Presentation
HE12 - Examining Stressors and Coping Strategies Among ICU Residents: A Mixed-Method Work System Analysis
SessionPoster Session 2
DescriptionIntroduction
Residents in the intensive care unit (ICU) a known to experience stress due to the demanding work environment, challenging residency program, and stage of their life. Inadequate coping mechanisms and high stress levels are associated with decreased medical performance which could have negative consequences for the resident’s mental health and their care provision, and subsequently patient safety. To prioritize and improve their well-being and performance, it is important to understand what work stressors contribute to their stress levels and how they cope with stressful situations to manage their stress levels.
The objective of this mixed-methods study is to 1) evaluate the level of stress of residents in the ICU related to work stressors; 2) identify stressful situations from the perspectives of residents; 3) identify coping mechanisms used by residents. In this research we place the findings of each of these objectives in the context of the work system of the ICU to create actionable insights for work system improvement.
Methods
This research utilizes secondary data from the “TILES-19” dataset, which includes behavioral, physiological, and psychological information about medical residents working in an ICU, collected between November 2019 and April 2020. The study took place at the Los Angeles County and University of Southern California Medical Center, with 57 medical residents participating. The residents represented varying demographics, including gender, race, program type, and year of residency.
The study collected daily and weekly stress levels using surveys. Daily stress levels were rated on a scale from 1 (not stressed) to 7 (a great deal of stress) via end-of-day surveys, completed by 55 residents. Weekly stress levels, assessed by end-of-week surveys, measured specific work-related stressors such as difficult patient interactions, conflicts with coworkers, and patient deaths. Thirty-six residents completed at least one weekly survey. Post-study interviews were conducted with all 57 residents, lasting 15–20 minutes, focusing on how they managed stressful situations in the ICU.
Stress levels were analyzed by calculating averages and standard deviations for each survey question, classifying stress into low (<3), moderate (3-5), and high (>5). Interview responses were transcribed, coded, and categorized by themes, separating stressful situations from coping strategies.
The SEIPS 2.0 model (Systems Engineering Initiative for Patient Safety) was used to analyze the work system and identify the stressors and coping mechanisms. The model examines how five factors—person, organization, tools and technology, tasks, and environment—interact in healthcare settings to influence outcomes. This framework allowed for a comprehensive understanding of how the work system contributed to stress and shaped coping strategies.
Results
Among the 57 respondents, 34 are male (60%), 23 are Female (40%). 32 are Asian American (32.56%), 16 White (16.28%), 3 Latino/a (5%), 1 Multi-ethnic (2%), 1 other (2%), 3 preferred not to answer (5%). They were categorized by program: 45 Internal Medicine (79%), 19 Emergency medicine (18%), and 2 Internal Medicine-Pediatrics (3%). The years of residency were 19 Year 1 (33%), 22 Year 2 (39%), and 16 Year 3 (28%)
Among the 55 residents, the average daily stress level was 3.293 out of 7 (SD: 1.085), indicating moderate stress levels. The three highest average weekly stressors are “difficult patient cases” (X: 4.398, SD: 1.639), “too many patients to care for” (X: 4.167, SD: 2.045), and “patient death” (X: 3.922, SD: 1.904), which are considered moderate stress levels (3-5) and these three stressors are categorized as the work system factor “tasks”. The three lowest stressors are “Was paged into work to provide emergency medical care” (X: 1.972, SD: 1.678), “Had to supervise more junior residents or staff” (X: 2.453, SD: 1.300), and “conflict with co-workers” (X: 2.889, SD: 1.868), which considered low-stress levels (<3) and each of these stressors were categorized as the work system factor “organization”. For the quantitative work stressors only three of the five work system factors were identified, i.e., “tasks”, “tools and technologies”, and “organization”.
The qualitative results reveal that the most mentioned stressful situations among to the 57 residents are related to the theme workload, like very sick patients (n= 14, “Tasks”), coded patients (n= 13, “Tasks”), and a high census (n= 5, “Tasks”). The other discovered themes are, team, difficult task, clerical, covid and other. Within these themes the relatively frequently mentioned stressful situation codes are difficult interactions with family (n=5, “Tasks”), conflict at work (n=6, “Organization”), and COVID-19 (n=5, “External environment”). Six themes are discovered for the coping mechanisms: sought emotional support, asked for help, humor, prepared and persisted, processed alone, and other. Within these themes for most frequently mentioned codes are debriefing at work (n=17, “Organization”), asking for advice (n-11, “Organization”), and team support (n=8, “Organization”).
Conclusion
The highest occupational stress levels of residents in the ICU were identified to be related to their occupational tasks, like difficult patient cases, a high workload, and patient death. Similarly, the most stressful situations described were complex patient cases, and patients that coded. Although most of the stress is attributed by their occupational tasks, we find that residents mostly use strategies for coping with stressful situations within their organization, for example, debriefing with people at work, asking others for help, and feeling support from their team. These findings provide insights into the contributors of occupational stress and opportunities for mitigating stressful situations by supporting residents by alleviating stress or providing a supportive work environment that enhances coping strategies for residents. Organizations could leverage these insights to refine the work system of the ICU and create interventions supporting workforce resilience.
Residents in the intensive care unit (ICU) a known to experience stress due to the demanding work environment, challenging residency program, and stage of their life. Inadequate coping mechanisms and high stress levels are associated with decreased medical performance which could have negative consequences for the resident’s mental health and their care provision, and subsequently patient safety. To prioritize and improve their well-being and performance, it is important to understand what work stressors contribute to their stress levels and how they cope with stressful situations to manage their stress levels.
The objective of this mixed-methods study is to 1) evaluate the level of stress of residents in the ICU related to work stressors; 2) identify stressful situations from the perspectives of residents; 3) identify coping mechanisms used by residents. In this research we place the findings of each of these objectives in the context of the work system of the ICU to create actionable insights for work system improvement.
Methods
This research utilizes secondary data from the “TILES-19” dataset, which includes behavioral, physiological, and psychological information about medical residents working in an ICU, collected between November 2019 and April 2020. The study took place at the Los Angeles County and University of Southern California Medical Center, with 57 medical residents participating. The residents represented varying demographics, including gender, race, program type, and year of residency.
The study collected daily and weekly stress levels using surveys. Daily stress levels were rated on a scale from 1 (not stressed) to 7 (a great deal of stress) via end-of-day surveys, completed by 55 residents. Weekly stress levels, assessed by end-of-week surveys, measured specific work-related stressors such as difficult patient interactions, conflicts with coworkers, and patient deaths. Thirty-six residents completed at least one weekly survey. Post-study interviews were conducted with all 57 residents, lasting 15–20 minutes, focusing on how they managed stressful situations in the ICU.
Stress levels were analyzed by calculating averages and standard deviations for each survey question, classifying stress into low (<3), moderate (3-5), and high (>5). Interview responses were transcribed, coded, and categorized by themes, separating stressful situations from coping strategies.
The SEIPS 2.0 model (Systems Engineering Initiative for Patient Safety) was used to analyze the work system and identify the stressors and coping mechanisms. The model examines how five factors—person, organization, tools and technology, tasks, and environment—interact in healthcare settings to influence outcomes. This framework allowed for a comprehensive understanding of how the work system contributed to stress and shaped coping strategies.
Results
Among the 57 respondents, 34 are male (60%), 23 are Female (40%). 32 are Asian American (32.56%), 16 White (16.28%), 3 Latino/a (5%), 1 Multi-ethnic (2%), 1 other (2%), 3 preferred not to answer (5%). They were categorized by program: 45 Internal Medicine (79%), 19 Emergency medicine (18%), and 2 Internal Medicine-Pediatrics (3%). The years of residency were 19 Year 1 (33%), 22 Year 2 (39%), and 16 Year 3 (28%)
Among the 55 residents, the average daily stress level was 3.293 out of 7 (SD: 1.085), indicating moderate stress levels. The three highest average weekly stressors are “difficult patient cases” (X: 4.398, SD: 1.639), “too many patients to care for” (X: 4.167, SD: 2.045), and “patient death” (X: 3.922, SD: 1.904), which are considered moderate stress levels (3-5) and these three stressors are categorized as the work system factor “tasks”. The three lowest stressors are “Was paged into work to provide emergency medical care” (X: 1.972, SD: 1.678), “Had to supervise more junior residents or staff” (X: 2.453, SD: 1.300), and “conflict with co-workers” (X: 2.889, SD: 1.868), which considered low-stress levels (<3) and each of these stressors were categorized as the work system factor “organization”. For the quantitative work stressors only three of the five work system factors were identified, i.e., “tasks”, “tools and technologies”, and “organization”.
The qualitative results reveal that the most mentioned stressful situations among to the 57 residents are related to the theme workload, like very sick patients (n= 14, “Tasks”), coded patients (n= 13, “Tasks”), and a high census (n= 5, “Tasks”). The other discovered themes are, team, difficult task, clerical, covid and other. Within these themes the relatively frequently mentioned stressful situation codes are difficult interactions with family (n=5, “Tasks”), conflict at work (n=6, “Organization”), and COVID-19 (n=5, “External environment”). Six themes are discovered for the coping mechanisms: sought emotional support, asked for help, humor, prepared and persisted, processed alone, and other. Within these themes for most frequently mentioned codes are debriefing at work (n=17, “Organization”), asking for advice (n-11, “Organization”), and team support (n=8, “Organization”).
Conclusion
The highest occupational stress levels of residents in the ICU were identified to be related to their occupational tasks, like difficult patient cases, a high workload, and patient death. Similarly, the most stressful situations described were complex patient cases, and patients that coded. Although most of the stress is attributed by their occupational tasks, we find that residents mostly use strategies for coping with stressful situations within their organization, for example, debriefing with people at work, asking others for help, and feeling support from their team. These findings provide insights into the contributors of occupational stress and opportunities for mitigating stressful situations by supporting residents by alleviating stress or providing a supportive work environment that enhances coping strategies for residents. Organizations could leverage these insights to refine the work system of the ICU and create interventions supporting workforce resilience.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer