Impact of a Wellness Leadership Intervention on the Empathy, Burnout, and Resting Heart Rate of Medical Faculty.

Objective: To evaluate the efficacy of a wellness leadership intervention for improving the empathy, burnout, and physiological stress of medical faculty leaders. Participants and Methods: Participants were 49 medical faculty leaders (80% physicians, 20% basic scientists; 67% female). The 6-week course was evaluated with a 15-week longitudinal waitlist-control quasi-experiment from September 1, 2021, through December 20, 2021 (during the COVID-19 pandemic). We analyzed 3 pretest-posttest-posttest and 6 weekly survey measurements of affective empathy and burnout, and mean=85 (SD=31) aggregated daily resting heart rates per participant, using 2-level hierarchical linear modeling. Results: The course found a preventive effect for leaders' burnout escalation. As the control group awaited the course, their empathy decreased (coefficientTime=-1.27; P=.02) and their resting heart rates increased an average of 1.4 beats/min (coefficientTime=0.18; P<.001), reflecting the toll of the pandemic. Intervention group leaders reported no empathy decrements (coefficientTime=.33; P=.59) or escalated resting heart rate (coefficientTime=-0.05; P=.27) during the same period. Dose-response analysis revealed that both groups reduced their self-rated burnout over the 6 weeks of the course (coefficientTime=-0.28; P=.007), and those who attended more of the course showed less heart rate increase (coefficientTime∗Dosage=-0.05; P<.001). In addition, 12.73% of the within-person fluctuation in empathy was associated with burnout and resting heart rate. Conclusion: A wellness leadership intervention helped prevent burnout escalation and empathy decrement in medical faculty leaders during the COVID-19 pandemic, showing potential to improve the supportiveness and psychological safety of the medical training environment.

When to use your head and when to use your heart: the differential value of perspective-taking versus empathy in competitive interactions.

Four studies explored whether perspective-taking and empathy would be differentially effective in mixed-motive competitions depending on whether the critical skills for success were more cognitively or emotionally based. Study 1 demonstrated that individual differences in perspective-taking, but not empathy, predicted increased distributive and integrative performance in a multiple-round war game that required a clear understanding of an opponent's strategic intentions. Conversely, both measures and manipulations of empathy proved more advantageous than perspective-taking in a relationship-based coalition game that required identifying the strength of interpersonal connections (Studies 2-3). Study 4 established a key process: perspective-takers were more accurate in cognitive understanding of others, whereas empathy produced stronger accuracy in emotional understanding. Perspective-taking and empathy were each useful but in different types of competitive, mixed-motive situations-their success depended on the task-competency match. These results demonstrate when to use your head versus your heart to achieve the best outcomes for oneself.

Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes.

AIM: The aim of this study was to examine the influence of empowering work conditions and workplace incivility on nurses' experiences of burnout and important nurse retention factors identified in the literature. BACKGROUND: A major cause of turnover among nurses is related to unsatisfying workplaces. Recently, there have been numerous anecdotal reports of uncivil behaviour in health care settings. METHOD: We examined the impact of workplace empowerment, supervisor and coworker incivility, and burnout on three employee retention outcomes: job satisfaction, organizational commitment, and turnover intentions in a sample of 612 Canadian staff nurses. RESULTS: Hierarchical multiple linear regression analyses revealed that empowerment, workplace incivility, and burnout explained significant variance in all three retention factors: job satisfaction (R(2) = 0.46), organizational commitment (R(2) = 0.29) and turnover intentions (R(2) = 0.28). Empowerment, supervisor incivility, and cynicism most strongly predicted job dissatisfaction and low commitment (P < 0.001), whereas emotional exhaustion, cynicism, and supervisor incivility most strongly predicted turnover intentions. CONCLUSIONS: In our study, nurses' perceptions of empowerment, supervisor incivility, and cynicism were strongly related to job satisfaction, organizational commitment, and turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT: Managerial strategies that empower nurses for professional practice may be helpful in preventing workplace incivility, and ultimately, burnout.

Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates.

OBJECTIVE: To examine the effects of nurse, infant, and organizational factors on delivery of collaborative and evidence-based pain care by nurses. DESIGN: Cross sectional. SETTING: Two Level III neonatal intensive care units in 2 large tertiary care centers in Canada. PARTICIPANTS: A convenience sample of 93 nurses completed survey data on procedures they performed on ill neonates. The 93 nurses performed a total of 170 pain producing procedures on 2 different shifts. MAIN OUTCOME: Nurse use of evidence-based protocols to manage procedure related pain using a scorecard of nurses' assessment, management, and documentation. RESULTS: Procedural pain care was more likely to meet evidence-based criteria when nurse participants rated nurse-physician collaboration higher (odds ratio, 1.44; 95% confidence intervals 1.05-1.98), cared for higher care intensity infants (odds ratio, 1.21; 95% confidence intervals, 1.06-1.39), and experienced unexpected increases in work assignments (odds ratio, 1.55; 95% confidence intervals, 1.04-2.30). Nurses' knowledge about the protocols, educational preparation and experience were not significant predictors of evidence-based care for the most common procedures: heel lance and intravenous initiation. CONCLUSION: Nurse-physician collaboration and nurses' work assignments were more predictive of evidence-based care than infant and nurse factors. Nurses' knowledge regarding evidence-based care was not a predictor of implementation of protocols. In the final statistical modeling, collaboration with physicians, a variable amenable to intervention and further study, emerged as a strong predictor. The results highlight the complex issue of translating knowledge to practice, however, specific findings related to pain assessment and collaboration provide some direction for future practice and research initiatives.

Advancing measurement of patient safety culture.

OBJECTIVE: To examine the psychometric and unit of analysis/strength of culture issues in patient safety culture (PSC) measurement. DATA SOURCE: Two cross-sectional surveys of health care staff in 10 Canadian health care organizations totaling 11,586 respondents. STUDY DESIGN: A cross-validation study of a measure of PSC using survey data gathered using the Modified Stanford PSC survey (MSI-2005 and MSI-2006); a within-group agreement analysis of MSI-2006 data. Extraction Methods. Exploratory factor analyses (EFA) of the MSI-05 survey data and confirmatory factor analysis (CFA) of the MSI-06 survey data; Rwg coefficients of homogeneity were calculated for 37 units and six organizations in the MSI-06 data set to examine within-group agreement. PRINCIPAL FINDINGS: The CFA did not yield acceptable levels of fit. EFA and reliability analysis of MSI-06 data suggest two reliable dimensions of PSC: Organization leadership for safety (alpha=0.88) and Unit leadership for safety (alpha=0.81). Within-group agreement analysis shows stronger within-unit agreement than within-organization agreement on assessed PSC dimensions. CONCLUSIONS: The field of PSC measurement has not been able to meet strict requirements for sound measurement using conventional approaches of CFA. Additional work is needed to identify and soundly measure key dimensions of PSC. The field would also benefit from further attention to strength of culture/unit of analysis issues.

Why it pays to get inside the head of your opponent: the differential effects of perspective taking and empathy in negotiations.

The current research explored whether two related yet distinct social competencies -- perspective taking (the cognitive capacity to consider the world from another individual's viewpoint) and empathy (the ability to connect emotionally with another individual) -- have differential effects in negotiations. Across three studies, using both individual difference measures and experimental manipulations, we found that perspective taking increased individuals' ability to discover hidden agreements and to both create and claim resources at the bargaining table. However, empathy did not prove nearly as advantageous and at times was detrimental to discovering a possible deal and achieving individual profit. These results held regardless of whether the interaction was a negotiation in which a prima facie solution was not possible or a multiple-issue negotiation that required discovering mutually beneficial trade-offs. Although empathy is an essential tool in many aspects of social life, perspective taking appears to be a particularly critical ability in negotiations.

Do on-site patient satisfaction surveys bias results?

BACKGROUND: Response rates, patient sample characteristics, and patient satisfaction ratings were compared between two surveying methods: (1) surveys completed at the physician office site (on-site surveying), and (2) surveys mailed to patient homes following the encounter (mail-out/mail-back). METHODS: Surveying was completed at three physician practices within a 214-physician medical practice. Patients with physician appointments during four-hour time blocks were randomly split to receive either on-site or mail-based satisfaction surveys. RESULTS: Participants younger than 45 years of age provided much higher satisfaction ratings on site than they did by mail (p < .0001), and participants older than 45 years of age reported satisfaction levels consistently whether on site or by mail. Both age groups reported higher satisfaction with "people aspects" of care on site than they did by mail (p < .001). DISCUSSION: On-site methods may yield satisfaction results that are biased in a positive direction for younger patients and for all patients in which social desirability pressures are prominent. Therefore, organizations that rely on such information may have an inflated view of the patient's satisfaction with their care delivery experience. Secondly, because the differences in ratings are the greatest for the "people aspects" of care, if improvement efforts are prioritized on the basis of these rapid results, the wrong priorities may be set.