Burnout in psychiatric nursing

Burnout in the intensive care unit professionals

BACKGROUND

Professional burnout has been widely explored in health care. We conducted this study in our hospital intensive care unit (ICU) in United States to explore the burnout among nurses and respiratory therapists (RT).

MATERIALS AND METHODS

A survey consisting of two parts was used to assess burnout. Part 1 addressed the demographic information and work hours. Part 2 addressed the Maslach Burnout Inventory-Human Service Survey.

RESULTS

The analysis included 213 total subjects; Nurses 151 (71%) and RT 62 (29%). On the emotional exhaustion (EE) scale, 54% scored "Moderate" to "High" and 40% scored "Moderate" to "High" on the depersonalization (DP) scale. Notably 40.6% scored "Low" on personal accomplishment (PA) scale.

CONCLUSION

High level of EE, DP and lower PAs were seen among two groups of health care providers in the ICUs.

Self-Esteem, Job Satisfaction and Burnout between General and Psychiatric Nursing Staff

The purpose of this study was to compare self-esteem, job-satisfaction and burnout between psychiatric and general nurses as well as to determine how these three elements are interrelated to each other. Like other professionals, nurses are also at risk of developing problems like professional burnout and a sense of dissatisfaction regarding their jobs. Causal factors of burnout among professionals are multi-factorial, starting from socio-demographic and occupational background to one’s personality characteristics. In this study, 30 psychiatric nurses and 30 general nurses were selected through a purposive sampling method. This was a one-time cross-sectional hospital-based study, data was collected during the period September, 2008 to November, 2008 and written consent was taken from the subjects. Statistical measures like descriptive statistics, Chi-square test, t-test and Pearson’s correlation-coefficient were used to analyze the data. In this study psychiatric nurses had been found to have higher level of self-esteem than general nurses. Nurses working in a general hospital had been observed to have a higher level of burnout and lower job satisfaction than psychiatric nurses.

Work-related behaviour and experience patterns of nurses in different professional stages and settings compared to physicians in Germany

Working in a health-care profession is correlated with high levels of stress and potential burnout that are likely to increase over time. Few studies differentiate psychosocial stress between nurses in different clinical settings or professional stages. In this cross-sectional study, we compared the work-related behaviour and experience of nurses (n=389) and physicians (n=344) and of nurses across different career stages and clinical settings in Germany. Nurses had the lowest proportion of a healthy behaviour and experience pattern (11.6%) compared with student nurses (32.6%), senior nurses (25%), and physicians (16.7%). They also had the highest proportion of a burnout-related behaviour and experience pattern (32.8% vs 26.1% of student nurses, 18.3% of senior nurses, and 27.3% of physicians). In comparison with medical nurses, psychiatric nurses presented a significantly (P<0.01) lower proportion with a healthy (10.6% vs 21.8%) and burnout-related behaviour pattern (23.5% vs 29.6%), and a higher proportion showing a low commitment to work (61.4% vs 34.4%). Differences in health-related dimensions were primarily observed in the domains of professional commitment and stress resistance. The observed differences in behaviour and experience patterns as a function of health-care settings and career stages emphasize the need for specific interventions.

Psychiatric nursing as 'different' care: experience of Iranian mental health nurses in inpatient psychiatric wards

Patients with mental illness require unique and specific care. The purpose of this study was to explore the experiences of nurses, who provide such care for mentally ill people, within the context of Iranian culture. This hermeneutic phenomenological study was carried out in a university-affiliated hospital in an urban area of Iran. We interviewed 10 mental health nurses to capture in detail their experiences in psychiatric units, and the approach developed by Diekelmann et al. was employed to analyse the data. Four themes and five sub-themes were identified: 'being engaged with patients' (sub-themes: 'struggle for monitor/control', 'safety/security concerns', 'supporting physiological and emotional needs'), 'being competent', 'altruistic care' and 'facing difficulties and challenges' (sub-themes: 'socio-cultural' and 'organizational challenges'). The results provide valuable insights and greater understanding of the professional experiences of psychiatric nurses in Iran, and indicate the need for a stable and responsible organizational structure for those nurses who are expected to manage patient care in psychiatric wards.

Staff engagement as a target for managing work environments in psychiatric hospitals: implications for workforce stability and quality of care

AIMS AND OBJECTIVES

To examine relationships between practice environment ratings, workload, work engagement, job outcomes and assessments of quality of care in nursing personnel in psychiatric hospitals.

DESIGN

Cross-sectional survey.

BACKGROUND

A broad base of research studies in health care reveals important links between work environment factors, staff burnout and organisational outcomes that merit examination in inpatient mental healthcare settings. Work engagement, a positively framed parallel construct for burnout, may offer an additional insight into the impacts of work on staff.

METHODS

A sample of 357 registered nurses (65·5%), licensed practical nurses (23·5%) and non-registered caregiver (10·6%) of two Belgian psychiatric hospitals were surveyed. A causal model was tested using structural equation modelling, whereby it was proposed that work engagement would be influenced by work environment factors and itself impact perceived quality of care and staff job outcomes such as job satisfaction and turnover intentions.

RESULTS

An adjusted model was confirmed. Practice environment features influenced staff vigour and dedication and demonstrated positive effects on job satisfaction, turnover intentions and perceived quality of care through their effects on absorption.

CONCLUSION

The findings of this study suggest that work engagement is a likely direct consequence of practice environments that may ultimately have impacts on both staff and patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Leaders, nurse managers, clinicians as well as nurses themselves should be aware of the importance of work environments in mental healthcare facilities that favour engagement. Future efforts should focus on developing and sustaining practice environments that engage mental healthcare workers within interdisciplinary teams with the goal of creating a stable workforce possessing optimal possible knowledge, skills and abilities for delivering care.

Emotional intelligence as a moderator in the stress-burnout relationship: a questionnaire study on nurses

AIMS AND OBJECTIVES

To investigate inter-relationships between emotional intelligence (EI), work stress and burnout in a group of nurses in the Western Cape Province, South Africa. The moderating effect of EI in the stress-burnout relationship and group differences (nurses working in different wards) in burnout were also investigated.

BACKGROUND

Stress and subsequent burnout commonly threaten the occupational health and well-being of nurses in South Africa and elsewhere. Developing EI in nurses may increase individual stress resistance and combat burnout.

DESIGN

A cross-sectional research design with anonymous questionnaires was conducted. Self-report data were used.

METHODS

Survey data were collected from 122 nurses working in different wards at four hospitals from a private hospital group. The Swinburne University Emotional Intelligence Test, Sources of Work Stress Inventory and Maslach Burnout Inventory were used to measure EI, stress and burnout, respectively.

RESULTS

Consistent inverse relationships between emotional control and management as dimensions of EI, and stress and burnout emerged. A differential effect of high vs. low EI on the stress-burnout relationship was evident. Workload and the work/family interface emerged as significant predictors of burnout. Respondents working in maternity, paediatric and ER wards reported more feelings of personal accomplishment than those working in general wards.

CONCLUSIONS

Higher EI is significantly related with lower stress and burnout in a sample of South African nurses. The moderator effect of EI in the stress-burnout relationship suggests that enhanced EI may help diminish burnout development when chronic stress is experienced.

RELEVANCE TO CLINICAL PRACTICE

EI developmental interventions, if introduced in nursing curricula, may increase emotional coping resources and enhanced social skills, which may benefit the long-term occupational health of nurses. This may be relevant in developing countries, where environmental stressors related to the organisational context (budget constraints) and wider social factors (shortage of qualified nurses) are difficult to address.

Facing the challenges and building solutions in clinical psychiatric nursing in Iran: a qualitative study

Psychiatric nurses play an important role in the process of caring for mentally ill patients and are continually faced with the numerous challenges and complex issues related to this field. This study aimed to understand the perspectives of psychiatric nurses regarding the issues they face while providing care and examine the possible solutions for improvement of inpatient care in clinical settings. The study adopted a qualitative approach that utilized a content analysis of audio taped, semi-structured interviews that had been conducted with 24 nurses. Two main themes emerged from the data. The first, Challenges in Providing Care within Psychiatric Wards, had the following subthemes: Politics and Rules of Organization, Safety and Security Issues, Uncertainty about the Role, Lack of Trained Staff, and Sociocultural Issues. The second theme, Solutions for Improving Psychiatric Care, had the subthemes of Empowerment across four domains: Psychiatric Nurses, Mentally Ill Patients and their Families, The Psychiatric Mental Health System, and the Cultural Context. The results indicated that if nurses are expected to provide optimal nursing care within a psychiatric ward, then there is a need for a stable and responsible organizational structure, skilled psychiatric nurses, and community-based care along with an anti-stigma program.

Burnout of registered nurses in South Africa

AIM

The aims of this study were to validate the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) for registered nurses in South Africa and to analyse the differences between the levels of burnout of different biographical groups.

BACKGROUND

The nursing profession is seen as a stressful and emotionally demanding profession, which makes nurses susceptible to burnout.

METHOD

A cross-sectional survey design with a stratified random sample (n = 818) was used. The MBI-HSS and a biographical questionnaire were administered.

RESULTS

Exploratory factor analysis resulted in a three-factor structure of burnout, consisting of emotional exhaustion, depersonalization and personal accomplishment. Construct equivalence and reliability of the three factors were confirmed. Significant differences were found in burnout levels with regard to language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

CONCLUSIONS

The MBI-HSS showed acceptable validity and reliability for South African nurses. Burnout is associated with specific factors, including language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of the MBI-HSS is recommended to assess burnout of nurses in South Africa. Organisations employing nurses should intervene to prevent and/or manage burnout.

Secondary traumatic stress and associated factors among Japanese nurses working in hospitals

Nurses can experience secondary traumatic events while caring for patients. However, the severity of this issue is underestimated in Japan. To evaluate the prevalence and factors associated with secondary traumatic stress among general hospital nurses, we carried out a cross-sectional study at a general hospital in August 2006. The rate of experiencing secondary trauma was 90.3% (159 of 176 nurses; 52.1% response rate). The median score of the Impact of Event Scale-Revised was 4.0 (range, 0-56). In multiple regression analyses, variables correlated with the Impact of Event Scale included neuroticism, trauma severity and feelings of self-reproach. It is necessary to develop support systems for nurses at risk for secondary traumatic stress.

The relationship between psychosocial job stress and burnout in emergency departments: an exploratory study

BACKGROUND

The purpose of this study was to examine the relationship and predictive power of various psychosocial job stressors for the 3 dimensions of burnout in emergency departments.

METHODS

This study was structured as a cross-sectional design, with a questionnaire as the tool. The data were gathered using an anonymous questionnaire in 3 hospitals in Spain. The sample consisted of 191 emergency departments. Burnout was evaluated by the Maslach Burnout Inventory and the job stressors by the Nursing Stress Scale.

FINDINGS

The Burnout Model in this study consisted of 3 dimensions: emotional exhaustion, cynicism, and reduced professional efficacy. The model that predicted the emotional exhaustion dimension was formed by 2 variables: Excessive workload and lack of emotional support. These 2 variables explained 19.4% of variance in emotional exhaustion. Cynicism had 4 predictors that explained 25.8% of variance: Interpersonal conflicts, lack of social support, excessive workload, and type of contract. Finally, variability in reduced professional efficacy was predicted by 3 variables: Interpersonal conflicts, lack of social support, and the type of shift worked, which explained 10.4% of variance.

DISCUSSION

From the point of view of nurse leaders, organizational interventions, and the management of human resources, this analysis of the principal causes of burnout is particularly useful to select, prioritize, and implement preventive measures that will improve the quality of care offered to patients and the well-being of personnel.

Investigating the impact of psychosocial risks and occupational stress on psychiatric hospital nurses' mental well-being in Japan

A cross-sectional survey was conducted, with the aim to examine what stressors in the workplace and demographic factors were associated with signs and symptoms of poor well-being among psychiatric nurses. A structured questionnaire was distributed to nurses within six psychiatric hospitals in Japan. Information was collected on demographic information, work characteristics and two dimensions of well-being: feeling uptight and emotional exhaustion. Three hundred and sixty-one questionnaires were completed by participants. High rates of emotional exhaustion in psychiatric nurses were found to be predicted by young age, high psychological demands paired with low social support in the workplace, job strain (a proxy to occupational stress) and job strain paired with low social support. In addition, high rates of being tense/uptight were associated with high psychological job demand, low psychological job control, low social support in the workplace, high job strain and high job strain paired with low social support. The current study has found evidence of significant relationships between demographic factors and several work and organizational stressors and poor mental health among Japanese psychiatric nurses.

Development of the Psychiatric Nurse Job Stressor Scale (PNJSS)

AIMS

The aim of the present study was to develop a tool, the Psychiatric Nurse Job Stressor Scale (PNJSS), for measuring the stress of psychiatric nurses, and to evaluate the reliability and validity of the PNJSS.

METHODS

A total of 302 psychiatric nurses completed all the questions in an early version of the PNJSS, which was composed of 63 items and is based on past literature of psychiatric nurses' stress.

RESULTS

A total of 22 items from four factors, 'Psychiatric Nursing Ability', 'Attitude of Patients', 'Attitude Toward Nursing' and 'Communication', were extracted in exploratory factor analysis. With regard to scale reliability, the item-scale correlation coefficient was r = 0.265-0.570 (P < 0.01), the Cronbach alpha coefficient was 0.675-0.869, and the test-retest correlation coefficient was r = 0.439-0.771 (P < 0.01). With regard to scale validity, the convergent validity of the 'job stressor' scale was r = 0.172-0.420 (P < 0.01), and the predictive validity of the 'job reaction' scale was r = 0.201-0.453 (P < 0.01). The compatibility of the factor model to the data was 1.750 (χ(2) /d.f., 343.189/196, P < 0.01), the goodness of fit index was 0.910, the adjusted goodness of fit index was 0.883, the comparative fit index was 0.924, and the root mean square error of approximation was 0.050.

CONCLUSIONS

The PNJSS has sufficient reliability and validity as a four-factor structure containing 22 items, and is valid as a tool for evaluating psychiatric nurse job stressors.

Psychosocial work environment and prediction of job satisfaction among Swedish registered nurses and physicians - a follow-up study

In Sweden, the health care sector was subject to considerable changes during the 1990s: decreased costs, related staff redundancies and high rates of sick leave. The situation has now changed, and the sector is not facing the same all-embracing and turbulent changes. In addition, there is a shortage of nurses and physicians and a difficulty in retaining qualified staff. Regarding the psychosocial work environment, there is a lack of studies where both physicians and nurses are in focus. It is from a managerial perspective important to take a holistic approach towards questions regarding the work environment in general and the psychosocial work environment in particular. The aims of this study were to analyse similarities and differences in Registered Nurses and physicians' experience of quantitative and qualitative demands, control, role conflicts, role clarity, social support and job satisfaction in 2002 and 2009 and to analyse the stability in the prediction of job satisfaction over time. Questionnaires regarding psychosocial work environment aspects were distributed in 2002 and 2009, and a total of 860 nurses and 866 physicians answered the questionnaire. Independent t tests and linear stepwise regression analyses were conducted. The results indicate that the work environment has improved between 2002 and 2009 and that nurses experience their psychosocial working environment as more satisfactory than physicians. Social support, control, role conflicts, role clarity and qualitative demands were the best predictors of job satisfaction in 2002 and 2009. Quantitative demands did not contribute to predicting job satisfaction. Variables predicting job satisfaction are quite stable over time and are quite comparable for both nurses and physicians.

Mental health nursing in Jordan: an investigation into experience, work stress and organizational support

Changes in mental health services have an impact on the role and practice of mental health nurses. The purpose of this study was to examine Jordanian mental health nurses' experiences of providing mental health care, their work-related stress, and organizational support received. A descriptive correlation design was used. Data were collected using self-report questionnaires from 92 mental health nurses in Jordan. The result of this study revealed that mental health nurses shared a high level of agreement on the importance of most nursing tasks. Mental health nurses reported a moderate level of stress, with a lack of resources and relationship and conflict with other professionals being the most frequent stressors. Nurses perceived a low level of support for their work from their supervisors. Work stress and conflict with other professionals had a significant, negative correlation with the perception the nurses had of their immediate supervisors (r = -0.29, P < 0.001; r = -0.31, P < 0.001). There was no significant correlation between work stress, organizational support, and the nurses' age, sex, or level of education. This study has clinical implications in terms of developing strategies for reducing stress and improving organizational support among mental health nurses, and it should help in future research.

The Impact of Burnout on the Intention to Quit among Professional Nurses in the Free State Region — a National Crisis?

Thousands of qualified nurses leave the South African health sector on an annual basis owing to various reasons, including burnout. Research showed that demanding work circumstances could influence employees to consider whether to leave an organisation or not. The aim of this study was to determine the level of burnout among professional nurses and to explore the potential impact of burnout on the intention to quit/change. The sample consisted of 563 professional nurses representing 140 clinics located in five health districts in the Free State region. A total of 542 (97%) questionnaires were completed and returned. Participants in the study were predominantly black (83.8%), female (89.3%), day-shift working (89.8%) and full-time employed (99.8%). The measuring tools included a biographical questionnaire, Maslach's Burnout Inventory to determine the level of burnout of professional nurses, and an Intention to Quit/Change questionnaire. Analysis of variance was used to determine differences regarding burnout between different groups with varying degrees of intention to quit/change. Respondents exhibited high levels of Emotional Exhaustion, Depersonalization and average levels of Personal Accomplishment. Respondents with the highest levels of Emotional Exhaustion and Depersonalization and the lowest levels of Personal Accomplishment displayed a higher degree of intention to quit/change.

Burnout, social support, and job satisfaction among Jordanian mental health nurses

Burnout occurs in occupations, such as nursing, where a significant proportion of time is spent in close involvement with other people. Mental health nursing has been considered an area that is subjected to high levels of burnout. Burnout in mental health nursing affects both individuals and organizations. The purposes of this study were to measure the levels of burnout and identify the correlates of burnout among Jordanian mental health nurses. A descriptive correlational design was used to collect data from mental health nurses using the Maslach Burnout Inventory, Social Support Scale, Job Satisfaction Scale, and demographic and work-related variables through a self-reported questionnaire. The sample consisted of 181 mental health nurses recruited from all mental health settings in Jordan. Jordanian mental health nurses showed high levels of emotional exhaustion and moderate levels of depersonalization and personal accomplishment. Scores of job satisfaction and social support were slightly higher than the midrange. Significant correlations were found among burnout categories, job satisfaction, social support, and demographic and work-related variables. Predictor variables accounted for 32.7% of emotional exhaustion, 27.7% of depersonalization, and 16.8% of personal accomplishment. Results revealed that a comprehensive interventional approach aimed at minimizing the risk of burnout among mental health nurses is needed. Such an approach should involve interventions at both individual and organizational levels.

A review of research and strategies for burnout among Chinese nurses

Although the concept of burnout has been a significant nursing issue worldwide over the past 30 years, in China the relevant research about nursing burnout only started in the 1990s. In this time, nursing burnout has become increasingly prevalent. This article examines the research carried out both in China and internationally, in order to investigate the causes of stress that lead to burnout among nurses. With the key stressors identified, the article sets out a proposal for a programme to alleviate the stress of hospital nurses and help them to engage with their jobs.

Qualified and Unqualified (N-R C) mental health nursing staff--minor differences in sources of stress and burnout. A European multi-centre study

BACKGROUND

Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.

METHODS

A total of 196 nursing staff --124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds--working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).

RESULTS

(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.

CONCLUSION

The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).

The effects of potentiality education on potentiality and job satisfaction among psychiatric nurses in Taiwan

PURPOSE

This study evaluated the effects of a potentiality education program on potentiality and job satisfaction among psychiatric nurses.

DESIGN AND METHODS

This quasiexperimental study recruited 59 psychiatric nurses, of whom 26 were assigned to an experimental group, based on their interest in participating in the program, and 33 to a control group.

FINDINGS

The results indicated that the scores for job satisfaction were significantly higher in the experimental group than in the control group. Specifically, potentiality education promoted job satisfaction but had no significant influence on potentiality. PRACTICE APPLICATION: Increasing nurses' potentiality could help them to successfully cope with their large workload and the various challenges of their job.

Job satisfaction and burnout among staff working in community-based personality disorder services

AIMS

To examine levels of burnout among staff working in community-based services for people with personality disorder (PD) and to explore factors which add to or lower the risk of burnout among people working in such services.

METHODS

In-depth interviews with staff working at 11 dedicated community-based personality disorder services in England together with a cross-sectional staff survey using the Maslach Burnout Inventory.

RESULTS

Levels of burnout were generally lower than those reported in previous studies among mental health workers and levels of personal accomplishment were higher. Staff reported positive as well as negative experiences of working with people with PD. Strong team-work, clear leadership and opportunities for reflective practice were thought to protect staff from burnout.

CONCLUSIONS

The low levels of burnout we found may reflect the early stage of the development of these services. However, it is also possible that working with people with PD does not in itself lead to burnout, especially when services are organized to share and contain work-related anxiety.

Burnout and perceptions of conscience among health care personnel: A pilot study

Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group.

Burnout in the mental health workforce: a review

There are enormous concerns regarding the recruitment, retention, training, and performance of the behavioral health workforce. Paramount among these concerns is turnover, which causes disruption in continuity of care, diminishes access to care while a position remains vacant, and poses financial hardship on the provider organization through costs related to recruitment, orientation, and training of a new hire. There is frequent mention of burnout within the literature and among behavioral health managers as a potential cause of turnover. However, there is no recent or comprehensive review of burnout that examines the evidence surrounding its validity, utility, and potential relationship to turnover. The purpose of this paper is to provide such a review by examining the construct of burnout, methodological and measurement issues, its prevalence in the mental health workforce, correlates of burnout, and interventions to decrease it. The implications for provider organizations and recommendations for future research are identified.

Influence of perceived organisational factors on job burnout: survey of community mental health staff

BACKGROUND

Staff burnout is a critical issue for mental healthcare delivery, as it can lead to decreased work performance and, ultimately, to poorer treatment outcomes.

AIMS

To explore the relative weight of job-related characteristics and perceived organisational factors in predicting burnout in staff working in community-based psychiatric services.

METHOD

A representative sample of 2000 mental health staff working in the Veneto region, Italy, participated. Burnout and perceived organisational factors were assessed by using the Organizational Checkup Survey.

RESULTS

Overall, high levels of job distress affected nearly two-thirds of the psychiatric staff and one in five staff members suffered from burnout. Psychiatrists and social workers reported the highest levels of burnout, and support workers and psychologists, the lowest. Burnout was mostly predicted by a higher frequency of face-to-face interaction with users, longer tenure in mental healthcare, weak work group cohesion and perceived unfairness.

CONCLUSIONS

Improving the workplace atmosphere within psychiatric services should be one of the most important targets in staff burnout prevention strategies. The potential benefits of such programmes may, in turn, have a favourable impact on patient outcomes.

Personality traits among burnt out and non-burnt out health-care personnel at the same workplaces: a pilot study

Stress-related illnesses, such as burnout, have increased over the last decade, but not everyone at the same workplace develops burnout, suggesting that individual factors may contribute to this phenomenon. The aim of this study was to describe patterns of personality traits among two groups of health-care personnel from the same workplaces, one group on sick leave due to medically-assessed burnout, and one group with no indication of burnout, respectively. Fourteen psychiatric- (n = 7) and elderly (n = 7)-care units, located in one specific area in a municipality in northern Sweden, participated in this questionnaire-based study. The participants (n = 40), on sick leave due to medically-assessed burnout (n = 20), and those with no indication of burnout (n = 20), respectively, completed Cattell's 16 Personality Factors Questionnaire between February and December 2004. Conventional statistical methods and partial least square regression were used to analyze data. The results showed that the burnout group had lower scores regarding emotional stability and higher scores regarding anxiety than the non-burnout group, but the results also showed a wide variation of personality traits within groups. The most important indicators for belonging to the burnout group were 'openness to changes' and 'anxiety', and for belonging to the non-burnout group, 'emotional stability', 'liveliness', 'privateness' (i.e. forthright or discreet), and 'tension'. The result indicates complex interactions between personality traits and the context in which the individual lives. It seems to be important to increase our awareness of when personality traits may constitute opportunities versus risks in dealing with one's existing circumstances.

A Survey of Burnout of the Mental Health Occupational Therapy Staff in the Psychiatric Hospital, Bahrain

Emotional burnout is associated with decreased job performance and poor career satisfaction. It has special significance in mental health care settings, where clinicians experience psychological, emotional and physical stress. This study aimed to determine the extent to which occupational therapy staff employed in a Bahrain mental health setting were affected by burnout.

Questionnaires were sent to all clinicians in the Psychiatric Hospital, Bahrain (n = 261). An effective response rate of 58% (n = 153) was achieved, with 13 of the responses being from the occupational therapy department. The research measure was the Maslach Burnout Inventory (MBI), comprising emotional exhaustion, depersonalisation and personal accomplishment.

The occupational therapy staff experienced a high level of emotional exhaustion, moderate depersonalisation and high personal accomplishment. They differed from other groups on the depersonalisation scale, scoring higher than any other professional group. The results are congruent with those of previous studies and it is proposed that the focus of future research should be on identifying causes of burnout.

Elevated diurnal salivary cortisol in nurses is associated with burnout but not with vital exhaustion

Studies on HPA axis regulation in burnout revealed heterogeneous results, possibly due to different psychometric and endocrine measurements, heterogeneous samples or small sample sizes. In the present study, the relationship between salivary cortisol during the day (four time points: 0700 h, 1130 h, 1730 h, and 2000 h) and burnout as well as vital exhaustion was investigated in a large sample of 279 nurses. Burnout was measured using the Maslach Burnout Inventory (MBI), which includes scales for emotional exhaustion, depersonalization, and personal accomplishment. A burnout criterion was assumed to be fulfilled, when any of the MBI scales was above the norm. Subjects with two burnout criterions fulfilled (N=18) were characterized by a higher cortisol release over the day compared to those reporting only one criterion (N=77) or no burnout (N=181) (ANOVA, p=.015). On the other hand, subjects who reported high levels of vital exhaustion did not differ from those who did not report signs of vital exhaustion. These findings provide further evidence for HPA axis dysregulation in burnout.

The relationship between job stressors, hardy personality, coping resources and burnout in a sample of nurses: a correlational study at two time points

BACKGROUND

Nursing is considered as a risk profession with high levels of stress and burnout, and these levels are probably increasing.

OBJECTIVES

This study assessed temporal and cross-sectional relationships between job stressors, hardy personality and coping resources on burnout dimensions among nurses.

DESIGN

Temporal and cross-sectional effects were evaluated. A sample of 98 nurses from Portugal completed the Nursing Burnout Scale at two time points. The data were analysed using descriptive statistics, Pearson correlations, and hierarchical linear regression analyses regressing Wave 2 burnout dimensions.

RESULTS

The study confirmed the specific contribution of control and challenged hardy personality dimensions as the explanation of burnout. However, commitment did not show any effects in this study. Social support and active coping were also relevant predictors of burnout dimensions. Specifically, active coping had an inverse temporal effect on depersonalisation and lack of personal accomplishment. In relation to the burnout process, depersonalisation appeared as an antecedent of lack of personal accomplishment.

CONCLUSIONS

The present study is an initial step to comprehend the link between job stressors, hardy personality, coping resources and diminishing burnout.

Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings

The aim of this study was to investigate whether nurses' efforts and rewards, as well as the effort-reward imbalance (ERI) and burnout, differ between subjects working in psychiatric vs. medical hospitals and between nurses under education and examined nurses respectively. Furthermore, the relationship between ERI and burnout was evaluated. Nursing is associated with high levels of emotional strain and heavy workloads. Burnout and a negative ERI can result in high absenteeism and turnover and have been identified as reasons why nurses leave their profession. In the last decade, working conditions of the nursing profession have changed in Germany, but somatic and psychiatric hospitals developed in different ways. This development may lead to different profiles. A sample of 389 nurses (78.8% female) in four German hospitals was investigated. A total of 147 nurses worked in psychiatric hospitals and 236 nurses worked in medical (somatic) hospitals. Fifty participants were still under education. The Effort-Reward Imbalance Inventory measures effort, reward and overcommitment at job and provides an imbalance score between effort and reward. The Maslach Burnout Inventory with the subscales, emotional exhaustion, lack of accomplishment and depersonalization, was also used. Nurses working in medical hospitals reported more burnout and had higher ERI scores. Subjects under education were comparable to examined nurses in terms of burnout but had lower ERI scores. Multiple regression analyses showed all ERI scales to be significant predictors for emotional exhaustion, while age, field of work and educational status further predict effort or ERI respectively. At present, the working situation of nurses in different settings appears to be characterized by a perceived imbalance of effort and reward and is associated with a high risk of developing burnout symptoms.

Workplace stressors and coping strategies among Chinese psychiatric nurses

PURPOSE

This study was conducted with Chinese psychiatric nurses to identify their workplace stressors and coping strategies, as well as the relationships between their demographics, workplace stressors, and coping strategies.

DESIGN AND METHODS

This survey was conducted, with the use of three questionnaires, on 188 psychiatric nurses recruited via convenient sampling in central China.

FINDINGS

The findings indicated that (a) workload and dealing with death/dying were the greatest workplace stressors; (b) positive coping strategies were the most often used coping strategies; and (c) a series of correlation results occurred. PRACTICE APPLICATION: Understanding the relationship between workplace stressors, effective and ineffective coping, and demographics can contribute to designing less stressful environments and more constructive coping strategies.

The relationship between staff members' working conditions and patients' perceptions of the treatment environment

BACKGROUND

The psychosocial climate of inpatient units has proved to be related to both patient satisfaction and outcome.

AIMS

The aims of the study were twofold: to study the relationship between patient and staff satisfaction, and to study the relationship between the patients' perception of the treatment environment and the perceived working conditions of the staff.

METHOD

A total of 129 different patients completed the Ward Atmosphere Scale (WAS) and a General Satisfaction Index (GSI) at 11 time points between 1981 and 2000. Staff members completed the Working Environment Scale-10 (WES-10) and the GSI. Z-scores were calculated to describe the fluctuations in the WAS, WES-10 and the GSI subscale scores.

RESULTS

The study revealed a strong correlation between patient satisfaction and staff satisfaction. Staff satisfaction correlated significantly with the WAS subscales of Practical orientation and Staff control. Furthermore, the study revealed a significant correlation between patient satisfaction and staff members' perception on the WES-10 subscale of Self-realization.

CONCLUSION

This exploratory study revealed that the working conditions of staff are related to both patient satisfaction and the patients' perceptions of the treatment environment. A satisfactory working environment for psychiatric staff members seems important for the quality of care perceived by patients.

Burnout and physical and mental health among Swedish healthcare workers

AIM

This paper is a report of a study to investigate how burnout relates to self-reported physical and mental health, sleep disturbance, memory and lifestyle factors.

BACKGROUND

Previous research on the possible relationship between lifestyle factors and burnout has yielded somewhat inconsistent results. Most of the previous research on possible health implications of burnout has focused on its negative impact on mental health. Exhaustion appears to be the most obvious manifestation of burnout, which also correlates positively with workload and with other stress-related outcomes.

METHOD

A cross-sectional study was conducted, using questionnaires sent to all employees in a Swedish County Council (N = 6118) in 2002. The overall response rate was 65% (n = 3719). A linear discriminant analysis was used to look for different patterns of health indicators and lifestyle factors in four burnout groups (non-burnout, disengaged, exhausted and burnout).

RESULTS

Self-reported depression, anxiety, sleep disturbance, memory impairment and neck- and back pain most clearly discriminated burnout and exhausted groups from disengaged and non-burnout groups. Self-reported physical exercise and alcohol consumption played a minor role in discriminating between burnout and non-burnout groups, while physical exercise discriminated the exhausted from the disengaged group.

CONCLUSION

Employees with burnout had most symptoms, compared with those who experienced only exhaustion, disengagement from work or no burnout, and the result underlines the importance of actions taken to prevent and combat burnout.

Dealing with stress: patterns of self-comfort among healthcare students

Stress among healthcare students is a growing problem. As self-comfort is assumed to be a way of coping with stressful emotions, the aim of this study was to describe the patterns of self-comforting actions that healthcare students usually use in distress. One hundred and sixty-eight healthcare students volunteered to write down accounts of what they do when they comfort themselves. Their accounts were analysed using qualitative content analysis. The findings reveal two themes: Ingressing and Transcending. Ingressing comprises the sub-themes Unloading, Distracting, Nurturing oneself, Withdrawing and Reassuring. Transcending comprises the sub-themes Opening up and Finding new perspectives. These findings are in line with some stress-reducing strategies described in the literature on stress management. Winnicott's theory about the phenomenon of transition is used to interpret the findings. In the light of Winnicott's theory, self-comforting measures can be comprehended as the ability to transfer early childhood experiences of being nurtured and comforted into well-adapted strategies to effect relaxation and gain strength.

Sources of stress and burnout in acute psychiatric care: inpatient vs. community staff

BACKGROUND

Professionals who work alone or in small teams often provide services for people with serious mental health problems in community settings. Stress is common in community teams and this may cause burnout and threaten the quality and stability of the services. This study compares levels of burnout and sources of stress among community and acute ward staff in six European centres.

METHODS

A total of 6 acute ward (N = 204) and community staff (N = 209) in 5 different European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) the Agervold Questionnaire for psychosocial work environment (QPWES) in addition to a comprehensive demographic questionnaire.

RESULTS

In the univariate analyses, except for Emotional Exhaustion (MBI), there were no differences in burnout between the two groups of staff. Community teams reported more organisational problems, higher work demands, less contact with colleagues, but also better social relations and more control over their work. The ward staff was more satisfied with the organisational structure and access to colleagues, but complained about lack of control over operating conditions at work. The multivariate analyses identified four groups of staff: (1) a Control-dissatisfied and Contact satisfied group (N = 184) with 2/3 coming from the wards. (2) A Contact-satisfied and Work-demand dissatisfied group (N = 147) with (3/4) from the community staff. (3) A Control- and Contact dissatisfied group (N = 47) with a majority from community teams, and (4) a Contact- and Work demand satisfied group (N = 37) with a majority from the wards.

CONCLUSION

Burnout as measured was not a serious problem among community and ward staff members, and did not differentiate between the two groups. Acute ward working implied lack of control but much contact with colleagues, whereas community work entailed more control but demanding work in terms of difficult task and hard-to-find-solutions.

Burnout syndrome among critical care healthcare workers

PURPOSE OF REVIEW

Burnout syndrome is a psychological state resulting from prolonged exposure to job stressors. Because ICUs are characterized by a high level of work-related stress, a factor known to increase the risk of burnout syndrome, we sought to review the available literature on burnout syndrome in ICU healthcare workers.

RECENT FINDINGS

Based on most recent studies, severe burnout syndrome (as measured using the Maslach Burnout Inventory) is present in about 50% of critical care physicians and in one third of critical care nurses. Strikingly, determinants of burnout syndrome are different in the two groups of caregivers. Namely, intensivists who have severe burnout syndrome are those with a high number of working hours (number of night shifts and time from last vacation) but determinants of severe burnout syndrome in ICU-nurses are related to ICU organization and end-of-life-related characteristics. ICU conflicts, however, were independent predictors of severe burnout syndrome in both groups.

SUMMARY

Recent studies reported high levels of severe burnout syndrome in ICU healthcare workers and identified potential targets for preventive strategies such as ICU working groups, communication strategies during end-of-life care and prevention and management of ICU conflicts.

Empowerment in the interpersonal field: discourses of acute mental health nurses

Social policy greatly influences the working environment of mental health nurses but in practice can be difficult to translate. Empowerment of service users is one area that is constantly significant in policy, locally and nationally, yet quite difficult to define in practice. This ethnomethodological study explored the practice of 10 mental health nurses working in an acute admissions unit. Through semi-structured interviews, the nurses were asked to discuss the taken-for-granted methods of empowerment with individual service users, their families and with work colleagues. The results were thematically analysed and compared with international findings, which reflected an awareness among mental health nurses of empowering practice in four areas. These were: Working with mental illness, Making connections, Responsibility and Teamworking.