Patient Mistakes, Burnout Among Front Line Workers May be Avoided with Inexpensive, Brief Interventions

Nancy Grover

Sarasota, FL ( – Healthcare workers and first responders have been struggling with unprecedented psychological stress during the pandemic, leading to potential clinical practice failures, that may impact patient health and increase burnout. But organizations that employ these workers don’t necessarily need to use expensive, time-consuming solutions. A brief, smartphone intervention may have a major impact, according to a new study.

“Positive emotions (PEs) broadly support physical health and wellbeing, and underlying psychological health and resilience,” wrote the researchers, in the BMJ journal Occupational and Environmental Medicine. “PEs also facilitate complex decision making and interpersonal communication, which are essential in good clinical practice.”

In an effort to increase the positive emotions and decrease the negative emotions among first line workers, medical workers and emergency responders in the Midwest participated in a study during May and June of 2020. They completed interventions one time daily for one week via smartphone application.

The daily interventions lasted for just several minutes each, and included:

  • Expressive writing
  • Adaptive emotion regulation activity
  • Positive emotion-generation activities

“The results indicated a 13% increase in positive emotion, and decrease in negative emotion by 44%” according to the findings. “This investigation suggests both feasibility and efficacy for a brief, daily, ambulatory intervention which could provide essential psychological support to individuals at risk in the workplace.”

The Intervention

Conventional interventions during the pandemic have shown only limited benefit to help front line workers suffering with psychological stress. The researchers looked to other means.

“There has been compelling evidence of the broad benefits of expressive writing for stressed populations to facilitate the review of emotionally evocative experiences in relation to health and occupational functioning,” they wrote. “One mechanism may be the role documentation of stressful experience plays, but also the emotion-regulatory benefit of self-distancing from the evocative elements of experience through shifts in perspective. In addition, positive emotional responses are broadly considered to be the cornerstone of well-being and happiness, and are consistently predictive of psychological health over time … Importantly, there is also evidence that well-being and health can be enhanced and maintained, even in those under significant stress, through brief PE prompts directing people to savour the good (eg, gratitude journaling).”

Twenty-eight participants agreed to be included in the study and downloaded the research application to their smartphones. The three exercises used in the study are based on a combination of existing interventions.

Expressive writing has been shown to provide benefits to workers, especially to facilitate the review of troubling experiences. The researchers, therefore, looked at the role of documenting these incidents, along with self-distancing from the elements of these experiences by shifting the perspective. The first exercise for each participants was to type a narrative of challenges that occurred that day.

Next was to practice adaptive emotional regulation “by revisiting distressing events from a distanced perspective, which constituted an explicit self-distancing activity,” the authors wrote.

Lastly, the participants had to respond to at least one of eight randomized prompts to generate PE. Some of the participants were grouped into a higher dose category and were required to respond to at least two of the prompts.


“Before and after each toolkit session, participants rated intensity of specific negative (disgust, anger, sadness, fear, distress) and PE (happiness, amusement, affection, contentment, relief) words on a 5-point scale (from 1=‘not at all’ to 5=‘extremely’) used commonly in ambulatory research,” the study said. “Initial analyses of within-person average change scores confirmed all participants received benefit.”

The researchers found that the last step — completion of the PE prompts — was key to the overall benefits, especially among those in the higher dose category.

“This novel intervention, tested with experienced medical and emergency personnel during early pandemic months, significantly decreased NE and increased PE after only 3–6min of daily activity,” the authors wrote. “Those randomised to the higher dose and who completed at least two sessions benefited significantly more.”

The small population of participants was admittedly a limitation of the study. However, it shows promise for helping front line workers deal with the stress they experienced during the pandemic and other crises.

“Finally, the online nature of our intervention may also increase its accessibility to other at-risk communities impacted by COVID-19 or in other high-risk contexts,” the study concluded. “Emotional experiences of essential personnel impact their own health as well as patient care. This ambulatory tool may fill a critical need as adjuvant to conventional treatments and institutional support structures for personnel at risk due to occupational stress.”

News brought to you by