Journal of Healthcare Management最新文献

Goal: Healthcare professionals (HCPs) working long shifts are prone to physical, emotional, and psychological stress leading to harmful effects on their mental health, an issue compounded by the COVID-19 pandemic. Novel efforts such as virtual reality (VR)-based immersion have been explored to mitigate this problem in HCPs. However, the studies vary in their clinical settings, scales used for measuring outcomes related to mental health, sample size, and other relevant parameters. We conducted a systematic review (SR) to collate all available evidence on the feasibility and efficacy of VR-based interventions for reducing stress, burnout, fatigue, and anxiety in HCPs.

Methods: We searched major databases for comprehensive literature on HCP mental well-being measures in September 2023 and February 2024. Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool, and PRISMA guidelines were used for reporting this SR.

Principal findings: A total of 17 studies out of 1,422 citations were included in the final analysis. The number of study participants ranged from 14 to 219 (1,053 total). Seven studies were randomized controlled trials, and the rest were pre-post intervention studies. Meta-analysis was not feasible because the included studies were heterogeneous in their study settings, methodology, and assessed mental health domain. Based on the EPHPP tool, one study had a strong global rating, two had a moderate rating, and 14 had a weak rating.

Practical applications: VR-based interventions during break times appear to be feasible and useful in addressing HCP stress, burnout, fatigue, and anxiety. However, limited high-quality studies warrant caution in interpretation.

Goal: Solutions to address healthcare worker well-being since the COVID-19 pandemic have been tested with varying acceptance and effectiveness. Little is known about how the values underpinning medical professionalism might be leveraged to support healthcare workers during a public health emergency. We sought to characterize the experiences of frontline physicians and nurses during the pandemic through the lens of medical professionalism and identify potential levers that could be activated in future emergencies to better protect the healthcare workforce.

Methods: We conducted semistructured interviews with 23 physicians and nurses who worked in emergency departments, ICUs, or other acute care settings at two urban teaching hospitals at the start of the pandemic. Interviews were conducted in spring and summer 2022, and were audio recorded, transcribed, and thematically analyzed.

Principal findings: Three themes emerged reflecting different orientations of professionalism that helped clinicians persevere through the pandemic but were also threatened by the most challenging stages of the pandemic: (1) the call of duty to a greater good (service orientation); (2) a shared identity as a specialized professional (team orientation); and (3) the ability to maintain a human connection with their patients (humanistic orientation). These central orientations of professionalism helped healthcare workers to continue providing care during the pandemic by focusing on achieving a greater good in the face of unprecedented challenges, accessing a shared identity with other healthcare workers to find peer support and maintain a sense of pride in their work, and finding ways to connect on a personal level with patients and families despite strict isolation requirements and fear for personal safety. When these values were not realized, or when they were noticeably absent, healthcare workers felt discouraged, abandoned or alone, and burned out.

Practical applications: Leveraging common aspects of medical professionalism during a public health emergency may help healthcare workers find meaning in their work and mitigate feelings of burnout. Simple actions, such as maintaining a leadership presence on the floors, encouraging peer-to-peer activities or huddles, and acknowledging the need for human connection, are likely feasible to implement during an emergency and effective at fostering a sense of professional community that could buoy healthcare workers during extremely challenging times.

Goal: African Americans lack participation in clinical trials, and therefore, are underrepresented in medical initiatives that can provide life-saving treatment. This research examines the attitudes, beliefs, and perceptions of African Americans toward participation in clinical trials.

Methods: Researchers conducted a survey using a representative sample of African Americans in the United States (n = 1,260). Structural equation modeling was used to analyze the data.

Principal findings: Findings indicate that behavioral beliefs about clinical trials are positively related to attitudes about participating in clinical trials. Furthermore, attitudes are positively related to intentions to participate in clinical trials. Participation in clinical trials is also dictated by social influence. Results indicate that what "important others" think about participation in clinical trials is positively related to trial participation; however, risk perceptions are negatively related to trial participation. Findings reveal that gender and educational attainment moderate risk perceptions. African American women and those with less educational attainment possess risk perceptions, which negatively influence their intention to participate in clinical trials.

Practical applications: This research highlights how behavioral beliefs and attitudes are positively linked to participation intentions, while subjective norms further reinforce the influence of social pressures on decision-making. Importantly, risk perceptions serve as a significant barrier to participation, particularly among African American women and individuals with lower educational attainment. These findings point to the need for targeted interventions that address specific concerns and build trust through culturally informed, accessible communication. By developing communication strategies that enhance positive beliefs, leverage community influence, and reduce perceived risks, research and healthcare communities can take meaningful steps toward fostering inclusion and trust.