Preventive staff-support interventions for health workers.
BACKGROUND
Healthcare workers need to be supported to maintain sufficient levels of motivation and productivity, and to prevent the debilitating effects of stress on mental and physical well-being.


OBJECTIVE
To assess the effects of preventive staff-support interventions to healthcare workers.


METHODS
We searched The Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (and the database of studies awaiting assessment), Biblioweb (searched 28 August 2008); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3) (searched 28 August 2008); MEDLINE, Ovid 1950 to August Week 2 2008 (searched 26 August 2008); CINAHL, Ovid 1982 to August Week 4 2008 (searched 26 August 2008); EMBASE, Ovid 1980 to 2008 Week 34 (searched 26 August 2008); PsycINFO, Ovid 1806 to July Week 5 2008 (searched 27 August 2008); Soc iological Abstracts, CBA 1952 to present (searched 28 August 2008).


METHODS
Randomised controlled trials of interventions to support healthcare workers in coping with work-related stress, preventing burnout and improving job satisfaction, without changing contractual conditions of service or physical work environment. Three types of interventions were included in this review: (1) support groups for staff; (2) training in stress management techniques; and (3) management interventions for supporting staff.


METHODS
Two authors independently performed study selection, quality assessments and data abstraction.


RESULTS
Ten studies involving 716 participants met the criteria for inclusion. None assessed the effects of support groups for health workers. Eight studies assessed the effects of training interventions in various stress management techniques on measures of stress and/or job satisfaction, and two studies assessed the effects of management interventions on stress, job satisfaction and absenteeism.Three studies demonstrated a beneficial effect of stress management training intervention on job stress. Only one of these showed that this effect is sustainable over the medium-term. One study demonstrated the beneficial effect of a high intensity, stress management training intervention on burnout. Low and moderate intensity stress management training interventions failed to demonstrate benefit on burnout or staff satisfaction.Management interventions demonstrated increases in job satisfaction, but failed to show effect on absenteeism.Most studies had several methodological shortcomings leaving them vulnerable to potential biases.


CONCLUSIONS
There is insufficient evidence for the effectiveness of stress management training interventions to reduce job stress and prevent burnout among healthcare workers beyond the intervention period. Low quality evidence suggests that longer-term interventions with refresher or booster sessions may have more sustained positive effect, but this needs to be rigorously evaluated in further trials.Low quality evidence exists to show that management interventions may improve some measures of job satisfaction. However, further trials are needed to assess whether this finding is replicable in other settings. There was insufficient evidence of the benefit of management interventions on staff absenteeism.Rigorous trials are needed to assess the effects of longer-term stress management training and management interventions in primary care and developing country settings.
van Wyk
Brian E
BE
School of Public Health, University of the Western Cape, Modderdam Road, Bellville, South Africa, 7535.
Pillay-Van Wyk
Victoria
V
D000041:Absenteeism; D015982:Bias; D002055:Burnout, Professional / Q000517:prevention & control; D019049:Developed Countries; D006282:Health Personnel; D006801:Humans; D007588:Job Satisfaction; D009740:Nursing Staff; D009784:Occupational Diseases / Q000517:prevention & control* / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological / Q000517:prevention & control*