Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Cochrane Work has produced many systematic reviews of interventions that might help workers stay safe in the workplace. In this podcast, Roos Schelvis, senior researcher in mental health and work and Sietske Tamminga, assistant professor, both from Amsterdam University Medical Center in the Netherlands discuss the May 2023 update of one of these, which looks at the effects of individual-level stress interventions for healthcare workers.

Sietske: Hi Roos, first of all, could you tell us a little about stress in healthcare workers?

Roos: Thanks, Sietske. Yes I can healthcare workers often deal with stressful and emotional situations when they are providing patient care, as well as the high work demands and long hours that come with working in the healthcare institutions. So if stressful situations persist for an extended period of time and the worker is unable to recover properly, then stress symptoms might develop. And these symptoms can be either physical such as headache, back ache, muscle tension or pain; but they can as well be mental like impaired concentration.We also see stress resulting in behavioural problems like coming more into conflict with other people such as your colleagues and lastly we also see emotional symptoms of stress of consequences of stress like feeling unstable for example.

Sietske: This sound serious. Does this cause particular challenges for healthcare?

Roos: Well yes, we think it does actually. Because healthcare workers already experience higher levels of stress compared to the rest of the working population, and this makes it particularly harmful for them. On top of this, there is also already a shortage of healthcare workers due to high turnover rates, and effective prevention of stress may help to reduce this.

Sietske: So, how might we help these healthcare workers?

Roos: We can do a range of things actually, we can either change things in the organisation that healthcare workers work for to prevent stressful situations as much as possible, or we can change the individual's working situation or we can change the way individuals themselves deal with the stress that is there.
And in our review, we looked at interventions where participating individuals were supported in making changes in their work. We excluded programs where the work itself was changed or were organizational level changes were made . And the interventions we did study, we divided them into: 
- Firstly, interventions that focus one's attention on the experience of stress like stressful thoughts, stressful feelings, stressful behaviours) 
- And secondly, interventions that focus one's attention away from the experience of stress by means of what we call psychological disengagement 

Sietske: So if I understood correctly, Yoga would be an intervention that focus one's attention away from the experience of stress? 

Roos: Exactly, like just like doing sports for example that would also do the trick.

Sietske: Okay, sowhat was the evidence?

Roos: We found 117 studies involving nearly 11,000 healthcare workers across almost all continents . And in these studies there was always  an individual-level stress reduction intervention compared to either no intervention, or compared to no stress reduction intervention.

Sietske: Wow that's a lot. And, what do these studies tell us?

Roos: Well, we found – and that is the good news I think – we found that healthcare workers may be able to reduce their stress by means of these types of interventions such as cognitive behaviour training, or exercising or listening to music. And the interesting thing was that focusing on the experience of stress or away from it was both effective.

Sietske: That sounds like it doesn't really matter what you do as long as you do something.

Roos: Yeah, and I think it is important that employers provide employees with a broad range of options so that you can choose something that really suit you or that suits your needs so to say because these interventions may help the healthcare workers themselves and these benefits of course may spill over to patients they care for, and the organisations they work for.

Sietske: Okay so overall, what's your take-home message?

Roos: Well in general, employers I would say they should not hesitate to facilitate a range of stress reduction interventions for their employees because they work and this might bring important benefits in healthcare. And for my Academic colleagues I would say that we should also focus on studying the long term effect of stress management interventions  because these still remain unknown. And secondly, and a larger effect for more health care workers might be expected if psychosocial working conditions are improved and one can do so by  organizational level interventions, policies for example.

Sietske: So in research, we should study also the long term effects of these interventions on an individual level and we should also focus on organisational level interventions?

Roos: Yes, correctly and this might be more challenging or difficult but that's what we are in science for.

Sietske: Thanks very much. If people would like to read the review or a summary, how can they get hold of it?

Roos: It's available online – you can go to Cochrane Library dot com and type 'stress prevention healthcare' in the search box. And You'll see our review at the top of the list.

Sietske: thank you.