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Open Access 01-12-2023 | Burnout Syndrome | Research

Relationship between three aspects of resilience—adaptive characteristics, withstanding stress, and bouncing back—in hospital workers exposed to prolonged occupational stress during the COVID-19 pandemic: a longitudinal study

Authors: Robert G. Maunder, Benjamin Rosen, Natalie D. Heeney, Lianne P. Jeffs, Jane Merkley, Kate Wilkinson, Jonathan J. Hunter, Jennie Johnstone, Rebecca A. Greenberg, Lesley A. Wiesenfeld

Published in: BMC Health Services Research | Issue 1/2023

Abstract

Background

The term resilience is used to refer to multiple related phenomena, including: (i) characteristics that promote adaptation to stressful circumstances, (ii) withstanding stress, and (iii) bouncing back quickly. There is little evidence to understand how these components of resilience are related to one another. Skills-based adaptive characteristics that can respond to training (as opposed to personality traits) have been proposed to include living authentically, finding work that aligns with purpose and values, maintaining perspective in the face of adversity, managing stress, interacting cooperatively, staying healthy, and building supportive networks. While these characteristics can be measured at a single time-point, observing responses to stress (withstanding and bouncing back) require multiple, longitudinal observations. This study’s aim is to determine the relationship between these three aspects of resilience in hospital workers during the prolonged, severe stress of the COVID-19 pandemic.

Methods

We conducted a longitudinal survey of a cohort of 538 hospital workers at seven time-points between the fall of 2020 and the spring of 2022. The survey included a baseline measurement of skills-based adaptive characteristics and repeated measures of adverse outcomes (burnout, psychological distress, and posttraumatic symptoms). Mixed effects linear regression assessed the relationship between baseline adaptive characteristics and the subsequent course of adverse outcomes.

Results

The results showed significant main effects of adaptive characteristics and of time on each adverse outcome (all p < .001). The size of the effect of adaptive characteristics on outcomes was clinically significant. There was no significant relationship between adaptive characteristics and the rate of change of adverse outcomes over time (i.e., no contribution of these characteristics to bouncing back).

Conclusions

We conclude that training aimed at improving adaptive skills may help individuals to withstand prolonged, extreme occupational stress. However, the speed of recovery from the effects of stress depends on other factors, which may be organizational or environmental.

Bruyneel A, Smith P, Tack J, Pirson M. Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium. Intensive Crit Care Nurs. 2021;65:103059. https://doi.org/10.1016/J.ICCN.2021.103059.CrossRefPubMedPubMedCentral

Maunder RG, Heeney ND, Kiss A, et al. Psychological impact of the COVID-19 pandemic on hospital workers over time: Relationship to occupational role, living with children and elders, and modifiable factors. Gen Hosp Psychiatry. 2021;71:88–94. https://doi.org/10.1016/j.genhosppsych.2021.04.012.CrossRefPubMedPubMedCentral

Cañadas-De La Fuente GA, Gómez-Urquiza JL, Ortega-Campos EM, Cañadas GR, Luis Albendín-García |, De La Fuente-Solana EI. Prevalence of burnout syndrome in oncology nursing: A meta-analytic study. Psychooncology 2018;27(5):1426–1433. https://doi.org/10.1002/pon.4632.

Gómez-Urquiza JL, De la Fuente-Solana EI, Albendín-García L, Vargas-Pecino C, Ortega-Campos EM, Cañadas-De la Fuente GA. Prevalence of Burnout Syndrome in Emergency Nurses: A Meta-Analysis. Crit Care Nurse. 2017;37(5):e1–9. https://doi.org/10.4037/CCN2017508.CrossRefPubMed

Woo T, Ho R, Tang A, Tam W. Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. J Psychiatr Res. 2020;123:9–20. https://doi.org/10.1016/j.jpsychires.2019.12.015.CrossRefPubMed

Zhang Q, Mu MC, He Y, Cai ZL, Li ZC. Burnout in emergency medicine physicians A meta-analysis and systematic review. Medicine (Baltimore). 2020;99(32):e21462. https://doi.org/10.37766/inplasy2020.6.0060.CrossRefPubMed

Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res. 2014;14(1):325. https://doi.org/10.1186/1472-6963-14-325.CrossRefPubMedPubMedCentral

Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334–41. https://doi.org/10.7326/0003-4819-149-5-200809020-00008.CrossRefPubMed

Smeds MR, Janko MR, Allen S, et al. Burnout and its relationship with perceived stress, self-efficacy, depression, social support, and programmatic factors in general surgery residents. Am J Surg. 2020;219:907–12. https://doi.org/10.1016/j.amjsurg.2019.07.004.CrossRefPubMed

10.

Williams ES, Rathert C, Buttigieg SC. The Personal and Professional Consequences of Physician Burnout: A Systematic Review of the Literature. Med Care Res Rev. 2020;77(5):371–86. https://doi.org/10.1177/1077558719856787.CrossRefPubMed

11.

Choi BS, Kim JS, Lee DW, et al. Factors Associated with Emotional Exhaustion in South Korean Nurses: A Cross-Sectional Study. Psychiatry Investig. 2018;15(7):670–6. https://doi.org/10.30773/pi.2017.12.31.CrossRefPubMedPubMedCentral

12.

Dall’ora C, Ball J, Reinius M, Griffiths P. Burnout in nursing: a theoretical review. Hum Resour Health. 2020;18:41. https://doi.org/10.1186/s12960-020-00469-9.CrossRefPubMedPubMedCentral

13.

Azam K, Khan A, Alam MT, Toqeer M. Introduction causes and adverse impact of physician burnout: a systematic review. JCPSP. 2017;27(8):495–501.PubMed

14.

Panagioti M, Geraghty K, Johnson J, et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction. JAMA Intern Med. 2018;178(10):1317. https://doi.org/10.1001/jamainternmed.2018.3713.CrossRefPubMedPubMedCentral

15.

Raso R, Fitzpatrick JJ, Masick K. Nurses’ Intent to Leave their Position and the Profession During the COVID-19 Pandemic. J Nurs Adm. 2021;51(10):488–94. https://doi.org/10.1097/NNA.0000000000001052.CrossRefPubMed

16.

Said RM, El-Shafei DA. Occupational stress, job satisfaction, and intent to leave: nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt. ESPR. 2021;28(7):8791–801. https://doi.org/10.1007/s11356-020-11235-8.CrossRefPubMed

17.

Registered Nurses’ Association of Ontario (RNAO). Work and Wellbeing Survey Results.; 2021.

18.

Buerhaus PI. Current Nursing Shortages Could Have Long-Lasting Consequences: Time to Change Our Present Course. Nurs Econ. 2021;39(5):247–50.

19.

Alameddine M, Bou-Karroum K, Hijazi MA. A national study on the resilience of community pharmacists in Lebanon: a cross-sectional survey. J Pharm Policy Pract. 2022;15(1):1–10. https://doi.org/10.1186/S40545-022-00406-2/TABLES/5.CrossRef

20.

Alameddine M, Bou-Karroum K, Ghalayini W, Abiad F. Resilience of nurses at the epicenter of the COVID-19 pandemic in Lebanon. Int J Nurs Sci. 2021;8(4):432–8. https://doi.org/10.1016/J.IJNSS.2021.08.002.CrossRefPubMedPubMedCentral

21.

Maunder RG, Heeney ND, Strudwick G, et al. Burnout in Hospital-Based Healthcare Workers during COVID-19. 2021. https://doi.org/10.47326/OCSAT.2021.02.46.1.0. Published online October 7.

22.

Baskin RG, Bartlett R. Healthcare worker resilience during the COVID-19 pandemic: An integrative review. J Nurs Manag. 2021;29(8):2329–42. https://doi.org/10.1111/JONM.13395.CrossRefPubMedPubMedCentral

23.

Rieckert A, Schuit E, Bleijenberg N, et al. How can we build and maintain the resilience of our health care professionals during COVID-19? Recommendations based on a scoping review. BMJ Open. 2021;11(1):e043718.CrossRefPubMed

24.

Labrague LJ. Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies. J Nurs Manag. 2021;29(7):1893–905. https://doi.org/10.1111/JONM.13336.CrossRefPubMedPubMedCentral

25.

Barasa E, Mbau R, Gilson L. What Is Resilience and How Can It Be Nurtured? A Systematic Review of Empirical Literature on Organizational Resilience. Int J Health Policy Manag. 2018;7(6):491–503. https://doi.org/10.15171/IJHPM.2018.06.CrossRefPubMedPubMedCentral

26.

Luthar SS, Cicchetti D. The construct of resilience: Implications for interventions and social policies. Dev Psychopathol. 2000;12(4):857–85.CrossRefPubMedPubMedCentral

27.

Baskin RG, Bartlett R. Healthcare worker resilience during the COVID-19 pandemic: An integrative review. J Nurs Manag. 2021;29(8):2329–42. https://doi.org/10.1111/jonm.13395.CrossRefPubMedPubMedCentral

28.

Wiig S, O’hara JK. Resilient and responsive healthcare services and systems: challenges and opportunities in a changing world. BMC Health Serv Res. 2021;21:1037. https://doi.org/10.1186/s12913-021-07087-8.CrossRefPubMedPubMedCentral

29.

Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129–46. https://doi.org/10.1016/j.mayocp.2016.10.004.CrossRefPubMed

30.

Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. https://doi.org/10.1002/DA.10113.CrossRefPubMed

31.

Elliott TR, Perrin PB, Bell AS, Powers MB, Warren AM. Resilience, coping, and distress among healthcare service personnel during the COVID-19 pandemic. BMC Psychiatry. 2021;21:489. https://doi.org/10.1186/s12888-021-03506-6.CrossRefPubMedPubMedCentral

32.

Winwood PC, Colon R, McEwen K. A Practical Measure of Workplace Resilience: Developing the Resilience at Work Scale. J Occup Environ Med. 2013;55(10):1205–12. https://doi.org/10.1097/JOM.0b013e3182a2a60a.CrossRefPubMed

33.

Jovanović A, Klimek P, Renn O, et al. Assessing resilience of healthcare infrastructure exposed to COVID-19: emerging risks, resilience indicators, interdependencies and international standards. Environ Syst Decis. 2020;40:252–86. https://doi.org/10.1007/s10669-020-09779-8.CrossRefPubMedPubMedCentral

34.

Chen S, Bonanno GA. Psychological adjustment during the global outbreak of COVID-19: A resilience perspective. Psychol Trauma. 2020;12(S1):S51–4. https://doi.org/10.1037/tra0000685.CrossRefPubMed

35.

Ray-Sannerud BN, Leyshon S, Vallevik VB. Introducing routine measurement of healthcare worker’s well-being as a leading indicator for proactive safety management systems based on resilience engineering. Procedia Manuf. 2015;3:319–26. https://doi.org/10.1016/J.PROMFG.2015.07.163.CrossRef

36.

Bjurling-Sjöberg P, Göras C, Lohela-Karlsson M, Nordgren L, Källberg AS, Castegren M. Resilient performance in healthcare during the COVID-19 pandemic (ResCOV): study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety. BMJ Open. 2021;11:e051928. https://doi.org/10.1136/bmjopen-2021-051928.CrossRefPubMed

37.

Yi JP, Vitaliano PP, Smith RE, Yi JC, Weinger K. The role of resilience on psychological adjustment and physical health in patients with diabetes. Br J Health Psychol. 2008;13(2):311–25. https://doi.org/10.1348/135910707X186994.CrossRefPubMed

38.

Hourani L, Bender RH, Weimer B, et al. Longitudinal study of resilience and mental health in marines leaving military service. J Affect Disord. 2012;139(2):154–65. https://doi.org/10.1016/j.jad.2012.01.008.CrossRefPubMed

39.

Youssef NA, Green KT, Beckham JC, Elbogen EB. A 3-Year Longitudinal Study Examining the Effect of Resilience on Suicidality in Veterans. Ann Clin Psychiatry. 2013;25(1):59–66.PubMedPubMedCentral

40.

Green KT, Beckham JC, Youssef N, Elbogen EB. Alcohol Misuse and Psychological Resilience among US Iraq and Afghanistan Era Veteran Military Personnel. Addictive Behaviours. 2014;39(2):406–13. https://doi.org/10.1016/j.addbeh.2013.08.024.CrossRef

41.

Elbogen EB, Molloy K, Wagner R, et al. Psychosocial Protective Factors and Suicidal Ideation: Results from a National Longitudinal Study of Veterans. J Affect Disord. 2020;260:703–9. https://doi.org/10.1016/j.jad.2019.09.062.CrossRefPubMed

42.

Lu C, Liao YH, Fan BF, et al. Epidemiology and Psychiatric Sciences The impact of COVID-19 on subthreshold depressive symptoms: a longitudinal study. Epidemiol Psychiatr Sci. 2021;30(e20):1–11. https://doi.org/10.1017/S2045796021000044.CrossRef

43.

Wister A, Li L, Cosco TD, Mcmillan J, Griffith LE. Multimorbidity resilience and COVID-19 pandemic self-reported impact and worry among older adults: a study based on the Canadian Longitudinal Study on Aging (CLSA). BMC Geriatr. 2022;22:92. https://doi.org/10.1186/s12877-022-02769-2.CrossRefPubMedPubMedCentral

44.

Hirten RP, Danieletto M, Tomalin L, et al. Factors associated with longitudinal psychological and physiological stress in health care workers during the covid-19 pandemic: Observational study using apple watch data. J Med Internet Res. 2021;23(9):1–15. https://doi.org/10.2196/31295.CrossRef

45.

D’ettorre G, Ceccarelli G, Santinelli L, et al. Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review. Int J Environ Res Public Health. 2021;18(2):601. https://doi.org/10.3390/IJERPH18020601.CrossRefPubMedPubMedCentral

46.

Ching SM, Ng KY, Lee KW, et al. Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis. PLoS One. 2021;16(10):e0257983. https://doi.org/10.1371/JOURNAL.PONE.0257983.CrossRefPubMedPubMedCentral

47.

Maunder RG, Heeney ND, Hunter JJ, et al. Trends in burnout and psychological distress in hospital staff over 12 months of the COVID-19 pandemic: a prospective longitudinal survey. J Occup Med Toxicol. 2022;17(1):1–11.CrossRef

48.

Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Consulting Psychologists Press; 1996.

49.

Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018;320(11):1131. https://doi.org/10.1001/JAMA.2018.12777.CrossRefPubMedPubMedCentral

50.

Weiss D, Marmar C. The Impact of Event Scale—Revised. In: Wilson J, Keane T, eds. Assessing Psychological Trauma and PTSD. Second edi. The Guilford Press; 1997:399–411.

51.

Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32:959–76. https://doi.org/10.1017/S0033291702006074.CrossRefPubMed

52.

Kessler RC, Barker PR, Colpe LJ, et al. Screening for Serious Mental Illness in the General Population. Arch Gen Psychiatry. 2003;60(2):184–9.CrossRefPubMed

53.

Pulcrano M, Evans SRT, Sosin M. Quality of Life and Burnout Rates Across Surgical Specialties: A Systematic Review. JAMA Surg. 2016;151(10):970–8. https://doi.org/10.1001/JAMASURG.2016.1647.CrossRefPubMed

54.

Garrosa E, Moreno-Jiménez B, Liang Y, González JL. The relationship between socio-demographic variables, job stressors, burnout, and hardy personality in nurses: An exploratory study. Int J Nurs Stud. 2008;45(3):418–27. https://doi.org/10.1016/J.IJNURSTU.2006.09.003.CrossRefPubMed

55.

Canadian Medical Association. CMA national physician health survey a National Snapshot.; 2018.

56.

R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. Published 2021. Accessed 14 June 2023. https://www.R-project.org/.

57.

Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018;320(11):1131–50. https://doi.org/10.1001/jama.2018.12777.CrossRefPubMedPubMedCentral

58.

Gomez-Urquiza JL, De la Fuente-Solana EI, Albendin-Garcia L, Vargas-Pecino C, Ortega-Campos EM, Canadas-Dela Fuente GA. Prevalence of Burnout Syndrome in Emergency Nurses: A Meta-Analysis. Crit Care Nurse. 2017;37(5):1–9. https://doi.org/10.4037/ccn2017508.CrossRef

59.

Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184–9. https://doi.org/10.1001/archpsyc.60.2.184.CrossRefPubMed

60.

Creamer M, Bell R, Failla S. Psychometric properties of the Impact of Event Scale—Revised. Behav Res Ther. 2003;41(12):1489–96. https://doi.org/10.1016/J.BRAT.2003.07.010.CrossRefPubMed

61.

Bonanno GA. Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive after Extremely Aversive Events? Am Psychol. 2004;59(1):20–8. https://doi.org/10.1037/0003-066X.59.1.20.CrossRefPubMed

62.

Galatzer-Levy IR, Huang SH, Bonanno GA. Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation. Clin Psychol Rev. 2018;63:41–55. https://doi.org/10.1016/J.CPR.2018.05.008.CrossRefPubMed

63.

Winwood PC, Colon R, McEwen K. A practical measure of workplace resilience: developing the resilience at work scale. J Occup Environ Med. 2013;55(10):1205–12. https://doi.org/10.1097/JOM.0b013e3182a2a60a.CrossRefPubMed

64.

Sheppard KN, Runk BG, Maduro RS, et al. Nursing Moral Distress and Intent to Leave Employment During the COVID-19 Pandemic. J Nurs Care Qual. 2022;37(1):28–34. https://doi.org/10.1097/ncq.0000000000000596.CrossRefPubMed

65.

Lou NM, Montreuil T, Feldman LS, et al. Nurses’ and Physicians’ Distress, Burnout, and Coping Strategies During COVID-19. J Contin Educ Heal Prof. 2022;42(1):e44–52. https://doi.org/10.1097/ceh.0000000000000365.CrossRef

66.

Dionisi T, Sestito L, Tarli C, et al. Risk of burnout and stress in physicians working in a COVID team: A longitudinal survey. Int J Clin Pract. 2021;75:e14755. https://doi.org/10.1111/ijcp.14755.CrossRefPubMed

67.

Müller MM, Baillès E, Blanch J, et al. Burnout among hospital staff during the COVID-19 pandemic: Longitudinal results from the international Cope-Corona survey study. J Psychosom Res. 2023;164:111102. https://doi.org/10.1016/J.JPSYCHORES.2022.111102.CrossRefPubMed

68.

Armstrong SJ, Porter JE, Larkins JA, Mesagno C. Burnout, stress and resilience of an Australian regional hospital during COVID-19: a longitudinal study. BMC Health Serv Res. 2022;22(1):1–13. https://doi.org/10.1186/S12913-022-08409-0.CrossRef

69.

Hines SE, Chin KH, Glick DR, Wickwire EM. Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18:488. https://doi.org/10.3390/ijerph18020488.CrossRefPubMedPubMedCentral

70.

Sinsky CA, Biddison LD, Mallick A, Dopp AL, Perlo J, Lynn L, Smith CD. Organizational Evidence-Based and Promising Practices for Improving Clinician Well-Being. NAM Perspect. 2020;2020:10.31478/202011a. https://doi.org/10.31478/202011a.

71.

Maunder RG, Lancee WJ, Mae R, et al. Computer-Assisted Resilience Training to Prepare Healthcare Workers for Pandemic Influenza: A Randomized Trial of the Optimal Dose of Training.; 2010. https://doi.org/10.1186/1472-6963-10-72.

72.

Maunder RG, Heeney ND, Strudwick G, et al. Burnout in Hospital-Based Healthcare Workers during COVID-19. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021;2(46). https://doi.org/10.47326/ocsat.2021.02.46.1.0.

73.

Title: Relationship between three aspects of resilience—adaptive characteristics, withstanding stress, and bouncing back—in hospital workers exposed to prolonged occupational stress during the COVID-19 pandemic: a longitudinal study
Authors: Robert G. Maunder
Benjamin Rosen
Natalie D. Heeney
Lianne P. Jeffs
Jane Merkley
Kate Wilkinson
Jonathan J. Hunter
Jennie Johnstone
Rebecca A. Greenberg
Lesley A. Wiesenfeld
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Burnout Syndrome
COVID-19
Published in: BMC Health Services Research / Issue 1/2023
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-023-09731-x

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Relationship between three aspects of resilience—adaptive characteristics, withstanding stress, and bouncing back—in hospital workers exposed to prolonged occupational stress during the COVID-19 pandemic: a longitudinal study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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