在 COVID-19 大流行期间，多维压力源和保护因素塑造了美国两个大城市医生的工作环境和与工作相关的幸福感。
Multidimensional stressors and protective factors shaping physicians' work environments and work-related well-being in two large US cities during COVID-19.
机构信息
Department of Social Medicine and Center for Bioethics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
出版信息
Am J Ind Med. 2023 Oct;66(10):854-865. doi: 10.1002/ajim.23520. Epub 2023 Jul 24.
INTRODUCTION
Clinician burnout and poor work-related well-being reached a critical inflection point during the COVID-19 pandemic. This article applies a novel conceptual model informed by the Total Worker Health® approach to identify and describe multilevel stressors and protective factors that affected frontline physicians' work environments and work-related well-being.
METHODS
We conducted a qualitative study of hospital-based physicians from multiple hospital types in Los Angeles and Miami who cared for COVID-19 patients. Semistructured interviews lasting 60-90 min were conducted over Zoom. Interview transcripts were thematically coded using Dedoose qualitative software.
RESULTS
The final sample of 66 physicians worked in 20 hospitals. Stressors in the social, political, and economic environment included dealing with the politicization of COVID-19, including vaccine hesitancy; state and federal governmental COVID-19 policies and messaging; and shifting CDC guidance. Employment and labor pattern stressors included the national nursing shortage, different policies for paid time off, furloughs, reduced pay, and layoffs. Organizational-level stressors included institutional policies, staffing constraints and high patient volume (i.e., increased number of cases and longer lengths of stay), and perceived poor leadership. At the individual worker level, stressors included concerns about viral transmission to family, strained personal relationships, and work-life fit, particularly for those with young children. Respondents identified promising protective factors at multiple levels, including responsive state leadership, job security, concrete opportunities to provide input into institutional policy, strong leadership and communication, and feeling cared for by one's institution.
CONCLUSION
Findings support a multi-level strategy that acknowledges internal organizational and external factors shaping clinicians' work-related well-being, consistent with the Total Worker Health® approach.
简介
在 COVID-19 大流行期间，临床医生倦怠和工作相关福祉不佳达到了一个关键的转折点。本文应用了一种新的概念模型，该模型借鉴了“全面员工健康”方法，以确定和描述影响一线医生工作环境和工作相关福祉的多层次压力源和保护因素。
方法
我们对洛杉矶和迈阿密多家医院的住院医师进行了一项定性研究，这些医生照顾 COVID-19 患者。通过 Zoom 进行了持续 60-90 分钟的半结构化访谈。使用 Dedoose 定性软件对访谈记录进行主题编码。
结果
最终的 66 名医生样本来自 20 家医院。社会、政治和经济环境中的压力源包括应对 COVID-19 的政治化，包括疫苗犹豫；州和联邦政府的 COVID-19 政策和信息传递；以及不断变化的 CDC 指南。就业和劳动力模式压力源包括全国性的护士短缺、带薪休假、停薪留职、减薪和裁员的不同政策。组织层面的压力源包括机构政策、人员配备限制和高患者量（即增加病例数和更长的住院时间）以及感知到的不良领导。在个体工人层面，压力源包括对家庭病毒传播的担忧、紧张的人际关系以及工作与生活的契合度，特别是对于有年幼子女的人。受访者在多个层面确定了有希望的保护因素，包括反应灵敏的州领导层、工作保障、为机构政策提供投入的具体机会、强有力的领导和沟通，以及感受到机构的关怀。
结论
研究结果支持一种多层次的策略，该策略承认影响临床医生工作相关福祉的内部组织和外部因素，与“全面员工健康”方法一致。
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