Submitted by: So, cheril d.
Article 3
Burnout in Health Care Providers of dialysis service in Northern Italy-multicentre study

This article is a study regarding the burnout level of the physicians vs. nurses. It is done to assess their working capabilities in the dialysis unit, and to investigate their relationship with the quality of life.

For the first time in 1974 Freudenbereger used the term "burn-out". it is to describe a state of generalized fatigue recognized by mental health professionals in their own workplace. Freudenberger described burn-out in the following way: “collapse, exhaustion or extreme fatigue resulting from an excessive demand of energy, strength or resources.” Freudenberger 1974’s definition of burn-out explains that “an individual becomes rigid, stubborn and intransigent. According to him progress and constructive change requires more effort that the individuals are stocked up to their work thus it results to depression wherein individual can’t promote a high quality of care to their clients.

At the time, Freudenberger suggested that the individuals most likely to experience burn-out were those who felt internal pressure to devote body and soul to their work in helping others, those who are dedicated in there their works suffers most. while also feeling external pressure to give of themselves. The term burn-out according to Freudenberger in only applicable to those individualswho requires a heightened level of empathy for example the nurses, doctors and the teachers. The original concept of burn-out included only those individuals whose positions required a heightened level of empathy, as in the case for nurses, doctors and teachers.

Those in the said career when engage to burn-out, they are experience a sense of loss of energy and sense of achievement in their particular profession, I can say that professionalism is slighltly diminished which should be given priority to because personality is one of the foundation in giving a high quality service toward patients.

Quote: As expected, job tension was a key predictor of exhaustion.

By using Maslach Burnout inventory the results shows that nurses have high level of burnout than physicians due to their prolonged contacts with their invalidated patients during shift. Working conditions is independent predictor of burnout, also with gender as well as family situation. Nurses are burnout due to emotional exhaustion, maybe thru to their different intensity and duration of patient-health care provider relationship, meaning the nurse stays much longer with the patient, the nurses spent half of their day in the unit than the doctors although doctors have the most time in a day but nurses has most days in a week. Working tensions may greatly affect quality of care thus giving a negative impact on the nurse and physicians treatment to patients.
quote: In 1975, Freudenberger described three types of workers particularly vulnerable to burn-out:
• The dedicated worker who accepts too heavy a workload
• The over-determined worker whose life outside work becomes unsatisfactory
• The authoritative worker who believes nobody other than themselves can work as effectively.

According to Freudenberger these are the ones who are affected by burnout and physical exhaustion, those physicians and nurses who have a heavy workload must delegate some of their works to the other staff so that equality of work is obtained. People who has a superiority complex, that’s there is no other greater than them, those people must schedule themselves for a personality check, or undergo a psychiatric testing to evaluate his role in the field. A heavy heaps on their family situation over their work loads gives them stress thus making them a well-balanced being that is very inappropriate in providing nursing care.

In conclusion though burnout nurses and physicians is not a critical problem in northern
Italy, nevertheless in the Philippines most nurses are exhausted in their work on dialysis unit due to the long time shift, nursing administrator must give priority to these because due to stress nurses can’t provide an appropriate quality of care to their patients.

Guideline question:
1. What are the primary cause why burnout occurs?
2. Can the professionals avoid burnout from occurring?
3. Can burnout lead to deterioration and oneself?

References:
1. AIDSLINE MED/93294102
van Servellen G; Leake B; School of Nursing, University of California Los Angeles. Burn-out in hospital nurses: a comparison of acquired immunodeficiency syndrome, oncology, general medical, and intensive care unit nurse samples. http://www.aegis.com/aidsline/1993/sep/M9390526.html
2. Douglas institute,(2009) http://www.leburnoutsesoigne.com/burn-out/history.html.
3. http://en.wikipedia.org/wiki/Burnout_(psychology), page was last modified on 18 June 2009 at 01:41

Burnout is a highly psychological term, like stress, which has somatic manifestations (manifestations of which include manifestations of increased stress hormones [increased heart rate, palpitations], coronary heart disease, and other circulatory system related-diseases) which can penultimately lead to rapid bodily deterioration unless acted upon.
Like any other clinical condition burnout is primarily caused by a myriad of diverse factors. It is never a one-primary-factor condition that a one-shot intervention can make it go away. To quote Rafii et al (2004), “nurses' and patients' personal characteristics and social support influenced nurses' responses to burnout. Personal characteristics of the nurses and patients, especially when interacting, had a more powerful effect. They altered emotional, attitudinal, behavioral and organizational responses to burnout and determined the kind of caring behavior. Social support had a palliative effect and altered emotional responses and some aspects of attitudinal responses. ” [1] Hebert et al (2007) also offer another factor, to quote “family caregivers are integral to the care of patients with physical or mental impairments. Unfortunately, providing this care is often detrimental to the caregivers' health. As a result, in the last decade, there has been a proliferation of interventions designed to improve caregivers' well-being. Interventions for caregivers of persons at end-of-life, however, are relatively few in number and are often underdeveloped. They also are typically designed to help reduce the work of caregiving or to help caregivers cope with the physical and emotional demands of providing care. While useful, these interventions generally ignore a primary stressor for family caregivers—a loved one's suffering.” [2] This undoubtedly supports the argument mentioned. A nurse’s personal characteristics may place him/her at risk of burnout, but if her social skills are highly developed and a suffering is factored out and vice-versa, then it just has to have an effect in preventing burnout from occurring.
Professionals can avoid burn-out, and there are several instituted interventions that have been already in place to counter it. An encyclopedia article from Wikipedia [3] suggests several ways to cope with burnout that were conveniently grouped into three main strategies: Organizational aspects, which aim to decrease stress and increase interpersonal skills include counselling and stress management; Individual aspects which focus on the nurse such as problem-based and appraisal-based coping; and Social Support. Hebert et al (2007), has tried a twenty-week, nurse-lead cognitive-behavioral based intervention which taught caregivers on how to emotionally support their patients and facilitate communication has reportedly relieved some of the strains the caregivers were experiencing. [2] A study from Stuart and Sundeen (1987) quoted from the study of Rafii et al (2004) concluded that spiritual beliefs also influence the person’s coping patterns and may significantly reduce stress. [4]

1 - Forough Rafii, Fatemeh Oskouie (2004), and Mansoure Nikravesh, Factors involved in nurses' responses to burnout: a grounded theory study, lifted from the Bio Med Central Nursing, accessed June 22, 2009 retrieved from www.pubmedcentral.nih.gov
2 - Randy S. Hebert, MD, MPH, Robert M. Arnold, MD, and Richard Schulz, PhD (2006), Improving Well-Being in Caregivers of Terminally Ill Patients: Making the Case for Patient Suffering as a Focus for Intervention Research, lifted from the National Institutes of Health Author Manuscripts, accessed June 22, 2009 retrieved from www.pubmedcentral.nih.gov
3 – Burnout (Psychology), from the Wikipedia, the free encyclopedia, http://en.wikipedia.org/wiki/Burnout_(psychology)
4 - Stuart GW, Sundeen SJ (1987), Principles and practice of psychiatric nursing. 3. St Louis: the CV Mosby co., 1987

Comment.
Burnout can be experienced by care providers because of the stressors in their working environment and from their clients. Some of the reasons why care providers are experiencing burnout are understaffing, increasing severity of client illnesses, adjusting to various work shift being expected to assume responsibilities for which one is not prepared, inadequate support from peers and supervisors, caring for dying clients, and so on. Nurses can prevent burnout by means of first, identifying the cause of the phenomenon, once identified planning for stress reduction is the next step. Burnout can make a care provider not so well that he can not perform his jobs accordingly. If not managed this could lead to severe fatigue, physical and emotional depletion.


Reference:

Barabara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, Fundamentals of Nursing, (7th ed.) p. 1026, New Jersey, Pearson Education Inc.,

Nurses, in some ways, are like clients too, they are vulnerable in having stress and anxiety which could be work-related. Some nurses cope successfully the demands of work they have to do, while some nurses experience burnout which is a “complex syndrome of behaviours that can be likened to the exhaustion stage of the general adaptation syndrome” (KOZIER, 2004). Nurses who experience burnout can affect the expected outcome of the job performance which could result to probable medication error, thus, placing the life of patient in danger. And so, like clients, they need to implement stress reduction management too.
REFERENCE:
Kozier, B., Erb, G., Berman, A., Snyder, S., (2004). Fundamentals of Nursing. New Jersey, Pearson Education Inc.,

Nurses, like clients, are susceptible to experiencing anxiety and stress. Nursing practice involves many stressors related to both clients and working environment— understaffing, severity of client illnesses, adjusting to various work shifts, being expected to assume responsibilities for which one is not prepared, inadequate support from supervisors and peers and son on. Although most nurses cope effectively with the physical and emotional demands of nursing in some situations nurses become overwhelmed and develop burnout, a complex syndrome of behaviors that can be linked to the exhaustion stage of the general adaptation syndrome.

Refferenc:
Barbara Kozier (2004) fundamentals of Nursing; seventh edition (page 1026).New Jersey: Pearson Education Inc

“The term burn-out according to Freudenberger in only applicable to those individualswho requires a heightened level of empathy for example the nurses, doctors and the teachers. The original concept of burn-out included only those individuals whose positions required a heightened level of empathy, as in the case for nurses, doctors and teachers.”

It is true that those who are perfectionist, workaholic, and those who care for others are vulnerable to burnouts. Yet, using empathy promotes good relationship to your patients. It provides good feedback to the patient and same to the nurse which cultivates the nurse-patient relationship. And according to Rafii et.al (2004)”… the effect of social support on the nurses' responses to burnout was not as powerful as the nurses' and patients' characteristics.” So, having a good relationship with the patient promotes satisfaction and motivation to nurses.

“…personality is one of the foundation in giving a high quality service toward patients.”

I agree to the statement above. As indicated in the article of Rafii et. al (2004) these personal characteristics such as conscience, religious beliefs, personal philosophy, commitment, a sense of responsibility, and altruism facilitated caring behaviors influences the way of thinking of nurses. They may some times attribute their hardship to the Almighty Father. Yet these optimistic thoughts may be changed by negative factors that have occurred for a long time. So, motivations, inspirations, and support by those in authorities and significant others would help to uplift the emotions and energy of the nurses thus resulting to a more productive work.

Reference:
Rafii, F., Oskouie, F., & Nikravesh, M. (2004). Factors involved in nurses' responses to burnout: a grounded theory study. BioMed Central, 3; 6. Retrieved June 23, 2009, from PubMed Central.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=534790&tool=pmcentrez

Nurses are humans, capable of doing the best in their jobs but still have limitations. Between juggling family and work and giving self to both, dissatisfaction with work environment and salary, it is hardliy surprising if there is a lot of nurses experiencing burnout.
This is an issue that should not be taken lightly as this certainly affect the nurse's well being as well as quality of patient care.


Vahey, DC., Aiken, LH., Sloane, DM., Clarke, SP., and Vargas D. (2004). Nurse Burnout and Patient Satisfaction. Retrieved June 23, 2009 from http://www.rwjf.org/pr/product.jsp?id=14338