What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care

Abstract

ObjectiveTo determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals.DesignThis study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme.ResultsA total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive–behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions’ interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience.ConclusionsThese findings provide realistic and reliable reporting of outcomes to better support implementation within the ‘real world’. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.

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

“…This study identified theory prepositions that were previously reported in the umbrella review ( Adnan et al, 2022 ). This included (1) the use of a tailored intervention, (2) the process of learning and education, (3) engagement, and (4) maintaining the quality of interventions in terms of delivery, duration, and intensity.…”

“…Twenty-one experts were interviewed to determine what individual interventions work for the critical care workforce, under what circumstances, and why. The program theory from an umbrella review was used to guide the questions and develop a refined program theory exclusively directed to critical care healthcare professionals ( Adnan et al, 2022 ). A wide range of experts from differing professional fields was included within the population sample, encompassing in gender, state/country, and specialty (academic/clinical) variations.…”

“…The CMOC tables ( Supplementary File 3 ) were provided (in confidence) with a relevant selection of provisional results of the umbrella review (in press), being a modified version of the results table that described the intervention’s context (i.e., population and setting), mechanism (i.e., how/why the intervention works, duration, context, follow-up), and outcomes (i.e., implicit and explicit reasoning and effectiveness) ( Adnan et al, 2022 ).…”

“…Evidence of interventions that address well-being and burnout specific to the critical care health professional community is lacking. In an umbrella review and realist-theory synthesis (in press) that focused on individual-level interventions, we identified contextual factors and mechanisms of interventions that broadly applied to the healthcare workforce ( Adnan et al, 2022 ). While we were able to determine what interventions were likely to work, for whom and under what circumstances in the general population of healthcare professionals, our theoretical synthesis and preposition were not specific to the unique needs and profile of CCHP (because of a limited number of original intervention studies in CCHP).…”

“…While we were able to determine what interventions were likely to work, for whom and under what circumstances in the general population of healthcare professionals, our theoretical synthesis and preposition were not specific to the unique needs and profile of CCHP (because of a limited number of original intervention studies in CCHP). Additionally, the umbrella review identified gaps in understanding how self-efficacy, self-care, social support, and awareness/mindfulness may improve emotional intelligence and resilience—well-being indicators ( Adnan et al, 2022 ). Moreover, there was insufficient evidence to consider the context-mechanism-outcome configurations for the critical care population.…”