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The site is secure. Working in the stressful environment of the Intensive Care Unit ICU is an emotionally charged challenge that might affect the emotional stability of medical staff. The quality of care for ICU patients and their relatives might be threatened through long-term absenteeism or a brain and skill drain if the healthcare professionals leave their jobs prematurely in order to preserve their own health.

The purpose of this review is to evaluate the literature related to emotional distress among healthcare professionals in the ICU, with an emphasis on the prevalence of burnout and compassion fatigue and the available preventive strategies.

Studies reporting the prevalence of burnout, compassion fatigue, secondary traumatic stress and vicarious trauma in ICU healthcare professionals were included, as well as related intervention studies.

Forty of the identified publications, which included 14, respondents, met the selection criteria. Two studies reported the prevalence of compassion fatigue as 7. A wide range of intervention strategies emerged from the recent literature search, such as different intensivist work schedules, educational programs on coping with emotional distress, improving communication skills, and relaxation methods. The true prevalence of burnout, compassion fatigue, secondary traumatic stress and vicarious trauma in ICU healthcare professionals remains open for discussion.

A thorough exploration of emotional distress in relation to communication skills, ethical rounds, and mindfulness might provide an appropriate starting point for the development of further preventive strategies.

A growing body of evidence suggests that burnout among ICU nurses [ 1 ] and ICU physicians [ 2 ] is a remarkable result of the demanding and continuously high-stress work environment. It has been suggested that ICU professionals could be emotionally affected by end-of-life issues [ 3 ], ethical decision making [ 4 ], observing the continuous suffering of patients [ 5 ], disproportionate care or medical futility [ 6 ], miscommunication [ 7 ], and demanding relatives of the patients [ 8 ].

Moreover, many patients in the ICU lack decision-making capacity; therefore, the healthcare professionals depend on communication with relatives for decision making, which can complicate the communication process [ 9 ]. In addition, the ICU work environment has become increasingly technical, which requires extended skills in advanced life sustaining medical therapies.

These aspects may lead to moral distress or avoidance behavior [ 10 ], and consequently increase emotional distress. It might even result in long-term absenteeism or a threatening brain and skill drain if the professionals leave their jobs prematurely to preserve their own health, ultimately leading to economic burdens [ 11 ]. In addition, these processes may even reduce the quality of care for patients and relatives [ 12 ].

Work-related stress with the accompanying emotions provoked specifically in ICU is well documented over the previous years [ 12 — 15 ]. The high-stakes, high stress environment that ICU professionals practice in, are incredibly demanding intellectually, physically, and emotionally. Both physical warning signs such as headaches, sleeping disturbances, low back pain and stomach problems and mental responses such as irritability or hostility, loss of concentration, low self-confidence and emotional instability could indicate individual stress reactions [ 16 — 18 ].

However, these are non-specific symptoms which cannot depict the origin of stress and subsequently constrain effective coping mechanisms or the developing of preventive strategies for this ongoing process. Stress reactions are the first indication of the presence of an emotional trauma. These reactions are defined as a set of conscious and unconscious behaviors, cognitions and emotions, to deal with the stressor [ 19 ]. In the research field of traumatization, which focuses on the process and origin of developing stress symptoms, there is a distinct difference in primary and secondary traumatization [ 20 ].

Primary traumatization is the process that can occur from having persistent, intense and direct contact with a traumatic event, such as a situation of war, violence or sexual abuse.

This process can lead to posttraumatic stress disorder [ 21 ]. Secondary traumatization is the process via an indirect exposure, which may develop from hearing about a traumatic event or caring for someone who has experienced a traumatic event. This process may lead to burnout, compassion fatigue, vicarious trauma, and secondary traumatic stress [ 20 , 22 ]. Burnout BO , an emotional and behavioral impairment that results from the exposure to high levels of occupational stress, has been described as a combination of three factors: emotional exhaustion, depersonalization and personal accomplishment [ 23 ].

Individuals who are at risk of a BO, usually have some level of perfectionism and feel guilty if they do not perform as well as they would like to. This goal-oriented mindset could cause an extreme imbalance in work-related situations and might lead to long-term absenteeism. Although BO can be severe, it has also been viewed as a contagious syndrome [ 24 ]. The social context, and especially the interaction with complaining colleagues, might play an important role in the development of BO.

Furthermore, BO has been mentioned as a fashionable diagnosis because a clear and standardized definition is lacking [ 8 , 25 ]. A substantial number of studies on BO in a broad range of professions were published and a peak in media coverage occurred since the first description [ 26 ]. However, since its origination, the operationalization and measurement of BO have differed enormously.

Compassion fatigue CF has been defined as a state of physical or psychological distress in caregivers, which occurs as a consequence of an ongoing and snowballing process in a demanding relationship with needy individuals [ 27 , 28 ]. CF was described for the first time in the early nineties as the loss of compassion in result of repeated exposure to suffering during work [ 30 ].

CF consists of two parts. The first part contains issues such as exhaustion, frustration, and depression, typical associated with BO. Although BO is closely related to CF, the underlying mechanism most likely differs. BO is believed to be related to occupational factors, such as workload, autonomy, and rewarding, rather than personal relationships [ 32 ].

In contrast, an inability to engage, or enter into a caring relationship, is considered to be the core of CF [ 33 ]. What becomes more and more apparent is the level of complexity in the various concepts and mutual relationships. Besides the already mentioned interchangeably usage of CF and STS, a significant positive correlation between CF and BO was found in some studies, suggesting an overlay in one or more of the components of these phenomena [ 20 , 22 ].

According to Elkonin and Lizelle, BO illustrates the end result of traumatic stress in the professional life of the caregiver and could be an extreme case of CF [ 22 ]. This review explores all mentioned concepts, taken together in this study as emotional distress, because of the same range of causes, coping mechanisms, and consequences in the field of traumatization.

The main purpose of this review was to evaluate the literature on emotional distress among professionals in the ICU according the PRISMA method, with an emphasis on the prevalence of burnout and compassion fatigue.

We enhanced some new knowledge in this field to assess the current literature precisely and compare the measuring instruments and the results of the studies. Furthermore, while the sometimes devastating personal and organizational consequences of BO and CF have been published previously, very few studies have addressed the effectiveness of preventive strategies.

This review aims to provide a starting point for clinical practice guideline developers and summarizes interventions to prevent the negative consequences of emotional distress among healthcare professionals in the ICU.

The following research questions have been addressed:. A systematic review of the scientific literature was conducted to obtain original articles for appraisal. Pre-determined search strategies were followed and quality criteria were applied as guidelines to conduct the review process [ 35 ]. This review study did not need ethical approval nor was individual consent needed.

This search was supplemented with compassion fatigue and secondary traumatic stress as free text words. All terms were tailored to the thesaurus of each database, the complete search strategy is recorded in the protocol S1 Table. Local unpublished surveys, unpublished reports and academic theses were not included.

All references were retrieved, organized and stored with EndNote X7. In the first round, the references from each database were screened by the title and abstract for relevancy. We were particularly interested in effects of the interventions on the professional quality of life of the individual workers. We chose as the initial search year because the first article on CF in nurses was published that year [ 30 ], the search included original articles written in the English language all years through 30 June We excluded studies on coping with work stress and the causes and consequences of BO.

Finally, the included articles were manually checked for new references until no further studies were identified. A set of quality criteria was developed to assess the methodological soundness [ 27 , 35 ], see Table 1. The total study quality has been computed as Disagreements between the three reviewers were discussed until a consensus was reached. The review process, which is illustrated in Fig 1 , began with references retrieved from the electronic databases.

A few studies were excluded because prevalence could not be calculated from the presented data [ 37 — 39 ] or effects of the intervention were not measured [ 17 ]. Finally, a sample of 30 eligible articles on the prevalence of emotional distress and 10 associated intervention studies were appraised as methodologically sound and included for extensive review [ 20 , 22 , 40 — 77 ].

An adapted PRISMA flowchart of the total review process on the prevalence of compassion fatigue and burnout among healthcare professionals in the intensive care unit. An overview of the included publications, with the study characteristics such as setting, sample size, sample characteristics and quality assessment, is provided in Table 2. The number of respondents varied between 25 and 3,; in most studies female respondents were over-represented.

The response rates varied between In Table 3 all the sample characteristics are summarized. Additionally, this questionnaire distinguishes also the positive effects of caring, referred to as compassion satisfaction. Over time, this tool has been validated in various healthcare work environments and has proven to be reliable and feasible for medical staff [ 27 , 79 ]. The MBI is a highly reliable and validated item self-report questionnaire that evaluates the three domains of BO in independent subscales: emotional exhaustion, depersonalization and personal accomplishment.

The latter study also stated that the prevalence would be Similarly, Czaja et al. Some other studies defined a high risk for BO by a cut-off score in the emotional exhaustion subscale, leading to estimates of prevalence varying from Correspondingly, no clustering of prevalence rates was identified for specific hospital settings i.

A summary of the diverse measurement instruments, cut-off scores and reported prevalence, are shown in Table 5. The included studies reported a broad range of variables related to emotional distress, see Table 6. Work environment [ 22 , 46 , 68 , 74 ], professional role [ 61 , 67 ] and conflicts [ 46 , 64 ] were significantly and positively related to the measured phenomenon.

However, some studies stated opposite results. Most confusing variable was the female sex, with an increasing [ 46 , 66 ] versus a decreasing [ 61 ] effect, and no significantly measured influence [ 42 , 50 , 52 , 64 ] on emotional distress. A wide range of intervention strategies to reduce emotional distress among ICU professionals emerge from the recent literature, see Table 7. Ten studies measured the effect of an intervention, such as different intensivist work schedules [ 40 , 48 ], educational programs on emotional distress [ 45 , 58 ], improving elements of family-centered care and communication skills [ 56 , 65 , 71 ], strategies regarding personality and coping [ 62 , 63 ], and relaxation exercises [ 59 , 75 ] such as yoga and mindfulness.

In addition, seven of the included studies suggested preventive strategies, varying from improving the work environment [ 49 , 55 , 68 ], focussing more on social support and individual coping strategies [ 54 ], changing team composition to include a greater number of women [ 61 ], developing teambuilding and periodic job rotation [ 42 ], and a mix of all these elements [ 67 ]. According to Quenot et al.

These strategies comprised elements in the organization, i. Another promising preventive strategy is mindfulness training. West et al. Furthermore, Lederer et al.

 
 

 

EndNote X7/X8/X9/20 Windows: Install Word CWYW

 
Click the EndNote menu and select ‘Customizer’. Solves the Acrobat addin problem as well, so this seems to be a pretty general problem. According to the Drift documentation, this is the anonymous identifier token. Skip to main content. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. In reply to macropod’s post on March 28,

 
 

EndNote Windows or Mac, Cite While You Write CWYW tools missing or disabled in MS Word

 
 
In MS Word: go to File > Options > Add-ins > select COM Add-ins from the Manage drop-down menu > press Go. If the EndNote CWYW function is. Just install the connection files for the databases you want to search. Then you can use EndNote to connect to a database, conduct your search, collect what you. MS Word: Click on the File ribbon and select ‘Options’. · Click on ‘Add-ins’. · Change the ‘Manage’ options to ‘Disabled Items’ (bottom of the screen). · Click Go.