Tuesday, April 7, 2015

Preventing occupational stress in healthcare workers

Cochrane: Healthcare workers suffer from work-related or occupational stress. Often this is because healthcare workers face high expectations and they may not have enough time, skills and social support at work. This can lead to severe distress, burnout or physical illness. In the end, healthcare workers may be unable to provide high quality healthcare services. Stress and burnout can also be costly because affected healthcare workers take sick leave and may even change jobs.
We evaluated how well different ways to prevent healthcare workers' stress or burnout work.

Study characteristics

We included 58 studies that included altogether 7188 participants. Fiftyfour of the included studies were randomised controlled studies and four were non-randomised studies. We categorised the interventions as either cognitive-behavioural training, mental and physical relaxation, or organisational changes.

Key findings and quality of the evidence
Cognitive-behavioural interventions
According to six studies, there was low-quality evidence that cognitive-behavioural training decreased stress with about 13% when compared to no intervention and when measured at follow-up periods ranging from less than a month up to two years. It is unclear how relevant this reduction is for a person with stress. The results were similar when cognitive-behavioural training was combined with relaxation. However, in three studies, stress levels were similar after a cognitive-behavioural training course compared to other training that was not focused on stress management but on the content of care.
Mental and physical relaxation interventions
In 17 studies there was low- to moderate-quality evidence that both mental and physical relaxation led to a reduction of 23% in stress levels compared to no intervention.
Organisational interventions
Organisational interventions were aimed at changing working conditions in 20 studies, improving support or mentoring in six studies, changing content of care in four studies, improving communication skills in one study and improving work schedules in two studies. Shorter or interrupted work schedules reduced stress levels in two studies but there was no clear benefit of any of the other organisational interventions.

We conclude that cognitive-behavioural training as well as mental and physical relaxation all reduce stress moderately. Changing work schedules can also reduce stress, but other organisational interventions have no clear effects. We need randomised studies with at least 120 participants and preferably a single component intervention. Organisational interventions need to be better focused on addressing specific factors that cause stress.
Authors' conclusions: 
There is low-quality evidence that CBT and mental and physical relaxation reduce stress more than no intervention but not more than alternative interventions. There is also low-quality evidence that changing work schedules may lead to a reduction of stress. Other organisational interventions have no effect on stress levels. More randomised controlled trials are needed with at least 120 participants that compare the intervention to a placebo-like intervention. Organisational interventions need better focus on reduction of specific stressors.