Burned out or "just" depressed? An existential phenomenological exploration of burnout

Psychiatry as a vocation: Moral injury, COVID-19, and the phenomenology of clinical practice

In this article, we focus on a particular kind of emotional impact of the pandemic, namely the phenomenology of the experience of moral injury in healthcare professionals. Drawing on Weber's reflections in his lecture Politics as a Vocation and data from the Experiences of Social Distancing during the COVID-19 Pandemic Survey, we analyse responses from healthcare professionals which show the experiences of burnout, sense of frustration and impotence, and how these affect clinicians' emotional state. We argue that this may relate to the ethical conflicts they experience when they are forced to make clinical decisions where there are no optimal outcomes, and how in turn that impacts on their own emotional state. We then further examine the notion of 'burnout' and the phenomenology of 'moral injury'. Our argument is that these experiences of moral injury across a range of clinicians during the pandemic may be more prevalent and long-standing in psychiatry and mental health than in other areas of healthcare, where ethically difficult decisions and resource constraints are common outside times of crisis. Hence, in these clinical arenas, moral injury and the phenomenology of emotional changes may be independent of the pandemic. The insights gained during the pandemic may provide wider insights into the challenges of developing services and training the workforce to provide appropriate mental health care.

COVID-19 pandemisinin ilk dalgasında sağlık çalışanlarının tükenmişliği: meta analiz

conditions during the COVID-19 pandemic, threaten the lives and physical well-being of healthcare workers (HCWs), and also their mental health, such as burnout, etc. which is often neglected. The aim of this review is to analyze published studies on the proportion of burnout among HCWs during the first wave of the COVID-19. Materials and Methods: We conducted a systematic review of studies that reported burnout (measured by Maslach Burnout Inventory) among HCWs during the COVID-19 pandemic and searched PubMed, PsycINFO, and WOS of relevant articles up to Feb 25th, 2021. Out of 145 non-duplicate studies, 10 were included in the meta-analysis. Results: The overall estimated pooled proportion for emotional exhaustion (EE) was 31% (95% CI: 24%-40%), for depersonalization (DP) was 28% (95% CI: 23%-38%) and 22% (95% CI: 13%-34%) for personal accomplishment (PA). The results show that in countries where the number of cases is high and the number of beds and doctors is low, the level of EE appears to be slightly lower and PA is slightly higher. However, there were no significant differences according to subgroup analyses. Conclusion: Evidence from early studies highlight the fact that a significant proportion of HCWs suffers from burnout during this pandemic. It will be necessary to pay close attention to HCWs' mental health and identify ways to reduce risks and prepare a rehabilitation program for the HCWs during and after the pandemic.

Enabling personal recovery from fibromyalgia - theoretical rationale, content and meaning of a person-centred, recovery-oriented programme

Background

Fibromyalgia (FM) is a contested, chronic widespread pain syndrome on which recommended therapies have short-lasting, moderate effects. Nevertheless, some patients become symptom-free, and their recovery experiences inspired us to develop a patient-centred recovery-oriented programme (PROP) delivered in a group format. Presently, we describe the theoretical rationale, purpose and content of the PROP, and its meanings for clinicians and patients.

Methods

A multidisciplinary clinical team, a leader of a rehabilitation unit, and two researchers coproduced the PROP. Five full-day seminars were arranged to bridge research and clinical experiences. Qualitative studies about patients’ illness and recovery experiences and questions by researchers facilitated reflections on clinical experiences. The meaning of the PROP was examined using focus group and individual interviews with patients and clinicians immediately after completing the course and after 1–1.5 years.

Results

The biopsychosocial model displays the research evidence across biological, mental and social impacts of FM, justifying that life stress can be an illness-maintaining factor in FM. The content addresses enabling patients to heal their own life and self by modifying life stress. Patients engage in making sense of the relationship between FM, themselves, and life through exploring, discovering and creating appropriate solutions for their daily social life. The PROP reduced uncertainties and brought a positive attitude and hope to the groups. After 1 year, patients are still engaged in recovery work, experience more good days, and maintain hope for further recovery. By sharing and reflecting on clinical experiences, a unified clinical team was established that continues to develop their competency.

Conclusion

To our knowledge, the PROP is the first programme for patients with FM that results from a process of coproducing knowledge, is based on explicit theoretical rationale, and facilitates a personal experiential recovery process. PROP is found to be meaningful and to work by patients and clinicians.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06295-6.