Women in Healthcare Experiencing Occupational Stress and Burnout During COVID-19: a Rapid Review
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Open access Original research BMJ Open: first published as 10.1136/bmjopen-2021-048861 on 8 April 2021. Downloaded from Women in healthcare experiencing occupational stress and burnout during COVID-19: a rapid review Abi Sriharan ,1 Savithiri Ratnapalan,2,3 Andrea C Tricco ,1,4 Doina Lupea5 To cite: Sriharan A, ABSTRACT Strengths and limitations of this study Ratnapalan S, Tricco AC, Context COVID-19 has had an unprecedent impact on et al. Women in healthcare physicians, nurses and other health professionals around ► This rapid review included 47 studies representing experiencing occupational stress the world, and a serious healthcare burnout crisis is and burnout during COVID-19: 18 668 women in healthcare. emerging as a result of this pandemic. a rapid review. BMJ Open ► This study used Bolman and Deal’s (2017) four- Objectives We aim to identify the causes of occupational 2021;11:e048861. doi:10.1136/ frame leadership model to explain the contextual stress and burnout in women in medicine, nursing and bmjopen-2021-048861 factors of stress and burnout experienced by women other health professions during the COVID-19 pandemic health professionals. ► Prepublication history for and interventions that can support female health ► This study used the WHO guidelines on rapid re- this paper is available online. professionals deal with this crisis through a rapid review. To view these files, please visit views and reported using the Preferred Reporting Methods We searched MEDLINE, Embase, CINAHL, the journal online (http:// dx. doi. Items for Systematic Reviews and Meta-Analyses PsycINFO and ERIC from December 2019 to 30 September org/ 10. 1136/ bmjopen- 2021- guidelines to guide this rapid review. 2020. The review protocol was registered in PROSPERO 048861). ► Quality of evidence was assessed using the Quality and is available online. We selected all empirical studies Rating Scheme for Studies and Other Evidence. Received 11 January 2021 that discussed stress and burnout in women healthcare ► Due to the heterogeneity of data collected in the in- Revised 08 March 2021 workers during the COVID-19 pandemic. cluded studies, a meta-analysis was not appropriate. Accepted 15 March 2021 Results The literature search identified 6148 citations. A review of abstracts led to the retrieval of 721 full-text articles for assessment, of which 47 articles were included for review. Our findings show that concerns of safety Women in healthcare experience specific (65%), staff and resource adequacy (43%), workload and challenges with adapting to COVID-19 http://bmjopen.bmj.com/ compensation (37%) and job roles and security (41%) related public health measures, in addition to appeared as common triggers of stress in the literature. Conclusions and relevance The current literature the pre- existing systemic challenges related to workplace gender bias, discrimination, sexual primarily focuses on self- focused initiatives such 7 as wellness activities, coping strategies, reliance of harassment and inequities. The pandemic © Author(s) (or their family, friends and work colleagues to organisational- has taken a disproportionate toll on women 8 employer(s)) 2021. Re- use led initiatives such as access to psychological support in the workplace. Women make up 75% permitted under CC BY- NC. No and training. Very limited evidence exists about the of HCWs globally.9 Female physicians are commercial re- use. See rights organisational interventions such as work modification, already more likely than male physicians to on September 24, 2021 by guest. Protected copyright. and permissions. Published by financial security and systems improvement. BMJ. experience depression, burnout and suicidal 10 11 1Institute of Health Policy, ideation. On average, women performed Management and Evaluation, 2.5 times of unpaid work per day compared University of Toronto, Toronto, INTRODUCTION with men as parents and primary caregivers Ontario, Canada to family members.12 2 The health sector is facing an unprecedented Division of Emergency burden due to the ongoing COVID-19 In this review, we explore factors that may Medicine, Hospital for Sick Children, Toronto, Ontario, pandemic. Healthcare workers (HCWs) are influence stress and burnout in women health Canada at the frontline providing essential services, professionals and describe how different type 3Department of Paediatrics, The and they are experiencing increased harass- of intervention organisations can offer to Temerty Faculty of Medicine, ment, stigmatisation, physical violence and support women health professionals. Toronto, ON, Canada psychological trauma, including increased 4Li Ka Shing Knowledge Institute, Unity Health, Toronto, rates of burnout, depression, anxiety, Ontario, Canada substance abuse and suicide due to COVID- METHODS 5Ontario Medical Association, 19.1–4 Amnesty International has recorded the Overall objectives Toronto, Ontario, Canada deaths of over 7000 health workers worldwide The overall objectives of this review are to: Correspondence to due to COVID-19. In the USA alone, over 250 (A) explore the triggers of occupational Dr Abi Sriharan; 000 health workers have been infected, and stress and burnout faced by women in health- 5 6 abi. sriharan@ utoronto. ca nearly 1000 deaths have occurred. care during the COVID-19 pandemic and (B) Sriharan A, et al. BMJ Open 2021;11:e048861. doi:10.1136/bmjopen-2021-048861 1 Open access BMJ Open: first published as 10.1136/bmjopen-2021-048861 on 8 April 2021. Downloaded from identify interventions that can support their well-being included primary where data were collected and anal- through a systematic review. ysed using objective quantitative, qualitative and mixed methods. We excluded editorials and opinion pieces. Materials and methods We conducted a rapid review in accordance with the WHO Patient and public involvement Rapid Review Guide13 and reported using the Preferred No patient involved. Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA). The review protocol was registered in PROS- Search methods and information sources PERO and is available online (CRD42020189750). We conducted comprehensive literature search strategies in the following electronic databases: MEDLINE (via Ovid), Ethical considerations Embase (via Ovid), CINAHL (via EBSCOhost), PsycINFO This study used secondary data analysis using published (via Ovid) and ERIC (via ProQuest). We developed our research; therefore, it did not require submission to the search strategies via an academic health sciences librarian research ethics committee. with input from the research team. The search was origi- nally built in MEDLINE Ovid and peer-reviewed using the Theoretical model Peer Review of Electronic Search Strategies tool.17 We limited The WHO classified burnout and occupation stress as an our searches to articles published in English no later than 30 14 occupational phenomenon. In this context, we used September 2020. The final search results were exported into Bolman and Deal’s (2017) four-frame model of leader- Covidence, review management software, where duplicates ship to understand the stress and burnout experienced were identified and removed. by women health professionals.15 The four-frame model provides an approach to describe organisational issues Screening process through four perspectives: structural, human resource, To minimise selection bias, we piloted 20 citations against symbolic and political. The structural frame focuses on a priori inclusion and exclusion criteria. After high agree- rules, roles, strategy, policies, technology and work envi- ment was achieved, two reviewers independently screened all ronment. The human resource frame considers indi- citations. Conflicts were resolved by discussion or via a third vidual needs, skills and relationships. The political frame reviewer. The same process was used for full- text screening of examines power, conflict, competition and organisa- potentially eligible studies. tional politics, and the symbolic frame includes culture, meaning, rituals and stories. Rating of the quality of evidence The strength of data and subsequent recommendations for Research questions interventions were graded according to the Quality Rating The following research questions guided the rapid review: Scheme for Studies and Other Evidence by two reviewers http://bmjopen.bmj.com/ what are the triggers of stress and burnout in women in independently, with discrepancies resolved after joint review 18 healthcare? What interventions are effective in preventing and discussion. occupational stress and burnout? Data extraction Eligibility criteria We used a predefined data extraction form to extract data The eligibility criteria are included in table 1. First, we from the papers included in the rapid review. To ensure the were only interested in articles published from December integrity of the assessment, we piloted the data extraction 2019 to 30 September 2020 (the last day of the literature form on three studies. We extracted the following informa- on September 24, 2021 by guest. Protected copyright. search). We chose this timeframe to include research tion from the studies: the first author, year of publication, related to experiences during the COVID-19 pandemic. health professionals enrolled in the study, geographic loca- Our study specifically focused on the experiences of tion, study methods, quality of evidence, triggers of stress and women in healthcare, encompassing a broad array of burnout, interventions and outcomes. health professionals