Psychological factors and communication skills training in intensive care medical staff

Abstract

Background: Intensive care settings have been shown to present a demanding work setting with health related and work-related consequences for intensive care medical staff. The health-related consequences observed are high levels of burnout, traumatic stress, symptoms of anxiety, depression, and fatigue. Specific stressors mentioned by staff is high workload, moral distress, end-of-life issues, and interpersonal issues/conflicts with colleagues, patients, and relatives. During the covid-19 pandemic, the need for healthcare organizations to attend to the occupational psychological health of staff has been evidently clear. Although, the prevalence of stress in intensive care has been previously observed and reported on, at least since the 70s.

Purpose and aims: Overall purpose of thesis was threefold; to improve knowledge on occupational psychological health among healthcare staff, particularly in intensive care settings, to develop a behavioural intervention to improve communication skills and management of distress to enhance occupational health, and to evaluate the implementation of psychological support to ICU staff. The thesis included four studies and the specific aim of study I was to evaluate the reliability and validity of a Swedish version of the Work-related Acceptance and Action Questionnaire (WAAQ), a self-report questionnaire measuring psychological flexibility at work. Study II evaluated the relationship between psychological flexibility (measured by WAAQ) and other aspects of occupational psychological health, i.e., perceived stress, general mental health, and work engagement, in a sample of intensive care medical staff. Study III evaluated the effects of a Behavioral Skills Training (BST) program on dependent measures of occupational psychological health in a sample of intensive care medical staff. Finally, study IV evaluated the implementation and feasibility of a psychological support model rapidly developed and implemented for ICU staff during the first wave of the covid-19 pandemic.

Methods: Four studies were included in the thesis. Study I used a cross-sectional design to evaluate reliability and validity of a measure of psychological flexibility, WAAQ, in a sample of healthcare professionals. In a subsample of participants, a longitudinal design was used to evaluate test-retest reliability. Measures used in the study were three self-report questionnaires, WAAQ, PSS-10 (Perceived Stress Scale-10), and UWES (Utrecht Work Engagement Scale) and the sample consisted of 184 healthcare professionals. Study II evaluated the relationship between psychological flexibility (WAAQ), work engagement (UWES), perceived stress (PSS-10), and general mental health (GHQ-12) in a cross-sectional design in a sample of intensive care medical staff. A longitudinal design was used in a subsample (n=46) to further evaluate the relationship between WAAQ and UWES. Study III evaluated the effects of the BST program in a pre-post uncontrolled trial with three assessment points (pre, mid, and post). Study IV used a cross-sectional and qualitative design to evaluate implementation of the support model.

Results: In study I, WAAQ showed good internal consistency and good test-retest reliability. Furthermore, it showed a significant negative relationship with perceived stress and significant positive relationship with work engagement. In study II, a hierarchical regression analysis showed WAAQ to explain variance in UWES when controlling for PSS-10 and GHQ-12. Additionally, WAAQ had a significant indirect effect on the relationship between perceived stress (PSS-10) and work engagement (UWES), and the relationship between general mental health (GHQ-12) and work engagement (UWES). In Study III, dependent t-test and linear mixed model analysis of occupational psychological health showed decrease in perceived stress (PSS-10) and improved general mental health (GHQ-12). It showed no change on measures of psychological flexibility (WAAQ) or work engagement (UWES) Study IV showed that although all support efforts were used, daily group sessions followed by peer support had the highest attendance ratings in relation to awareness. Furthermore, interviews with psychologists delivering support showed three themes labelled utility, challenges, and keys to implementation.

Conclusions: Results from study I support the use of the Swedish version of WAAQ as a measure of psychological flexibility among healthcare professionals, and considering the sample composition, especially among highly educated female samples. Study II showed support for the utility of psychological flexibility and work engagement to assess and characterize occupational psychological health among intensive care medical staff. Although tentative, findings of study III, support the use of the BST program to promote occupational psychological health among intensive care medical staff. Lastly, the process evaluation of the support model delivered during the pandemic, suggested the importance of a rapid implementation of support when needed, and that success is dependent on the managers to facilitate and implement the interventions, as well as access to competent resources.