Adnan Nurul B B, Baldwin Claire, Dafny Hila A, Chamberlain Diane
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.
Front Psychol. 2022 Sep 28;13:991946. doi: 10.3389/fpsyg.2022.991946. eCollection 2022.
This study aimed to determine what, how, and under what circumstances individual-focused interventions improve well-being and decrease burnout for critical care healthcare professionals.
This realist approach, expert opinion interview, was guided by the Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II) guidelines. Semi-structured interviews with critical care experts were conducted to ascertain current and nuanced information on a set of pre-defined individual interventions summarized from a previous umbrella review. The data were appraised, and relationships between context, mechanisms, and outcomes were extracted, which created theory prepositions that refined the initial program theory.
A total of 21 critical care experts were individually interviewed. By understanding the complex interplay between organizational and personal factors that influenced intervention uptake, it was possible to decipher the most likely implementable intervention for critical care healthcare professionals. The expert recommendation suggested that interventions should be evidence-based, accessible, inclusive, and collaborative, and promote knowledge and skill development. Unique mechanisms were also required to achieve the positive effects of the intervention due to the presence of contextual factors within critical care settings. Mechanisms identified in this study included the facilitation of self-awareness, self-regulation, autonomy, collaboration, acceptance, and inclusion (to enable a larger reach to different social groups).
This validation of a theoretical understanding of intervention that addressed well-being and burnout in critical care healthcare professionals by expert opinion demonstrated essential mechanisms and contextual factors to consider when designing and implementing interventions. Future research would benefit by piloting individual interventions and integrating these new theoretical findings to understand better their effectiveness for future translation into the "real-world" setting.
本研究旨在确定以个体为中心的干预措施在何种情况下、如何以及为何能改善重症监护医护人员的幸福感并减轻职业倦怠。
本研究采用现实主义方法，即专家意见访谈，以《现实主义与元叙事证据综合：不断发展的标准II》（RAMESES II）指南为指导。对重症监护专家进行了半结构化访谈，以获取有关一组先前系统评价总结的预定义个体干预措施的当前细微信息。对数据进行了评估，并提取了背景、机制和结果之间的关系，从而形成了完善初始项目理论的理论命题。
共对21位重症监护专家进行了单独访谈。通过了解影响干预措施采用的组织因素和个人因素之间的复杂相互作用，可以解读出对重症监护医护人员最有可能实施的干预措施。专家建议表明，干预措施应基于证据、易于获得、具有包容性且相互协作，并促进知识和技能发展。由于重症监护环境中存在背景因素，还需要独特的机制来实现干预措施的积极效果。本研究确定的机制包括促进自我意识、自我调节、自主性、协作、接纳和包容（以便更广泛地覆盖不同社会群体）。
通过专家意见对解决重症监护医护人员幸福感和职业倦怠问题的干预措施的理论理解进行的验证，展示了设计和实施干预措施时需要考虑的基本机制和背景因素。未来的研究通过试点个体干预措施并整合这些新的理论发现，将有助于更好地理解它们在未来转化为“现实世界”环境中的有效性。
