Burnout and 'stress of conscience' among healthcare personnel

Title. Burnout and ‘stress of conscience’ among healthcare personnel Aim. This paper reports a study examining factors that may contribute to burnout among healthcare personnel. Background. The impact on burnout of factors such as workload and interpersonal conflicts is well‐documented. However, although health care is a moral endeavour, little is known about the impact of moral strain. Interviews reveal that healthcare personnel experience a troubled conscience when they feel that they cannot provide the good care that they wish – and believe it is their duty – to give. Methods. In this cross‐sectional study, conducted in 2003, a sample of 423 healthcare personnel in Sweden completed a battery of questionnaires comprising the Maslach Burnout Inventory, Perception of Conscience Questionnaire, Stress of Conscience Questionnaire, Social Interactions Scale, Resilience Scale and a personal/work demographic form. Results. Regression analysis resulted in a model that explained approximately 59% of the total variation in emotional exhaustion. Factors associated with emotional exhaustion were ‘having to deaden one's conscience’, and ‘stress of conscience’ from lacking the time to provide the care needed, work being so demanding that it influences one's home life, and not being able to live up to others’ expectations. Several additional variables were associated with emotional exhaustion. Factors contributing to depersonalization were ‘having to deaden one's conscience’, ‘stress of conscience’ from not being able to live up to others’ expectations and from having to lower one's aspirations to provide good care, deficient social support from co‐workers, and being a physician; however, the percentage of variation explained was smaller (30%). Conclusion. Being attentive to our own and others’ feelings of troubled conscience is important in preventing burnout in health care, and staff need opportunities to reflect on their troubled conscience. Further research is needed into how a troubled conscience can be eased, particularly focusing on the working environment.     

护士工作压力、生活质量、心理健康与工作倦怠关系的研究

目的:探讨护士工作压力、生活质量、心理健康与工作倦怠的关系。方法:抽取昆明市某综合医院的护士476人,采用护士工作压力源量表、世界卫生组织生活质量评定量表、工作倦怠量表和症状自评量表进行评估。探讨护士工作压力源、生活质量、心理健康与工作倦怠的相互作用方式和途径。结果:工作倦怠可直接显著影响护士心理健康,而工作压力和生活质量都可通过工作倦怠对护士心理健康产生间接影响。结论:工作倦怠是护士工作压力、生活质量影响心理健康的中间环节。     

Burnout and its correlates among nursing staff: questionnaire survey

AIM: This paper is a report of a study to determine the burnout level and its correlates in nurses. BACKGROUND: Healthcare providers and especially nurses are generally considered a high risk group regarding work stress and burnout and this syndrome has been a major concern in the field of occupational health. METHOD: The study was carried out at a university hospital in Turkey during May-June 2005. A total of 418 nurses from the 474 working at the hospital at the time (88.2%) answered a self-administered questionnaire including the Maslach Burnout Inventory. FINDINGS: All the nurses were female, with a mean age of 30.6 (5.4) and a median age of 29 years. The mean score was 17.99(6.35) for the Emotional Exhaustion subscale, 5.72 (3.87) for the Depersonalization subscale and 19.83 (4.66) for the Personal Accomplishment subscale. Emotional Exhaustion decreased with increasing age (P < 0.05). Total time in the job, weekly working hours, shift-working and the unit where employed influenced burnout scores (P < 0.05). Not being happy with relations with superiors, not finding the job suitable, feeling anxious about the future, perceived poor health, problems with personal life and financial difficulties were also factors influencing burnout scale scores (P < 0.05). CONCLUSION: It is necessary to consider nurses having the characteristics shown as the correlates of burnout in this study as a target group, to screen periodically the burnout status and improve their working conditions, especially relationships with colleagues.     

Health-promoting behavior and quality of life among caregivers and non-caregivers in Taiwan: a comparative study

Title.  Health-promoting behavior and quality of life among caregivers and noncaregiversin Taiwan: a comparative study.
Aim.  This paper is a report of a study conducted to compare middle-aged female family caregivers and non-caregivers in terms of: (a) differences in quality of life and health-promoting lifestyle behaviors; and (b) the relationship between health-promoting lifestyle behaviors and quality of life.
Background.  Caregiving for older relatives is a stressful responsibility that detracts from the quality of life of female caregivers and imposes barriers to practising healthy behaviors. Recent studies on caregiving responsibilities have been primarily conducted in Western cultural contexts, with few studies of Chinese groups.
Method.  This cross-sectional, comparative study included a convenience sample of 39 female caregivers and 98 non-caregivers recruited in southern Taiwan in 2007. Data were collected using the World Health Organization Quality of Life Instrument-BREF Taiwanese version and Health Promotion Lifestyle Profile II.
Results.  The majority of caregivers reported a low level of caregiving input with family support. They also reported a statistically significantly higher proportion of health-promoting behaviors than non-caregivers, although quality of life did not differ between the two groups. Practising healthy behaviors may more strongly influence quality of life in caregivers than in non-caregivers.
Conclusion.  Policymakers should consider direct family support and uphold the value of family cohesion in order to maintain healthy behaviors and a high quality of life in family caregivers. Further studies with larger and more comparably-sized participant groups are recommended to investigate the interactions between levels of care, family support, caregiving consequences, health-promoting behaviors and the caregivers' quality of life.     

Critical incident exposure in South African emergency services personnel: prevalence and associated mental health issues

Objectives

To assess critical incident exposure among prehospital emergency services personnel in the developing world context of South Africa; and to assess associated mental health consequences.

Methods

We recruited a representative sample from emergency services in the Western Cape Province, South Africa, to participate in this cross sectional epidemiological study. Questionnaires covered critical incident exposure, general psychopathology, risky alcohol use, symptoms of post‐traumatic stress disorder (PTSD), and psychological and physical aggression between co‐workers. Open ended questions addressed additional stressors.

Results

Critical incident exposure and rates of general psychopathology were higher than in studies in the developed world. Exposure to critical incidents was associated with general psychopathology, symptoms of PTSD, and with aggression between co‐workers, but not with alcohol use. Ambulance, fire, and sea rescue services had lower general psychopathology scores than traffic police. The sea rescue service also scored lower than traffic police on PTSD and psychological aggression. The defence force had higher rates of exposure to physical assault, and in ambulance services, younger staff were more vulnerable to assault. Women had higher rates of general psychopathology and of exposure to psychological aggression. Other stressors identified included death notification, working conditions, and organisational problems.

Conclusions

Service organisations should be alert to the possibility that their personnel are experiencing work ‐related mental health and behavioural problems, and should provide appropriate support. Attention should also be given to organisational issues that may add to the stress of incidents. Workplace programmes should support vulnerable groups, and address death notification and appropriate expression of anger.     

Drinking habits and prevalence of heavy drinking among occupational healthcare patients

Objective

To estimate the proportion of heavy drinkers among occupational healthcare patients and evaluate their characteristics.

Design

Patients visiting their doctor in six occupational health clinics were asked to complete a questionnaire containing the Alcohol Use Disorders Identification Test (AUDIT) and other questions concerning health.

Setting

Occupational health services.

Subjects

A total of 757 patients participated in the study.

Main outcome measure

Heavy drinking was defined as having a score of 10 or more (men) or 8 or more (women) in the AUDIT questionnaire.

Results

Of the men 114 (29%) and of the women 48 (13%) were heavy drinkers. Only smoking differentiated both male and female heavy drinkers from moderate drinkers among the clinically relevant characteristics.

Conclusion

There are a considerable number of heavy drinkers among occupational healthcare patients. Heavy drinkers do not have any particularly specific characteristics except for the drinking that distinguish them from other patients. Thus, screening is necessary to identify heavy drinkers in occupational healthcare settings.     

Roles and responsibilities in substance use prevention in the school setting: views among Finnish school personnel representatives

ObjectiveThis study explores the views of Finnish school personnel representatives regarding substance use prevention responsibilities.DesignTwenty-two focus groups were conducted within the scope of a regional intervention study in 2019. Qualitative content analysis was performed.SettingFocus group interviews were conducted in the school setting.SubjectsFocus group participants included representatives for educational personnel and student welfare personnel working in basic education, general upper secondary education or vocational education settings.Main outcome measuresViews and experiences concerning roles and responsibilities in primary prevention of substance use.ResultsFindings highlight the need for intersectoral efforts and intra-school collaboration in primary prevention efforts, but also in mental health promotion – on which the informants placed great emphasis. The health promotion leadership in schools, structural guidelines and the school curriculum could both challenge and support school personnel in their roles. An increased need to focus on the early years of life and related responsibilities of the homes was emphasized, along with the need to place more emphasis on health education in the first years of basic education, and responsibilities related to early risk identification.ConclusionThe findings highlight a need to develop structures and role clarity among school personnel, which can advance further development of intra-school and inter-sectoral collaboration in primary substance use prevention and mental health promotion. In the Finnish context, the successful implementation of relevant legislation, which some school representatives view as unclear or contravening, could be further supported.

Key points

• Views regarding responsibilities in primary substance use prevention in the school setting have been less researched in the Nordic countries:
• The importance of inter-sectoral and intra-school collaboration is emphasized among school personnel representatives, including the role of the homes
• Primary prevention and mental health promotion responsibilities are viewed as less clear than secondary and tertiary prevention responsibilities
• Structural guidelines concerning e.g. confidentiality aspects and curriculum features can both support and challenge school representatives in their roles

     

二级医院精神科护士心理健康状况和生活质量调查分析

目的了解二级医院精神科护士心理健康状况及生活质量现状。方法采用症状自评量表和生活质量综合评定问卷对二级医院104名精神科护士及50名同级医院非精神科护士进行测评。结果精神科护士除人际关系因子低于常模组（P〈0．05）、敌对因子与常模组差异无统计学意义（P〉0．05）外,其余因子分均明显高于常模组（P〈0．01）。总体生活质量及躯体功能、心理功能、社会功能、物质生活4个维度得分均低于对照组（P〈0．05或P〈0．01）。结论二级医院精神科护士心理健康水平和生活质量相对较差,应引起重视。     

Real mental health promotion requires a reorientation of nursing education, practice and research

The evidence for the individual, social and economic benefits of mental health promotion is now well established. The indication is that a broader public health approach that addresses social and environmental factors related to mental health and well-being is required. Mainstream mental health services, however, continue to operate in relative isolation, allocating the greatest proportion of funding and resources to the treatment of mental illness and disorder. Relevant to health promotion, this paper explores the bidirectional link between physical and mental health and the social determinants of mental health. The growing interest in the positive aspects of health and well-being which focuses on wellness rather than illness is also discussed. One example of how mental health nurses can adopt principles of positive mental health to education, practice and research is presented. The author proposes that as the largest professional group in health care, nurses must become more actively involved in initiatives that reorientate practices and services away from an illness culture towards the adoption of wider mental health promotion principles.     

慢性精神分裂症患者职业康复疗效与自测健康的评估

目的评估慢性精神分裂症患者职业康复的疗效与健康状况的关系.方法58例康复期患者参与群体式、协同性的工疗活动,经过5个月训练,应用IPROS量表前后评定.并用自测健康评定量表评定,与一般人群进行比较.结果IPROS除社交因子外,其余项目减分差异有统计学意义(P＜0.001).患者健康状况在整体感觉、心理、社会健康因子等方面与对照组无差异(P＞0.05),但生理健康因子分则明显低于对照组(P＜0.001).结论患者经职业康复训练后,整体功能明显提高且健康状况接近一般人群,但应注意改善患者躯体健康状况.     

Predicting health-related quality of life by using a health promotion model among Iranian adolescent girls: a structural equation modeling approach

Predicting the significant determinants of health-related quality of life through the application of structural equation modeling in adolescents has received little attention in the health education and health promotion literature. The purpose of this study was to investigate the relationships between self-efficacy, barriers, social support, health-promoting lifestyle, and health-related quality of life among Iranian adolescent girls. Pender's health promotion model guided this study. This was a cross-sectional survey of 500 students who were recruited in Kashan, Iran. Their health-related quality of life was measured by using the Short Form Health Survey. A path analysis was conducted to predict the health-related quality of life determinants. The results indicated that 71% of the variance in health-related quality of life could be predicted by the variables. The results affirmed that self-efficacy was the most significant predictor of the students' health-related quality of life. It was concluded that interventions that are aimed at improving self-efficacy can lead to the enhancement of health-related quality of life among adolescent girls in the developing country of Iran.     

社区精神分裂症照顾者精神卫生知识知晓率及生活质量状况调查

目的：了解社区精神分裂症照顾者精神卫生知识知晓状况及生活质量状况,为社区干预提供依据。方法对129例社区精神分裂症患者照顾者采用精神卫生与心理保健知识问卷及世界卫生组织生存质量评定量表进行测评分析。结果本组精神分裂症照料者对精神卫生知识知晓率为55．8％,精神卫生基本知识正确回答率为35．7％-65．6％,平均43．2％;精神卫生知识知晓照料者生存质量评定量表的心理领域、独立性领域、社会关系领域及环境领域评分显著高于不知晓者（ P＜0．05或0．01）。结论社区精神分裂症患者精神卫生知识知晓状况较差,知晓者的生活质量明显高于不知晓者。     

Pre-military abuse,mental health,and hazardous alcohol use among military personnel

The present study examined whether pre-military sexual and physical abuse and negative mental health symptoms prior to military service contributed to hazardous alcohol use (i.e., alcohol-related consequences, dependency symptoms, and consumption) controlling for combat exposure. Participants were a community sample of 506 (183 women) active duty, National Guard/reservists, and veterans who completed an online survey assessing pre-military abuse, pre-military mental health symptoms, combat exposure, and hazardous drinking. Results using structural equation modeling showed that while controlling for gender and combat exposure, pre-military sexual abuse was associated with higher negative mental health symptoms prior to joining the military, which in turn was associated with higher reports of current alcohol consumption. Our findings suggest that hazardous alcohol use may not be strictly related to experiences on the battlefield and that mental health prior to military enlistment may be associated with later alcohol consumption. Limitations and future directions are discussed.     

Do nurses working in adult psychiatry take into consideration the support network of families affected by parental mental disorder?

The aim of this study was to gain information about registered and practical mental health nurses' activities concerning support network of families affected by parental mental illness. Data were collected using a structured questionnaire distributed to all 608 practical and registered mental health nurses working in adult psychiatric units in five Finnish university hospitals. A total of 311 nurses returned completed questionnaires (response rate 51%). Sixty per cent (n = 222) of registered nurses and 36% (n = 88) of practical mental health nurses responded. Information about family relationships and socio-economic situation was gathered regularly by all nurses. The nurses' individual characteristics, such as being a parent, further family education and use of family-centred care, were significantly related to their activeness in discussing the family's support network with the parents. Discussing family relationships and families support networks forms part of patient care in adult psychiatric nursing with families with dependent children (under 18 years of age). Nurses can work directly with the parents to aid them to strengthen their support network for themselves and their children.     

脑卒中患者心理状况及其与生活质量的相关性

目的探讨脑卒中患者心理状况及其与生活质量的相关性。方法选用汉密尔顿抑郁量表(Hamilton rating scale for depression,HRSD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HMAM)、脑卒中专用生活质量量表(stroke-specific quality of life,SS-QOL)对103例脑卒中患者进行调查。了解脑卒中患者心理状况及其与生活质量的相关性。结果 103例患者中抑郁68例(66.02%),总分(31.62±12.58)分;焦虑52例(50.49%),总分(22.17±5.38)分;患者抑郁和焦虑总分与其生活质量呈负相关(均P0.01)。结论脑卒中患者抑郁、焦虑不良情绪发生率高,抑郁、焦虑得分越高者其生活质量越差。