What are the essential components to implement individual-focused interventions for well-being and burnout in critical care healthcare professionals? A realist expert opinion

Abstract

BackgroundThis study aimed to determine what, how, and under what circumstances individual-focused interventions improve well-being and decrease burnout for critical care healthcare professionals.MethodThis realist approach, expert opinion interview, was guided by the Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II) guidelines. Semi-structured interviews with critical care experts were conducted to ascertain current and nuanced information on a set of pre-defined individual interventions summarized from a previous umbrella review. The data were appraised, and relationships between context, mechanisms, and outcomes were extracted, which created theory prepositions that refined the initial program theory.ResultsA total of 21 critical care experts were individually interviewed. By understanding the complex interplay between organizational and personal factors that influenced intervention uptake, it was possible to decipher the most likely implementable intervention for critical care healthcare professionals. The expert recommendation suggested that interventions should be evidence-based, accessible, inclusive, and collaborative, and promote knowledge and skill development. Unique mechanisms were also required to achieve the positive effects of the intervention due to the presence of contextual factors within critical care settings. Mechanisms identified in this study included the facilitation of self-awareness, self-regulation, autonomy, collaboration, acceptance, and inclusion (to enable a larger reach to different social groups).ConclusionThis validation of a theoretical understanding of intervention that addressed well-being and burnout in critical care healthcare professionals by expert opinion demonstrated essential mechanisms and contextual factors to consider when designing and implementing interventions. Future research would benefit by piloting individual interventions and integrating these new theoretical findings to understand better their effectiveness for future translation into the “real-world” setting.

Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review

“…For those who stay, the RNS of this review were keen to break the cycle of violence towards new nurses when they join the profession, but there is a lingering concern that RNS and new nurses exposed to WPV, and negative work culture may later adopt the violent behaviours of their senior nurses (Thomas, 2010). Negative work cultures and lack of management support prevent accessibility and engagement to interventions (Adnan, Baldwin, et al, 2022).…”

Is this the solution to wellbeing and burnout management for the critical care workforce? A parallel, interventional, feasibility and realist informed pilot randomized control trial protocol

“…The purpose of integrating IMP was due to the key component of ‘tailoring’, which was identified in Adnan et al (2022) refined program theory [ 32 , 33 ]. Tailoring caters towards the individual’s experience, addressing contextual factors and mechanisms.…”

“…It is used to respect the differences amongst people, which influences attitudes and facilitates behavior change by attending to the specific needs of end-users [ 30 , 31 ]. By understanding tailoring, and the aforementioned research and practice context for critical care healthcare professionals, our research team were prompted to conduct an umbrella review that sought individual interventions to improve wellbeing and decrease burnout for critical care healthcare professionals [ 32 , 33 ]. This was followed by realist expert opinion paper by Adnan et al (2022) that interviewed 21 critical care experts to describe (using theory prepositions) contextual factors and mechanisms required for an intervention to work for critical care healthcare professionals [ 32 ].…”

“…By understanding tailoring, and the aforementioned research and practice context for critical care healthcare professionals, our research team were prompted to conduct an umbrella review that sought individual interventions to improve wellbeing and decrease burnout for critical care healthcare professionals [ 32 , 33 ]. This was followed by realist expert opinion paper by Adnan et al (2022) that interviewed 21 critical care experts to describe (using theory prepositions) contextual factors and mechanisms required for an intervention to work for critical care healthcare professionals [ 32 ]. Tailoring was highlighted as an essential component in both the umbrella review and expert opinion methodologies, which enabled development and refinement of a program theory of individual-focused interventions for healthcare professionals in critical care settings [ 32 , 33 ].…”

“…This was followed by realist expert opinion paper by Adnan et al (2022) that interviewed 21 critical care experts to describe (using theory prepositions) contextual factors and mechanisms required for an intervention to work for critical care healthcare professionals [ 32 ]. Tailoring was highlighted as an essential component in both the umbrella review and expert opinion methodologies, which enabled development and refinement of a program theory of individual-focused interventions for healthcare professionals in critical care settings [ 32 , 33 ]. The authors then used the program theory to guide the design of the intervention in this study.…”