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减少医生和护士职业倦怠的干预措施:系统评价与荟萃分析综述

Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses.

作者信息

Zhang Xiu-Jie, Song Yingqian, Jiang Tongtong, Ding Ning, Shi Tie-Ying

机构信息

Department of Nursing, The First affiliated Hospital of Dalian Medical University, Dalian, China.

College of nursing, Chiba university, Chiba, Japan.

出版信息

Medicine (Baltimore). 2020 Jun 26;99(26):e20992. doi: 10.1097/MD.0000000000020992.

Abstract

OBJECTIVE

Numerous systematic reviews and meta-analyses on the interventions to reduce burnout of physicians and nurses have been published nowadays. This study aimed to summarize the evidence and clarify a bundled strategy to reduce burnout of physicians and nurses.

METHODS

Researches have been conducted within Cochrane Library, PubMed, Ovid, Scopus, EBSCO, and CINAHL published from inception to 2019. In addition, a manual search for relevant articles was also conducted using Google Scholar and ancestral searches through the reference lists from articles included in the final review. Two reviewers independently selected and assessed, and any disagreements were resolved through a larger team discussion. A data extraction spreadsheet was developed and initially piloted in 3 randomly selected studies. Data from each study were extracted independently using a pre-standardized data abstraction form. The the Risk of Bias in Systematic reviews and assessment of multiple systematic reviews (AMSTAR) 2 tool were used to evaluate risk of bias and quality of included articles.

RESULTS

A total of 22 studies published from 2014 to 2019 were eligible for analysis. Previous studies have examined burnout among physicians (n = 9), nurses (n = 6) and healthcare providers (n = 7). The MBI was used by majority of studies to assess burnout. The included studies evaluated a wide range of interventions, individual-focused (emotion regulation, self-care workshop, yoga, massage, mindfulness, meditation, stress management skills and communication skills training), structural or organizational (workload or schedule-rotation, stress management training program, group face-to-face delivery, teamwork/transitions, Balint training, debriefing sessions and a focus group) and combine interventions (snoezelen, stress management and resiliency training, stress management workshop and improving interaction with colleagues through personal training). Based on the Risk of Bias in Systematic reviews and AMSTAR 2 criteria, the risk of bias and methodological quality included studies was from moderate to high.

CONCLUSIONS

Burnout is a complicated problem and should be dealt with by using bundled strategy. The existing overview clarified evidence to reduce burnout of physicians and nurses, which provided a basis for health policy makers or clinical managers to design simple and feasible strategies to reduce the burnout of physicians and nurses, and to ensure clinical safety.

摘要

目的

如今已发表了大量关于减少医生和护士职业倦怠干预措施的系统评价和荟萃分析。本研究旨在总结证据并阐明一种减少医生和护士职业倦怠的综合策略。

方法

在Cochrane图书馆、PubMed、Ovid、Scopus、EBSCO和CINAHL中检索从创刊到2019年发表的研究。此外,还使用谷歌学术进行了相关文章的手动检索,并通过最终综述中纳入文章的参考文献列表进行追溯检索。两名评审员独立选择和评估,任何分歧通过更大规模的团队讨论解决。开发了一个数据提取电子表格,并在3项随机选择的研究中进行了初步试用。使用预先标准化的数据提取表独立提取每项研究的数据。使用系统评价中的偏倚风险和多项系统评价评估(AMSTAR)2工具来评估纳入文章的偏倚风险和质量。

结果

共有2014年至2019年发表的22项研究符合分析条件。先前的研究调查了医生(n = 9)、护士(n = 6)和医疗服务提供者(n = 7)的职业倦怠情况。大多数研究使用MBI来评估职业倦怠。纳入的研究评估了广泛的干预措施,包括以个人为中心的(情绪调节、自我护理工作坊、瑜伽、按摩、正念、冥想、压力管理技能和沟通技能培训)、结构或组织层面的(工作量或排班轮值、压力管理培训项目、小组面对面授课、团队合作/过渡、巴林特培训、汇报会和焦点小组)以及综合干预措施(多感官环境疗法、压力管理和复原力培训、压力管理工作坊以及通过个人培训改善与同事的互动)。根据系统评价中的偏倚风险和AMSTAR 2标准,纳入研究的偏倚风险和方法学质量从中度到高度不等。

结论

职业倦怠是一个复杂的问题,应采用综合策略来应对。现有综述阐明了减少医生和护士职业倦怠的证据,为卫生政策制定者或临床管理者设计简单可行的策略以减少医生和护士的职业倦怠并确保临床安全提供了依据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7396/7328917/009a5781c2d1/medi-99-e20992-g002.jpg

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