilot an in-person or virtual mindfulness-based cognitive therapy (MBCT) program enhanced resilience and a similarly designed attention control group. Methods: We randomized ICU nurses with symptoms of burnout syndrome and decreased resilience to an MBCT program or a similarly formatted book club control. Our primary outcome was change in resilience as measured by the Connor-Davidson Resilience Scale (CD-RISC). Results: One-hundred one nurses completed study-related procedures. Overall, 70% had baseline symptoms of anxiety and 26% had symptoms of depression. For the in-person cohorts, there was no statistical difference between intervention and control groups regarding the total number of sessions attended (3.85 days ± 1.4 versus 3.75 days ± 0.15; p = 0.64). Using the Client/Patient Satisfaction Questionnaire-8 (CSQ-8), satisfaction scores were higher in the intervention group for weeks two through four of the program: p = 0.03, 0.0003, 0.007 respectively. There was no difference in the change in CD-RISC scores between the two groups (mean difference: treatment = 5.0, control = 7.0; p = 0.30). The online intervention cohort had greater improvements in the change of their median emotional exhaustion burnout scores when compared to the in-person intervention cohorts (-5 [-8 to -1.5] vs. 2 [-5 to 8], p = 0.049). Conclusions: We developed a feasible and acceptable in-person and online MBCT-ICU intervention that did not increase resilience scores in ICU nurses when compared to an attention control group. These results could help guide the proper design of larger trials to determine the efficacy of other resilience interventions.

Depressive Symptoms, Help-Seeking, and Barriers to Mental Healthcare Among Healthcare Professionals in Lithuania.

Summary. Background:Previous research suggests that healthcare professionals (HCPs) experience high levels of work-related psychological distress, including depressive symptoms. Due to the stigma of mental health problems and other barriers, HCPs are likely to be hesitant to seek appropriate mental healthcare. We aimed to explore these phenomena among HCPs in Lithuania.Methods:A web survey inquiring about depressive symptoms, help-seeking, and barriers to mental health-care was conducted. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). 601 complete questionnaires were included in the analyses. The barriers to help-seeking were identified using the inductive content analysis approach. Descriptive, non-parametric, and robust statistical analysis was performed using SPSS software. Results:Most of the respondents have reported depression-like symptoms over the lifetime, although only about a third of them sought professional help. Of those, roughly half preferred a private specialist. The stigma and neglect of mental health problems were the most common barriers to help-seeking. Around half of the HCPs believed that seeking mental healthcare can imperil their occupational license. About a quarter of the HCPs screened positive for clinically relevant depressive symptoms. Statistically significant differences in the PHQ-9 score were found between categories of healthcare specialty, marital status, religious beliefs, workplace, and years of work as a HCP. Fewer years of work and younger age were associated with the higher PHQ-9 score.Conclusions:Our findings suggest that HCPs in Lithuania may be inclined not to seek appropriate mental healthcare and experience poor mental health, although stronger evidence is needed to verify these findings.

Psychological distress symptoms among healthcare professionals are significantly influenced by psychosocial work context, Ethiopia: A cross-sectional analysis.

Work-related psychosocial hazards result in numerous adverse effects on physical and psychological health, a reduction in quality of life and a decline in performance capacity to workers. While the condition is widespread across various occupations, healthcare sectors are acknowledged to be at high risk. In developing countries such as Ethiopia, however, the lack of reliable data on psychosocial hazards including psychological distress (PD) often hampers officials from planning for preventive actions. This study assessed the magnitude and influencing factors of PD among healthcare professionals in Gondar city, Ethiopia. We employed a cross-sectional survey of 422 healthcare professionals selected with a stratified random sampling technique between April and March 2019. The symptoms of psychological distress were assessed with a standardized 10 items Kessler Psychological Distress Scale instrument. Bivariate and multivariate analyses were conducted by use of SPSS program version 20. Factors associated with psychological distress symptoms were ascertained at < 0.05 p-value. Adjusted odds ratio (AOR) with a confidence interval (CI) of 95% was used to determine the strength of associations. In total, 417questionnaires fully completed and returned with a response rate of 98.8%. Age ranges from 23 to 57 with a mean of 31.00 (± 8.219 SD) years. Work-related psychological distress symptoms in the past 4weeks stood at 44.4% (N = 185) [95%CI (39.8, 49.4)]. Being female worker [AOR: 2.07; 95% CI (1.29, 3.32)], high job demand [(AOR: 1.53; 95% CI (1.10, 2.57)] and low job control [AOR: 2.54; 95% CI (1.60, 4.04)] were significant factors of psychological distress. This study underscores the level of psychological distress among healthcare professionals is high. The experiences of psychological distress symptoms were significantly influenced by socio-demographic factors including sex and psychosocial job characteristics such as job demand and job control. Efforts to prevent the mental health of workers including psychological distress symptoms need to focus on individual attributes and job contexts.

Work-related physical activity and psychological distress among women in different occupations: a cross-sectional study

BackgroundRecent evidence suggests that work-related physical activity may not have the same mental health benefits as leisure-time physical activity. Further, work-related physical activity is likely to include a variety of different behaviours for people with different occupations. As such, the aim of this study was to determine if occupation type moderated the association between work-related physical activity and psychological distress.MethodsA randomly selected sample of 1080 women from Melbourne, Australia completed the International Physical Activity Questionnaire (IPAQ) and General Health Questionnaire (GHQ-30), and reported their current occupation.ResultsLinear regression analyses indicated that occupation significantly moderated the association between work-related walking and psychological distress (F [8, 55] = 2.26, p = .036). Given evidence of moderation, we fitted linear regression models to test the associations between work-related physical activity and psychological distress for three separate groups; professionals, sales and services workers, and tradespersons. Female tradespersons who engaged in a low (B = − 3.81, p = .006) or high amount of work-related walking (B = − 3.23, p = .029), had significantly lower psychological distress symptoms than those who engaged in no work-related walking. There were no significant associations between work-related physical activity of any intensity and psychological distress for professionals, or sales and service workers.ConclusionsGiven the relationship does not exist across all occupations, work-related physical activity should not be promoted above and beyond leisure-time physical activity. However, walking at work may be important in reducing psychological distress for some people and should therefore, not be discounted.

Psychological impact of working in paediatric intensive care. A UK-wide prevalence study

ObjectiveTo determine the prevalence of work-related psychological distress in staff working in UK paediatric intensive care units (PICU).DesignOnline (Qualtrics) staff questionnaire, conducted April to May 2018.SettingStaff working in 29 PICUs...

Compassion Satisfaction Among Social Work Practitioners: The Role of Work–Life Balance

Previous research has established that social work practitioners are especially vulnerable to work-related psychological distress and burnout due to the high-stress nature of the profession, yet less research has focused on examining factors are associated with social worker retention. Emerging research on compassion satisfaction suggests that this factor could mitigate professional burnout, yet there is a gap in research focusing explicitly on examining compassion satisfaction among social workers. To address this gap in knowledge, this quantitative study collected survey data on practicing social workers who were alumni from a large southeastern university (n = 120) to examine individual and organizational factors associated with compassion satisfaction. Multiple regression analyses revealed that higher levels of emotional intelligence, perceived work autonomy, and perceived work–life balance were associated with an increase in compassion satisfaction among experienced, licensed social work practitioners. Findings have implications for how social work employers can promote compassion satisfaction through cultivating emotional intelligence among practitioners, allowing social workers autonomy in decision making, and providing supportive work environments. Recommended directions for future research include longitudinal studies with large sample sizes that expound research on compassion satisfaction by examining the role of additional factors, such as client population, job role characteristics, and supervisor support.

Childbearing women's experiences of midwives' workplace distress: Patient and public involvement

Background Some midwives experience work-related psychological distress. This can reduce the quality and safety of maternity services, yet there are few interventions to support midwives. Aim To explore and voice the perceptions of new mothers in relation to the barriers to receiving high-quality maternity care, the psychological wellbeing of midwives and the development and evaluation of an online intervention designed to support them. GRIPP2 reporting checklists were also used to demonstrate how patient and public involvement works in research. Methods A co-design approach was used in a discussion group to collect qualitative data from 10 participants. A framework approach was used for analysis. Findings Unique findings included midwives crying, becoming emotional and seeking support from service users. Overall, seven patient and public involvement outcomes relating to intervention development and data collection were identified. Conclusion Maternity service improvement strategies may only be wholly effective once they include the provision of effective midwifery workplace support.

Work-related psychological distress and social dysfunction in Nurses at Haji Hospital Medan-Indonesia

Work-related psychological distress and social dysfunction in Nurses at Haji Hospital Medan-Indonesia

A systematic mixed-methods review of interventions, outcomes and experiences for midwives and student midwives in work-related psychological distress

Backgroundwithin challenging work environments, midwives and student midwives can experience both organisational and occupational sources of work-related psychological distress. As the wellbeing of healthcare staff directly correlates with the quality of maternity care, this distress must be met with adequate support provision. As such, the identification and appraisal of interventions designed to support midwives and student midwives in work-related psychological distress will be important in the pursuit of excellence in maternity care. Objectivesto identify interventions designed to support midwives and/or student midwives in work-related psychological distress, and explore any outcomes and experiences associated with their use.Data sources; study eligibility criteria, participants, and interventions This systematic mixed-methods review examined 6 articles which identified interventions designed to support midwives and/or student midwives in work-related psychological distress, and reports both the outcomes and experiences associated with their use. All relevant papers published internationally from the year 2000 to 2016, which evaluated and identified targeted interventions were included. Study appraisal and synthesis methodsthe reporting of this review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of each study has been appraised using a scoring system designed for appraising mixed-methods research, and concomitantly appraising qualitative, quantitative and mixed-methods primary studies in mixed reviews. Bias has been assessed using an assessment of methodological rigor tool. Whilst taking a segregated systematic mixed-methods review approach, findings have been synthesised narratively. Findingsthis review identified mindfulness interventions, work-based resilience workshops partnered with a mentoring programme and the provision of clinical supervision, each reported to provide a variety of both personal and professional positive outcomes and experiences for midwives and/or student midwives. However, some midwives and/or student midwives reported less favourable experiences, and some were unable to participate in the interventions as provided for practical reasons. Limitationseligible studies were few, were not of high quality and were limited to international findings within first world countries. Additionally, two of the papers included related to the same intervention. Due to a paucity of studies, this review could not perform sensitivity analyses, subgroup analyses, meta-analysis or meta-regression. Conclusions and implications of key findingsthere is a lack of evidence based interventions available to support both midwives and student midwives in work-related psychological distress. Available studies reported positive outcomes and experiences for the majority of participants. However, future intervention studies will need to ensure that they are flexible enough for midwives and student midwives to engage with. Future intervention research has the opportunity to progress towards more rigorous studies, particularly ones which include midwives and student midwives as solitary population samples

The case for developing an online intervention to support midwives in work-related psychological distress

Background: Midwives experience episodes of work-related psychological distress owing to the emotionally difficult and traumatic work environments they endure. There is a need to develop interventions to effectively support midwives, as the wellbeing of midwives can be directly correlated with the quality and safety of maternity care. Aims: This project aims to make the case for the development of an online support intervention, designed to effectively support midwives in distress. Methods: Literature reviews were conducted, and midwives and other subject experts were recruited to participate in a Delphi study via a research blog. Findings: Following literature reviews and a structured consultation with 66 participants, it was found that the development of an online intervention designed to support midwives with work-related psychological distress should prioritise confidentiality and anonymity, along with 24-hour mobile access and a range of other components. Conclusions: This research makes the case for the development of an online intervention designed to support midwives in work-related psychological distress. The author invites all midwives to support and follow ongoing research in this area via The Academic Midwife page on Facebook.

Depersonalization reconsidered: An empirical analysis of the relation between depersonalization and cynicism in an extended version of the Maslach Burnout Inventory

The Maslach Burnout Inventory (MBI), the most widely used operationalization of burnout, exists in two qualitatively different versions (Human Services Survey/Educators Survey and General Survey). One common concept, however, is used to characterize the measured phenomenon. The aim of the present study is to investigate two associated dimensions of burnout – depersonalization and cynicism – as operationalized in two versions of the MBI. The dimensions have been described and used as related expressions of mental distancing within the burnout concept, but the relation between the two aspects of distancing have to a little degree been studied empirically and previous studies have been limited to confirmatory factor analyses. In this study, exploratory and confirmatory factor analysis, analyses of correlations between burnout scales and analyses of correlations between burnout scales and different antecedents of burnout, other work-related attitudes and psychological distress were conducted for eight different human services professions in Norway (N = 1798). The results showed that depersonalization and cynicism emerged as two correlated, but distinct, dimensions, and the results were robust across factor analytic methods and correlation analyses. In addition, partial correlation analyses showed that depersonalization shared very little unique variance with the criterion variables, whereas cynicism shares considerably more unique variance with the same variables. The findings cast doubts on the conception of depersonalization and cynicism as related facets of a common, overarching burnout concept and suggest that cynicism is a more central aspect of burnout than is depersonalization.

Achieving Consensus for the Design and Delivery of an Online Intervention to Support Midwives in Work-Related Psychological Distress: Results From a Delphi Study.

BackgroundSome midwives are known to experience both professional and organizational sources of psychological distress, which can manifest as a result of the emotionally demanding midwifery work, and the traumatic work environments they endure. An online intervention may be one option midwives may engage with in pursuit of effective support. However, the priorities for the development of an online intervention to effectively support midwives in work-related psychological distress have yet to be explored.ObjectiveThe aim of this study was to explore priorities in the development of an online intervention to support midwives in work-related psychological distress.MethodsA two-round online Delphi study was conducted. This study invited both qualitative and quantitative data from experts recruited via a scoping literature search and social media channels.ResultsIn total, 185 experts were invited to participate in this Delphi study. Of all participants invited to contribute, 35.7% (66/185) completed Round 1 and of those who participated in this first round, 67% (44/66) continued to complete Round 2. Out of 39 questions posed over two rounds, 18 statements (46%) achieved consensus, 21 (54%) did not. Participants were given the opportunity to write any additional comments as free text. In total, 1604 free text responses were collected and categorized into 2446 separate statements of opinion, creating a total of 442 themes. Overall, participants agreed that in order to effectively support midwives in work-related psychological distress, online interventions should make confidentiality and anonymity a high priority, along with 24-hour mobile access, effective moderation, an online discussion forum, and additional legal, educational, and therapeutic components. It was also agreed that midwives should be offered a simple user assessment to identify those people deemed to be at risk of either causing harm to others or experiencing harm themselves, and direct them to appropriate support.ConclusionsThis study has identified priorities for the development of online interventions to effectively support midwives in work-related psychological distress. The impact of any future intervention of this type will be optimized by utilizing these findings in the development process.

Confidentiality, anonymity and amnesty for midwives in distress seeking online support - Ethical?

Midwife health is intrinsically linked to the quality of safe patient care. To ensure safe patient care, there is a need to deliver emotional support to midwives. One option that midwives may turn to may be a confidential online intervention, instead of localised, face-to-face support. Following the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards, this realist synthesis approach explores the ethical considerations in permitting confidentiality, anonymity and amnesty in online interventions to support midwives in work-related psychological distress. An iterative search methodology was used to select nine papers for review. To assimilate information, papers were examined for ideas relating to ethical dimensions of online interventions to support midwives in work-related psychological distress. This review takes a narrative approach. Online interventions can support the development of insight, help seeking and open discussion. Additionally, Internet support groups can become morally persuasive in nature. Anonymity and confidentiality are both effective and therapeutic features of online interventions when used in collaboration with effective online moderation. Yet, ethical dilemmas remain where users cannot be identified. Confidentiality and anonymity remain key components of successful online interventions. However, sanctioning the corollary component of amnesty may provoke moral discomfort for those seeking immediate accountability. For others, amnesty is seen as essential for open disclosure and help seeking. Ultimately, the needs of midwives must be balanced with the requirement to protect the public and the professional reputation of midwifery. In supporting midwives online, the principles of anonymity, confidentiality and amnesty may evoke some resistance on ethical grounds. However, without offering identity protection, it may not be possible to create effective online support services for midwives. The authors of this article argue that the principles of confidentiality, anonymity and amnesty should be upheld in the pursuit of the greatest benefit for the greatest number of people.

Burnout and risk of burnout in the teams of bone marrow transplant:a multicentre Italian survey

. Burnout and risk of burnout in the Italian teams of bone marrow transplant: a multicentre survey. The term burnout is used to describe a state of work-related psychological distress in healthcare employees characterized by three related, but independent, components: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). The aim of this study was to evaluate the prevalence of burnout and stress symptoms in physicians, nurses, and other healthcare professionals in Italian Bone Marrow Transplantation Units. All personnel of a multidisciplinary group of the Italian Group of Bone Marrow Transplantation were asked to answer two different validated questionnaires: the Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-12) for the assessment of general wellbeing. Logistic regression was used to investigate possible risk factors for burnout. This study showed a relatively low burnout prevalence (3.7%), however about 43.5% of health workers were at risk for developing a burnout syndrome. No personal or center characteristics seemed related to burnout risk, but there was a strong correlation between higher scores from the general health questionnaire and burnout risk. Results from our survey suggest that burnout is a relevant problem in transplant teams and as such strategies should be implemented to prevent it.