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      Qualitative interview study of strategies to support healthcare personnel mental health through an occupational health lens

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          Abstract

          Background

          Employee Occupational Health (‘occupational health’) clinicians have expansive perspectives of the experience of healthcare personnel. Integrating mental health into the purview of occupational health is a newer approach that could combat historical limitations of healthcare personnel mental health programmes, which have been isolated and underused.

          Objective

          We aimed to document innovation and opportunities for supporting healthcare personnel mental health through occupational health clinicians. This work was part of a national qualitative needs assessment of employee occupational health clinicians during COVID-19 who were very much at the centre of organisational responses.

          Design

          This qualitative needs assessment included key informant interviews obtained using snowball sampling methods.

          Participants

          We interviewed 43 US Veterans Health Administration occupational health clinicians from 29 facilities.

          Approach

          This analysis focused on personnel mental health needs and opportunities, using consensus coding of interview transcripts and modified member checking.

          Key results

          Three major opportunities to support mental health through occupational health involved: (1) expanded mental health needs of healthcare personnel, including opportunities to support work-related concerns (eg, traumatic deployments), home-based concerns and bereavement (eg, working with chaplains); (2) leveraging expanded roles and protocols to address healthcare personnel mental health concerns, including opportunities in expanding occupational health roles, cross-disciplinary partnerships (eg, with employee assistance programmes (EAP)) and process/protocol (eg, acute suicidal ideation pathways) and (3) need for supporting occupational health clinicians’ own mental health, including opportunities to address overwork/burn-out with adequate staffing/resources.

          Conclusions

          Occupational health can enact strategies to support personnel mental health: to structurally sustain attention, use social cognition tools (eg, suicidality protocols or expanded job descriptions); to leverage distributed attention, enhance interdisciplinary collaboration (eg, chaplains for bereavement support or EAP) and to equip systems with resources and allow for flexibility during crises, including increased staffing.

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          Most cited references28

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          Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

          Key Points Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
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            Qualitative Inquiry and Research Design: Choosing Among Five Approaches

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              Applying the Lessons of SARS to Pandemic Influenza

              We describe an evidence-based approach to enhancing the resilience of healthcare workers in preparation for an influenza pandemic, based on evidence about the stress associated with working in healthcare during the SARS outbreak. SARS was associated with significant long-term stress in healthcare workers, but not with increased mental illness. Reducing pandemic-related stress may best be accomplished through interventions designed to enhance resilience in psychologically healthy people. Applicable models to improve adaptation in individuals include Folkman and Greer’s framework for stress appraisal and coping along with psychological first aid. Resilience is supported at an organizational level by effective training and support, development of material and relational reserves, effective leadership, the effects of the characteristics of “magnet hospitals,” and a culture of organizational justice. Evidence supports the goal of developing and maintaining an organizational culture of resilience in order to reduce the expected stress of an influenza pandemic on healthcare workers. This recommendation goes well beyond the provision of adequate training and counseling. Although the severity of a pandemic is unpredictable, this effort is not likely to be wasted because it will also support the health of both patients and staff in normal times.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2024
                12 January 2024
                : 14
                : 1
                : e075920
                Affiliations
                [1 ]departmentCenter for Innovation to Implementation , Ringgold_19977VA Palo Alto Health Care System , Menlo Park, California, USA
                [2 ]Ringgold_10624Stanford University School of Medicine , Stanford, California, USA
                [3 ]Ringgold_2546Case Western Reserve University , Cleveland, Ohio, USA
                [4 ]Ringgold_12239Emory University School of Medicine , Atlanta, Georgia, USA
                [5 ]departmentEmployee Occupational Health , Ringgold_19988Wilmington VA Medical Center , Wilmington, Delaware, USA
                [6 ]departmentOccupational Health Service , VA Palo Alto Health Care System , Palo Alto, California, USA
                [7 ]departmentCenter for the Study of Healthcare Innovation, Implementation & Policy , VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
                [8 ]departmentDepartment of Health Policy and Management , Fielding School of Public Health, University of California Los Angeles , Los Angeles, California, USA
                [9 ]departmentDepartment of Medicine , Geffen School of Medicine, UCLA , Los Angeles, California, USA
                Author notes
                [Correspondence to ] Dr Cati Brown-Johnson; catibj@ 123456stanford.edu ; Dr Karleen Giannitrapani; karleen@ 123456stanford.edu

                CB-J and CD are joint first authors.

                Author information
                http://orcid.org/0000-0002-5415-3665
                http://orcid.org/0000-0003-0987-6204
                Article
                bmjopen-2023-075920
                10.1136/bmjopen-2023-075920
                10806949
                38216178
                c053f203-2da5-4e38-a4dd-47d3c2332070
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 26 May 2023
                : 22 November 2023
                Funding
                Funded by: U.S. Department of Veterans Affairs (Health Services Research and Development);
                Award ID: C19 20-207
                Categories
                Occupational and Environmental Medicine
                1506
                1716
                Original research
                Custom metadata
                unlocked

                Medicine
                mental health,qualitative research,occupational & industrial medicine
                Medicine
                mental health, qualitative research, occupational & industrial medicine

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