define burnout assess burnout symptoms describe early warning signs discuss contributing factors ...
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Define burnout Assess burnout symptoms Describe early warning signs Discuss contributing factors Discuss resolution and resilience
Burnout is physical, emotional or spiritual exhaustion brought about by sustained stress without adequate adjustment.
Burnout is otherwise know as exhaustion or when the bodily reserves used in the stress response have been used up.
Excessive prolonged stress Feeling of overwhelm Feeling of unable to meet constant
demands
Burnout is not a diagnostic category
International diagnostic classification criteria do not consider burnout as a disease
burnout as such is not a valid reason for sickness absence
• Negative consequences for employees (lack of interest in work – existential doubts)
• Consequences for clients (low quality of service)
• High costs for organizations• Its excessive spread (around 20% of the
employees)• Important social problem but still unclear
concept
Impaired performance
Poorer patient care
Professional problems: Lawsuits Suspensions License revocation Leave profession
Relationship difficulty
Physical problems
Addictions
Anxiety, depression, suicide
Healthcare professionals are at increased risk for professional burnout.
A recent survey showed that 1 in 2 US physicians has symptoms of burnout.
This likely is rooted in the care delivery system rather than the personal characteristics of few susceptible individuals.
Arch Internal Med, 2012
Stress can be described as a circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person.
“our reaction to events, environmental or internal, that tax or exceed our adaptive resources.”
Excited
Relaxed Ah!
Uh Oh!
Normal
Excited
Relaxed
Uh Oh!
Breakdown
Uh Oh!
Uh Oh!
Stage 1:Stress Arousal
Stage 2:Energy Conservation
Stage 3:Exhaustion
Persistent irritability Persistent anxiety High blood pressure/heart problems Inability to concentrate/forgetfulness Insomnia Headaches Bruxism
Late for work/turning work in late Procrastination Three-day weekend Social withdrawal Increase in coffee, tea, cola, alcohol
Substance abuse (so treated usually as symptoms):
more alcohol and drugs, poor eating, more or less than before, drinking more coffee if smoking - more cigarettes Developing or worsening of bad habits -
instead of giving help and relief, diminishes one’s physical resilience.
withdrawal from or even breakdown of meaningful and important relationships and friendships
withdrawal from pleasant activities – because of tiredness and lack of motivation
working more but less effectively and worse
Instead of helping, diminishes one’s psychological resilience.
Chronic: Sadness Depression Stomach/bowel problems Mental/physical fatigue Headaches
Desire to drop out of society Move away from friends, work,
family Possible suicide ideation
job characteristics work demands / challenges, work relationships, employee-patient relationships, role ambiguity / conflict
organizational characteristics workplace infrastructure, rewards/punishments linked to job performance, staff support
personal characteristicssuch as age, gender, and coping skills.
AccountantAccountant
ArtistArtist
Auto MechanicAuto Mechanic
ForesterForester
Low-StressOccupations
High-StressOccupations
Hospital managerHospital manager
Physician (GP)Physician (GP)
PsychologistPsychologist
School principalSchool principal
Police officerPolice officer
Police DispatcherPolice Dispatcher
Air Traffic ControllerAir Traffic Controller
Waiter/waitressWaiter/waitress
Medium-StressOccupations
excessive or high workloads, the emotional demands of dealing with
sick patients and their families and with patients whose behaviors are difficult
lack of staff support, uncertainty concerning treatment,
conflict with other nurses, supervisors and medical staff,
dealing with death and dying, management difficulties, issues involving patient care, concerns about technical knowledge
and skills
JobResources
Support
Autonomy +
Feedback
Coaching
JobDemands
Workload
Emotions
Intimity
Work-Home
Burnout
Engagement
-
+ Client Satisfaction
Efficiency+
-
Source: Taris, Bakker et al. (in prep.)
Impaired health
Low motivation
Impaired health
Motivation
Health
Low motivation
Health
Motivation
L
H
L
H
JOB RESOURCES
JOB
DE
MA
ND
S
ImbalancedWork
Partner
Family
Friends
Personal
Household
Spiritual
Recreation
Health
Exercise
Work
Work
Partner
Family
Friends
Personal
Household
Spiritual
Recreation
Health
Exercise
Burnout and PersonalityBurnout and Personality
• Neuroticism Neuroticism • Low extraversionLow extraversion• Low hardinessLow hardiness• External locus of controlExternal locus of control• Low self-esteemLow self-esteem• Type A personalityType A personality
More critical self
Pushed vs. pulled to goal
Unrealistic goals
Results focused vs. journey
Self attack: unmet goals
Fear failure/disappointing
Procrastinate
Defensiveness
Low self esteem
In 1981, Maslach and Jackson defined occupational burnout syndrome as a syndrome of maladaptive response to stress
emotional exhaustion, depersonalization reduced personal accomplishment.
DepersonalizationDepersonalization
Reduced PersonalReduced PersonalAccomplishmentAccomplishment
Physiological,Physiological,
psychological,psychological,
and behavioraland behavioral
consequencesconsequences
EmotionalEmotionalExhaustionExhaustion
Interpersonal andInterpersonal andRole-Related StressorsRole-Related Stressors
Emotional exhaustion - also called compassion fatigue, it represents the first stage of burnout and plays a central role in the burnout process.
Depersonalization - follows emotional exhaustion and is identified by the treatment of others as objects rather than people.
Reduced personal accomplishment - the final component of job burnout which refers to the decline in one's feelings of competence and success.
High Moderate Low
Emotional exhaustion
27 or over 17-26 0-16
Deperson- alization
13 or over 7-12 0-6
Personal accomplishme
nt
0-31 32-28 39 or over
Increased: Physical symptoms
& illness
Relationship difficulties
Negative thoughts
Eating, spending, smoking, drinking, gambling, unprotected sex
Decreased: Pleasure with
relationship & activities
Exercise, nutrition, socializing, laughing
Depression and burnout are not identical, although their symptoms may be overlapping
At individual level burnout may form a part of the aetiology of depression
More research is needed on the relationship between burnout and mental disorders
Depression• Depressive mood• Unhappiness,
displeasure• Weight loss• Fearfulness• Sleeping problems
(wake up early)• Guilt feelings• Suicide thoughts• Indecisiveness • Attribution of the
problem: sickness• General• Low vitality
Burnout• Anger, aggression• Low pleasure• No weight symptoms• No fearfulness• Sleeping problems
(difficulty to fall asleep)
• Guilt feelings • No suicide thoughts• Indecisiveness
(complaint) • Attribution of the
problem: work• Work-related• Moderate vitality
Stress TestStress TestSelf Assessment ExerciseSelf Assessment Exercise
How often do you…1. find yourself with insufficient time to do
things you really enjoy?
2. wish you had more support/assistance?
3. lack sufficient time to complete your work most effectively?
Stress TestStress TestSelf Assessment ExerciseSelf Assessment Exercise
4. have difficulty falling asleep because you have too much on your mind?
5. feel people simply expect too much from you?
6. feel overwhelmed?
Stress TestStress TestSelf Assessment ExerciseSelf Assessment Exercise
7. find yourself becoming forgetful or indecisive because you have too much on your mind?
8. Consider yourself to be in a high-pressure situation?
Stress TestStress TestSelf Assessment ExerciseSelf Assessment Exercise
9. feel you have too much responsibility for one person?
10. feel exhausted at the end of the day?
“The key is not to avoid stress altogether but to manage stress in such a way that we avoid the negative consequences of stress”
Manage yourself Manage your reaction to stressors Manage the amount of stress
Know Yourself Know your limitations Gage your reactions, learn to take each day
one step at a time Become a “Stress Expert”, know about Stress
and how it affects your mind and body. Don’t do nothing, if you think you are getting
burned out and have the symptoms speak to someone about it!
Find;What aspects of work are most
gratifying?(relationships, teaching,
research, program development)
How do professional demands affect us?
How do we view the rewards of our work?
Learn what causes you stress Learn how to recognize effects of
stress in yourself Develop coping strategies and self
care techniques to conquer stress Physical self care Emotional and Cognitive Self care Relational Self-Care Spiritual Self Care
Do you want to be helping?If you appreciate help as a virtue, let other
people be helpful for you
If you forget, that you are a human being, consider:
you use your own body and mind to help others, so you are kind of helping tools
– you take care of your machines and domestic tools, don’t you?
Cultivate Relationships Set Boundaries, priorities, education,
keeping an open mind Take time out for yourself Eat/Exercise Ask for help Acknowledge your emotions Stress Reduction techniques( music,
medication, journaling) Mentoring/Peer Support Group Support Promote self-awareness, create a place to
retreat/unwind Explore professional and personal goals
Cultivate Relationships Set Boundaries, priorities, education,
keeping an open mind Take time out for yourself Eat/Exercise Ask for help Acknowledge your emotions Stress Reduction techniques( music,
medication, journaling) Mentoring/Peer Support Group Support Promote self-awareness, create a place to
retreat/unwind Explore professional and personal goals
Talking to peers, others Journaling Taking time off Balancing professional life with
personal life Maintain a good team, promote
teamwork Grieving for our patients, attending
memorialsDavid F. Giansiracusa MD, Palliative Care Update, Sustaining
Our Ability to Provide Palliative Care
Supportive verbal group modalities Psychodrama / play therapy / art
therapy Recreational music Exercise
Jerome Stone author of Minding the Bedside: Nursing from the Heart of the Awakened Mind