Rattray Janice, Miller Jordan, Pollard Beth, McCallum Louise, Hull Alastair, Ramsay Pam, Salisbury Lisa, Scott Teresa, Cole Stephen, Dixon Diane
School of Health Sciences, University of Dundee, Dundee, Scotland.
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland.
Health Soc Care Deliv Res. 2024 Dec 18:1-32. doi: 10.3310/PWRT8714.
To use the job demands-resources model of occupational stress to quantify and explain the impact of working in critical care during the COVID-19 pandemic on nurses and their employing organisation.
Two-phase mixed methods: a cross-sectional survey (January 2021-March 2022), with comparator baseline data from April to October 2018 (critical care nurses only), and semistructured interviews.
Critical care nurses ( = 461) and nurses redeployed to critical care ( = 200) who worked in the United Kingdom National Health Service (primarily Scotland) between January 2021 and March 2022. The 2018 survey was completed by 557 critical care nurses (Scotland only). Survey response rate in Scotland was 32% but could not be determined outside Scotland. Forty-four nurses were interviewed (critical care = 28, redeployed = 16).
A survey measured job demands, job resources, health impairment, work engagement and organisational outcomes. Data were compared to 2018 data. Regression analyses identified predictors of health impairment, work engagement and organisational outcomes. Semistructured interviews were conducted remotely, audio-recorded and transcribed. Data were analysed deductively using framework analysis.
Three-quarters of nurses reached threshold for psychological distress, approximately 50% reached threshold for burnout emotional exhaustion and a third clinically concerning post-traumatic stress symptoms. Compared to 2018, critical care nurses were at elevated risk of probable psychological distress, odds ratio 6.03 (95% CI 4.75 to 7.95); burnout emotional exhaustion, odds ratio 4.02 (3.07 to 5.26); burnout depersonalisation, odds ratio 3.18 (1.99 to 5.07); burnout accomplishment, odds ratio 1.53 (1.18 to 1.97). There were no differences between critical care and redeployed nurses on health impairment outcomes, suggesting elevated risk would apply to redeployed nurses. Job demands increased and resources decreased during the pandemic. Higher job demands predicted greater psychological distress. Job resources reduced the negative impact of job demands on psychological distress, but this moderating effect was not observed at higher levels of demand. All organisational outcomes worsened. Lack of resources predicted worse organisational outcomes. In interviews, staff described the pace and amount, complexity, physical and emotional effort of their work as the most difficult job demands. The sustained high-demand environment impacted physical and psychological well-being, with most interviewees experiencing emotional and physical exhaustion, burnout, and symptoms of post-traumatic stress disorder. Camaraderie and support from colleagues and supervisors were core job resources. The combination of sustained demands and their impact on staff well-being incurred negative organisational consequences, with increasing numbers considering leaving their specialty or nursing altogether. Dissemination events with a range of stakeholders, including study participants, identified staffing issues and lack of learning and development opportunities as problematic. Critical care nurses are concerned about the future delivery of high-quality critical care services. Positive aspects were identified, for example, reduced bureaucratic systems, increased local autonomy and decision-making, recognition of the critical care nurse skill set.
The National Health Service needs to recognise the impact of COVID-19 on this staff group, prioritise the welfare of critical care nurses, implement workplace change/planning, and support them to recover from the pandemic. The National Health Service is struggling to retain critical care nurses and, unless staff welfare is improved, quality of care and patient safety will likely decline.
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) as award number NIHR132068.
运用职业压力的工作需求-资源模型，量化并解释在新冠疫情期间从事重症护理工作对护士及其雇主组织的影响。
两阶段混合方法：横断面调查（2021年1月至2022年3月），并与2018年4月至10月的对照基线数据（仅针对重症护理护士）进行比较，以及半结构化访谈。
2021年1月至2022年3月期间在英国国家医疗服务体系（主要是苏格兰地区）工作的重症护理护士（n = 461）和被重新调配至重症护理岗位的护士（n = 200）。2018年的调查由557名重症护理护士（仅苏格兰地区）完成。苏格兰地区的调查回复率为32%，但苏格兰以外地区无法确定。44名护士接受了访谈（重症护理 = 28名，重新调配 = 16名）。
一项调查测量了工作需求、工作资源、健康损害、工作投入和组织成果。将数据与2018年的数据进行比较。回归分析确定了健康损害、工作投入和组织成果的预测因素。半结构化访谈通过远程方式进行，进行录音和转录。使用框架分析对数据进行演绎分析。
四分之三的护士达到心理困扰阈值，约50%达到职业倦怠情绪耗竭阈值，三分之一有临床意义的创伤后应激症状。与2018年相比，重症护理护士出现可能的心理困扰的风险升高，优势比为6.03（95%置信区间4.75至7.95）；职业倦怠情绪耗竭，优势比为4.02（3.07至5.26）；职业倦怠去个性化，优势比为3.18（1.99至
