Preventive staff-support interventions for health workers

 

Abstract

Background

Healthcare workers need to be supported to maintain sufficient levels of motivation and productivity, and to prevent the debilitating effects of stress on mental and physical well-being.

Objectives

To assess the effects of preventive staff-support interventions to healthcare workers.

Search methods

We searched The Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (and the database of studies awaiting assessment), Biblioweb (searched 28 August 2008); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3) (searched 28 August 2008); MEDLINE, Ovid 1950 to August Week 2 2008 (searched 26 August 2008); CINAHL, Ovid 1982 to August Week 4 2008 (searched 26 August 2008); EMBASE, Ovid 1980 to 2008 Week 34 (searched 26 August 2008); PsycINFO, Ovid 1806 to July Week 5 2008 (searched 27 August 2008); Sociological Abstracts, CBA 1952 to present (searched 28 August 2008).

Selection criteria

Randomised controlled trials of interventions to support healthcare workers in coping with work-related stress, preventing burnout and improving job satisfaction, without changing contractual conditions of service or physical work environment. Three types of interventions were included in this review: (1) support groups for staff; (2) training in stress management techniques; and (3) management interventions for supporting staff.

Data collection and analysis

Two authors independently performed study selection, quality assessments and data abstraction.

Main results

Ten studies involving 716 participants met the criteria for inclusion. None assessed the effects of support groups for health workers. Eight studies assessed the effects of training interventions in various stress management techniques on measures of stress and/or job satisfaction, and two studies assessed the effects of management interventions on stress, job satisfaction and absenteeism.

Three studies demonstrated a beneficial effect of stress management training intervention on job stress. Only one of these showed that this effect is sustainable over the medium-term. One study demonstrated the beneficial effect of a high intensity, stress management training intervention on burnout. Low and moderate intensity stress management training interventions failed to demonstrate benefit on burnout or staff satisfaction.

Management interventions demonstrated increases in job satisfaction, but failed to show effect on absenteeism.

Most studies had several methodological shortcomings leaving them vulnerable to potential biases.

Authors' conclusions

There is insufficient evidence for the effectiveness of stress management training interventions to reduce job stress and prevent burnout among healthcare workers beyond the intervention period. Low quality evidence suggests that longer-term interventions with refresher or booster sessions may have more sustained positive effect, but this needs to be rigorously evaluated in further trials.

Low quality evidence exists to show that management interventions may improve some measures of job satisfaction. However, further trials are needed to assess whether this finding is replicable in other settings. There was insufficient evidence of the benefit of management interventions on staff absenteeism.

Rigorous trials are needed to assess the effects of longer-term stress management training and management interventions in primary care and developing country settings.

 

Plain language summary

Preventive staff-support interventions for health workers

Health workers need to be supported to reduce job-related stress, prevent burnout and improve motivation. This review identified 10 studies involving 716 health workers aimed at assessing the effects of preventive staff-support interventions. Eight studies involved short to medium-term training in stress management techniques, given predominantly to nurses in secondary and tertiary care settings. Four of these studies demonstrated beneficial effects of stress management training interventions in reducing some measures of job-related stress over the short-term. However, due to inadequate follow- up it is not clear whether these benefits are sustainable over longer periods. Most studies had several methodological shortcomings. Two studies involved management interventions to improve job satisfaction and absenteeism. The evidence from these two studies is insufficient to conclude that there is clear benefit from management interventions for staff support.

 

摘要

背景

預防性的員工支持介入措施

健康照護工作人員須要被支持的感覺，以維持有效率的動力與生產力，才能避免壓力對心理與生理帶來的過勞影響。

目標

探討預防性員工支持介入措施對健康照護工作人員的影響。

搜尋策略

我們蒐尋了The Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (與等候指示的研究資料庫) ，Biblioweb (到2008年8月28日); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3) (到2008年8月28日); MEDLINE, Ovid 1950 to August Week 2 2008 (到2008年8月26日); CINAHL, Ovid 1982 to August Week 4 2008 到2008年8月26日); EMBASE, Ovid 1980 to 2008 Week 34 (到2008年8月26日); PsycINFO, Ovid 1806 to July Week 5 2008 (到2008年8月27日); Sociological Abstracts, CBA 1952 to present (到2008年8月28日), 這些文獻。

選擇標準

隨機對照試驗。比較健康照護工作人員在有介入支持的與沒有改變勞動契約或工作環境兩組情況下，對工作壓力的調適、職業倦怠、與工作滿意度的差別。 這篇文獻回顧的介入措施包括 (1) 工作人員的支持團體 (2) 壓力管理技巧的訓練 (3) 管理支持工作人員的介入措施。

資料收集與分析

兩位作者獨立執行文獻選擇、品質評估及資料擷取。

主要結論

10個研究716參與者符合篩選的標準。沒有研究探討支持團體對健康工作人員的影響。8個研究評估接受各種壓力管理技巧訓練對測量壓力或工作滿意度的影響，2個研究評估管理對壓力、工作滿意度及曠職等介入措施的影響。結果3個研究顯示對工作壓力的管理訓練是有效的，其中一個顯示這種效果可以維持中等期間，一個研究顯示密集的職業倦怠壓力管理訓練的好處。中低密集程度的壓力管理訓練無法顯示對職業倦怠語員工滿意度的好處，管理介入措施顯示可以增加工作滿意度，但對曠職的情況沒有影響。大部份的研究有方法學上的缺點使它們的結果可能有偏差。

作者結論

沒有充份的證據顯示利用壓力管理訓練以降低工作壓力及預防職業倦怠對健康照護人員是有效的。 低品質的證據建議長期性的加薪或鼓勵措施可能有較正向的效果，但在未來的試驗中，這項措施仍須經過嚴格的評估。低品質的證據顯示對介入措施的管理可能會增加一部分的工作滿意度。不過，未來的研究須要評估以上建議是否能夠複製到其他的工作單位。沒有充份證據顯示管理介入措施對員工的曠職有好處，須要更嚴謹的研究去評估長期壓力管理訓練與管理介入措施的在基層照護與開發中國家的影響。

翻譯人

本摘要由中華民國急重症護理學會黃品甄翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

對健康照護工作人員的預防性的員工支持介入措施：健康照護工作者須要被支持以減少工作相關的壓力避免職業倦怠及提升工作動力。本文獻回顧探討10個研究共716健康工作人員，目的為了評估預防性員工支持介入措施的效果。8個研究給予次級與三級照護機構的主要護理人員，短期至中期的壓力管理技巧訓練中。其中4個研究顯示壓力管理訓練措施在短期內可以降低部分工作相關的壓力指標，但是，由於沒有適當的追蹤，對這些研究的結果是否能夠長期維持並不清楚。多數研究有些方法學上的缺點，有2個研究是探討管理介入措施是否能改善工作滿意度及曠職，但無充份證據顯示管理支持員工介入措施是有好處的。