Perceived inability to help is associated with client‐related burnout and negative work outcomes among community mental health workers

Community mental health is a vital service, but it faces ongoing challenges from its high staff‐turnover rates. The current study provides a preliminary test of a novel explanation for employee disengagement in community mental health. It is proposed that providing assistance to clients, while simultaneously feeling that only limited progress is being made, is associated with client‐related burnout among community mental health providers, leading to negative work outcomes. Employees (N = 349) from three non‐governmental community mental health organisations in Australia completed a survey assessing their perceptions of client improvement from treatment, client‐related burnout and a range of organisational outcomes. Analyses revealed that perceptions that clients are not improving was associated with burnout, which in turn is related to lower job satisfaction, decreased job engagement, poorer workplace well‐being, and increased turnover intentions. These findings suggest that interventions that highlight positive changes among clients could reinforce the important service provided by community mental health employees and may minimise burnout and negative work outcomes.     

Investigating the JD‐R occupational stress model with Australian direct‐care workers: A focus group approach

This study aimed to explore the use of a contemporary workplace stress model, the Job Demands‐Resources model, with direct‐care workers using a qualitative approach. The JD‐R model has successfully been used to predict health outcomes across different occupations using quantitative methods. However, the use of the generic questionnaire developed for this model may not always be appropriate. Direct‐care workers (n = 19) attended two focus groups and reported on their job demands, job resources and personal resources. Six themes relating to demands across the two groups: funding insecurity, time pressure, hindrance demands, poor systems, emotional engagement and dealing with client crises were identified. Participants identified clinical supervision, social support and progressive workplace resources as job resources. Finally, the personal resources identified by participants were professional behaviours, disposition and self‐care. The JD‐R model and its standard questionnaire captures some of these aspects of direct‐care work, but many were not assessed. As such, future investigations with direct‐care workers should ensure items related to poor systems, progressive workplace resources, disposition and professional behaviours are included. Alternatively, a qualitative approach should be used as a first step in the development of valid questionnaires when investigating workplace stress with this group to ensure their experience is accurately quantified.     

Does it matter what your reasons are when deciding to disclose (or not disclose) a disability at work? The association of workers’ approach and avoidance goals with perceived positive and negative workplace outcomes

Deciding whether to disclose a disability to others at work is complex. Many chronic mental and physical health conditions are associated with episodic disability and include times of relative wellness punctuated by intermittent periods of activity limitations. This research draws on the disclosure processes model to examine approach and avoidance disclosure and non-disclosure goals and their association with perceived positive and negative workplace outcomes. Participants were 896 employed individuals (57.7% women) living with a chronic physical or mental health/cognitive condition. They were recruited from an existing national panel and completed an online, cross-sectional survey. Participants were asked about disclosure decisions, reasons for disclosure/non-disclosure, demographic, work context and perceived positive and negative disclosure decision outcomes (e.g., support, stress, lost opportunities). About half the sample (51.2%) had disclosed a disability to their supervisor. Decisions included both approach and avoidance goals. Approach goals (e.g., desire support, want to build trust, maintain the status quo at work) were significantly associated with perceived positive work outcomes regardless of whether a participant disclosed or did not disclose a disability at work, while avoidance goals (e.g., concerns about losing one’s job, feeling forced to disclose because others notice a problem) were associated with perceived negative work outcomes. The findings highlight benefits and challenges that workers perceive arise when they choose to disclose or not disclose personal health information. By better understanding disclosure decisions, we can inform organizational health privacy and support gaps to help sustain the employment of people living with disabilities.

     

Supervisor and Organizational Factors Associated with Supervisor Support of Job Accommodations for Low Back Injured Workers

Purpose Temporary job accommodations contribute to the prevention of chronic work disability due to low back pain (LBP) through the facilitation of early return to work; yet, workplace dimensions of job accommodation are poorly understood. The objective of this study was to determine supervisor and organizational factors associated with supervisors’ support for temporary job accommodations for LBP injured workers. Methods Supervisors were recruited from 19 workplaces in the USA and Canada and completed an online survey regarding job accommodation practices and potential associated factors with respect to a case vignette of a worker with LBP. Multivariable linear regression was used to identify the most parsimonious set of factors associated with supervisors’ support for accommodations. Results A total of 804 supervisors participated with 796 eligible for inclusion in the analysis. The final set of factors explained 21 % of the variance in supervisors’ support for temporary job accommodations. Considerate leadership style (β = 0.261; 95 % CI 0.212, 0.310), workplace disability management policies and practices (β = 0.243; 95 % CI 0.188, 0.298), and supervisor autonomy for designing and providing workplace accommodations (β = 0.156; 95 % CI 0.071, 0.241) had the largest effect on supervisor support for accommodations. Conclusion Factors predicting supervisors’ likelihood to accommodate LBP injured workers include use of considerate leadership style, workplace disability management policies and practices, and supervisor autonomy. Workplace interventions targeting these factors should be developed and evaluated for their ability to improve work disability prevention outcomes.     

Measuring Workplace Social Support for Workers with Disability

Introduction Social support in the workplace has been has been demonstrated to serve as a contributor to a worker??s ability to manage work demands and to manage stress. Research in the area of disability management indicates that interpersonal factors play an important role in the success of return-to-work interventions. The role of workplace support has received limited attention in rehabilitation, despite the salience of support to the disability management process. Prior to this study, there existed no validated quantitative measure of social support for workers who re-enter the workplace following injury or disability. Methods A support measure prototype, the Support for Workers with Disability Scale, was tested with 152 workers in accommodated work situations. Four validation tools were used to assess criterion validity. Factor analysis was used to validate the content structure and reduce the total number of response items. Additional analysis was conducted to determine the ability of the measure to discriminate between groups, and to provide insight into how social support operates in workplaces. Results Based on analysis, a reduced measure consisting of 41 items and measuring supervisor, co-worker, and non-work supports was created. Secondary analysis disclosed information concerning the nature of supports in the workplace. Higher levels of support were identified for workers with fewer work role limitations and for those with one versus multiple injury claims. Conclusions This tool provides a validated outcome measure for research examining the social aspects of workplace disability. It can also serve as a quality management tool for human resource professionals engaged in continuous improvement of disability management programs.     

‘We’re all wounded healers’: A qualitative study to explore the well‐being and needs of helpline workers supporting survivors of domestic violence and abuse

Domestic violence and abuse (DVA) can include physical, psychological, sexual, emotional or financial abuses, and is a globally widespread problem across all age groups, cultures and socioeconomic groups. Alongside the impacts of DVA experienced by survivors, there is a growing recognition that other people, who form the support network of survivors, may also be affected by the situation. Domestic violence organisations such as helplines are important third sector services supporting survivors. However, there has been little research into the impact on those providing the support. This qualitative study of domestic violence helpline workers explored their needs and well‐being. We used qualitative methodology, conducting interviews with staff recruited from a selection of different helplines who all undertook direct client‐focused work. The interviews used a semi‐structured format and followed a topic guide covering the training received before commencing work, self‐care strategies, the impact of work on their daily life and support offered by their employer. Ten helpline staff were interviewed, all female. Following analysis of the qualitative data, a number of themes emerged. Participants disclosed numerous ways in which their work challenged their well‐being, including burnout, impact on personal relationships, and lack of training and support at work. Participants used some self‐care strategies in order to “switch off” from work, but they also wanted clinical supervision to support them with the difficulties they experienced at work. This study suggests that helpline staff should receive more education about trauma triggers, and ongoing support to reduce the impact on their home and social life, thus improving mental well‐being and job satisfaction. This work begins the debate on the well‐being needs of frontline helpline workers, and whether better meeting these needs can facilitate the provision of better support.     

The moral orders of work and health: a case of sick leave due to burnout

Being on sick leave due to burnout entails a high level of accountability. Persons suffering from burnout do not automatically play a legitimate sick role because of the fuzziness of the burnout concept. In addition, while being on sick leave, they are in a non‐working position, which is against the ideals of work‐centred society. Therefore, they are required to explain their ‘deviant’ situation. Drawing on the interview data, the article explores how sick leave is explained and justified in narrative accounts by Finnish burnout sufferers. Results show that sick leave makes the moral orders of work, health and illness visible. Sick leave as a process involves negotiation of one's status and worth in the categories of ‘respectable employee’ and ‘credible patient’. A transition to sick leave requires causal explanations of burnout, which aim to legitimate ill‐being. Being on sick leave creates an obligation for activity and productivity that is ‘work‐like’ management of health. The study shows the fundamental level at which work structures everyday life, routines, and habits in the work‐centred society. In this context, burnout sufferers struggle to legitimise their work‐related distress and absence from work and restore their morally worthy identities.     

社会支持对工作压力与工作倦怠关系的调节作用

目的探讨社会支持在企业员工工作压力与工作倦怠之间关系的调节作用。方法采用工作压力量表、MBI-GS工作倦怠量表通用版和社会支持量表,随机抽取深圳市3家大型企业1 068名员工进行自填式问卷调查。采用相关分析、简单线性回归分析和复回归分析等统计方法,检验水准α为0.05。结果企业员工工作压力与工作倦怠显著正相关（r=0.39）,客观支持、主观支持和对支持的利用度与工作倦怠显著负相关（r=-0.31,-0.30,-0.16）。简单回归分析结果显示,工作压力对情绪衰竭（男β=0.62,女β=0.84）、消极怠慢（男β=0.47,女β=0.72）和专业低效能感（男β=0.18,女β=0.45）均有正向预测作用,且对女性员工的影响力度高于男性。复回归分析结果显示,引入客观支持、主观支持和对支持的利用度后,工作压力对工作倦怠、情绪衰竭、消极怠慢和专业低效能感的回归系数均显著下降（男β由0.41、0.62、0.47、0.18分别降为0.31、0.50、0.41、0.09,女β由0.55、0.84、0.72、0.45分别降为0.50、0.78、0.68、0.38）。在同等压力状态下,高客观支持和高主观支持员工的工作倦怠水平显著低于低客观支持和低主观支持的员工,工作压力由低到高,高、低客观支持差值分别为0.43、0.45、0.34,高、低主观支持差值分别为0.33、0.35、0.47。结论工作压力是工作倦怠的重要影响因素,社会支持是工作压力和工作倦怠的有效调节变量,女性员工的工作压力和社会支持对工作倦怠的影响大于男性。     

工作压力、应对方式、社会支持对工作倦怠的效应分析

目的探讨企业员工工作倦怠与工作压力、应对方式、社会支持之间的关系。方法采用分阶段随机抽样方法,抽取深圳市3家大型企业1068名员工,应用工作压力量表、MBI-GS工作倦怠量表通用版、应对方式量表和社会支持量表进行自填式问卷调查。结果企业员工工作压力和消极应对与工作倦怠呈正相关（r=0.39,0.21）,积极应对、客观支持、主观支持和对支持的利用度与工作倦怠呈负相关（r=-0.30,-0.31,-0.30,-0.16）。采用结构方程模型进行路径分析显示,工作压力对工作倦怠具有正向预测力,总体效应为0.61,直接效应为-0.50,通过应对方式和社会支持产生的间接效应为1.11。应对方式和社会支持对工作倦怠具有显著的负向直接效应（路径系数分别为-1.29和-0.22）。结论工作压力、应对方式和社会支持均是影响工作倦怠的重要因素,应对方式和社会支持在工作压力对工作倦怠的影响中有显著的调节和中介作用。     

医护人员职业倦怠影响因素的结构方程模型分析

目的 了解医护人员职业倦怠的影响因素及其作用机制,为采取有针对性的干预措施提供科学依据。方法 采用多阶段随机抽样方法,选取湖北省某地区1 938名医护人员为研究对象进行职业倦怠现况调查,运用结构方程模型探讨其工作压力、焦虑、社会支持、自我效能等对职业倦怠的作用机制。结果 湖北省某地区医护人员的职业倦怠综合得分为[34.00(25.00, 41.00)]分,职业倦怠检出率为64.09%。工作压力、焦虑与职业倦怠均呈正相关(均有P<0.05);社会支持、自我效能与职业倦怠均呈负相关(均有P<0.05)。结构方程模型分析结果显示,工作压力对职业倦怠有直接正向效应(β=0.451,P=0.010),并通过焦虑产生间接影响(β=0.129,P=0.010);焦虑对职业倦怠有直接正向效应(β=0.360,P=0.010);社会支持对职业倦怠有直接负向效应(β=-0.141,P=0.010),调节变量工作压力与支持利用度对职业倦怠有负向效应(β=-0.051,P=0.018)。结论 工作压力和焦虑为湖北省某地区医护人员职业倦怠的危险因素,提高社会支持特别是支持利用程度可以有效地减少其职业...     

Factors Affecting the Professional Well-Being of Child Life Specialists

Survey responses from 156 child life specialists in the United States and Canada were analyzed for the purpose of testing a conceptual model depicting predictors of three measures of professional well-being: burnout, job dissatisfaction, and intentions to leave a job. Predictor variables included individual factors, measures of workload, attributes of role stress, and sources of social support. Social support was viewed both as a variable exerting a direct influence on professional well-being and as a moderating variable. Results indicated that role stress (especially role ambiguity) was the best predictor of burnout and job dissatisfaction. Lack of supervisor support was found to be the best predictor for job dissatisfaction and intentions to leave a job. Implications for practices in the workplace are discussed.     

The burden of care: a focus group study of healthcare practitioners in Scotland talking about parental drug misuse

Parenting and family support are key prevention and intervention strategies for improving outcomes for children and families affected by parental drug misuse. However, little is known about the delivery of parenting support for drug‐dependent parents, particularly within universal healthcare services. This study aimed to explore the way healthcare practitioners engage with this challenging agenda. Four multidisciplinary focus groups involving a purposive sample of 18 experienced healthcare professionals were conducted in Scotland. Participants included general practitioners, midwives, public health nurses and addiction staff who work together to provide care for vulnerable families. A focus group topic guide was developed to explore the views and experiences of these healthcare professionals in relation to providing parenting support for drug‐using parents, predominantly those receiving opioid substitution therapy. Data were analysed using a constant comparison method and thematic approach. The overarching narrative which united the focus group discussions was about the ‘burden of care’ that these families pose for frontline healthcare professionals. Recurring themes centred on three key issues: the problematic nature of drug‐using parents themselves; clinical challenges in living up to the ideals of professional practice; and the wider context in which current practice is governed. Professionals expressed ambivalence over their parenting support role; anxiety over responsibility for intervening with this ‘hard‐to‐engage’ population; and concern over ‘dwindling’ resources and lack of organisational support. Nevertheless, strategies and opportunities for providing parenting support were acknowledged and there was consensus about the need for further skills training. Despite a proliferation of policy and good practice guidance on the delivery of parenting support for drug‐dependent parents, the findings of this study suggest that significant challenges remain. Notably, our findings raise questions about whose role it is to provide parenting support to drug‐using mothers and fathers, especially those who are not involved in the child protection system.     

Identifying and Prioritizing Workplace Climate Predictors of Burnout Among VA Primary Care Physicians

Burnout, or job-related stress, affects more than half of all US physicians and has been linked to increased medical errors, staff turnover, and reduced productivity. Primary care physicians (PCPs) experience among the highest burnout rates in medicine. Workplace climate, defined as shared worker attitudes and perceptions of their work environment, is a leading determinant of physician burnout. However, prior studies have not examined the relative importance of different elements of workplace climate (eg, leadership, support). Our study identifies and prioritizes workplace climate predictors of physician burnout among PCPs employed by Veterans Affairs (VA) nationwide. We conducted a cross-sectional analysis of data from the 2013-2017 VA All Employee Survey (AES), an annual organizational census that includes questions on burnout and workplace climate. Dependent variables addressed two dimensions of burnout from the Maslach Burnout Inventory (eg, emotional exhaustion and depersonalization); symptoms > once per week indicated burnout. Independent variables included 30 questions related to elements of workplace climate (ie, leadership, support, rewards, recognition, autonomy, satisfaction, tolerance, conflict, workload, growth opportunity, physical and psychological safety, communication, collaboration, risk-taking, and sense of belonging and purpose) scored on a 5-point agreement/satisfaction scale. We included PCP demographic covariates. Independent and dependent variables were measured from separate random samples to avoid method bias. Collapsing AES responses among PCPs on the medical-site level by reporting year, we used the semi-automated LASSO procedure to identify workplace climate predictors of burnout and assessed their relative importance using the Shapely value decomposition. PCPs employed at 157 VA medical sites nationwide. Among a sample of 305 facility-year observations, an average of 65.5% of PCPs screened positive for emotional exhaustion and 47.8% for depersonalization. We identified 7 workplace climate predictors of emotional exhaustion (pseudo R2 for full model = 0.667). The majority of explained variation in emotional exhaustion was attributable to perceptions of workload (32.6%), organization satisfaction (28.2%), and organization support (19.4%); other contributors included praise (7.8%), employee development (8.1%), psychological safety (1.9%), and innovation (2.0%). We identified 9 workplace climate predictors of depersonalization (pseudo R2 for full model = 0.590). The majority of explained variation in depersonalization was attributable to workload (25.3%), organization satisfaction (22.9%), and connection to VA mission (20.7%); other contributors included job control (11.4%), praise (9.6%), work/family balance (9.1%), quality of direct supervision (<1%), psychological safety (<1%), and innovation (<1%). Apart from innovation, higher agreement/satisfaction scores for workplace climate predictors were associated with a lower likelihood of PCP burnout. The most influential workplace climate predictors of burnout among PCPs included perceptions of workload, organization satisfaction, organization support, and connection to institutional mission. Praise, employee development, job control, and work/family balance were moderately influential. Identifying and understanding the relative importance of workplace climate factors are important for guiding optimal allocation of health organization resources to mitigate and prevent burnout within the PCP workforce. To address burnout, our research suggests organizations should prioritize practices and policies that reduce physician workload and create a supportive work environment that promotes employee satisfaction and sense of connection to institutional mission. Department of Veterans Affairs.     

事业单位管理者和高校教师的职业倦怠现状及其影响因素

目的 了解事业单位管理者和高校教师的职业倦怠现状及其影响因素.方法 采用分层整群随机抽样的方法抽取管理者、高校教师等1250名作为样本进行问卷调查.结果 男性的人格解体和职业倦怠得分均高于女性;不同民族职业倦怠得分无明显差异;年轻人、工作早期、低收入、低学历和未婚者较容易产生职业倦怠.社会支持、内控、积极应对与职业倦怠呈负相关,职业应激、外控、心理控制、消极应对与职业倦怠呈正相关.影响职业人群职业倦怠的主要因素有人口学特征(低年龄、低工龄、低收入、低学历和未婚)、社会支持、心理控制感、应对方式和职业应激,其中职业应激是主要的影响因素.职业应激可以直接导致职业倦怠,同时又受到心理控制等调节变量的影响对职业倦怠产生间接作用.结论 职业倦怠随着职业人群人口学特征的不同而有差异,同时受到心理控制等变量的调节.     

Caring labour,intersectionality and worker satisfaction: an analysis of the National Nursing Assistant Study (NNAS)

Caring labour in long‐term care settings is increasingly important as the US population ages. Ethnographic research on nursing assistants (NAs) portrays nursing home care as routine and fast paced in facilities that emphasise life maintenance more than care. Recent interview‐based and small quantitative studies describe a mix of positive and negative aspects of NA work, including the rewards of caring, despite shortcomings in working conditions and pay. The current study continues this research but, for the first time, using national data. The 2004 Centers for Disease Control and Prevention’s National Nursing Assistant Study (NNAS) provides survey data from 3,017 NAs working in long‐term care facilities across the US. The NNAS results confirm the importance and centrality of caring to NAs’ work. NAs motivated by caring for others were significantly more satisfied with their jobs than those motivated by other reasons, such as convenience or salary. Overall, NAs report surprisingly high job satisfaction, particularly with learning new skills, doing challenging work, and organisational support for caring labour. Areas of dissatisfaction were salary, time for reproductive labour, and turnover. Intersectional analysis revealed race and citizenship played a stronger role than gender in worker satisfaction.     

Recruitment and retention issues for occupational therapists in mental health: Balancing the pull and the push

Background/aim: Recruitment and retention issues for mental health occupational therapists have been the subject of significant concern for many years. This paper describes recruitment and retention issues as reported by mental health occupational therapists employed by a large Area Health Service in metropolitan Sydney. Method: Thirty‐eight mental health occupational therapists (response rate 84%) completed a survey in the first half of 2008. Key themes investigated were: overall satisfaction; attractive elements of positions; positive aspects of positions; constraints of positions; factors associated with leaving positions; supervision; professional development; career pathways; and interest in and access to management positions. Results: Key elements that kept respondents in positions included the nature of the work, being in a supportive team and the opportunity to use occupational therapy skills. Elements that prompted people to consider leaving positions were the desire for new and different types of work, a desire to work closer to home, insufficient time or high workloads, feeling ‘bored’ or ‘stale’, organisational change or juggling multiple demands, working in unsupportive or dysfunctional teams and family or other personal factors. Conclusions: The results supported the development of a ‘push and pull’ conceptualisation of recruitment and retention issues, including job‐related (intrinsic) and non‐job‐related (extrinsic) issues. This conceptualisation allows organisations to closely examine factors that attract practitioners to positions and those that support or damage staff tenure.     

Community pharmacists at transition to independent practice: Isolated,unsupported, and stressed

While there is evidence from nursing and medicine that transition to independent practitioner is challenging and has implications for patient care, there is little research exploring novice community pharmacists' (NCPs) transition. This study aimed to identify the challenges faced by NCPs at transition to independent practitioner and perceptions of the relative importance of these challenges. Nominal group discussions were held between November 2015 and April 2016, in North West England, with purposively sampled NCPs, early career pharmacists, work‐based preregistration tutors, and pharmacy support staff. In response to the question “What are the challenges faced by NCPs at transition?” participants individually wrote down and subsequently called out, in round‐robin fashion, then discussed, and broadly categorised challenges before ranking them in order of importance. Discussions were audio‐recorded with consent, transcribed, and analysed thematically. Twenty‐five participants from independent, supermarket, and small and large multiple pharmacies took part in five nominal group discussions. Challenges experienced through interacting with the workplace environment were identified as: (in order of importance) relationship management; confidence; decision‐making; being in charge and accountable; and adapting to the workplace. With the exception of disagreement between pharmacists and pharmacy support staff regarding whether adapting to the team was challenging for NCPs, all participants reported challenges experienced through interacting with the workplace environment. Challenges were described as inducing psychosocial stress, particularly because NCPs acquired immediate professional accountability, worked in isolation from experienced peers, and faced job‐related pressures. Interpretation of the findings suggests that the Karasek job‐demand‐control‐support (JDCS) model of occupational stress provides valuable insight about transition for NCPs. NCPs' jobs are classified as high strain, where high workplace demands coupled with NCPs' lack of control in being able to meet demands, together with isolation and lack of support, result in transition being characterised as causing isostrain, where the workplace becomes a “noxious” environment.     

心理一致感在护士工作压力与共情疲劳间的中介作用

目的 探讨心理一致感在肿瘤医院护士工作压力与共情疲劳间的中介作用.方法 2021年1—6月随机选取本院护士62名作为研究对象,使用护士工作压力源量表、心理一致感量表及护士专业生活品质量表评价护士的工作压力、心理一致感、共情疲劳,分析心理一致感在护士工作压力与共情疲劳间的中介作用.结果 护士工作压力与工作倦怠、二次创伤呈...     

The current and future role of the dietetic support worker

Background: The role of the dietetic support worker (DSW) was developed to provide cost‐effective support to dietetic services in the National Health Service (NHS). However, there is little evidence about how the role is perceived or the impact of the introduction of Agenda for Change in 2004 (a guide to pay terms and conditions for NHS staff) on role definition. The present study aimed to gather evidence from DSWs and dietitians on the current role of the DSW to help inform the future development of the role. Methods: A questionnaire survey was conducted on DSWs and dietitians in 10 trusts in the East of England. Issues included qualifications, experience, training, satisfaction with Agenda for Change, supervision and responsibility. Themes were further explored by semi‐structured telephone interviews conducted on a subsample. Results: Eighteen out of 24 DSWs and 62 out of 98 dietitians responded to the questionnaire. The role of the DSW is highly valued by dietitians. Over three‐quarters of DSWs and over 90% of dietitians agree that the employment of DSWs improved the working lives of dietitians. Only 50% of DSWs were happy with their Agenda for Change banding, although this did not adversely affect their job satisfaction. Both groups saw the role of the DSW becoming more specialised, despite concerns about access to appropriate training and the lack of a structured career pathway. Conclusions: This study identified issues relating to the future development of the role of the DSW from the viewpoint of DSWs and dietetic assistants.