Burnout in renal care professionals

Burnout is defined as "a syndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment that can occur among individuals who work with people in some capacity", and it can be considered as a result of long-term exposure to occupational stress. Frequently reported occupational stressors among caring professionals are those intrinsic to the job, related to patient demands, related to roles within the organisation, and those related to relationships at work and career development. In renal care however, there are some unique characteristics such as technologically advanced equipment, the intensive caring environment and the long-term relationships being established between the carer and chronic renal patients, that one should take into consideration. It seems that job resources may act as moderators to burnout. Furthermore, specific personality characteristics and socio-demographic variables seem to affect the burnout experience. Individual and social organisational means for burnout prevention and coping are discussed and suggested.     

Work-related stress and occupational burnout in AIDS caregivers: test of a coping model with nurses providing AIDS care

Occupational stress and burnout are potential threats to quality of care for people living with HIV/AIDS. A total of 445 nurses who provide care to people living with HIV/AIDS responded to an anonymous postal survey that consisted of: demographic and work history questions, the Maslach Burnout Inventory, Rotter's Internal-External Locus of Control scale, and internal and external coping styles as measured by the Ways of Coping scale. Path analyses showed that both external (13.6% of the variance) and internal (3.1% of the variance) coping styles significantly predicted levels of burnout among AIDS caregivers, over and above participants' age, perceived workload and locus of control. Mediation analyses further showed that external coping mediates the effect of locus of control on burnout, but internal coping styles do not exhibit mediation. Results therefore replicate and extend previous research demonstrating the important roles of cognitive and behavioural coping styles in understanding burnout among providers of AIDS care.     

The relationship between recognition,rewards and burnout in AIDS caring

The positive psychological and sociological dimensions of AIDS care provision may produce important information to assist burnout prevention. While most studies on stress and burnout in AIDS health care have focused on the negative and difficult aspects of this work, few have considered the notion that the rewards of care-giving may buffer against stress or counterbalance experiences that may otherwise lead to burnout. A study of HIV/AIDS volunteers examined the relationship between stressors, rewards and burnout, using the HIV Volunteer Inventory and the Maslach Burnout Inventory. Correlation data indicates that a lack of a sense of personal accomplishment is a contributor to frequency of burnout. Over a fifth of the variance of burnout frequency can be accounted for by both stress and reward factors. Qualitative interview data also support the importance of rewards. Rewards in the form of gratitude from clients and recognition and support from management positively influenced the organizational climate. This study points to the need to find ways to increase the recognition and rewards experienced by carers. The potential benefits include reduced attrition and burnout and enhanced quality of life in the work setting.     

Quantitative analysis of burnout and its associated factors in AIDS nursing

A study was conducted to examine burnout and associated factors in the nursing care of AIDS patients in the hospital setting. Oncology nurses served as a comparison group and 64 subjects completed the Maslach Burnout Inventory. Although nurses working in the area of Oncology suffered burnout with greater frequency, nurses working in the area of AIDS showed greater intensity of burnout after adjustment for frequency of burnout. The study identified hospital differences in burnout scores, lending support to the environmental model of burnout proposed by Maslach. Male nurses were as likely to suffer burnout as female nurses. Having previously worked in other stressful areas did not influence burnout scores. On the other hand nurses who had worked in a particular unit for a greater length of time were more likely to suffer burnout, and age significantly influenced burnout inversely.     

High level of burnout in intensivists: prevalence and associated factors

RATIONALE: Professional burnout is a psychological syndrome arising in response to chronic interpersonal stressors on the job. There is the perception that intensivists are particularly exposed to stress because lives are literally in their hands. OBJECTIVE: To evaluate the prevalence and associated factors (patients or organization) of burnout among physicians working in intensive care units (ICUs) (including interns, residents, fellows, and attending physicians). METHODS: A 1-day national survey was conducted in adult ICUs in French public hospitals. MEASUREMENTS: The level of burnout was evaluated on the basis of the Maslach Burnout Inventory (MBI). MAIN RESULTS: A total of 189 ICUs participated and 978 surveys were returned (82.3% response rate). A high level of burnout was identified in 46.5% of the respondents. Ordinal logistic regression showed that female sex (odds ratio, 1.58; 95% confidence interval, 1.09 to 2.30) was independently associated with a higher MBI score. Whereas no factor related to the severity of illness of patients was retained by the model, organizational factors were strongly associated with a higher MBI score. Workload (the number of night shifts per month, a long period of time from the last nonworking week, night shift the day before the survey) and impaired relationships (such as conflict with another colleague intensivist, and/or with a nurse) were the variables independently associated with a higher MBI score. In contrast, the quality of the relationships with chief nurses and nurses was associated with a lower MBI score. CONCLUSIONS: Approximately one-half of the intensivists presented a high level of burnout. Organizational factors, but not factors related to the patients, appeared to be associated with burnout.     

Burnout

Burnout is primarily conceptualized by work psychology. It describes symptoms resulting from a long-standing, finally derailing adjustment to work-related stressors. Burnout is not a proper diagnosis according to traditional classification systems. However, ICD-10 considers burnout as a significant factor representing major personal problems that have impact on health status and illness behaviour. Burnout may be considered either as a transitional or persisting adjustment reaction to work-related stress, a condition of increased risk regarding to serious mental illnesses and physical diseases, or an integral syndrome of these various conditions. The core symptom of exhaustion or persisting tiredness must be carefully assessed in respect of depressive, anxiety and somatoform disorders from the perspective of psychiatric differential diagnosis. In most cases of a serious burnout the diagnosis of major depression can be established and should lead to proper psychotherapeutic and/or pharmacological treatments. Any aetiopathogenetic evaluation may be favourably done within a multifactorial biopsychosocial model. Consequences for medical care will be described.     

Emotional reactions of haemophilia health care providers

This study investigated the prevalence and impact of job burnout and job satisfaction among health care professionals working with HIV-infected patients with haemophilia, using a survey that included the Maslach Burnout Inventory (MBI). A minority (7.4%) of the 213 respondents met the criteria for job burnout as assessed by the MBI. Nearly 90% of the respondents reported 'liking' their job, although only 46% anticipated being in the same job in 5 years. The following factors were associated with increased degrees of burnout: greater perceived colleague stress, less overall job satisfaction, greater perceived stress in the working environment, fewer team meetings and fewer years of career experience. Mental health professionals were also less likely than physicians to report burnout. A multiple logistic regression found that providers who reported stress with colleagues were 42% more likely than their peers to be classified as experiencing a high level of job burnout. This study underscores the importance of a well-functioning team in buffering the inevitable stresses of caring for haemophilia patients with HIV.     

Critical care family needs: nurse-family member confederate pairs

In this study we explored the relationship between critical care family members' perceived needs and the assessment of these needs by a confederate sample of intensive care unit (ICU) nurses. Family needs were measured by using Molter's revised Critical Care Family Needs Inventory. Data consisted of 92 confederate pairs of Critical Care Family Needs Inventory responses obtained from 92 family members of adult patients hospitalized in a variety of ICUs and 49 ICU nurses providing direct care for these patients. Paired t tests (two tailed) were calculated to detect significant differences between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of the needs studied. Family members' perceptions and ICU nurses' assessments of the most and least important critical care family needs were identified. Significant (p less than 0.001 to p less than 0.05) differences were detected between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of 15 (50%) of the critical care family needs studied. Therefore, it appears that these nurses were only moderately accurate in their assessments of critical care family needs. Implications for nursing practice, education, and research were identified and discussed.     

WHY RENAL NURSES COPE SO WELL WITH THEIR WORKPLACE STRESSORS

Background: Previous studies have found significant stressors experienced by nurses working in haemodialysis units yet renal nurses appear to report less burnout than other nurses. Objectives: This study aims to undertake an inductive process to better understand the stressors and the coping strategies used by renal nurses that may lead to resilience. Method: Sixteen haemodialysis nurses from a metropolitan Australian hospital and two satellite units participated in open‐ended interviews. Data were analysed from a grounded theory methodology. Measures of burnout and resilience were also obtained. Results: Two major categories of stressors emerged. First, due to prolonged patient contact, family‐like relationships developed that lead to the blurring of boundaries. Second, participants experienced discrimination from both patients and staff. Despite these stressors, the majority of participants reported low burnout and moderately high‐to‐high levels of resilience. The major coping strategy that appeared to promote resilience was emotional distancing, while emotional detachment appeared to promote burn‐out. Conclusion: Assisting nurses to use emotional distancing, rather than emotional detachment strategies to engender a sense of personal achievement may promote resilience.     

Burnout syndrome in critical care nursing staff

RATIONALE: Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff. OBJECTIVES: To identify determinants of BOS in critical care nurses. METHODS: We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data. MEASUREMENTS AND MAIN RESULTS: Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96-0.99; p=0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52-0.91; p=0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56-0.97; p=0.03); (3) quality of working relations (1-10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16-1.30; p=0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86-0.98; p=0.02) or physicians (OR, 0.81; CI, 0.74-0.87; p=0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04-1.85; p=0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01-1.29; p=0.04). CONCLUSION: One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.     

Burnout in internal medicine physicians: Differences between residents and specialists

BACKGROUND: Burnout poses a substantial problem for physicians' well-being and for the quality of health care. The role of workload in comparison to subjective work characteristics has been rarely studied. The purpose of this study was to explore the associations of burnout with workload and subjective work characteristics in internal medicine specialists and residents. METHODS: A cross-sectional study using an anonymous mailed survey was used. Some 103 specialists and 143 residents participated in the study. Burnout was measured using the Maslach Burnout Inventory. Subjective work characteristics included perceived job demands in terms of time pressure, mental effort and emotional labor. Workload was assessed in terms of average number of hours worked per week. RESULTS: Emotional exhaustion in medical specialists was only predicted by perceived job demands [odds ratio 3.7 (CI 1.7-7.9), P<0.001]. Emotional exhaustion in medical residents was only predicted by emotional labor [odds ratio 1.9 (CI 1.2-3.0), P=0.003]. Depersonalization among medical specialists was only predicted by emotional labor [odds ratio 2.7 (CI 1.1-6.7), P=0.032], while depersonalization among medical residents was only predicted by number of hours worked per week [odds ratio 1.1 (CI 1.1-1.2), P=0.007]. DISCUSSION: Perceived working conditions were more important than workload in explaining the variance in burnout. In addition, burnout in medical specialists and residents was linked to different characteristics of their working environment.     

Increase of burnout among emergency department professionals due to emotional exhaustion during the SARS-Cov2 pandemic: Evolution from 2016 to 2021

The objective is to establish there have been any significant changes in the evolution of levels of burnout and empathy at the different Emergency Department in our region, bearing the severe acute respiratory syndrome coronavirus 2 pandemic. This cross-sectional observational study was conducted in a healthy region between November 2020 and January 2021. Lleida emergency care centers. All the doctors and nurses of the health were contacted by email. Empathy was measured using the Spanish version of the Jefferson scale of physician empathy. Burnout was measured using the Maslach Burnout Inventory (MBI) in the version validated in Spanish. Sociodemographic data were also recorded. We compared the data with 2016 results. A total of 159 professionals agreed to participate in this study. A significant increase in the MBI score was observed in the 2020 to 2021 sample (39.5 vs 49.7), mostly due to an increase in the MBI-EE (21.5 vs 28.5), as well as an increase in the Jefferson scale of physician empathy score (112 vs 116). (P = .039). There were no differences when analyzing the association between professions (nurses or doctors) or years worked, burnout, and empathy. For 2020 to 2021, the 41 to 50 years age group showed the highest burnout (MBI score). Emergency department practitioners suffered more burnout compared to 2016, especially due to emotional exhaustion (P < .001). Despite practitioners’ improved degree of empathy, which had been described as being preventative against burnout, during the COVID-19 pandemic, over-involvement may have led to empathic stress and emotional exhaustion, giving rise to greater burnout.     

Yoga complemented cognitive behavioral therapy on job burnout among teachers of children with autism spectrum disorders

Background/objective:Job burnout is a syndrome of reaction to chronic job-related stress which affects overall health, limits occupational efficacy, and personal accomplishments of employees thereby thwarting organizational outcomes. Burnout symptoms are common among teachers of children with autism spectrum disorders (ASD) and affect the academic progress of the children. This study investigated the effectiveness of Yoga-based cognitive behavioral therapy (Y-CBT) in reducing occupational burnout among teachers of children with autism in Lagos States, Nigeria.Methods:A group-randomized control-trial with immediate intervention and waitlist control groups was design was adopted. Participants included 58 teachers of children with autism in public and private special schools in the area. Participants were randomly assigned to Y-CBT (N = 29) and waitlist control (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments Demographic variable, Single Item Stress Questionnaire (SISQ), and Maslach Burnout Inventory-Educators’ Survey (MBI-ES) were used to collect data. Data were collected at baseline; post-test and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts.Results:Results revealed that job-burnout reduced significantly at post-test assessment among the Y-CBT group compared to the waitlisted group. The reduction in the participant was sustained across 3months follow-up evaluation.Conclusion:It was concluded that Y-CBT modalities could help to reduce the burnout symptoms among teachers of children with ASD.     

Relationship between oxidative and occupational stress and aging in nurses of an intensive care unit

Stressful conditions lead to formation of excessive reactive oxygen species (ROS) and cause oxidative stress and aging. The aim of this study was to determine superoxide dismutase (SOD) and catalase (CAT) activity, and malondialdehyde (MDA) levels in nurses of a hospital intensive care unit according to demographic and occupational parameters, and to analyse the relationship with aging. Thirty-two nurses working in an intensive care unit and 35 aged-matched healthy individuals of both sexes as a control group were surveyed. No significant variations with respect to sex were detected in SOD, CAT, MDA and burnout levels. MDA levels increased with age in both the control group and the nurses, and we observed significant differences in MDA levels between the control group and nurses for all age groups. Significant variations in MDA levels were detected between single (286.12 ± 8.41) and married (318.82 ± 6.02), people, between those who frequently practice some kind of sport (281.41 ± 7.32) and those who never participate in sport (298.24 ± 8.11) ,and between those who frequently eat fruit and greens (289.75 ± 8.41) and those who never eat them (315.12 ± 7.21). Significant differences were detected between smokers and nonsmokers in SOD, CAT and MDA, but not for alcohol, coffee, tea or cola consumption. Higher SOD activity and MDA levels were detected in nurses on evening and night shifts (P < 0.01); these nurses also scored significantly higher on burnout subscales. These results suggest that: (1) occupational stress increases oxidative stress levels as a response to elevated ROS generation; (2) occupational stress increases MDA levels as a response to an elevation in free radical generation and can lead to aging; (3) working evening and night shifts increases oxidative and burnout levels. It is evident that preventive changes in job conditions and lifestyle are necessary to improve the quality of life of nurses who work in intensive care units.     

Recruitment and retention: successful strategies in critical care

Recruitment and retention of critical care nurses is a major concern for nurse managers. Factors that affect recruitment and retention are management style, perceptions of isolation, stress, and burnout. Decentralization, primary nursing, and clinical advancement programs are strategies that allow nurses to participate in decision making at the unit level and to be recognized for their individual contributions. The application of these strategies to a cardiac surgery intensive care unit is presented.     

How to prevent burnout in cardiologists? A review of the current evidence,gaps, and future directions

Burnout is rising in all physicians, and cardiologists are not an exemption. Cardiology is a very popular specialty among medical students as it is associated with outstanding training standards and high prestige and income. In this review, we critically summarize the evidence on consequences, causes, and evidence-based interventions for burnout with a view toward recommending the best strategies for promoting wellness in cardiologists. Only a handful of studies have examined burnout specifically in cardiologists. Evidence therefore was mainly extrapolated by larger studies in all physicians and other physician specialties. Burnout in cardiologists has serious negative personal and professional consequences and is associated with suboptimal healthcare outcomes for patients. Burnout in cardiologists is primarily driven by professional and healthcare system demands and inefficiencies such as excessive workload and role complexity, training and certification demands, inefficient compensation models and lack of resources, computerization, and loss of autonomy. Moreover, loss of connectedness with patients, difficulties in balancing work and personal life and overvaluing compulsiveness and perfectionism in medical practice further increase the risk for burnout. Burnout among cardiologists may be best mitigated by organizational strategies complemented by individual stress reduction and reflection techniques under the resilience-based approach. Large-scale strategies are needed to mitigate burnout and promote physician wellness as a shared responsibility of healthcare systems and individuals and be committed in creating a new culture in medicine.     

Interactive relationships between hospital patients' noise-induced stress and other stress with sleep.

OBJECTIVE: The purpose of this study was to test the hypothesis that hospital noise-induced subjective stress would interact with other subjective environmental and personal stress in a relationship with poorer patient sleep. METHODS: A secondary data analysis was done using correlations and hierarchical multiple regression. Ninety-seven cardiac patients participated after transfer from critical care to a general unit. The independent variables were assessed with Topf's 24-item Disturbance Due to Hospital Noise Scale and 5-point items for other environmental stress (ie, bed, lights) and personal stress (ie, pain, anxiety). Sleep was evaluated with the Verran and Snyder-Halpern Sleep Scale. RESULTS: Hierarchical multiple regression led to a multiple R of 0.435 (P <.01). An interaction term, subjective noise stress x subjective bed stress x subjective pain x subjective anxiety accounted for a significant amount of sleep variance (12%, F = 13.63, P =.000). Subjective bed stress x subjective pain accounted for an additional 5% (F = 6.4, P =.013). CONCLUSIONS: Studies using research designs that assess relationships between multiple patient stress variable interactions and sleep or other stress-related outcomes may produce more accurate results than studies on the independent effects of different types of stress.     

Using a Single Item to Measure Burnout in Primary Care Staff: A Psychometric Evaluation

Background

Burnout affects nearly half of all U.S. nurses and physicians, and has been linked to poor outcomes such as worse patient safety. The most common measure of burnout is the well-validated Maslach Burnout Inventory (MBI). However, the MBI is proprietary and carries licensing fees, posing challenges to routine or repeated assessment.

Objective

To compare a non-proprietary, single-item burnout measure to a single item from the MBI Emotional Exhaustion (MBI:EE) subscale that has been validated as a standalone burnout measure.

Design

Cross-sectional online survey.

Participants

A sample of primary care providers (PCPs), registered nurses, clinical associates (e.g., licensed practical nurses (LPNs), medical technicians), and administrative clerks in the Veterans Health Administration surveyed in 2012.

Main Methods

We compared a validated one-item version of the MBI:EE and a non-proprietary single-item burnout measure used in the Physician Work Life Study. We calculated kappa statistics, sensitivity and specificity, positive predictive (PPV) and negative predictive values (NPV), and area under the receiver operator curve (AUC). We conducted analyses stratified by occupation to determine the stability of the correlation between the two measures.

Key Results

We analyzed responses from 5,404 participants, including 1,769 providers and 1,380 registered nurses. The prevalence of burnout was 36.7 % as measured on the single MBI:EE item and 38.5 % as measured on the non-proprietary single-item measure. Relative to the MBI:EE, the non-proprietary single-item measure had a correlation of 0.79, sensitivity of 83.2 %, specificity of 87.4 %, and AUC of 0.93 (se = 0.004). Results were similar when stratified by respondent occupation.

Conclusions

A non-proprietary single-item measure served as a reliable substitute for the MBI:EE across occupations. Because it is non-proprietary and easy to interpret, it has logistical advantages over the one-item MBI.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-014-3112-6) contains supplementary material, which is available to authorized users.Key words: Workforce, Psychometrics, Physician satisfaction     

The Interrelationships of Coping Styles and Professional Burnout Among Physiotherapists: A Cross-Sectional Study

Burnout is a pathological syndrome in which emotional exhaustion (EE), depersonalization (DEP), and a reduced sense of personal accomplishment (PA) develop in response to prolonged occupational stress. Those working in the physiotherapy profession appear to be at risk for professional burnout brought on by the specific character of the medical professions, involving continuous contact with patients and associated stress, as well as poor working conditions. However, literature data concerning the scale of professional burnout and its psychosocial correlates remain scarce.The aim of the present study was to assess the scale of professional burnout among physiotherapists and to determine the interrelationships between coping styles and burnout symptoms.The sample consisted of 117 professionally active physiotherapists (90 women and 27 men) aged 21 to 55 years (mean [M] 31.88, standard deviation [SD] = 9.14, responsiveness rate of 80.6%) from randomly selected medical institutions of the Lodz Region. The study was conducted using the Maslach Burnout Inventory (MBI) and Coping Inventory for Stressful Situations (CISS) by Endler and Parker. Demographic and job-related data on the respondents were also collected.Task-oriented coping correlated negatively with DEP, EE, and low PA, in contrast to emotion-oriented coping. No correlation was found between avoidance-oriented coping and burnout symptoms. Similarly, no interactive correlations between coping styles and particular burnout symptoms were confirmed.Coping styles correlate independently with professional burnout, without any mutual correlations. Physiotherapists employing a wider spectrum of task-oriented strategies are slightly more satisfied with their job. The incidence of burnout syndrome in the analyzed group is similar to that observed in other medical professions and requires the adoption of preventive measures.