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Health care stress: It’s Rampant, but Dearth of Data on Interventions

This may not surprise you if you are reading this on a mobile device while running down a hospital hallway, but healthcare workers are most stressed out workers in the country.

Well, maybe this website survey didn’t include air traffic controllers, but a poll of 3,211 workers placed healthcare workers at the very white-knuckled pinnacle of stress mountain. In fact only 14% of them are not stressed. That’s if you consider 69% of healthcare respondents reported being “stressed” and another 17% listed their condition as “highly stressed.”

“Often this is because healthcare workers face high expectations and they may not have enough time, skills and social support at work,” according to the authors of a recent Cochrane review report. “This can lead to severe distress, burnout or physical illness.”

Intuitively one would think that any of the commonly known approaches would help de-stress health care workers, but it turns out to be surprisingly difficult to quantify the effects of the various interventions in healthcare. Given these rather discouraging results, we reached out via email to lead author Jani H. Ruotsalainen, MSc, managing editor of the Cochrane Occupational Safety and Health Review Group at the Finnish Institute of Occupational Health in Kuopio. The rigors of a Cochrane review are not to be underestimated, but we threw caution to the wind and asked Ruotsalainen to do the same and flat-out speculate about the results.

Do you have any opinion on why the data do not show a greater benefit to cognitive-behavioral training (CBT) as well as mental and physical relaxation to reduce stress?

Ruotsalainen: “Given the nature of systematic reviews in trying to overcome the problems of individual studies and trying to extract an overall ‘truth’ regarding the magnitude of effect for a particular intervention, such as how much on average does CBT reduce stress, it would be going beyond the data to conjecture how and why the effect size is what it is. Of course we can make educated guesses based on obvious shortcomings in the included studies, such as problems in keeping intervention and control groups truly separate and following up people for long periods of time after the intervention. But unfortunately this type of research is not the best way to answer any questions beginning with why.”

Based on your findings, would it be fair to say it is better to have such programs than not?

Ruotsalainen: “Absolutely. We can say without any doubt that healthcare workers’ stress can be reduced with CBT and relaxation programs. However, to say if they would help in any given particular context, one would first need to know the current situation, i.e. magnitude/prevalence of the stress/burnout problem. If, for example, a particular hospital/care facility had tackled the issue with vigor and had already achieved significant results over time then it would be silly to expect much further improvement.”

For more on this story see the July 2015 issue of Hospital Employee Health.