Psychosocial determinants of burnout in geriatric nursing

Psychological well-being of hospice staff: systematic review

BACKGROUND

Poor psychological well-being among healthcare staff has implications for staff sickness and absence rates, and impacts on the quality, cost and safety of patient care. Although numerous studies have explored the well-being of hospice staff, study findings vary and the evidence has not yet been reviewed and synthesised. Using job demands-resources (JD-R) theory, this review aimed to investigate what factors are associated with the well-being of hospice staff.

METHODS

We searched MEDLINE, CINAHL and PsycINFO for peer-reviewed quantitative, qualitative or mixed-methods studies focused on understanding what contributes to the well-being of hospice staff who provide care to patients (adults and children). The date of the last search was 11 March 2022. Studies were published from 2000 onwards in the English language and conducted in Organisation for Economic Co-operation and Development countries. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was conducted using a result-based convergent design, which involved an iterative, thematic approach of collating data into distinct factors and mapping these to the JD-R theory.

RESULTS

A total of 4016 unique records were screened by title and abstract, 115 full-text articles were retrieved and reviewed and 27 articles describing 23 studies were included in the review. The majority of the evidence came from studies of staff working with adult patients. Twenty-seven individual factors were identified in the included studies. There is a strong and moderate evidence that 21 of the 27 identified factors can influence hospice staff well-being. These 21 factors can be grouped into three categories: (1) those that are specific to the hospice environment and role, such as the complexity and diversity of the hospice role; (2) those that have been found to be associated with well-being in other similar settings, such as relationships with patients and their families; and (3) those that affect workers regardless of their role and work environment, that is, that are not unique to working in a healthcare role, such as workload and working relationships. There was strong evidence that neither staff demographic characteristics nor education level can influence well-being.

DISCUSSION

The factors identified in this review highlight the importance of assessing both positive and negative domains of experience to determine coping interventions. Hospice organisations should aim to offer a wide range of interventions to ensure their staff have access to something that works for them. These should involve continuing or commencing initiatives to protect the factors that make hospices good environments in which to work, as well as recognising that hospice staff are also subject to many of the same factors that affect psychological well-being in all work environments. Only two studies included in the review were set in children's hospices, suggesting that more research is needed in these settings.

PROSPERO REGISTRATION NUMBER

CRD42019136721 (Deviations from the protocol are noted in Table 8, Supplementary material).

Relationships between frustration intolerance beliefs, cognitive emotion regulation strategies and burnout among geriatric nurses and care assistants

The purpose of this study was to address cognitive emotional factors (frustration intolerance beliefs, cognitive emotion regulation strategies) related to burnout among professionals caring for older persons. A sample of 202 nurses and care assistants for older people completed online questionnaires about their cognitive emotion regulation strategies, frustration intolerance beliefs, and burnout. Use of maladaptive strategies, especially self-blame and catastrophizing, predicted greater emotional exhaustion and depersonalization. Adaptive strategy use, such as refocusing on planning and positive reappraisal, was found to be linked to both lower emotional exhaustion and higher personal accomplishment. Frustration intolerance beliefs appeared to be closely associated with the emotional exhaustion and depersonalization dimensions of burnout, with higher frustration intolerance beliefs indicating a high risk of depersonalization. The present findings have several practical implications for reducing nurses' burnout based on cognitive behavioral therapy approaches, such as rational emotive behavior or mindfulness therapies.

Does geriatric nursing staff burnout predict well-being of LTC residents?

Nursing staff in residential settings are exposed to a large number of stressors. This study examined the relationship between geriatric nursing staff (GNS) burnout and the well-being of residents in long-term care (LTC) facilities. Data were obtained concerning 590 older residents who were served by 315 GNS in 172 LTC facilities in Taiwan, using multilevel modeling. The depersonalization (DP) dimension of burnout in GNS was consistently related to various resident well-being outcomes. Higher DP among GNS was associated with lower residential satisfaction and perceived quality-of-life, as well as more depressive symptoms among older LTC residents. The findings support the claim that DP among GNS has a greater role in determining LTC resident well-being than other dimensions of burnout. Efforts should be made to mitigate the emergence of DP among GNS. Support and education are also needed to enable GNS to foster positive interactions and relationships with LTC residents.

Who Cares for Those Who Take Care? Risks and Resources of Work in Care Homes

Over the years – due to the aging population, the process of corporatisation and a demand for a higher quality of services – professionals who work in Care Homes have been exposed to an increasing risk of physical and emotional malaise because of the number of challenges they’ve been asked to manage. Given these factors, there is a growing interest in the study and understanding of professions in geriatric care settings. In the literature there is a prevalence of quantitative studies offering an overview in terms of indicators – at the individual or group or organizational level – concerning the potential development of situations of professional malaise. Conversely, there is a lack of qualitative studies exploring the risk and protection factors. For this reason, in this study we decided to use a qualitative approach to explore “more up close” this kind of organizational context and to keep together the different levels in systemic terms in order to identify – according to professionals’ perceptions – resource factors (in order to leverage these aspects) and fatigue factors (to identify them and treat them). Three Italian Care Homes were involved and the interview’s sample was composed of 45 professionals – 15 nurses, 30 total Patient Care Assistants (PCAs) and Auxiliary Care Assistants (ACAs), of these, 17 males and 28 females, with an average age of 43 years (SD = 0.78) – selected using a sampling of maximum variability. From the analysis of the materials there seem to be four profiles of the professionals involved. Implications to ensure a functional human resource management are discussed for the purpose of promote the well-being of the various professionals, and, as a result, an increasing quality of service.

Coping, Cognitive Emotion Regulation, and Burnout in Long-Term Care Nursing Staff: A Preliminary Study

Direct care workers (e.g., certified nursing assistants [CNAs]) employed in long-term care (LTC) are particularly vulnerable to the experience of burnout, yet they have received relatively less research attention compared to Licensed Practical Nurses and Registered Nurses. Within the burnout literature, evidence suggests that the deployment of certain coping strategies influences levels of burnout. The current study examined the extent to which coping (e.g., problem-focused, emotion-focused, and dysfunctional coping) and cognitive emotion regulation strategies (e.g., positive reappraisal) predicted burnout after controlling for covariates (age, sleep duration). Fifty-six CNAs were surveyed at four skilled nursing facilities in the United States. Dysfunctional coping was significantly associated with emotional exhaustion and depersonalization. Among cognitive emotion regulation strategies, positive reappraisal was significantly associated with depersonalization. Shorter sleep duration was associated with significantly greater depersonalization. Findings suggest the need to develop interventions for CNAs aimed at reducing dysfunctional coping strategies and increasing sleep duration.

The mediating effects of coping strategies on the relationship between secondary traumatic stress and burnout in professional caregivers in the UAE

BACKGROUND

Professional caregivers dealing with traumatized victims or mental health clients are at increased risk for developing the same symptoms as persons who are exposed directly to the trauma.

AIMS

This research was aimed at examining the relationship between secondary traumatic stress, burnout and coping strategies in 502 professional caregivers who work in schools, hospitals, charity institutes and welfare centers in the United Arab Emirates (UAE). A further aim was to test the mediating effect of coping on the relationship between burnout and secondary traumatic stress.

METHODS

Measures used in this study were the Professional Quality of Life Questionnaire (ProQOL), The General Health Questionnaire (GHQ-28), The Maslach Burnout Inventory: Human Services Survey (MBI-HSS) and Endler and Parker's Coping Inventory.

RESULTS

Task-focused coping, personal accomplishment and compassion satisfaction were negatively associated with secondary traumatic stress. Burnout, emotion-focused and distraction coping were positively related to secondary traumatic stress. Coping partially mediated the relationship between burnout and secondary traumatic stress. There were also significant gender differences in depersonalization and distraction coping.

CONCLUSIONS

Efforts need to focus on improvement of caregivers' work environments, enhancing their coping skills and professional development.

Perceptions of Conscience in Relation To Stress of Conscience

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire containing the Perceptions of Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a `good' health care professional.

Occupational Stress and Coping among Nurses

This paper explores nurses’ occupational stressors and coping mechanisms. In nurses occupational stress appears to vary according to individual and job characteristics, and work-family conflict. Common occupational stressors among nurses are workload, role ambiguity, interpersonal relationships, and death and dying concerns. Emotional distress, burnout and psychological morbidity could also result from occupational stress. Nurses’ common coping mechanisms include problem solving, social support and avoidance. Perceived control appears to be an important mediator of occupational stress. Coping and job satisfaction appear to be reciprocally related. Shift work is highly prevalent among nurses and a significant source of stress. The effects, moderating influences, coping mechanisms and risk factors associated with shift work are considered in detail here. Prophylactic and curative measures are important for nurses at both personal as well as organisational levels.

Expanding the occupational health methodology: A concatenated artificial neural network approach to model the burnout process in Chinese nurses

Artificial neural networks are sophisticated modelling and prediction tools capable of extracting complex, non-linear relationships between predictor (input) and predicted (output) variables. This study explores this capacity by modelling non-linearities in the hardiness-modulated burnout process with a neural network. Specifically, two multi-layer feed-forward artificial neural networks are concatenated in an attempt to model the composite non-linear burnout process. Sensitivity analysis, a Monte Carlo-based global simulation technique, is then utilised to examine the first-order effects of the predictor variables on the burnout sub-dimensions and consequences. Results show that (1) this concatenated artificial neural network approach is feasible to model the burnout process, (2) sensitivity analysis is a prolific method to study the relative importance of predictor variables and (3) the relationships among variables involved in the development of burnout and its consequences are to different degrees non-linear.

PRACTITIONER SUMMARY

Many relationships among variables (e.g., stressors and strains) are not linear, yet researchers use linear methods such as Pearson correlation or linear regression to analyse these relationships. Artificial neural network analysis is an innovative method to analyse non-linear relationships and in combination with sensitivity analysis superior to linear methods.

Self-Esteem, Job Satisfaction and Burnout between General and Psychiatric Nursing Staff

The purpose of this study was to compare self-esteem, job-satisfaction and burnout between psychiatric and general nurses as well as to determine how these three elements are interrelated to each other. Like other professionals, nurses are also at risk of developing problems like professional burnout and a sense of dissatisfaction regarding their jobs. Causal factors of burnout among professionals are multi-factorial, starting from socio-demographic and occupational background to one’s personality characteristics. In this study, 30 psychiatric nurses and 30 general nurses were selected through a purposive sampling method. This was a one-time cross-sectional hospital-based study, data was collected during the period September, 2008 to November, 2008 and written consent was taken from the subjects. Statistical measures like descriptive statistics, Chi-square test, t-test and Pearson’s correlation-coefficient were used to analyze the data. In this study psychiatric nurses had been found to have higher level of self-esteem than general nurses. Nurses working in a general hospital had been observed to have a higher level of burnout and lower job satisfaction than psychiatric nurses.

The relationship between psychosocial job stress and burnout in emergency departments: an exploratory study

BACKGROUND

The purpose of this study was to examine the relationship and predictive power of various psychosocial job stressors for the 3 dimensions of burnout in emergency departments.

METHODS

This study was structured as a cross-sectional design, with a questionnaire as the tool. The data were gathered using an anonymous questionnaire in 3 hospitals in Spain. The sample consisted of 191 emergency departments. Burnout was evaluated by the Maslach Burnout Inventory and the job stressors by the Nursing Stress Scale.

FINDINGS

The Burnout Model in this study consisted of 3 dimensions: emotional exhaustion, cynicism, and reduced professional efficacy. The model that predicted the emotional exhaustion dimension was formed by 2 variables: Excessive workload and lack of emotional support. These 2 variables explained 19.4% of variance in emotional exhaustion. Cynicism had 4 predictors that explained 25.8% of variance: Interpersonal conflicts, lack of social support, excessive workload, and type of contract. Finally, variability in reduced professional efficacy was predicted by 3 variables: Interpersonal conflicts, lack of social support, and the type of shift worked, which explained 10.4% of variance.

DISCUSSION

From the point of view of nurse leaders, organizational interventions, and the management of human resources, this analysis of the principal causes of burnout is particularly useful to select, prioritize, and implement preventive measures that will improve the quality of care offered to patients and the well-being of personnel.

Quality geriatric care as perceived by nurses in long-term and acute care settings

AIMS AND OBJECTIVES

This study focused on differences in nurses' satisfaction with the quality of care of older people and with organisational characteristics and work environment in acute care and long-term care settings.

BACKGROUND

Numerous studies have explored links between nurses' satisfaction with care and work environments on the one hand and a variety of physical, behavioural and psychological reactions of nurses on the other. One key to keeping nurses in the workplace is a better understanding of nurses' satisfaction with the quality of care they provide.

DESIGN

Descriptive design.

METHOD

The self-selected sample included 298 registered nurses and licensed practical nurses who provide care to minority, underserved and disadvantaged older populations in 89 long-term care and <100 bed hospitals in 38 rural counties and eight metropolitan areas in a Southern state. All completed the Agency Geriatric Nursing Care survey, which consisted of a 13-item scale measuring nurses' satisfaction with the quality of geriatric care in their practice settings and an 11-item scale examining obstacles to providing quality geriatric care. Demographic variables were compared with chi-square. Independent t-tests were used to examine differences between nurses in long-term care and acute care settings.

RESULTS

Significant differences were found in level of satisfaction and perceived obstacles to providing quality care to older adults between participants from acute and long-term care. Participants in long-term care had greater satisfaction with the quality of geriatric care than those in acute facilities.

CONCLUSIONS

Nurses in long-term care were more satisfied that care was evidence-based; specialised to individual needs of older adults; promoted autonomy and independence of elders; and was continuous across settings. Participants in acute facilities perceived more obstacles to providing quality geriatric care than nurses in long-term care facilities.

RELEVANCE TO CLINICAL PRACTICE

Modification of hospital geriatric practice environments and leadership commitment to evidence-based practice guidelines that promote autonomy and independence of patients and staff could improve acute care nurses' perceptions of quality of geriatric care.

Burnout among hospital nurses in China

AIM

The aim of this study was to examine the level of burnout and factors that contribute to burnout in hospital nurses in the People's Republic of China.

BACKGROUND

While burnout among hospital nurses has been widely researched in western countries, little research has investigated burnout among hospital nurses in China.

METHOD

A translated version of the Maslach Burnout Inventory-Human Services Survey was used to measure burnout in 249 randomly selected nurses from various wards of a large teaching hospital in Beijing, China. Questionnaire packs were sent to the hospital wards where selected nurses worked. One hundred and twenty-eight nurses returned the completed questionnaire. The response rate was 51%.

RESULTS

The results showed moderate levels of Emotional Exhaustion and Personal Accomplishment, and low levels of Depersonalization. Age, years of experience and professional title had a significant positive relationship with Emotional Exhaustion and Personal Accomplishment. Older, married nurses with more personal responsibilities and in a more senior position experienced higher levels of Emotional Exhaustion.

CONCLUSION

The findings suggest that burnout is a significant issue for nurses in China.

IMPLICATIONS FOR NURSING MANAGEMENT

The results of this study indicate that working environment factors such as relationships with coworkers and managers may contribute to or mitigate burnout. There is a need to address personal and professional support, life-work balance, personal accomplishment and educational programmes to reduce burnout in nurses working in China.

Contribution of the psychosocial work environment to psychological distress among health care professionals before and during a major organizational change

The aim of this study was to investigate the relationships between 4 dimensions of the psychosocial work environment (psychological demands, decision latitude, social support, and effort-reward) among health care professionals as well as their psychological distress during a reorganization process. A correlational descriptive design was used for this quantitative study. A total of 159 health care professionals completed the questionnaire at T1, and 141 at T2. First, before the work reorganization, effort-reward imbalance was the sole variable of the psychological work environment that significantly predicted psychological distress. Second, the high overall level of psychological distress increased during the process of organizational change (from T1 to T2). Finally, effort-reward imbalance, high psychological demands, and low decision latitude were all significant predictors of psychological distress at T2, during the organizational change. In conclusion, to reduce the expected negative outcomes of restructuring on health care practitioners, managers could increase the number of opportunities for rewards, carefully explain the demands, and clarify the tasks to be performed by each of the employees to reduce their psychological burden and increase their perceptions of autonomy.

Occupational Health Issues Among Employees of Home Care Agencies

L'objectif de cette communication est d'explorer les problèmes de santé occupationnelle qui touchent les employés des agences de soins à domicile. Les résultats d'un sondage et de groupes de discussion menés auprès de 892 employés de bureau et employés itinérants de trois agences de soins à domicile sans but lucratif montrent que les employés des agences de soins à domicile présentent un degré élevé de stress, de fatigue et d'épuisement. Ce stress relié au travail est particulièrement ressenti par les cadres, les infirmières et les thérapeutes. Lorsqu'on les compare aux résultats de l'Enquête sur la santé des Canadiens, on note que les employées des agences de soins à domicile sont plus susceptibles que la moyenne des travailleuses de souffrir d'allergies, d'asthme, d'arthrite ou de rhumatismes, de problème de dos, de haute pression, de migraines et de blessures reliées au travail. Plusieurs employées d'agences de soins à domicile signalent des douleurs ou des malaises dans plusieurs parties du corps. Les employées itinérantes de ces agences souffrent d'entorses ou de foulures, de luxations, de fractures et d'ecchymoses consécutives au fait qu'elle doivent soulever ou déplacer des patients, se pencher ou forcer, ou qu'elles font des chutes accidentelles. Elles souffrent également davantage de microtraumatismes répétés et ont davantage d'accidents d'automobiles. Le personnel de bureau des agences souffre de microtraumatismes répétés et de problèmes respiratoires. La communication aborde les conséquences pour l'établissement des politiques et la recherche.

Application of artificial neural networks to a study of nursing burnout

Nursing is generally considered to be a profession with high levels of emotional and physical stress that tend to increase. These high stress levels lead to a high risk of burnout. The objective was to assess whether artificial neural network (ANN) paradigms offer greater predictive accuracy than statistical methodologies, which are commonly used in the field of burnout. A radial basis function (RBF) network and hierarchical stepwise regression was used to assess burnout. The comparison of the two methodologies was carried out by analysing a sample of 462 nurses and student nurses. The subjects were from three hospitals in Madrid (Spain), who completed the 'Nursing Burnout Scale' survey. A RBF network was better suited for the analysis of burnout than hierarchical stepwise regression. The outcomes indicate furthermore that the relationship with the burnout process of the predictive variables age, job status, workload, experience with pain and death, conflictive interaction, role ambiguity and hardy personality is not entirely linear. The usage of ANNs in the field of burnout has been justified due to their superior ability to capture non-linear relationships, which is relevant for theory development. STATEMENT OF RELEVANCE: Due to the superior ability to capture non-linear relationships, ANNs are better suited to explain and predict burnout and its subdimensions than common statistical methods. From this perspective, more specific programmes to prevent burnout and its consequences in the workplace can be designed.

Burnout in the mental health workforce: a review

There are enormous concerns regarding the recruitment, retention, training, and performance of the behavioral health workforce. Paramount among these concerns is turnover, which causes disruption in continuity of care, diminishes access to care while a position remains vacant, and poses financial hardship on the provider organization through costs related to recruitment, orientation, and training of a new hire. There is frequent mention of burnout within the literature and among behavioral health managers as a potential cause of turnover. However, there is no recent or comprehensive review of burnout that examines the evidence surrounding its validity, utility, and potential relationship to turnover. The purpose of this paper is to provide such a review by examining the construct of burnout, methodological and measurement issues, its prevalence in the mental health workforce, correlates of burnout, and interventions to decrease it. The implications for provider organizations and recommendations for future research are identified.

The relationship between job stressors, hardy personality, coping resources and burnout in a sample of nurses: a correlational study at two time points

BACKGROUND

Nursing is considered as a risk profession with high levels of stress and burnout, and these levels are probably increasing.

OBJECTIVES

This study assessed temporal and cross-sectional relationships between job stressors, hardy personality and coping resources on burnout dimensions among nurses.

DESIGN

Temporal and cross-sectional effects were evaluated. A sample of 98 nurses from Portugal completed the Nursing Burnout Scale at two time points. The data were analysed using descriptive statistics, Pearson correlations, and hierarchical linear regression analyses regressing Wave 2 burnout dimensions.

RESULTS

The study confirmed the specific contribution of control and challenged hardy personality dimensions as the explanation of burnout. However, commitment did not show any effects in this study. Social support and active coping were also relevant predictors of burnout dimensions. Specifically, active coping had an inverse temporal effect on depersonalisation and lack of personal accomplishment. In relation to the burnout process, depersonalisation appeared as an antecedent of lack of personal accomplishment.

CONCLUSIONS

The present study is an initial step to comprehend the link between job stressors, hardy personality, coping resources and diminishing burnout.

Demanding behaviours and workload in elderly care in Sweden: occurrence at two time points within a decade

The aim of this study was to investigate the occurrence of demanding behaviours in persons >or=65 years receiving home care or living in sheltered accommodation at two points in time, 1993 and 2002. Another aim was to investigate whether the perceived workload in staff had changed during this period. All persons >or=65 years living at home and utilizing home care services or those who lived in some form of sheltered housing were included and assessed by staff using a three-part questionnaire, in two cross-sectional studies. The study group comprised 1187 and 1017 participants which equals 77% and 99% respectively. Symptoms and degree of behavioural and psychiatric symptoms common in dementia that were assessed with a subscale in The Gottfries-Bråne-Steen Scale, demonstrated an all over increase from 1993 to 2002. Items from The Multi Dimensional Dementia Assessment Scale (MDDAS) measured a decrease in 'daily' occurrences of dementia symptoms but an increase in 'sometimes per week'. A mixed pattern was seen concerning behaviours where increases as well as decreases were found. The behaviours 'constantly seeking attention' and 'shrieking continuously' increased significantly. The number of individuals showing restless, aggressive or shrieking behaviours increased significantly over the decade. Two items from the MDDAS were used to measure the workload. The physical workload increased significantly over the decade whereas the rising tendencies of the psychological workload were not statistically significant. The mean age over the decade had increased from 83 to 86 years, which together with the findings make the recipients of home care and sheltered housing a very vulnerable group. The demanding problems place considerable pressure on staff.

Gradual loss of homelikeness in exhaustion disorder

Our aim with the present study was to explore the lived experiences of the process leading to exhaustion. Within a hermeneutic phenomenological perspective, semistructured interviews were conducted with eleven individuals on sick leave because of exhaustion disorder. The findings were interpreted as a process of five stages of losing one's homelikeness in the body and in the familiar world: (a) the body calling for attention, (b) loss of self-recognition, (c) uncanniness, (d) fighting for survival, and (e) existential breakdown. Findings help us to identify early signs of exhaustion disorder and highlight the need for treatments that focus on bodily experiences and habitual stress-related patterns. Helping the patient to regain homelikeness is an important treatment goal.

[The characteristics of nurses' and caregivers' behaviour in different clinical settings with special attention to burnout syndrome]

The author draws attention to the up-to-datedness of the selected topic and its personal and institutional effects. Stress in work (workplace stress) has a significant role in the pathomechanism of burnout. Nurses are exposed to excessive stress burden in work so expected incidence of burnout is relatively high among them. Goal of this study is to draw a picture about the situation, condition of mental health, degree and rate of burnout in nurses in given health care situations.

METHODS

Self-completed, anonymous questionnaire questioning the surveyed socio-demographic data while using three standardized questionnaires with the measurement of the degree of burnout, physical and mental exhaustion and fatigue as well as dysfunctional attitudes.

RESULTS

The study surveyed 805 individuals analyzing the specific characteristics of supporting relationship and joining points between degree of burnout and (hospital) department care form. Among 374 nurses working in the intensive care unit 9.4% suffer from burnout, while among 155 nurses working in active care unit this rate is 0.6%. According to the findings of the study there are also other influential elements, namely the facts that nurses have part-time jobs (second jobs) besides their full-time jobs and the lack of moral and financial respect or recognition. Among the surveyed population 273 individuals--33.9%--are at risk regarding burnout, 44 individuals--5.5%--show signs of burnout and 7 individuals--0.9%--are in a condition where treatment is needed. The study supposed the influential role of certain personality factors (dysfunctional attitudes) in the development of burnout. Comparison showed that burnout phenomenon and dysfunctional attitudes are correlated.

CONCLUSION

The survey results confirmed that socio-demographic factors had no effect on burnout development. The severity of patients' condition and the degree of permanent stressful situation in intensive care units are among determinant workplace factors.

Personal determinants of burnout in nursing staff at geriatric centers

There is a high prevalence of stress in the workplace among nursing personnel at elderly care-centers. The general impression is that these high stress levels are related to conflict within the workplace. The purpose of this study is to evaluate whether personal factors (in particular personality and values), are related to burnout. For this reason we asked a sample of 42 nursing personnel from care-centers for the elderly to complete a self-administered questionnaire on conflict at work, stress at work, personality and motivational values for nursing professionals in elderly residences. Personality variables and motivational values were found to be significantly related to the appearance of stress in the workplace.

Psychological, lifestyle and coping contributors to chronic fatigue in shift-worker nurses

AIM

This paper is a report of a study to assess the following in shift-worker nurses: (1) the relationships amongst chronic fatigue and psychological variables including anxiety, mood and locus of control; (2) the relationships amongst chronic fatigue and a number of lifestyle factors such as shiftwork, sleep and exercise; and (3) various coping behaviours that best predict chronic fatigue.

BACKGROUND

In the shift-working population, individual psychological, lifestyle and coping differences influence fatigue levels. However, some of these factors are somewhat unexplored and their relative contribution to fatigue remains poorly understood. Methods. An exploratory design was adopted with 111 eldercare shift-worker nurses. Data were collected during 2006. Nurses completed self-administered questionnaires examining fatigue, anxiety, mood disturbance, locus of control, sleep, work, lifestyle and coping characteristics.

FINDINGS

Multiple regressions showed that mood disturbance, locus of control and trait anxiety are statistically significant predictors of chronic fatigue. Poor sleep quality was the lifestyle factor which most strongly contributed to fatigue. Other lifestyle predictors included higher workload perception, lack of exercise and the non-availability of support. Whilst problem-focused coping behaviours were not associated with fatigue, coping by using alcohol, letting emotions out and avoiding the situation significantly predicted chronic fatigue.

CONCLUSION

The challenge for improving the fatigue outcomes requires further investigation of the profile of a nurse who is at a high risk of fatigue, and then integrating this profile into a fatigue management programme which considers relative contributions of the psychological, lifestyle and coping factors.

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.

Staff satisfaction with work, perceived quality of care and stress in elderly care: psychometric assessments and associations

AIMS

To evaluate validity and reliability of three questionnaires measuring 'work satisfaction', 'patient care' and 'staff health' for staff in elderly care and to study the relationship between staff members' satisfaction with work and perceived stress.

BACKGROUND

Increased workload, difficulties in recruiting and retaining nurses are reported in elderly care. Valid and reliable instruments measuring staffs' perceptions of work are needed.

METHODS

A convenience sample of 299 staff answered the questionnaires.

RESULTS

Factor analysis of 'work satisfaction' gave eight factors, 'patient care' four factors and 'staff health' two factors, explaining 52.2%, 56.4% and 56.8% of the variance. Internal consistency was mostly satisfactory. Multiple regression analysis revealed a model that explained 41% of the variance in perceived stress symptoms.

CONCLUSIONS

There was support for the instruments' validity and reliability. Older age, higher scores/satisfaction with workload, cooperation, expectations and demands, personal development and lower scores on internal motivation contributed to less stress.

The relationships among workplace stressors, coping methods, demographic characteristics, and health in Australian nurses

Nursing is known to be stressful. Stress detrimentally can influence job satisfaction, psychological well-being, and physical health. There is a need for increased understanding of the stress that nurses experience and how best to manage it. Three hundred twenty Australian acute care public hospital nurses participated in a study by completing four questionnaires that examined (a) how various workplace stressors relate to ways of coping, demographic characteristics, and physical and mental health and (b) which workplace stressors, coping mechanisms, and demographic characteristics were the best predictors of physical and mental health. Significant correlations were found between stressors and physical and mental health. Multiple regression showed age to be the only significant predictor of physical health. The best coping predictors of mental health were escape-avoidance, distancing, and self-control. Other significant predictors of mental health were support in the workplace, the number of years worked in the unit, and workload. Mental health scores were higher for nurses working more years in the unit and for those who used distancing as a way of coping. Mental health scores were lower for nurses who used escape-avoidance, lacked workplace support, had high workload, and used self-control coping. The findings have implications for organizational management, particularly in terms of recommendations for stress management, social support, and workload reduction.

A comparative study of organisational characteristics, work characteristics and nurses' psychological work reactions in a hospital and nursing home setting

OBJECTIVES

The aim of the current study was twofold. First, we explored whether there were any differences concerning organisational characteristics, work characteristics and psychological work reactions in two types of health care setting, hospitals and nursing homes. Second, it was investigated and validated whether relationships between organisational characteristics, work characteristics and psychological work reactions found in research on hospital nursing are also present in nursing homes.

METHODS

The variables were assessed by questionnaires that were distributed among nurses and caregivers in 15 randomly selected general hospitals and 14 nursing homes in the Netherlands. Manova and hierarchical regression analyses were carried out to explore differences in the variables and in relationships between the variables.

RESULTS AND CONCLUSION

Results show that the major difference in hospital-based and nursing home practice is in the work organisation as assessed by the organisational characteristics "environmental uncertainty" and "decision authority". Relations found between variables are in majority in line with the JDC-model and confirm the applicability of this theory in different types of health care settings.

Staff's experience of and the management of violent incidents in elderly care

Violence towards staff has become an important issue, since it has been reported to be common in various health care settings. This study aimed to describe emotional reactions among staff being exposed to violence in residential community care for the elderly: to investigate consequences from violent incidents and to describe the management of violent incidents. Data were collected by telephone interviews with nursing staff reporting incidents of violence. During the period of investigation, 97 of 848 staff (11.4%) reported that they had been exposed to violence. More than one-third of them reported subsequent wound and bruises from the incident and two of the exposed staff consulted a doctor because of the violent incident. The most frequently reported reactions among the staff were aggression, astonishment, and antipathy against the perpetrating care recipient, as well as insufficiency, powerlessness, insult and fear. A majority of the incidents were judged as intentionally perpetuating from the care recipient. Most of the violent incidents were managed by informal discussions in the working team. A low number of the reported incidents of violence involved formal discussions with nurse managers.

Explanatory model of health in bereaved parents post-fetal/infant death

In order to identify which features contribute to attenuating or intensifying the deleterious consequences of a perinatal loss such that some family systems endure and sometimes even thrive when faced with such a situational stressor, while other family units seem to deteriorate and disintegrate under similar circumstances, an explanatory model of health was tested. The purpose of this longitudinal study was to examine how the relationships between the elements in the model namely: resources both internal (hardiness) and external (marital and social supports), as well as appraisal of the situation, predicted the health of 110 bereaved couples (husbands and wives).

Picking behaviour in cognitively impaired residents in geriatric settings: prevalence of the behaviour and characteristics of the residents

This paper presents the findings of a point prevalence study performed at all geriatric settings within a county in Northern Sweden. The aims of the study were twofold: to investigate the prevalence of picking behaviour in cognitively impaired residents in various kinds of geriatric care settings and describe the characteristics of the residents, and to investigate how the residents who exhibit picking behaviour are experienced by their care providers. The study comprises 1928 cognitively impaired residents. The prevalence of picking behaviour was found to be 17%. Multivariate analyses showed that behavioural and psychiatric symptoms such as 'often stands at the outer door and wants to go out', 'wanders alone or with other patients back and forth', 'aggressive threats to patients and staff' and being 'manic' and 'fearful' were associated with picking behaviour. Other factors associated with picking behaviour were 'taking part in daily tasks', 'can walk without assistance' and imposing a high psychological workload. Furthermore, residents who exhibited picking behaviour were experienced by care providers as more uncertain and unhappier than residents who did not behave in this way.

Burnout among nursing staff in accident and emergency and acute medicine: a comparative study

This study was designed to identify the prevalence of burnout among nurses working in Accident and Emergency (A & E) and acute medicine, to establish factors that contribute to stress and burnout, to determine the experiences of nurses affected by it and highlight its effects on patient care and to determine if stress and burnout have any effects on individuals outside the clinical setting. A triangulated research design was used incorporating quantitative and qualitative methods. Maslach Burnout Inventory was used. Nurses working in acute medicine experienced higher levels of emotional exhaustion than their A & E counterparts. The overall level of depersonalization was low. High levels of personal accomplishment were experienced less by junior members of staff. Stress and burnout have far reaching effects both for nurses in their clinical practice and personal lives. If nurses continue to work in their current environment without issues being tackled, then burnout will result. The science of nursing does not have to be painful, but by recognition of the existence of stress and burnout we can take the first steps towards their prevention.

Lang and Goulet Hardiness Scale: development and testing on bereaved parents following the death of their fetus/infant

The process of development and testing of the Lang and Goulet Hardiness Scale (LGHS), a self-report instrument designed to measure hardiness in bereaved parents following the death of their fetus/infant, is presented. Hardiness is a personal resource, composed of 3 interdependent components that are characterized by a sense of personal control over the outcome of life events and hardships such as the death of a fetus/infant, an active orientation toward meeting the challenges brought on by the loss, and a belief in the ability to make sense of one's own existence following such a tragedy. The concept of hardiness has been studied by various disciplines and in a multitude of settings to understand its ability to lessen potentially negative effects of life stress. However, it has never been studied within the context of parental bereavement. The LGHS was developed systematically, originating from a concept analysis. A panel of 15 experts was used to establish content validity.A pretest was conducted on 73 bereaved individuals to assess convergent and discriminant validity of the LGHS. Subsequently, a validation study on 220 bereaved parents who had experienced the death of their fetus/infant 2 months previously was conducted including a retest 6 months after the loss with 192 of the remaining participants. Analyses reveal that the LGHS is a valid and reliable instrument for measuring hardiness and that it is sensitive enough to detect changes in the construct over time.

Optimism and coping as moderators of the relationship between chronic stress and burnout

Using a model based on Lazarus (1999) and previous research, specific relationships were predicted between the antecedent conditions of chronic stress, personal moderation factors of optimism/pessimism, and coping on the one hand, and the affective outcome of burnout on the other. Participants were 82 information service workers whose jobs required them to evaluate and remediate computer programming problems in anticipation of the Y2K deadline. Multiple regression analysis indicated that Optimism, Pessimism, Control Coping, and Escape Coping all moderated chronic stress for Emotional Exhaustion and Depersonalization, but not for Personal Accomplishment. Lower Optimism, higher Pessimism, lower Control Coping, and higher Escape Coping all related to increased workers' Depersonalization under conditions of higher chronic stress due to the approaching Y2K deadline. Lower Optimism and higher Pessimism were also related to higher Emotional Exhaustion under conditions of higher chronic stress due to the Y2K deadline. Beyond moderation effects, all moderator variables showed main effects with Emotional Exhaustion, Depersonalization, and Personal Accomplishment in the predicted directions. Suggestions are given for incorporating results into stress relief efforts in organizations.

The diversity of work: differences, similarities and relationships concerning characteristics of the organisation, the work and psychological work reactions in intensive care and non-intensive care nursing

The aim of this study was to examine differences in organisational characteristics, work characteristics and psychological work reactions, and to investigate relationships between these variables in intensive care units (ICUs) and non-ICUs. Questionnaires were distributed to intensive care (n = 184) and non-intensive care nurses (n = 927) working in 15 general hospitals in the Netherlands. MANOVA showed that ICU nurses reported significantly higher uncertainty, higher complexity, and higher decision authority than non-ICU nurses. Emotional exhaustion was significantly lower among ICU nurses. Regarding the pattern of relationships, the LISREL-analyses revealed that the indirect proposed pattern of relationships was invariant across the two samples, which means a validation of our research model.

Working in clients' homes: the impact on the mental health and well-being of visiting home care workers

The purpose of this paper is to examine the effects of working in clients' homes on the mental health and well-being of visiting home care workers. This paper reports the results of a survey of 674 visiting staff from three non-profit home care agencies in a medium-sized city in Ontario, Canada. Survey results are also complimented by data from 9 focus groups with 50 employees. For purposes of this study, home care workers include visiting therapists, nurses, and home support workers. Mental health and well-being is measured by three dependent variables: stress; job stress; and intrinsic job satisfaction. Multiple least squared regression analyses show several structural, emotional, physical, and organizational working conditions associated with the health and well-being of visiting home care workers. Overall, results show that workload, difficult clients, clients who take advantage of workers, sexual harassment, safety hazards, a repetitious job, and work-related injuries are associated with poorer health. Being fairly paid, having good benefits, emotional labour, organizational support, control over work, and peer support are associated with better health. Results suggest that policy change is needed to encourage healthier work environments for employees who work in clients' homes.

Incidence of violence towards staff caring for the elderly

A survey study concerning violence was conducted among staff (n=506) working with the elderly in residential settings and ordinary homes. The major aim of the study was to investigate the incidence of violence directed towards staff by elderly people living in residential settings. Furthermore, associations between the number of violent incidents and gender, age, year in service, year at present place of work, education of the staff, type of setting, the frequency and type of violence as well as the emotional reactions expressed by the staff should be examined. Forty percent of the staff was exposed to violence during the preceding year and 18% noted incidents of violence daily. A significantly larger proportion of staff working in nursing homes registered violence compared with those working in other types of settings. Physical violence was the most common (76%) type of violence. Powerlessness, sadness, anger and feelings of insufficiency were the most dominant feelings among staff facing by violent situations. Our results point to the necessity to further study caregivers' perception of patient violence and its impact on the quality of care.

Weathering the storm of perinatal bereavement via hardiness

Hardiness is a personal resource that can potentially diminish negative effects of life stress. To increase understanding of the role that it can have on the health protection and promotion of bereaved parents following a perinatal loss, this article uses J. Wilson's (1969) method to present a concept analysis of hardiness. This analysis provides not only a fresh perspective for understanding the experience of perinatal loss but has also induced the development of a hardiness instrument. Knowledge development in this area is paramount for professionals interested in enabling bereaved parents to draw on and develop their hardiness, not only to transcend the experience but ultimately to gain a sense of personal growth following their loss.

Burnout in psychiatric nursing

INTRODUCTION

Burnout in nursing is of both individual and organizational concern with ramifications for well-being, job performance, absenteeism and turnover. Burnout is rarely assessed as part of a comprehensive model of occupational stress, a short-coming which this paper attempts to redress.

METHOD

A randomly selected sample of 510 psychiatric nurses from one Scottish Trust completed a questionnaire based on a psychological model of occupational stress which included the Maslach Burnout Inventory (MBI) as the dependent variable.

FINDINGS

The respondents reported average, low and average levels of emotional exhaustion, depersonalization and personal accomplishment, respectively. The study sample had significantly lower scores on emotional exhaustion and depersonalization than normative data but also significantly lower levels of personal accomplishment than a normative group of physicians and nurses. Only 2.0% of the study sample could be categorized as having high burnout overall (i.e. high emotional exhaustion, high depersonalization, low personal accomplishment) and they differed significantly from the rest only in terms of males being over-represented. Hierarchical regression analysis revealed that selected explanatory variables accounted for 41.9% of emotional exhaustion, 16.4% of depersonalization and 25.6% of personal accomplishment in the study sample.

IMPLICATIONS

The paper discusses the implications of the findings in terms of a comprehensive approach to intervention aimed at minimizing the risk of burnout in psychiatric nurses. Such an approach will involve interventions at the organizational and individual level.

Self-reported musculoskeletal disorders among visiting and office home care workers

This paper examines the associations between self-reported musculoskeletal disorders (MSDs) and work factors and injuries among home care workers. Based on 99 focus group participants and 892 survey respondents, results show a high level of MSDs among both visiting and office home care workers. While visiting home care workers tend to feel pain in the back, office workers tend to report pain in the neck and shoulder. Hazards in clients' homes, injuries moving clients and stress are associated with self-reported MSDs for visiting home care workers. Repetitive tasks and stress are associated with self-reported MSDs for office home care workers. Age and months in the profession have no affect on self-reported MSDs.

Job stress and burnout among Canadian managers and nurses: an empirical examination

This study examined the relationship of job stress with burnout and its three dimensions (emotional exhaustion, lack of accomplishment and depersonalization), job satisfaction, organizational commitment and psychosomatic health problems. Data were collected by means of a structured questionnaire from Canadian managers (N = 67) and nurses (N = 173). Pearson correlation and moderated multiple regression were used to analyze the data. Job stress was significantly correlated with overall burnout and its three dimensions and job satisfaction in both samples. In the nursing sample, job stress was also significantly correlated with psychosomatic health problems and organizational commitment. Moderated multiple regression only marginally supported the role of gender as a moderator of stress-burnout relationship.