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Clinician Distress Trajectories When Caring for Seriously Ill Hospitalized Patients: A Mixed-Methods Study
Clinician Distress Trajectories When Caring for Seriously Ill Hospitalized Patients: A Mixed-Methods Study
상세정보
- 자료유형
- 학위논문 서양
- 최종처리일시
- 20250211152133
- ISBN
- 9798384024460
- DDC
- 610.73
- 서명/저자
- Clinician Distress Trajectories When Caring for Seriously Ill Hospitalized Patients: A Mixed-Methods Study
- 발행사항
- [Sl] : University of Pennsylvania, 2024
- 발행사항
- Ann Arbor : ProQuest Dissertations & Theses, 2024
- 형태사항
- 150 p
- 주기사항
- Source: Dissertations Abstracts International, Volume: 86-02, Section: B.
- 주기사항
- Advisor: Ulrich, Connie M.
- 학위논문주기
- Thesis (Ph.D.)--University of Pennsylvania, 2024.
- 초록/해제
- 요약Over 33 million people are hospitalized every year in the US, many of whom are seriously ill and experience substantial distress. Clinicians caring for these complex patients also experience distress while simultaneously juggling competing clinical demands. Clinician distress is underrecognized and rarely identified in real-time, however it may impact serious illness care and patient outcomes. The overall purpose of this prospective cohort study was to describe and identify clinician distress trajectories in general medicine hospital clinicians, i.e. physicians and advanced practice providers (APPs) caring for hospitalized seriously ill patients-defined as patients with a high-risk of short-term mortality-and examine how these trajectories affect palliative care delivery.Manuscript 1 employed dimensional analysis to understand the nature of clinician distress. Manuscripts 2 and 3 used data prospectively collected in 2023 with a total of 184 hospital encounters (clinicians, n=68, matched with seriously ill patients, n=151). In Manuscript 2, longitudinal cluster analysis resulted in four distress typologies: low (n=33), moderate (n=47), high (n=34), and variable (n=28). Clinicians also experience symptoms: fatigue (59.3%), stress (57.4%), worry (47.2%), insomnia (33.3%), anger (13.9%), sadness (9.3%), and pain (4.6%). Univariate logistic regression modeling, APPs were significantly more likely (OR=6.159, p=0.00255) than physicians to be in a higher distress typology. Clinicians with fatigue (OR=3.54, p=0.049), insomnia (OR=5.08, p=0.015), worry (OR=4.65, p=0.009), stress (OR=4.20, p=0.031), sadness (OR=21.0, p=0.018) were more likely in a higher distress typology.Manuscript 3 used qualitative interviews with clinicians (n=25) from each typology to comprehensively understand the experience of distress and integrate data. Qualitative themes of distress experience and sources of distress were compared within and between unique typologies. Mixed analysis confirmed typologies with increasing mean distress thermometer scores and clinician higher emotional symptom burden.Findings advance the understanding of in-the-moment psychological distress for hospital clinicians caring for those with serious illness. Not all clinicians experience distress in the same way; however, findings may help personalize interventions for distress based on the four distinct typologies. Immediate implications for healthcare systems in the current post-pandemic era are to acknowledge and quantify clinician distress, and to develop innovative ways to provide support to distressed clinicians.
- 일반주제명
- Nursing
- 일반주제명
- Mental health
- 일반주제명
- Bioinformatics
- 기타저자
- University of Pennsylvania Nursing
- 기본자료저록
- Dissertations Abstracts International. 86-02B.
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■00520250211152133
■006m o d
■007cr#unu||||||||
■020 ▼a9798384024460
■035 ▼a(MiAaPQ)AAI31483749
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a610.73
■1001 ▼aFoxwell, Anessa M.
■24510▼aClinician Distress Trajectories When Caring for Seriously Ill Hospitalized Patients: A Mixed-Methods Study
■260 ▼a[Sl]▼bUniversity of Pennsylvania▼c2024
■260 1▼aAnn Arbor▼bProQuest Dissertations & Theses▼c2024
■300 ▼a150 p
■500 ▼aSource: Dissertations Abstracts International, Volume: 86-02, Section: B.
■500 ▼aAdvisor: Ulrich, Connie M.
■5021 ▼aThesis (Ph.D.)--University of Pennsylvania, 2024.
■520 ▼aOver 33 million people are hospitalized every year in the US, many of whom are seriously ill and experience substantial distress. Clinicians caring for these complex patients also experience distress while simultaneously juggling competing clinical demands. Clinician distress is underrecognized and rarely identified in real-time, however it may impact serious illness care and patient outcomes. The overall purpose of this prospective cohort study was to describe and identify clinician distress trajectories in general medicine hospital clinicians, i.e. physicians and advanced practice providers (APPs) caring for hospitalized seriously ill patients-defined as patients with a high-risk of short-term mortality-and examine how these trajectories affect palliative care delivery.Manuscript 1 employed dimensional analysis to understand the nature of clinician distress. Manuscripts 2 and 3 used data prospectively collected in 2023 with a total of 184 hospital encounters (clinicians, n=68, matched with seriously ill patients, n=151). In Manuscript 2, longitudinal cluster analysis resulted in four distress typologies: low (n=33), moderate (n=47), high (n=34), and variable (n=28). Clinicians also experience symptoms: fatigue (59.3%), stress (57.4%), worry (47.2%), insomnia (33.3%), anger (13.9%), sadness (9.3%), and pain (4.6%). Univariate logistic regression modeling, APPs were significantly more likely (OR=6.159, p=0.00255) than physicians to be in a higher distress typology. Clinicians with fatigue (OR=3.54, p=0.049), insomnia (OR=5.08, p=0.015), worry (OR=4.65, p=0.009), stress (OR=4.20, p=0.031), sadness (OR=21.0, p=0.018) were more likely in a higher distress typology.Manuscript 3 used qualitative interviews with clinicians (n=25) from each typology to comprehensively understand the experience of distress and integrate data. Qualitative themes of distress experience and sources of distress were compared within and between unique typologies. Mixed analysis confirmed typologies with increasing mean distress thermometer scores and clinician higher emotional symptom burden.Findings advance the understanding of in-the-moment psychological distress for hospital clinicians caring for those with serious illness. Not all clinicians experience distress in the same way; however, findings may help personalize interventions for distress based on the four distinct typologies. Immediate implications for healthcare systems in the current post-pandemic era are to acknowledge and quantify clinician distress, and to develop innovative ways to provide support to distressed clinicians.
■590 ▼aSchool code: 0175.
■650 4▼aNursing
■650 4▼aMental health
■650 4▼aBioinformatics
■653 ▼aAdvanced practice providers
■653 ▼aPalliative care delivery
■653 ▼aClinician distress
■653 ▼aPsychological distress
■653 ▼aHospital clinicians
■690 ▼a0569
■690 ▼a0624
■690 ▼a0347
■690 ▼a0769
■690 ▼a0715
■71020▼aUniversity of Pennsylvania▼bNursing.
■7730 ▼tDissertations Abstracts International▼g86-02B.
■790 ▼a0175
■791 ▼aPh.D.
■792 ▼a2024
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T17163086▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
