Facing a blind alley - Experiences of stress-related exhaustion: a qualitative study

INTRODUCTION

Mental illness is a major concern in many countries. In Sweden, stress-related mental illness is currently the most frequent reason for sick leave.

OBJECTIVE

This study aimed to explore patients' experiences of stress-related exhaustion.

DESIGN

A qualitative study with interview data analysed using a phenomenological hermeneutic method.

SETTING

Participants were selected from public primary healthcare centres in a larger city in western Sweden.

PARTICIPANTS

Seven women and five men on sick leave from work due to stress-related exhaustion were included in the study.

FINDINGS

Stress-related exhaustion was experienced as a loss of access to oneself and one's context and feelings of being trapped and lost in life. The condition had a significant impact on personal identity, raised existential issues and was interpreted as facing a blind alley. Participants described a mistaken direction in life, being forced to stop, change direction and act differently.

CONCLUSION

Stress-related exhaustion is a challenging, life-changing existential experience that involves a crisis with an opportunity for new insights. Careful consideration of patients' narratives together with the expertise of healthcare professionals can be combined to improve health and optimise recovery based on individual's situation.

Just how wide should 'wide reading' be?

Educationalists introduce students to literature search strategies that, with rare exceptions, focus chiefly on the location of primary research reports and systematic reviews of those reports. These sources are, however, unlikely to adequately address the normative and/or metaphysical questions that nurses frequently and legitimately interest themselves in. To meet these interests, non-research texts exploring normative and/or metaphysical topics might and perhaps should, in some situations, be deemed suitable search targets. This seems plausible and, moreover, students are encouraged to 'read widely'. Yet accepting this proposition creates significant difficulties. Specifically, if non-research scholarly sources and artistic or literary (humanities) products dealing with normative/metaphysical issues were included in what are, at present, scientifically orientated searches, it is difficult to draw boundaries around what--if anything--is to be excluded. Engaging with this issue highlights problems with qualitative scholarship's designation as 'evidence'. Thus, absurdly, if qualitative scholarship's findings are labelled evidence because they generate practice-relevant understanding/insight, then any literary or artistic artefact (e.g. a throwaway lifestyle magazine) that generates kindred understandings/insights is presumably also evidence? This conclusion is rejected and it is instead proposed that while artistic, literary, and qualitative inquiries can provide practitioners with powerful and stimulating non-evidential understanding, these sources are not evidence as commonly conceived.

Content Comparison of Patient-Reported Outcome Instruments Used to Measure Burnout

The aim of this article is to compare the content of patient-reported outcome (PRO) burnout measures and to examine the degree of overlap between them and psychosocial difficulties (PSD) experienced by persons with burnout. The most frequently used PRO and qualitative studies were identified in two systematic literature reviews. Psychosocial difficulties identified in both sources were standardized and a qualitative content comparison was performed. Seven PROs and seven qualitative studies were selected. Energy and drive, emotional functions and work were key themes of both sources. Disparities were observed for problems in areas such as sleep, attention or family relationships, which were reported in several qualitative studies, but are seldom addressed in PROs. Several areas important to persons with burnout, such as family relationships, are seldom measured by currently used PROs. From a biopsychosocial perspective, these instruments cannot therefore be considered comprehensive enough to capture the whole experience of burnout and should be improved.

Living on the edge: a review of the literature

A comprehensive review of the literature of the universal experience of living on the edge is discussed. Literature was reviewed from biology, criminology, ecology, economics, ethics, finance, fine arts, historical biography, medicine, nursing, philosophy, physiology, psychology, sociology, and theology. Three themes emerged with this literature review: living on the edge as a sacred place one travels to or where one lives, living on the edge as a choice in taking risks and surviving danger, and living on the edge as engaging with health experiences in which persons and nurses coparticipate. Living on the edge is a visionary quest into a new frontier that holds illimitable possibilities that transform the world. The literature is discussed according to theoretical and research findings.

New opportunities for occupational therapy through the occupation of contemporary pilgrimage

Twenty-first century pilgrimage is a journey of great personal significance not limited to traditional religiosity. The transformative potential of this diverse and evolving occupation is increasingly evidence based. This opinion piece explores the definition of contemporary pilgrimage and underlines the relevance of this occupation to occupational therapists and their clients. The exceptional accessibility of contemporary pilgrimage is described, suggesting limitless opportunities for the use of pilgrimage as a therapeutic tool. Interdisciplinary examples of promoting wellbeing through contemporary pilgrimage are then presented. This opinion piece seeks to inspire a local response to this global phenomenon.

Validation of Karolinska Exhaustion Scale: psychometric properties of a measure of exhaustion syndrome

BACKGROUND

The syndrome of exhaustion is currently a medical diagnosis in Sweden. The description of the syndrome largely corresponds to the suggested core component of burnout, that is exhaustion. Karolinska Exhaustion Scale (KES) has been constructed to provide specific assessment of exhaustion in clinical and research settings.

AIM

The purpose of the present study was to examine the psychometric properties of this scale in its original and revised versions by examining the factorial structure and measures of convergent and discriminant validity.

METHODS

Data gathered from two independent samples (n1 = 358 & n2 = 403) consisting of patients diagnosed with 'reaction to severe stress, and adjustment disorder' were subjected to confirmatory factor analysis. The study's instruments were Karolinska Exhaustion Scale and Shirom Melam Burnout Measure. Correlation analyses were employed to follow up the established factorial structure of the scale. The study was ethically approved by Karolinska Institute regional ethic committee.

RESULTS

The findings demonstrated adequate fit of the data to the measurement model provided by the revised version of KES Limitations: The main limitation of the present study is the lack of a gold standard of exhaustion for direct comparison with KES. (KES-26) and partially supported convergent validity and discriminant validity of the scale.

CONCLUSION

The demonstrated psychometric properties of KES-26 indicate sound construct validity for this scale encouraging use of this scale in assessment of exhaustion. The factorial structure of KES-26 may also be used to provide information concerning possible different clinical profiles.

Existential issues among nurses in surgical care--a hermeneutical study of critical incidents

AIMS

To report a qualitative study conducted to gain a deeper understanding of surgical nurses' experiences of existential care situations. Background.  Existential issues are common for all humans irrespective of culture or religion and constitute man's ultimate concerns of life. Nurses often lack the strategies to deal with patients' existential issues even if they are aware of them.

DESIGN

This is a qualitative study where critical incidents were collected and analysed hermeneutically.

METHODS

During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1-2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used.

FINDINGS

The majority of incidents concerned nurses' experiences of caring for patients' dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses' personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care.

CONCLUSION

Findings are interpreted and discussed in the framework of Buber's philosophy of the relationships I-Thou and I-It, emphasizing nurses' different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.