■护士,助产士和护理人员是国家卫生服务中最大的临床工作人员集体,并且是一些心理疾病患病率最高的人群。现有的文献往往是专业特定的,并侧重于个人干预措施,使护士对良好的心理健康负责。助产士和护理人员自己。
■为了提高对如何,为什么和在什么情况下护士,助产士和护理人员经历与工作有关的心理健康;并确定可以实施哪些高质量的干预措施,以最大程度地减少这些职业的心理健康。
■与现实主义和元叙事证据综合相一致的现实主义综合方法:不断发展的标准\'报告指南。
■在医学文献分析和检索系统在线数据库中进行第一轮数据库搜索(通过Ovid),护理和相关健康文献数据库(通过EBSCO)和健康管理信息联盟数据库(通过Ovid)的累积指数,在2021年2月至3月期间进行,随后是补充搜索策略(例如,手工搜索,关键论文的专家征集)。采用了反向年代学筛选,旨在保留每个专业的30篇相关论文。第二轮数据库搜索(2021年12月)针对COVID-19特定文献和文献综述。没有应用日期限制。
■我们建立在七份关键报告的基础上,在第一轮中纳入了75篇论文(26篇护理,26助产,23名护理人员)加上44份专家征集文件,第二轮29篇文献综述和49篇COVID-19重点文章。通过现实主义综合,我们浮出了文献中的14个关键张力,并确定了五个关键发现,由26个上下文机制和结果配置支持。主要发现如下:(1)干预措施支离破碎,以个人为中心,对累积的慢性压力源认识不足;(2)在存在责备文化的情况下,很难促进员工的心理健康;(3)系统的需求往往凌驾于员工的工作幸福感之上(“服务和牺牲”);(4)在工作中坚持和实施价值观会产生意想不到的个人成本;(5)设计具有挑战性,确定和实施干预措施,以最佳方式为具有多样化和相互作用的压力源的不同员工群体工作。
■我们的现实主义综合强烈表明需要改善护士的系统工作条件和工作生活,助产士和护理人员改善他们的心理健康。个人,一次性心理干预不可能单独成功。心理疾病在这些工作人员群体中非常普遍(可能是慢性的、累积的和急性的),应该预料到并做好准备,确实正常化和预期。医疗保健组织需要(1)重新平衡工作环境,使医疗保健专业人员能够康复和发展;(2)投资于多层次系统方法,以促进员工的心理健康;并使用组织诊断框架,例如NHS英格兰和NHS改善健康和福祉框架,对员工福利进行自我评估和实施系统方法。
■未来的研究应该实施,完善和评估系统干预策略。干预和评价应根据经验与一线工作人员和工作人员专家共同设计,并尽可能为当地量身定制,组织和劳动力需求。
■在这三个专业中,文献的大小和质量并不相同,我们没有使用手工搜索和利益相关者/专家建议来进行引文搜索,以增加我们的样本。
■本研究注册为PROSPEROCRD42020172420。可从以下网址获得:https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42020172420。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:NIHR129528)资助,并在健康与社会护理提供研究中全文发表。12号9.有关更多奖项信息,请参阅NIHR资助和奖励网站。
国家卫生服务需要健康,激励员工提供高质量的病人护理。护士,由于压力大的环境和医疗工作的困难,助产士和护理人员的心理健康状况不佳(例如压力/焦虑)。这项研究旨在更好地了解护士心理健康不良的原因,助产士和护理人员,找出哪些干预措施可能有帮助,为什么。我们使用一种称为“现实主义回顾”的方法分析了文献,以了解干预措施是如何起作用的(或不起作用),为什么,为谁。我们在病人身上测试了我们的发现,公众,护士,我们的利益相关者小组的助产士和护理人员。我们审查了200多篇论文/报告,并确定了五个主要发现:(1)现有的解决方案(干预措施)脱节,主要关注个人(而不是系统),并且对持久的压力源认识不足;(2)当存在责备文化时,很难鼓励员工的心理健康;(3)系统的需求通常会超过员工在工作中的心理健康;(4)在工作中坚持和实施个人和专业价值观可能会产生负面的个人成本;(5)设计困难,确定并实施适合不同情况下心理健康不良原因的员工群体的解决方案。医疗保健组织应考虑:(1)改变(重新平衡)工作环境,以帮助医疗保健专业人员休息,恢复和发展;(2)投资于多层次系统(而不仅仅是个人)方法来改善员工的心理健康;(3)继续减少污名;(4)确保优先考虑员工的基本需求(休息/补水/热食),作为其他解决方案的基石;(5)解决指责文化,假设员工在困难的条件下尽力而为;(6)优先考虑员工的需求,以及病人的需要。我们将为政策制定者和组织领导人提供指导和建议,以改善解决心理疾病的工作文化,并提出新的研究领域。
UNASSIGNED: Nurses, midwives and
paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves.
UNASSIGNED: To improve understanding of how, why and in what contexts nurses, midwives and
paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions.
UNASSIGNED: Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards\' reporting guidelines.
UNASSIGNED: First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied.
UNASSIGNED: We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work (\'serve and sacrifice\'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors.
UNASSIGNED: Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being.
UNASSIGNED: Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs.
UNASSIGNED: The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample.
UNASSIGNED: This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.
The National Health Service needs healthy, motivated staff to provide high-quality patient care. Nurses, midwives and
paramedics experience poor psychological health (e.g. stress/anxiety) because of pressured environments and the difficulties of healthcare work. This study planned to better understand the causes of poor psychological ill-health in nurses, midwives and paramedics and find which interventions might help and why. We analysed the literature using a method called ‘realist
review’ to understand how interventions work (or not), why, and for who. We tested our findings with patients, the public, nurses, midwives and
paramedics in our stakeholder group. We reviewed over 200 papers/reports and identified five main findings: (1) existing solutions (interventions) are disjointed, focus mainly on the individual (not the system) and do not recognise enduring stressors enough; (2) when there is a blame culture it is difficult to encourage staff psychological well-being; (3) the needs of the system often override staff psychological well-being at work; (4) upholding and implementing personal and professional values at work can have negative personal costs; and (5) it is difficult to design, identify and implement solutions that work well for staff groups in different circumstances with varied causes of poor psychological health. Healthcare organisations should consider: (1) changing (rebalancing) the working environment to help healthcare professionals rest, recover and thrive; (2) investing in multiple-level system (not just individual) approaches to staff psychological well-being; (3) continuing to reduce stigma; (4) ensuring the essential needs of staff are prioritised (rest-breaks/hydration/hot food) as building blocks for other solutions; (5) addressing the blame culture, assuming staff are doing their best in difficult conditions; (6) prioritising staff needs, as well as patient needs. We will provide guidance and recommendations to policy-makers and organisational leaders to improve work cultures that tackle psychological ill-health and suggest new areas for research.