Stress burnout and psychosocial support for staff of the emergency medical services
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Stress, Burnout and Psychosocial Support for Staff of the Emergency Medical Services. Jana Seblova (1), Dana Hlavackova (1), Vladimír Kebza (2), Jana Vignerova (2), Blanka Cepicka (3) Ministry of Health, EMS of the Central Bohemian Region (1) National Institute of Public Health (2)

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Stress burnout and psychosocial support for staff of the emergency medical services l.jpg

Stress, Burnout and Psychosocial Support for Staff of the Emergency Medical Services

Jana Seblova(1), Dana Hlavackova (1),

Vladimír Kebza (2), Jana Vignerova (2), Blanka Cepicka (3)

Ministry of Health, EMS of the Central Bohemian Region (1)

National Institute of Public Health (2)

S.E.N.A. Prague (3)


Study stress of ems professionals with special attention to burnout syndrome l.jpg
STUDY : „Stress of EMS professionals Emergency Medical Serviceswith special attention to burnout syndrome“

  • 2003 – 2004

  • Objectives:

  • to analyze sources of stress associated with profession

    • degree of exposition to critical incidents

    • to analyze postitive factors

    • study average and individual rates of burnout syndrome (BOS)

  • 2004 – 2006

  • implementation of preventive and intervention psychological methods in the practice of EMS

  • 2005 - 2006

  • evaluation of these interventions and rates of BOS


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Questionnaires 2003/2005 Emergency Medical Services(created for the purpose of this study)

  • demographic items (age, sex, matrimonial status, position at work, lenght of practice, former specialization, postgraduate education…)

  • stressors and positive factors of the work in EMS – open questions + quantification (0-9), techniques of deescalation of stress (positive and negative)

  • exposition to critical incidents (predefined 5 indicators: death/injury on duty, multiple victim accidents, burn trauma, unsuccesful CPR or death of a child, endangering during duty – respondents were asked to specify)

  • screening questionnaire for burnout – 10 questions, simple rating (the same one used in the second phase)


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Results: exposition to predefined Emergency Medical Servicescritical incidents


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Results: stressors in EMS practice Emergency Medical Services

  • at least one stressor was named by 236 of 286 respondents (82,5%)

  • the most frequently named and the most intensive stressor was unsuccessful CPR or death of a child/young patient: 89 (31,1% of all respondents, average intensity 7,7 – maximum 9)

  • multiple victim accidents, disasters: 42 (14,7% - 6,5)

  • overtime hours, work in shifts, irregular life style: 38 (13,3% - 6,7)

  • interepesonal relations at work: 38 (13,3% - 5,9)

  • behaviour of the patients and relatives to EMS professionals: 35 (12,2% - 5,0)

  • work at medical dispatch – 28 of 51 dispatchers (54,9%)


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Results: stressors in EMS practice Emergency Medical Services


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Results: positive aspects of profession Emergency Medical Services

  • helping other people and saving their health/lives (136 = 46,9%, intensity 7,4)

  • „action“ type of work, wchich in not boring (89 = 30,7%, intensity 6,8)

  • contacting people – as colleagues, and also as patients (80 = 27,6%, intensity 6,7)

  • flexibile spare time due to working in shifts (38 = 13,3%) – the same number of respondents see shifts and irregular life style as a stressor!

  • ambivalence: shifts, colleagues, salary…


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Results: endangering during duty Emergency Medical Services

  • 235 field professionals (included: physicians, emergency medical nurses, paramedics/EMTs, excluded: dispatchers)

  • 201 respondents (85,5%) experienced some form of endangering themselves during duty

  • ambulance car accident: 96 persons (40,1%), 21 physicians (48,8%), 18 EMTs (44%), 52 emergency medical nurses or paramedics (34,4%)

  • aggression (patient, relatives, friends…): 154 (65,5%), physicians 32 (74,4%), EMTs 28 (68,3%), emergency medical nurses and paramedics 83 (55%) – often named alcohol and drugs associated with aggression towards helath care professionals


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Results: endangering during duty: assault Emergency Medical Services



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Material and methods - burnout Emergency Medical Services

  • 2003: 350 questionnaires sent, 290 returned (82,9%), 4 excluded (work position not defined) – 286 respondents

  • 2005: 750 questionnaires sent, 644 returned (85,8%), 597 respondents met inclusion criteria

    • (practice in EMS more than 1 year, half to full time job, agreement with participation)

  • basic comparison 2003/2005 and in 2005 group A = 372 (one or more psychological intervention) and B = 225 (no interventions) – using analysis of variance (ANOVA)

  • test of individual factor´s influence on BOS symptoms: General Linear Model (GLM), software SPSS, version 12

  • the same comparison for each of four professional groups


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    Results: symptoms of burnout Emergency Medical Services

    • no significant difference 2003/2005 and in the year 2005 in the group with and without psychological interventions

    • in medical nurses statistical significant improvement between 2003/2005 (0,030)

    • highly significant difference between the group of dispatchers compared to any other professional group

    • the other factor influencing highly significantly symptoms of BOS is the length of practice in EMS

    • no other factor has influence on the degree of BOS (sex, matrimonial status, any professional position other than dispatcher, age…)


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    Results: symptoms of burnout Emergency Medical Services

    • Variable Statistical significance (p)

    • ______________________________________________

    • Sex 0,842 n.s.

    • Age 0,164 n.s.

    • Lenght of practice 0,002

    • Matrimonial status 0,995 n.s.

    • Profesional position 0,000

    • Group of respondents 0,697 n.s.

    • (2003 / 2005)

    • Intervention yes/no 0,771 n.s.


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    Results: symptoms of burnout Emergency Medical Services


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    Preventive and intervention methods Emergency Medical Services(2004 – 2006)

    • preventive and educational lectures

    • communication training (dispatchers, teams)

    • psychological consultations concerning professional stress and coping with it

    • structured interviews

    • CISM (Critical Incident Stress Management) after critical incidents (Mitchell´s model)

      • physicians, medical nurses, paramedics, dispatchers


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    Satisfaction with psychological interventions Emergency Medical Services

    • preventive and educational lectures …………………92%

    • communication training…………………………………92%

    • CISM (Critical Incident Stress Management)

    • after critical incidents………………………………….. 83%

    • structured interviews………………………………….…81%

    • psychological consultations concerning

    • professional stress and coping with it…………………79%


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    Conclusions of the study: Emergency Medical Services

    • the only 2 factors influencing highly significantly symptoms of BOS are the position of dispatcher and length of practice in EMS

    • psychological techniques can improve the level of well-being of professionals, possible influence in the future - all kinds of interventions were postitively accepted

    • specific programmes are used for dispatchers as the amount of their professional stress is significantly higher and these programmes should be recommended for wider application

    • concentration on safe driving the ambulance car as prevention of accidents

    • specific intervention programme for victims of aggression should be created


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    Implementation of psychological techniques Emergency Medical Services

    • Education, preventive lectures:

      • EMS professionals – CME certified

      • middle management

      • dispatchers – CME certified

  • Communication training:

    • emergency nurses, paramedics, physicians

    • dispatchers

  • Supervision

    • field teams, dispatchers – feedback for management

    • individual supervision – on demand

    • top management

  • Consultations concerning professional stress

    • co-operating psychologist, based on obligatory professional secret


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    Building the system of CISM Emergency Medical Services

    • CISM – a system of preventive and intervention techniques

    • certified CISM courses – Dr. Thomas Appel-Schumacher, University of Maryland – 2004 (2 participants), 2006 and 2007 (organized by Ministry of Health, 15 + 10 participants) – some of them joined the system on voluntary basis as peers

    • crisis intervention: obligatory after large scale disasters

      • implemented in „Protocol for Major Incident“

      • in contract between organization and trade unions (care of employees)

  • Medical Director – the role of CISM coordinator (indication, type and timing of intervention, contacting mental health professional, logistics)


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    CISM in practice of EMS of the Central Bohemian region Emergency Medical Services

    • the first debriefing: after activation of disaster plan after serious traffic accident of a bus 6. 7. 2006, high mortality of victims, debriefing after 10 days from the accident

    • 3. 11. 2006: a traffic accidents of 2 ambulances and 1 police car in one emergency call (South Bohemian EMS) – a serious injury of emergency nurse and the rest of teams were also injured

    • 28. 7. 2007:activation of disaster plan - the thieves of iron caused a serious destruction of a former factory´s hall, some of the people were of entrapped, unknown number of affected people, danger for the rescuers….


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    CISM in practice of EMS of the Central Bohemian region Emergency Medical Services

    • 12. 4. 2008 – the emergency teams sent to the highway traffic accident, another car had crashed into the ambulance on scene, one dead victim and all injured members of the EMS team; they were trying to help all the other victims despite their own injuries untill other ambulances came on scene

    • 20. 10. 2008 – a car crash of ambulance with physician, the screw of the other ambulance provided first aid to the victims = colleagues

    • 15. 5. 2009 – the drunken patient attacked the screw (2 males, 1 female – all injured)


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    CISM in practice of EMS Emergency Medical Services… debriefings in pictures


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    Pilot project of Ministry of Health and EMS of the Capital Prague

    • study on stress nad burnout of all medical personnel including dispatchers compared to non-medical personnel

    • Maslach Burnout Inventory

    • high scores in emotional exhaustion

    • system of providing support based on group of peers (10 peers) with mental health professional´s supervision

    • voluntary basis with reimbursement in case of providing intervention

    • need for psychosocial support proved – average number of contacts 15/month

    • possible model for national system



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    National System of crisis intervention Prague

    • since 2009, organised by Ministry of Health – Department of Crisis Preparedness

    • working group for building national system of crisis intervention

    • a part of Departments of crisis management in organisations

    • Providers:

      • EMS (regional system of emergency care – 14 organisations) – in the next period co-operation with Police anf firefighters is planned (within „Integrated Rescue System“)

      • hospitals – University teching hospitals, regional…

      • regional authorities

      • volunteers and NGO´s


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    National System of crisis intervention Prague

    • Primary goals:

    • terminology, definition of tasks and responsibilities

    • database of peers

    • coordination on regional level

    • system of communication in case of need of intervention (individual vs. major incident) – telephone line 24/7/365

    • education of providers

    • financial resources

    • evaluation and feedback

    • PR


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    Thank You for attention… PragueQuestions? Comments? Remarks?


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