Submitted by: Charise A. Gonzales





The article primarily focused on the prevalence of burnout among dialysis health care workers. It targeted on assessing and comparing burnout levels in a sample of nurses and physicians working in dialysis units, and to investigate their relationships with quality of life, in a crosssectional observational study.

General Estimating Equations models were used for the analysis. Generalized estimating equations (GEE) are a convenient and general approach to the analysis of several kinds of correlated data. The main advantage of GEE resides in the unbiased estimation of population-averaged regression coefficients despite possible misspecification of the correlation structure. (Ghisletta and Spini, 2004)

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Burnout, based from the article, is a syndrome characterized by the three main components of emotional exhaustion, lack of empathy with patients and colleagues and diminished personal accomplishment that leads to decreased effectiveness at work. It is a distinct work-related syndrome and is not believed to pervade all aspects of personal life as depression. This syndrome includes a constellation of diverse manifestations such as fatigue, insomnia, irritability, inability to concentrate, decreased morale, a loss of quality in performance of work and an increased use of alcohol or drugs in order to cope at home or at work.

Burnout syndrome (BOS) was identified in the early 1970s in human service professionals, most notably health care workers . BOS has been described as an inability to cope with emotional stress at work or as excessive use of energy and resources leading to feelings of failure and exhaustion . Although depression affects nearly every aspect of the person's life, symptoms of burnout occur only at work; however, BOS also decreases overall well-being . Maslach and Jackson developed the Maslach Burnout Inventory (MBI) for detecting and measuring the severity of BOS. The scale evaluates three domains, namely, emotional exhaustion, depersonalization (negative or cynical attitudes toward patients), and loss of a feeling of personal accomplishment at work. Clinical symptoms of BOS are nonspecific and include tiredness, headaches, eating problems, insomnia, irritability, emotional instability, and rigidity in relationships with other people.
Wide variations in the prevalence of BOS in health care professionals have been reported across specialties, both in doctors and in nurses . Workplace climate and workload were determinants of BOS. However, higher levels of severe BOS were found in oncologists , anaesthesiologists, physicians caring for patients with AIDS , and physicians working in emergency departments . (Élie Azoulay, M.D., Ph.D, 2007)


People are emotionally, physically and spiritually exhausted. The daily demands of the job, the family and everything in between erode their energy and enthusiasm. The joy of success and the thrill of achievement are more and more difficult to attain> dedication and commitment to the job are fading. People are becoming cynical, keeping their distance, trying not to let themselves get too involved. (Maslach, Leiter, 1997)



This is nonetheless surprising, especially in the light of the professional burden carried daily by these health care professionals, who routinely face a long-term chronic illness such as end-stage renal failure. This occurs in a growing elderly population with frequent never-ending demands and/or non-compliance and poor prognosis, who often require heavy physical efforts, and may die
in the unit. Finally, these professionals spend long hours in a machine-related working surrounding.
Working from these assumptions, in the present study we sought to determine the prevalence of
burnout in a sample of Italian dialysis health care workers and to compare levels of burnout between
nurses and physicians.


Based from the study of the Institute of Oncology and Radiology of Serbia, Belgrade, Yugoslavia (2000) these are the symptoms of Burnout and measures to alleviate burnout syndrome:

Symptoms of Burn-out
• Irritability
• Debility
• Self-criticism
• Insomnia
• Fatigue
• Spinal Problems
• Lack of Organization
• Loss of Sense of Priority
• Depressive States
• Feeling of Failure
• Painful symptoms
• Social Isolation
• Poor concentration and performance
• Less caring attitudes
• Problems with the rest of the team


Paradoxically, the basic cause of stress, the workload, can become the only source of satisfaction for those experiencing burnout.

Measures to Alleviate Burnout Syndrome:
• Arrange the different duties so as to suit best the individual capabilities
• Establish a well run and fair rotation systems of duties and shifts
• Stimulate goals of high quality in work
• Organize a system of “breaks” during duties to diminish fatigue and tension
• Create protocols, a well define code, including an ethic committee, which will serve as guide in taking difficult vital decisions



In the conclusion of the study; ‘nurses appeared more burned-out in the emotional exhaustion scale than physicians, probably due to the different intensity and duration of the patient-health care provider relationship. In addition, working condition and personal situation were also associated to burnout. All these findings point to the need for burnout level monitoring, in order to recognize susceptible subjects
and implement timely organizational and supportive measures to increase the quality of working conditions in such environments, improving working lives of nurses and doctors, and thus preventing the deterioration of the quality of care.’



What has happened to bring on this crisis?
Why is burnout becoming a more common part of our vocational vocabulary?
Where does the roots of the problem, burnout, lie?



It is a fact that, amelioration of burnout symptoms may lead to better nurses and physician mental health and productivity ultimately leading to better health for patients.






References:

1- Paolo Ghisletta, Dario Spini, (2004),Journal of Educational and Behavioral Statistics, Vol. 29, No. 4, (pp.421-437), http://jeb.sagepub.com/cgi/content/abstract/29/4/421

2- Élie Azoulay, M.D., Ph.D,(2007), Burnout Syndrome in Critical Care Nursing Staff, Vol 175. ( pp. 698-704)American Journal of Respiratory and Critical Care Medicine,
http://ajrccm.atsjournals.org/cgi/content/full/175/7/698

3- Z.Tomasevic, S. Jelic, D. Radosavljevic, S. Jezdic, Institute of Oncology and Radiology of Serbia, Belgrade, Yugoslavia (2000), Burn-out Syndrome Among Medical Staff for the Institue of Oncology and Radiology of Serbia, http://www.onk.ns.ac.yu/Archive/vol8/PDFVol8/Plenary-Tomasevic.pdf

4- Christina Maslach, Michael Leiter,(1997), The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It, (pp. pp.1-5), Jossey-Bass Inc., Publishers, San Francisco California, 94104














[b][quote]

] 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:

Many instances in the life of a care provider that they experience burnout. I certainly believe that burnout can be experience by those who are novice in the filed. A great pressure can felt from their superiors and peers, in addition caring for clients who suffers from a serious disease could also result to burnout.





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

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Burnout is an occupational stress experienced by both Nurses and Physicians. In our country, the problem is often overlooked and underestimated by these professionals and just merely go on with their daily tasks and duties, not realizing the detrimental effects that it can bring to their health, team communication and quality of patient care.


Cases of burnout or emotional exhaustion usually occur in clinical areas dealing with serious life-threatening conditions such as those in the Emergency departments, Oncology units and Dialysis treatments/procedures among others.


A study on "Burnout: Need Help?" was conducted in 2008 by authors Gulalp, et. al to identify the relationship between Burnout Syndrome in Emergency Departments.





Researches on the risks of burnout in a health provider is limited, but one risk that is common among victims of this occupational stress is the display of Compassion Fatigue towards colleagues and patients, most especially.


A study on "Compassion Fatigue and Psychological Distress Among Social Workers: A Validation Study" was assessed by authors Adams, et. al:





Therefore, with the alarming consequences of burnout and compassion fatigue, appropriate measures should be made to safeguard the health providers' well-being in order for them to deliver consistent quality of care to their respective clients.




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REFERENCES:

1. Gulalp, B.; Karcioglu, O.; Sari, A. & Koseoglu, Z. 2008. Burnout: need help?. Journal of Occupational Medicine and Toxicology. Retrieved June 23, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2621227&tool=pmcentrez

2. Adams, R.E.; Boscarino, J.A. & Figley, C. 2009. Compassion Fatigue and Psychological Distress Among Social Workers: A Validation Study. Pub Med Central. Retrieved June 23, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2699394&tool=pmcentrez

The nurse with burnout manifests physical and emotional depletion, a negative attitude and self-concept, and feelings of hopelessness and helplessness. Nurses can prevent burnouts using techniques to manage stress discussed for clients. Nurses must first recognize their stress and become attuned to such responses as feelings of being overwhelmed, fatigue, angry outburst, physical illness, and increase in coffee drinking, smoking, or substance abuse. Once attuned to stress and personal reactions, it is necessary to identify which situations produce the most pronounced reactions so that steps maybe taken to reduce stress.


Kozier, B (2004). Fundamentals of Nursing (7th ed.). New Jersey: Pearson Education Inc

Burnout is a psychological term for the experience of long-term exhaustion and diminished interest. there are ways that we can deal with burnouts. Like stress management and social support will help an individual who is currently experincing bunouts. Burnout is not a recognized disorder in the Diagnostic and Statistical Manual of Mental Disorders.