目的:生育诊所重新开业后,生育工作人员在管理COVID-19相关不确定性方面有哪些经验?
结论:工作人员确定了许多COVID-19相关不确定性来源,主要是COVID-19健康威胁,大多数诊所和工作人员通过实施安全协议和建立强大的协作环境来有效地响应,这些环境促进了信息的获取和应用,以在快速变化的情况下指导组织的响应。但对工作人员和患者的成本。
背景:COVID-19对生育保健分娩造成了重大破坏,包括临时诊所关闭和治疗延迟。患者经历了严重的痛苦,包括对COVID-19及其疫苗对生育和怀孕影响的担忧。多项研究表明,与COVID-19相关的不确定性是医护人员的主要威胁和负担,但尚未在生殖医学中进行调查。
方法:横截面,在线混合方法双语(英语,西班牙语)调查(活跃于2021年1月25日至5月23日)分发给英国各地的生育工作人员,拉丁美洲和非洲。
方法:资格标准是成为一家生育诊所的医护人员,该诊所自COVID-19相关关闭以来已经重新开业,18岁或以上,并能用英语或西班牙语回答。这项调查是用英语创建的,翻译成西班牙语,使用Qualtrics提供,包括四个部分:1)背景和身心健康,2)关于COVID-19不确定性的开放式问题,3)关于不确定性的感知和影响的评估项目,(4)工作场所的变化。英国生育协会和非洲网络和辅助生殖登记处通过电子邮件超链接和社交媒体平台在英国和非洲分发了这项调查。阿根廷生殖医学学会和拉丁美洲辅助生殖网络以相同的方式在整个拉丁美洲分发了调查。对开放式问题的答复进行了主题分析,以产生基本代码。演绎编码将问题的子主题分为与不确定性管理理论相关的主题。对定量数据使用描述性统计和重复测量方差分析。
结果:共有382名员工同意了这项调查,107人没有完成(28%的减员),275人完成。63%是女性,69%是医生,79%在私人诊所工作。主题分析产生了727个代码,组织了92个子主题,抽象为18个主题和一个元主题,反映出不确定性是有压力但可管理的。与COVID-19威胁相关的不确定性类型(20.6%),未来的不可预测性(19.5%)沟通失败(11.4%)和工作场所变更(8.4%)。员工对不确定性的负面影响和正面影响的评估显着低于(P<0.001)压力评估,可控性,并拥有应对不确定性的能力。为了处理不确定性,诊所侧重于信息传播(30.8%)和建立协作工作环境(5.8%),而员工采用主动应对(41.8%)和情绪和认知处理(9.6%)。主要的组织反应包括工作重组(41.3%,例如,安全协议),适应逆境(9.5%,例如,用品,准备)和福利支持(13.8%),尽管员工认为缺乏支持(17.5%)。不确定性的负面后果是自我和患者福利更差(12.1%),以及由于虚拟医学和使用口罩而导致的交流更差(9.6%)。积极的后果是工作改进(8.3%),组织适应(8.3%),改善关系(5.6%)和个人适应(3.2%)。92%的参与者认为工作场所因COVID-19而经历的变化是负面的,9.1%也不为阴性也不为阳性,14.9%为阳性。大多数员工认为他们的身体(92.4%)和心理健康(89.5%)都很好。
结论:参与者是自我选择的,大多数是在拉丁美洲私人诊所工作的医生和胚胎学家。这项研究没有说明国家和地区COVID-19政策的可变性如何影响工作人员的不确定性经历。
结论:为了解决COVID-19不确定度,诊所需要促进协作(诊所,工作人员,患者)不确定性的处理,明确团队协调和沟通,组织的灵活性,并向工作人员和患者提供支持,强调认知应对,以减少威胁,增加对不确定性的容忍度。针对生育护理定制的不确定性管理干预措施整合了这些组成部分,可能会增加诊所对COVID-19相关不确定性和其他类型不确定性的抵御能力。
背景:卡迪夫大学资助的研究。S.G.报告FerringPharmaceuticalsA/S的咨询费,演讲者费用来自AccessFertility,SONA-PharmLLC,MeridianoCongressInternational和GedeonRichter,和MerckSeronoLtd.F.Z-H.的赠款报告FerringPharmaceuticalsA/S的演讲者费用,他是拉丁美洲ART注册中心的主席,伦理和公共政策委员会,和智利妇产科学会,和国际监督ART委员会副主席。K.A.,N.C.,G.BandJ.B.reportnoconflictinrelationtothiswork.
背景:不适用。
What are fertility staff experiences of managing COVID-19-related uncertainty after fertility clinics re-opened?
Staff identified many COVID-19-related uncertainty sources, the main being the COVID-19 health threat, to which most clinics and staff responded effectively by implementing safety protocols and building strong collaborative environments that facilitated the acquisition and application of information to guide organizational responses during a rapidly changing situation, but with costs for staff and patients.
COVID-19 created significant disruption in fertility care delivery, including temporary clinic closure and treatment delay. Patients experienced significant distress, including concerns regarding the impact of COVID-19 and its vaccine on fertility and pregnancy. Multiple studies show that COVID-19-related uncertainty is a major threat and burden for healthcare staff, but this has not been investigated in reproductive medicine.
A cross-sectional, online mixed-method bilingual (English, Spanish) survey (active 25 January-23 May 2021) was distributed to fertility staff across the UK, Latin America, and Africa.
Eligibility criteria were being a healthcare worker at a fertility clinic that had re-opened since its COVID-19-related closure, 18 years of age or older and ability to respond in English or Spanish. The survey was created in English, translated to Spanish, made available using Qualtrics, and consisted of four parts: (i) background and physical and mental wellbeing, (ii) open-ended questions regarding COVID-19 uncertainty, (iii) appraisal items regarding perceptions and impact of uncertainty, and (iv) changes in the workplace. The British Fertility Society and the African Network and Registry of Assisted Reproduction circulated the survey across the UK and Africa via email hyperlinks and social media platforms. The Argentinian Society of Reproductive Medicine and the Latin American Network of Assisted Reproduction distributed the survey across Latin America in the same manner. Thematic analysis was performed on responses from open-ended question to produce basic codes. Deductive coding grouped sub-themes across questions into themes related to the theory of uncertainty management. Descriptive statistics and repeated measures analysis of variance were used on the quantitative data.
In total, 382 staff consented to the survey, 107 did not complete (28% attrition), and 275 completed. Sixty-three percent were women, 69% were physicians, and 79% worked at private clinics. Thematic analysis produced 727 codes, organized in 92 sub-themes, and abstracted into 18 themes and one meta-theme reflecting that uncertainty is stressful but manageable. The types of uncertainties related to the threat of COVID-19 (20.6%), unpredictability of the future (19.5%), failure of communication (11.4%), and change in the workplace (8.4%). Staff appraisals of negative and positive impact of uncertainty were significantly lower (P < 0.001) than appraisals of stress, controllability, and having what it takes to cope with uncertainty. To process uncertainty, clinics focused on information dissemination (30.8%) and building a collaborative work environment (5.8%), while staff employed proactive coping (41.8%) and emotional and cognitive processing (9.6%). Main organizational responses consisted on work restructuring (41.3%, e.g. safety protocols), adapting to adversity (9.5%, e.g. supplies, preparation), and welfare support (13.8%), though staff perceived lack of support (17.5%). Negative consequences of uncertainty were worse self- and patient welfare (12.1%) and worse communication due to virtual medicine and use of mask (9.6%). Positive consequences were work improvements (8.3%), organizational adaptation (8.3%), improved relationships (5.6%), and individual adaptation (3.2%). Ninety-two percent of participants thought changes experienced in the workplace due to COVID-19 were negative, 9.1% nor negative nor positive, and 14.9% positive. Most staff thought that their physical (92.4%) and mental health (89.5%) were good to excellent.
Participants were self-selected, and most were physicians and embryologists working at private clinics based in Latin America. The study did not account for how variability in national and regional COVID-19 policy shaped staff experiences of uncertainty.
To address COVID-19 uncertainty, clinics need to promote collaborative (clinic, staff, patients) processing of uncertainty, clear team coordination and communication, organizational flexibility, and provision of support to staff and patients, with an emphasis on cognitive coping to decrease threat of and increase tolerance to uncertainty. Uncertainty management interventions bespoke to fertility care that integrate these components may increase clinics resilience to COVID-19-related and other types of uncertainty.
Cardiff University funded this research. S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International, and Gedeon Richter, and grants from Merck Serono Ltd. F.Z.-H. reports speaker fees from Ferring Pharmaceuticals A/S and that he is a chair of the Latin American Registry of ART, Committee of Ethic and Public Policies, and Chilean Society of Obstetrics and Gynecology and a vice chair of the International Committee for monitoring ART. K.A., N.C., G.B., and J.B. report no conflict in relation to this work.
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