Title: Mitigating the impacts of COVID-19 on critical care: An umbrella realist review of individual focused interventions for healthcare professionals
Abstract:
Background: Critical care healthcare professionals (CCHP) are threatened by high rates of burn-out and psychological comorbidities. Current research proposed an increase and exacerbation of these impacts from COVID-19 pandemic. Mental health disorders such as moral distress, compassion fatigue, and traumatic-stress disorders are at its peak, with little attention to seek resources to mitigate these experiences. It has contributed to low levels of well-being, which is vital to CCHP’s ability to engage within the workplace and provide quality and safe care to patients. The objective was to determine how, what, for whom, and under what circumstances individual-focused interventions are effective to improve well-being and decrease burn-out symptoms amongst critical care healthcare professionals.
Method: This umbrella realist review searched for published and unpublished meta-analysis and systematic reviews between 2016 and 2020. Databases used included Web of Science, MEDLINE, CINAHL, PsychInfo, Scopus, ISRCTN, and ClinicalTrials.gov. Data was extracted and analysed using the analytical thinking process of juxtaposition, reconciling, adjunction, consolidation of data, and situation of evidence to determine relationships between context, mechanisms, and outcomes (CMOs). The CMO enabled development of theory prepositions, which was used to refine the initial program theory.
Results: 17 reviews were mapped and a total of 81 individual-focused interventions were identified and categorised into the following divisions: cognitive-behavioural therapy, mindfulness, coping, and self-care strategies. Findings determined contextual factors such as workload, work schedules, personality traits, and ethnicity were routinely identified and were crucial components that determined the effectiveness of the intervention. Implicit identifications of mechanisms included the intervention’s ability to be accepted, interesting, and receptive. From this, six theory prepositions were developed, which suggested tailoring, structured education, engagement, self-awareness, overlooking work stressors, and unity of interventions and measures as imperative components to consider when implementing individual-focused interventions for critical care healthcare professionals.
Conclusion: Although the solution to decreasing burn-out and its symptoms are complex, this review offers a reliable and realistic reporting of outcomes to facilitate the implementation of individual-focused interventions in the ‘real world’. The lack of focus on critical care advocates future research to seek validation, such as through an expert opinion to attain better understanding of mechanisms, contextual factors, and their interactions for such population. Determining individual-focused interventions for critical care can potentially address the impacts of COVID-19 as it provides resources for CCHPs to utilise to maintain their mental health, improve well-being, and decrease potential burn-out symptoms.
Audience Take Away:
- The audience can understand current individual-focused interventions and its use to improve well-being and decrease burn-out and its symptoms.
- The research demonstrates a large gap in determining individual-focused interventions for critical care healthcare professionals, especially during an era where burn-out is at its peak. It provides researchers with an understanding that further in-depth investigation is required in this field.
- The application of realist evaluation provides a realistic view on the problem at hand and provides an understanding of why, how, and under what circumstances individual-focused interventions may or may not work. This method encourages researchers to have a better understanding of reality, what is needed, and assists in the path of knowledge translation of these individual-focused interventions.
It provides a foundation to the solutions of mitigating mental health impacts of COVID-19 on both critical care and healthcare professionals at large.
