Define burnout Assess burnout symptoms Describe early warning signs Discuss contributing factors ...

Define burnout Assess burnout symptoms Describe early warning signs Discuss contributing factors Discuss resolution and resilience

Burnout is physical, emotional or spiritual exhaustion brought about by sustained stress without adequate adjustment.

Burnout is otherwise know as exhaustion or when the bodily reserves used in the stress response have been used up.

Excessive prolonged stress Feeling of overwhelm Feeling of unable to meet constant

demands

Burnout is not a diagnostic category

International diagnostic classification criteria do not consider burnout as a disease

burnout as such is not a valid reason for sickness absence

• Negative consequences for employees (lack of interest in work – existential doubts)

• Consequences for clients (low quality of service)

• High costs for organizations• Its excessive spread (around 20% of the

employees)• Important social problem but still unclear

concept

Impaired performance

Poorer patient care

Professional problems: Lawsuits Suspensions License revocation Leave profession

Relationship difficulty

Physical problems

Addictions

Anxiety, depression, suicide

Healthcare professionals are at increased risk for professional burnout.

A recent survey showed that 1 in 2 US physicians has symptoms of burnout.

This likely is rooted in the care delivery system rather than the personal characteristics of few susceptible individuals.

Arch Internal Med, 2012

Stress can be described as a circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person.

“our reaction to events, environmental or internal, that tax or exceed our adaptive resources.”

Excited

Relaxed Ah!

Uh Oh!

Normal

Excited

Relaxed

Uh Oh!

Breakdown

Uh Oh!

Uh Oh!

Stage 1:Stress Arousal

Stage 2:Energy Conservation

Stage 3:Exhaustion

Persistent irritability Persistent anxiety High blood pressure/heart problems Inability to concentrate/forgetfulness Insomnia Headaches Bruxism

Late for work/turning work in late Procrastination Three-day weekend Social withdrawal Increase in coffee, tea, cola, alcohol

Substance abuse (so treated usually as symptoms):

more alcohol and drugs, poor eating, more or less than before, drinking more coffee if smoking - more cigarettes Developing or worsening of bad habits -

instead of giving help and relief, diminishes one’s physical resilience.

withdrawal from or even breakdown of meaningful and important relationships and friendships

withdrawal from pleasant activities – because of tiredness and lack of motivation

working more but less effectively and worse

Instead of helping, diminishes one’s psychological resilience.

Chronic: Sadness Depression Stomach/bowel problems Mental/physical fatigue Headaches

Desire to drop out of society Move away from friends, work,

family Possible suicide ideation

job characteristics work demands / challenges, work relationships, employee-patient relationships, role ambiguity / conflict

organizational characteristics workplace infrastructure, rewards/punishments linked to job performance, staff support

personal characteristicssuch as age, gender, and coping skills.

AccountantAccountant

ArtistArtist

Auto MechanicAuto Mechanic

ForesterForester

Low-StressOccupations

High-StressOccupations

Hospital managerHospital manager

Physician (GP)Physician (GP)

PsychologistPsychologist

School principalSchool principal

Police officerPolice officer

Police DispatcherPolice Dispatcher

Air Traffic ControllerAir Traffic Controller

Waiter/waitressWaiter/waitress

Medium-StressOccupations

excessive or high workloads, the emotional demands of dealing with

sick patients and their families and with patients whose behaviors are difficult

lack of staff support, uncertainty concerning treatment,

conflict with other nurses, supervisors and medical staff,

dealing with death and dying, management difficulties, issues involving patient care, concerns about technical knowledge

and skills

JobResources

Support

Autonomy +

Feedback

Coaching

JobDemands

Workload

Emotions

Intimity

Work-Home

Burnout

Engagement

-

+ Client Satisfaction

Efficiency+

-

Source: Taris, Bakker et al. (in prep.)

Impaired health

Low motivation

Impaired health

Motivation

Health

Low motivation

Health

Motivation

L

H

L

H

JOB RESOURCES

JOB

DE

MA

ND

S

ImbalancedWork

Partner

Family

Friends

Personal

Household

Spiritual

Recreation

Health

Exercise

Work

Work

Partner

Family

Friends

Personal

Household

Spiritual

Recreation

Health

Exercise

Burnout and PersonalityBurnout and Personality

• Neuroticism Neuroticism • Low extraversionLow extraversion• Low hardinessLow hardiness• External locus of controlExternal locus of control• Low self-esteemLow self-esteem• Type A personalityType A personality

More critical self

Pushed vs. pulled to goal

Unrealistic goals

Results focused vs. journey

Self attack: unmet goals

Fear failure/disappointing

Procrastinate

Defensiveness

Low self esteem

In 1981, Maslach and Jackson defined occupational burnout syndrome as a syndrome of maladaptive response to stress

emotional exhaustion, depersonalization reduced personal accomplishment.

DepersonalizationDepersonalization

Reduced PersonalReduced PersonalAccomplishmentAccomplishment

Physiological,Physiological,

psychological,psychological,

and behavioraland behavioral

consequencesconsequences

EmotionalEmotionalExhaustionExhaustion

Interpersonal andInterpersonal andRole-Related StressorsRole-Related Stressors

Emotional exhaustion - also called compassion fatigue, it represents the first stage of burnout and plays a central role in the burnout process.

Depersonalization - follows emotional exhaustion and is identified by the treatment of others as objects rather than people.

Reduced personal accomplishment - the final component of job burnout which refers to the decline in one's feelings of competence and success.

High Moderate Low

Emotional exhaustion

27 or over 17-26 0-16

Deperson- alization

13 or over 7-12 0-6

Personal accomplishme

nt

0-31 32-28 39 or over

Increased: Physical symptoms

& illness

Relationship difficulties

Negative thoughts

Eating, spending, smoking, drinking, gambling, unprotected sex

Decreased: Pleasure with

relationship & activities

Exercise, nutrition, socializing, laughing

Depression and burnout are not identical, although their symptoms may be overlapping

At individual level burnout may form a part of the aetiology of depression

More research is needed on the relationship between burnout and mental disorders

Depression• Depressive mood• Unhappiness,

displeasure• Weight loss• Fearfulness• Sleeping problems

(wake up early)• Guilt feelings• Suicide thoughts• Indecisiveness • Attribution of the

problem: sickness• General• Low vitality

Burnout• Anger, aggression• Low pleasure• No weight symptoms• No fearfulness• Sleeping problems

(difficulty to fall asleep)

• Guilt feelings • No suicide thoughts• Indecisiveness

(complaint) • Attribution of the

problem: work• Work-related• Moderate vitality

Stress TestStress TestSelf Assessment ExerciseSelf Assessment Exercise

How often do you…1. find yourself with insufficient time to do

things you really enjoy?

2. wish you had more support/assistance?

3. lack sufficient time to complete your work most effectively?

Stress TestStress TestSelf Assessment ExerciseSelf Assessment Exercise

4. have difficulty falling asleep because you have too much on your mind?

5. feel people simply expect too much from you?

6. feel overwhelmed?

Stress TestStress TestSelf Assessment ExerciseSelf Assessment Exercise

7. find yourself becoming forgetful or indecisive because you have too much on your mind?

8. Consider yourself to be in a high-pressure situation?

Stress TestStress TestSelf Assessment ExerciseSelf Assessment Exercise

9. feel you have too much responsibility for one person?

10. feel exhausted at the end of the day?

“The key is not to avoid stress altogether but to manage stress in such a way that we avoid the negative consequences of stress”

Manage yourself Manage your reaction to stressors Manage the amount of stress

Know Yourself Know your limitations Gage your reactions, learn to take each day

one step at a time Become a “Stress Expert”, know about Stress

and how it affects your mind and body. Don’t do nothing, if you think you are getting

burned out and have the symptoms speak to someone about it!

Find;What aspects of work are most

gratifying?(relationships, teaching,

research, program development)

How do professional demands affect us?

How do we view the rewards of our work?

Learn what causes you stress Learn how to recognize effects of

stress in yourself Develop coping strategies and self

care techniques to conquer stress Physical self care Emotional and Cognitive Self care Relational Self-Care Spiritual Self Care

Do you want to be helping?If you appreciate help as a virtue, let other

people be helpful for you

If you forget, that you are a human being, consider:

you use your own body and mind to help others, so you are kind of helping tools

– you take care of your machines and domestic tools, don’t you?

Cultivate Relationships Set Boundaries, priorities, education,

keeping an open mind Take time out for yourself Eat/Exercise Ask for help Acknowledge your emotions Stress Reduction techniques( music,

medication, journaling) Mentoring/Peer Support Group Support Promote self-awareness, create a place to

retreat/unwind Explore professional and personal goals

Cultivate Relationships Set Boundaries, priorities, education,

keeping an open mind Take time out for yourself Eat/Exercise Ask for help Acknowledge your emotions Stress Reduction techniques( music,

medication, journaling) Mentoring/Peer Support Group Support Promote self-awareness, create a place to

retreat/unwind Explore professional and personal goals

Talking to peers, others Journaling Taking time off Balancing professional life with

personal life Maintain a good team, promote

teamwork Grieving for our patients, attending

memorialsDavid F. Giansiracusa MD, Palliative Care Update, Sustaining

Our Ability to Provide Palliative Care

Supportive verbal group modalities Psychodrama / play therapy / art

therapy Recreational music Exercise

Jerome Stone author of Minding the Bedside: Nursing from the Heart of the Awakened Mind