Author: Nurul Adnan
Adnan, Nurul, 2024 Development and evaluation of the individualised psychosocial program to improve well-being and mitigate burnout in critical care healthcare professionals: A realist mixed method study, Flinders University, College of Nursing and Health Sciences
Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact copyright@flinders.edu.au with the details.
Background: Critical care healthcare professionals frequently experience high levels of burnout due to the demanding nature of their work. While numerous studies have explored organisational and systemic factors contributing to burnout, the role of individual-level interventions as coping mechanisms remains understudied. This research aims to investigate the effectiveness of individual-level interventions for critical care healthcare professionals' well-being and burnout, employing a realist approach to uncover what interventions work, why, how, and under what conditions.
Methods: An umbrella realist review was initially conducted to explore the existing literature and identify potential program theories. Subsequently, an expert opinion was sought to refine and develop a program theory for a unique individual-level intervention for critical care healthcare professionals. This program theory served as the foundation for a pilot randomised controlled trial (RCT) to assess the feasibility and effectiveness of the consult and problem-solving debrief intervention.
Results: The umbrella realist review highlighted the limited availability of individual -level interventions and the need for tailored approaches to address burnout among critical care healthcare professionals. The expert opinion refined the program theory, which emphasised the importance of personalised consult and problem-solving debriefs in mitigating burnout. The pilot RCT compared the individualised intervention with an active control group that received debrief sessions without the problem-solving approach. The intervention group demonstrated feasibility for recruitment (n=112) and retention for consult (100%) and debrief (93%). Data collection methods, including journal entries (33%), feedback questionnaire (53%), and semi-structured interviews (67%), were completed successfully. The intervention was deemed acceptable based on structural integrity, innovative approach, and implementation. Preliminary efficacy was evident, with significant improvements observed in personal accomplishment (p=.022) and emotional exhaustion (p=.039) post-intervention. Although depersonalization outcomes remained comparable, meaningful improvements were noted over time (p=.015). Significant improvements were also observed for various measures over a longitudinal three-month period.
Conclusion: This research contributed to the understanding of individual-level interventions for critical care healthcare professionals' burnout through a realist lens. The study findings have the potential to inform the development of effective interventions by identifying key elements, contextual factors, and mechanisms for successful implementation. The pilot RCT provided initial insights into the feasibility of the consult and problem-solving debrief as a potential intervention strategy, emphasising the need for further investigation and refinement.
Keywords: Critical Care, Healthcare Professionals, Individual Intervention, Realist Evaluation, Mixed Method
Subject: Health Sciences thesis
Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Nursing and Health Sciences
Supervisor: Professor Diane Chamberlain