Burnout in psychiatric nursing: a meta-analysis of related variables

Nurses' emotional exhaustion: Prevalence, psychosocial risk factors and association to sick leave depending on care setting-A quantitative secondary analysis

AIMS

To explore differences in the prevalence, psychosocial risk factors and the connection to annual sick leave of nurses' emotional exhaustion depending on the care setting.

DESIGN

Quantitative study.

METHODS

We conducted a secondary data analysis of a cross-sectional, representative survey with German nurses (BIBB/BAuA-Employment Survey 2018). We analysed data from three groups of nurses (hospital care HC: n = 333, nursing homes NH: n = 143, home health care HHC: n = 109). We calculated prevalence estimates for all psychosocial risk factors and emotional exhaustion and utilized Χ² -tests to explore differences relating to the care setting. We calculated risk estimates using logistic regression analyses.

RESULTS

Forty-four per cent of all nurses reported symptoms of emotional exhaustion. Care settings did not affect prevalence estimates (HC: 45.3%, NH: 37.8%, HHC: 50.5%). Weekend work was a risk factor for exhaustion. Being at the limit of efficiency was the only work-related psychosocial risk factor being independent of the care setting. Emotional demands were a significant risk factor for nurses working in HC and NH, and low team cooperation was a risk factor for nurses working in NH. Nurses' emotional exhaustion is associated with more sick leave days.

CONCLUSIONS

The high prevalence of nurses' emotional exhaustion is independent of the care setting. This threatens nurses' health and negatively affects the organization and society due to the relation to sick leave. Weekend work and quantitative demands relate to exhaustion independently of the care context. Emotional demands and low team cooperation show context-specific correlations.

IMPACT

Organizational interventions that limit quantitative demands are needed to prevent exhaustion among nurses. In HC and NH, measures are needed to improve coping with emotional demands and to strengthen team cooperation. Policymakers and nursing managers should take action to address nurses' emotional exhaustion.

NO PATIENT OR PUBLIC CONTRIBUTION

Due to the study design.

Burnout and job satisfaction among psychiatrists in the Mental Health Service, Hamad Medical Corporation, Qatar

BACKGROUND

Job satisfaction is a critical concern among medical staff and directly affects patient safety and quality of health care services. Burnout has been reported to be correlated with job satisfaction.

AIMS

This study aimed to determine the prevalence of burnout and level of job satisfaction among psychiatrists working in the Mental Health Service, Hamad Medical Corporation, Qatar, and examine correlations among socio-demographic variables, burnout, and job satisfaction.

METHOD

A cross-sectional survey was conducted using a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI), and the Job Descriptive Index (JDI).

RESULTS

One-third of psychiatrists reported high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Less than 20 % demonstrated high levels of depersonalization. Trainees were more burned out than senior psychiatrists. Opportunities for promotion was the only factor with which the majority of psychiatrists were not satisfied.

CONCLUSIONS

The prevalence of high burnout in psychiatrists remains lower in Qatar than in other countries. Lower levels of satisfaction with co-workers, work, supervision, opportunities for promotion, and the job in general increased emotional exhaustion and depersonalization. Interestingly, satisfaction with salary did not have a significant effect on burnout.

The risk of empathy: longitudinal associations between empathy and burnout

OBJECTIVE

Prior research on the relation between empathy and burnout in social professions appears to be inconsistent. Whereas some studies have claimed that empathy functions as a buffer against burnout, others have argued that empathy contributes to the development of burnout. One explanation for this disparity may be methodological as most studies have relied on cross-sectional single-measure designs. To examine their cross-sectional and longitudinal associations, the present study analyzed cross-lagged data of several measures of empathy and burnout.

DESIGN

Data from two longitudinal studies with three to twelve months between measurements were analyzed. The samples contained 172 nursing students and 186 nurses, respectively.

MAIN OUTCOME MEASURES

Empathy was assessed using the Interpersonal Reactivity Index, the Toronto Empathy Questionnaire, the Geneva Emotion Recognition Test, and the Social Mindfulness Test Paradigm. Burnout was assessed using the Maslach Burnout Inventory, the Irritation Scale, and the Copenhagen Burnout Inventory.

RESULTS

Results showed significant cross-sectional correlations between the questionnaire measures of empathy and burnout. However, there was insufficient support for the cross-lagged associations.

CONCLUSIONS

Associations between empathy and burnout may be attributed to the methodological limitations of cross-sectional designs. However, the influence of potential moderators is discussed as a promising direction of future research.

Burnout and job satisfaction of nursing staff in a South African acute mental health setting

Background

Psychiatric nurses constitute a fundamental part of the mental health care system in South Africa. However, high levels of burnout and job dissatisfaction among nursing staff have been associated with reduced empathy and quality of care, and poor service delivery. Stikland Psychiatric Hospital is a state psychiatric hospital situated in Belville and provides all levels of psychiatric care to a large part of the Cape metro region. To our knowledge, no previous studies have examined burnout and job satisfaction among nurses in this setting.

Aim

We assessed the relationship between burnout and job satisfaction among the nursing staff.

Setting

The study was conducted at Stikland Psychiatric Hospital, Cape Town, South Africa.

Methods

This cross-sectional study used the Copenhagen Burnout Inventory and an established job satisfaction questionnaire to assess burnout and job satisfaction among 127 staff members associated with psychiatric nursing.

Results

In this population comprising mostly female (83.5%) nurses, scores for personal, work-related and client-related burnout were relatively high, but job satisfaction was also high. Higher levels of burnout were significantly associated (Pearson's linear correlation, r = -0.077, p < 0.01) with lower levels of job satisfaction. There were no significant associations between burnout or job satisfaction and gender, rank or years of experience.

Conclusions

If mental health service delivery is to be optimised, supportive or preventative processes should be implemented to reduce the prevalence of burnout in psychiatric nurses. This study adds to the scarce local knowledge and provides information that can be used to inform the development of supportive strategies for psychiatric nursing staff in South Africa.

How Does Workplace Ostracism Lead to Service Sabotage Behavior in Nurses: A Conservation of Resources Perspective

This article aims to investigate how workplace ostracism acts as a motive behind customer service sabotage. We examine the role of stress as a meditating variable along with the moderation of perceived organizational support (POS) on the said association by using conservation of resources and equity theory. A total of 217 nurses from hospitals of the southern Punjab region in Pakistan participated in the study. Data were collected through survey and structured questionnaires. SPSS and AMOS were used to analyze data with the latest techniques of bootstrapping and process macros. The results showed that stress mediated between the association of workplace ostracism and service sabotage behavior. POS was confirmed as a moderator between this relationship. POS buffered the harmful effects of ostracism and stress on customer service, as POS demonstrates to personnel that they are cherished and respected by the organization. This lessens the strength of perceived stress due to workplace ostracism. Organizational leadership should take advantage of the stress-alleviating effect of POS, which is important in producing adequate levels of work performance.

Burnout and occupational stressors among non-medical occupational health staff

BACKGROUND

The work required to assist individuals in improving their mental health is stressful and known to be associated with burnout. In Japanese companies, non-medical occupational health (OH) staff often take the role of maintaining and improving workers' mental health. However, few studies have examined burnout in this population.

AIMS

To assess the relationship between burnout and occupational stressors among non-medical OH staff.

METHODS

We conducted a cross-sectional study of OH staff who had participated in mental health seminars between 2016 and 2018. Occupational stressors were assessed using the Japanese version of the Job Content Questionnaire. Burnout was assessed using the Japanese version of the Maslach Burnout Inventory.

RESULTS

We administered the survey to 230 non-medical OH staff, of which 188 completed the questionnaire. According to a hierarchical multiple linear regression analysis, high job demands were associated with greater emotional exhaustion, depersonalization and personal accomplishment. Greater job control was associated only with higher personal accomplishment. Lower job support was associated with greater emotional exhaustion and depersonalization.

CONCLUSIONS

The present study found relationships between occupational stressors and burnout dimensions among OH staff. To avoid burnout among non-medical OH staff, it is important to take measures against occupational stressors, especially job demands and low levels of job support.

Workplace Violence and Burnout Among Mental Health Workers

OBJECTIVE

The authors conducted a cross-sectional survey to investigate the association between episodes of patient aggression and burnout among mental health professionals.

METHODS

Scores of the Maslach Burnout Inventory (MBI) among 183 participants who completed a questionnaire on violence exposure were used as the outcome. Demographic and work-related variables were examined as potential moderators of the association between aggression and burnout.

RESULTS

Lifetime exposure to verbal or object aggression was associated with higher MBI scores. In stepwise regression, MBI score was positively associated with having experienced recent verbal aggression and with the number of symptoms experienced immediately after the worst event. MBI score was negatively associated with working in a university psychiatric inpatient unit. The association between verbal aggression and burnout was significant only among women.

CONCLUSIONS

Workplace violence may have a significant negative impact on subjective well-being and patient care and may contribute to burnout among mental health professionals.

"We Deal Here With Grey": Exploring Professional Boundary Development in a Forensic Inpatient Service

BACKGROUND

Maintaining appropriate professional boundaries with clients in mental health settings can be complex, particularly for forensic inpatient nurses and healthcare workers. The literature in this area has mainly focused on boundary violations, with little research on how staff members develop and maintain boundaries in forensic inpatient units, despite safe working relationships being beneficial for staff experience and client recovery.

METHOD

Interviews with 11 nurses and healthcare workers from forensic inpatient wards were analyzed using a constructivist grounded theory methodology.

RESULTS

A cyclical model of boundary development was developed in which staff initially acclimatize to the forensic environment before entering a calibration phase of constantly assessing and addressing professional boundary issues in daily working life. Staff members use this experience alongside reflection, social learning, and clinical supervision to undergo individual learning and team development. In the fourth phase, they use this learning to recalibrate their views on boundaries, themselves, and how they work with clients. This recalibration impacts on staff members' further management of daily boundaries, providing more materials for learning, which leads to further recalibration.

CONCLUSIONS

This study echoes previous literature suggesting the importance of supervision and reflective spaces in professional boundary understanding. The model is comparable with existing learning theory and reflects a clinical drive toward safe uncertainty. The importance of social and experiential learning is highlighted and has important implications for forensic nurses.

Burnout within forensic psychiatric nursing: Its relationship with ward environment and effective clinical supervision?

WHAT IS KNOWN ABOUT THIS SUBJECT?: Burnout is a prominent issue in psychiatric nursing and associated with significant adverse consequences for staff, service users and at an organizational level. Exploration of the extent and predictors of burnout in secure settings has received little research attention. It is not fully understood why prevalence rates of burnout in forensic settings are not elevated in comparison to other settings, despite the presence of known risk-related correlates. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: In contrast to previous research, findings suggest that clinical supervision may not be an effective, stand-alone intervention to support staff experiencing burnout. Thus, the current focus on clinical supervision to mitigate burnout may be insufficient in forensic services. The ward environment (specifically how safe staff feel, how therapeutic the ward feels and how well service users relate to one another) was found to be more important than clinical supervision in terms of burnout for forensic psychiatric nursing staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policies regarding staff health and well-being should be developed with due consideration given to the association between burnout and the working environment. It should not be assumed that clinical supervision is sufficient to mitigate burnout in practice. Further research assessing all types of support and the ward environment is needed to gain a better understanding of its relationship to burnout. ABSTRACT: Introduction Despite extensive research examining burnout in psychiatric nursing staff, literature exploring key predictors of burnout in secure psychiatric settings has been relatively neglected. Research has yet to explore burnout in these settings by adopting previously identified predictors such as support or the ward environment. Aim The current study aimed to reduce this gap by exploring burnout, the perceived effectiveness of clinical supervision and ward environment. Method In 2014, nursing staff working in a medium secure forensic psychiatric unit in the United Kingdom (N = 137) provided demographic information and completed the measures assessing: Burnout, clinical supervision and the ward environment. Results Approximately 10% of nursing staff could be classed as "burnt-out". The main predictors of burnout were age and ward environment. Clinical supervision had minimal association with burnout. Discussion The current study sheds doubt on clinical supervision as a potential intervention for burnout and results appear comparable to research within other settings. The implications of the ward environment, supervision and burnout are discussed herein. Implication for Practice Interventions may need to focus on a positive ward environment (including patient cohesion, experienced safety and enhancing the therapeutic atmosphere). Organizations should support younger nursing staff as they appear particularly vulnerable to burnout.

Variables associated with job satisfaction among mental health professionals

Recent mental health (MH) reforms have had a sharp impact on practices among MH professionals. A deeper understanding of factors contributing to their job satisfaction, in this context, may help improve quality and continuity of care. The purpose of this study was to identify variables associated with job satisfaction for 315 MH professionals in Quebec (Canada) after implementation of wide-ranging MH reforms. Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were conceptualized within five domains: 1) Professional Characteristics, 2) Team Attributes, 3) Team Processes, 4) Team Emergent States, and 5) Organizational Culture. Univariate, bivariate and multivariate analyses were performed. Job satisfaction was significantly associated with absence of team conflict, stronger team support, better team collaboration, greater member involvement in the decision-making process (Team Processes), Affective commitment toward the team (Team Emergent States), as well as lack of a market/rational culture (Organizational Culture). Job satisfaction was strongly related to team processes and, to a lesser extent, team emergent states.

Burnout Evaluation and Potential Predictors in a Greek Cohort of Mental Health Nurses

BACKGROUND

Job burnout is one of the most serious occupational health hazards, especially, among mental health nurses. It has been attributed among others to staff shortages, health service changes, poor morale and insufficient employee participation in decision-making.

AIM

The aim of this study was to measure burnout among mental health nurses, investigate relations between burnout and organizational factors and examine potential predictors of nurses' burnout. Specifically, this study aimed to investigate whether role conflict, role ambiguity, organizational commitment and subsequent job satisfaction could predict each of the three dimensions of burnout.

DESIGN/METHODOLOGY/APPROACH

During current cross sectional, the survey was administered to 232 mental health nurses, employed in four private psychiatric clinics in the region of Larissa, Thessaly, Greece in May 2015. Our findings were based on the responses to 78 usable questionnaires. Different statistical analyses, such as correlation analyses, regression analyses and analyses of variance were performed in order to explore possible relations.

FINDINGS

High emotional exhaustion (EE) accounted for 53.8% of the sample, while high depersonalization (DP) and high personal accomplishment (PA) accounted for 24.4% and 25.6%, respectively. The best predictors of burnout were found to be role conflict, satisfaction with workload, satisfaction with training, role ambiguity, satisfaction with pay and presence of serious family issues.

PRACTICAL IMPLICATIONS

These findings have implications for organizational and individual interventions, indicating that mental health nurses' burnout could be reduced, or even prevented by team building strategies, training, application of operation management, clear instructions and psychological support.

Impact of Burnout on Organizational Outcomes, the Influence of Legal Demands: The Case of Ecuadorian Physicians

Interest in burnout has developed extensively worldwide, but there is scarce the literature regarding the consequences that new legal demands have on burnout and on organizational outcomes in physicians. The global context of the medical profession has been characterized in the recent years by changes in the employment patterns, profound intensification of work, and increment of labor flexibility. In this context, the study aims to analyze the influence of burnout on organizational outcomes in physicians, depending on new legal demands perception in Ecuador. Regarding the method, the research was cross sectional and in the first stage, studied the psychometric characteristics, validity and reliability of the instrument to assess burnout through a series of confirmatory factor analyses (CFA). In a second part, we assessed, the robustness of the model of causal relations between the burnout dimensions and organizational outcomes. We carried out a series of path analysis, structural equation model. The study was accomplished in five hospitals and the sample was incidental, comprising 435 physicians from Ecuador. We divided the group in two subcategories, Sample A, composed by participants that considered that new Criminal Code (COIP) affects them and the Sample B, the group of physicians who believed that the COIP does not affect them. Burnout was assessed with the Spanish adaptation of the Maslach Burnout Inventory (MBI), the Organizational outcomes were measured with a seven-item self-report questionnaire, and we included an item regarding to the influence of new Criminal Code. We formulated four hypotheses, that considered that physicians who believed that the COIP affect them experience a greater negative influence of burnout on organizational outcomes. The results indicated that the group of physicians who believed that the COIP affects them (Sample A) experienced a greater negative influence of cynicism on productivity than Sample B. Moreover, the lack of efficacy dimension had more positive influence on turnover in group that believed that the Criminal Code does not affect their practice. The study is unique because incorporated new legal demands to traditional relation burnout and organizational outcomes in physicians.

Job satisfaction among mental healthcare professionals: The respective contributions of professional characteristics, team attributes, team processes, and team emergent states

Objectives

The aim of this study was to determine the respective contribution of professional characteristics, team attributes, team processes, and team emergent states on the job satisfaction of 315 mental health professionals from Quebec (Canada).

Methods

Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were organized into four categories according to a conceptual framework inspired from the Input-Mediator-Outcomes-Input Model. The contribution of each category of variables was assessed using hierarchical regression analysis.

Results

Variations in job satisfaction were mostly explained by team processes, with minimal contribution from the other three categories. Among the six variables significantly associated with job satisfaction in the final model, four were team processes: stronger team support, less team conflict, deeper involvement in the decision-making process, and more team collaboration. Job satisfaction was also associated with nursing and, marginally, male gender (professional characteristics) as well as with a stronger affective commitment toward the team (team emergent states).

Discussion and Conclusion

Results confirm the importance for health managers of offering adequate support to mental health professionals, and creating an environment favorable to collaboration and decision-sharing, and likely to reduce conflicts between team members.

Adaptation and Psychometric Evaluation of the Italian Version of the Attitude to Personality Disorder Questionnaire (APDQ)

The aim of the current study was to validate the Italian version of the Attitude to Personality Disorder Questionnaire (APDQ), assess its psychometric properties, and investigate nurses' attitudes toward patients with personality disorders. An Italian version of the APDQ was produced and administered to nurses working in the Bologna Mental Health Department. The instrument demonstrated good psychometric proprieties and a robust structure and supported the five-factor solution of the original English version. Findings showed that nurses experience negative feelings toward patients with personality disorders and found them difficult to care for. Attitude was found to be better among less experienced nurses and among those working in inpatient settings. The Italian version of the APDQ appears to be a useful instrument for assessing clinicians' attitudes in a variety of settings. Italian nurses were inclined to perceive these patients in a negative manner, frequently expressing aversive feelings.

Further examination of predictors of turnover intention among mental health professionals

WHAT IS KNOWN ON THE SUBJECT?: When mental health professionals leave organizations, detrimental effects on quality of patient care occur. Reasons for leaving include incivility, lack of autonomy, perceptions of unfair treatment and feeling psychologically unsafe at work. This paper sought to investigate additional reasons why mental health professionals intend to quit or to cognitively withdraw from their jobs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Past research on this topic is limited in its scope and data. Mainly fragmented evidence is available about predictors of job satisfaction and turnover intention (i.e. different mental health occupations examined in separate studies). Only two existing studies that examined broader mental health provider groups were limited by including few workforce settings, small sample sizes and insufficiently rigorous statistical analyses. We examined four occupations (mental health nurses, social workers, psychologists and psychiatrists), each represented through a large sample in multiple settings, all within one large healthcare network with complex patients. Our contribution is finding additional predictors (supervisory support, emotional exhaustion) of job satisfaction/turnover intention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizations can consider using culture change initiatives to increase civility at work; this includes leadership support and role modelling of workplace behaviours. Leaders should monitor staffing levels and high workloads to pre-empt emotional exhaustion, which predicts turnover. Hiring and training supervisors should involve not only technical expertise, but also 'soft skills' necessary for creating civil and supportive work environments. Leaders and managers should use employee feedback data (e.g. organizational surveys) to learn about the workplace environments, and address areas of employees' concern.

ABSTRACT

Introduction Given the global shortage of mental health professionals, high turnover rates within this workforce are concerning. We used United States of America Veterans Health Administration data to add to the limited knowledge about this topic. Aim We examined predictors of turnover intention, or an employee's cognitive withdrawal from their job, in a large sample of direct care mental health professionals, separating among occupations to increase the pragmatic relevance of our findings. Method Survey data from 10 997 mental health employees working in direct patient contact (2432 registered nurses, 3769 social workers, 2520 psychologists and 1276 psychiatrists) were used in a cross-sectional design with structural equation modelling techniques for model testing. Results Job satisfaction was predicted by civility (courteous and respectful workplace behaviours) and supervisory support. Job satisfaction predicted emotional exhaustion which predicted turnover intention. Job satisfaction also directly predicted turnover intention and turnover plans. Discussion Predictors of job satisfaction included civility and supervisory support. Emotional exhaustion predicted turnover intention. Results inform organizational actions to address these work environment characteristics. Implications for practice Organizations can initiate culture changes to improve civility and develop supervisors' 'soft skills' in conjunction with technical expertise.

Work-family conflict as a mediator between occupational stress and psychological health among mental health nurses in Japan

BACKGROUND

Occupational stress among mental health nurses may affect their psychological health, resulting in reduced performance. To provide high-quality, sustainable nursing care, it is necessary to identify and control the factors associated with psychological health among mental health nurses. The purpose of this study was to examine the role of work-family conflict (WFC) in the well-known relationship between occupational stress and psychological health among mental health nurses in Japan.

METHODS

In this cross-sectional study, data were gathered from 180 mental health nurses who had a coresident child or were married. Data from the Work-Family Conflict Scale, the Generic Job Stress Questionnaire, the Maslach Burnout Inventory-General Survey, and the Center for Epidemiologic Studies for Depression Scale were obtained via self-report questionnaires. The effects of occupational stress and WFC on psychological health were explored by hierarchical linear regression analysis.

RESULTS

The relationship between emotional exhaustion and occupational factors, including quantitative workload and the variance in workload, disappeared with the addition of WFC (each work interference with family [WIF] or family interference with work [FIW]). The relationship between emotional exhaustion and mental demands disappeared only with the addition of WIF. The relationship between depressive symptoms and variance in workload disappeared with the addition of WFC (each WIF or FIW).

CONCLUSION

Our findings may encourage hospital administrators to consider the risks of medical staff WFC. Furthermore, longitudinal investigations into the factors associated with WFC are required for administrative and psychological interventions.

Mental health workers’ views about their suicide prevention role

Aim

Mental Health workers bear responsibility for preventing suicide in their client group. Survey studies have indicated that staff can be seriously adversely affected when a client suicides. The aim of the current study is to describe and evaluate the effects on mental health (MH) workers of their ongoing role in managing suicidal behaviours and to identify the thoughts and feelings associated with this role.

Method

A survey was administered to 135 MH workers via an on-line self-report vehicle. The survey comprised standardised measures of anxiety and burnout as well as a questionnaire developed for this study concerning perceptions and attitudes to suicide and suicide prevention.

Results

Factor analysis of 12 retained items of the questionnaire identified three factors: 1) preventability beliefs (beliefs about suicide being always and/or permanently preventable); 2) associated distress (stress/anxiety about managing suicidal behaviour); and 3) the prevention role (covering views about personal roles and responsibilities in preventing suicidal behaviours). Analysis of these factors found that many MH workers experience an elevation of stress/anxiety in relation to their role in managing suicidal behaviours. This distress was associated with the emotional exhaustion component of burnout. Measures showed adverse responses were higher for outpatient than inpatient workers; for those who had received generic training in suicide prevention: and for those who had experienced a workplace related client suicide.

Conclusion

There is a need for the development of appropriate self-care strategies to alleviate stress in MH workers exposed to suicide.

The influence of trauma and patient characteristics on provider burnout in VA post-traumatic stress disorder specialty programmes

OBJECTIVE

Prolonged exposure (PE) and cognitive processing therapy (CPT) - post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health Administration (VHA) - expose the provider to graphic traumatic material. Little is known about the impact of traumatic material on VHA providers. The purpose of this study was to examine the relationship between trauma content, patient characteristics, and burnout among VHA PTSD Clinical Team (PCT) providers. It was hypothesized that trauma content and patient characteristics would significantly predict burnout in this population.

DESIGN

This cross-sectional study consisted of 137 participants. The sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.3).

METHODS

Participants completed an electronic survey that assessed demographics, patient characteristics (i.e., anger, personality disorder, malingering), trauma content characteristics (e.g., killing of women and children) as well as burnout as measured by the Maslach Burnout Inventory-General Survey (MBI-GS; Maslach et al., 1996, Burnout inventory manual. Palo Alto: Consulting Psychologist Press).

RESULTS

Over half of the study population reported being bothered by trauma content; however, trauma content did not predict burnout. Treating patients with personality disorders and suspected malingering predicted burnout in PCT providers. High numbers (77%) reported perceiving that emotional exhaustion impacted the quality of care they provided.

CONCLUSION

These findings suggest an important role of burnout assessment, prevention, and treatment strategies at the VHA.

PRACTITIONER POINTS

This paper addresses the impact of provider burnout on perceived quality of care. This paper also addresses potential predictors of burnout in PCT settings. This paper outlines potential remedies to provider burnout in the VHA.

Obsessive Passion as an Explanation for Burnout: An Alternative Theoretical Perspective Applied to Humanitarian Work

Burnout is an occupationally based syndrome that develops as a result of prolonged and cumulative stress. The experience of burnout has been documented in detail in a variety of human service professions. The purpose of this article is two-fold: to provide an alternative theoretical perspective on the development of burnout, which suggests it is not stressors per se that are responsible for burnout development; and, to use this alternative perspective as an explanation for burnout in the context of another human service profession — humanitarian work. Using the passion for activities notion conceptualised by Vallerand and colleagues (2003), it is explained how a lack of self-determination and autonomy leads to the development of an obsessive passion for an activity. Obsessive passion is linked to a variety of adverse cognitive and affective outcomes. This is then applied to the domain of humanitarian work, and it is suggested individuals with an obsessive passion are more likely to suffer adverse outcomes and consequently develop burnout when working in humanitarian crises. Some suggestions for future theoretical and empirical investigations regarding the relationship between obsessive passion and burnout are provided.

A pilot before-and-after study of a brief teaching programme for psychiatry trainees in mentalizing skills

Background and aims

Negative attitudes in clinicians towards people with personality disorder are common and associated with poor care. National guidelines recommend developing interventions to improve attitudes. Mentalization-based treatment theory and techniques provide a plausible intervention. We therefore evaluated the effect of teaching mentalizing skills on clinicians’ attitudes towards personality disorder.

Methods

Pilot before-and-after study of trainee psychiatrists receiving four teaching sessions in mentalizing skills. Self-report questionnaires were completed at baseline and post teaching programme.

Main outcome measure

Attitudes to Personality Disorder Questionnaire.

Secondary measure

Knowledge and Application of Mentalization-based treatment Questionnaire.

Results

Sixteen doctors were recruited with no study drop-out. Mean Attitudes to Personality Disorder Questionnaire score was superior post teaching programme versus baseline (135.3 vs. 124.5, standardised mean difference = 0.72, 95% confidence interval = 0.01 to 1.44). Mean Knowledge and Application of Mentalization-based treatment Questionnaire score was superior post teaching programme versus baseline (112.5 vs. 97.1, standardised mean difference = 1.83, 95% confidence interval 0.98 to 2.67).

Conclusions

As expected from a pilot study, the estimate of effect is imprecise. Within this limitation, our findings suggest that teaching in mentalizing skills improved attitudes and mentalization-based treatment knowledge to a clinically relevant degree. This has important implications for patient outcomes and staff development. Our study paves the way for a full-scale study to provide more precise and robust evidence.

Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study

BACKGROUND

Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses' experiences of patient violence in acute care inpatient psychiatric settings.

METHODS

An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation.

RESULTS

Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered "part of the job." Nurses often struggled with role conflict between one's duty to care and one's duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace.

CONCLUSIONS

Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.

Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study

Background

Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses’ experiences of patient violence in acute care inpatient psychiatric settings.

Methods

An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation.

Results

Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered “part of the job.” Nurses often struggled with role conflict between one’s duty to care and one’s duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace.

Conclusions

Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.

Exposure to aggressive behaviour and burnout in direct support providers: The role of positive work factors

Many direct support providers (DSPs) are exposed to aggressive behaviour in their work supporting adults with developmental disabilities service recipients. This is a work environment factor that has been linked to job burnout. The objective of this study was to examine the impact of positive work factors on emotional exhaustion (EE) among DSPs who are exposed to aggressive behaviour. Survey responses from 671 DSPs who were working in community service settings for adults with developmental disabilities, and were exposed to aggressive behaviour at least monthly were examined. Hierarchical linear regression examined the direct contribution and moderating role of positive work factors (self-efficacy for dealing with aggression and work contributions) on EE measured with the Maslach Burnout Inventory-Human Services Survey, after controlling for demographics, occupational variables, exposure to aggression and negative emotional reactions to aggression. Results showed that younger age, more experience, more depression/anger emotions in response to aggression, lower self-efficacy and low positive work contributions were significantly associated with EE. Positive work motivation was a moderator of exposure to aggression and EE. When work motivations were low, DSPs were more negatively affected by higher exposure to aggression. These findings suggest that in addition to addressing the negative emotional reactions to the aggressive behaviour encountered at work, it is also important to foster positive work factors which may be protective against EE.

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.

Working with the 'difficult' patient: the use of a contextual cognitive-analytic therapy based training in improving team function in a routine psychiatry service setting

The clinical management of 'difficult' patients is a major challenge which exposes mental health teams to an increased risk of frustration and stress and may lead to professional burnout. The aim of the present study was to investigate whether a cognitive-analytic therapy (CAT) based training undertaken by a mental health team working with 'difficult' patients reduced professional burnout symptoms, improved patients' service engagement and increased the levels of team-cohesion. Twelve mental health staff members from different professional and educational backgrounds took part in five 2-hour sessions providing a basic CAT training intervention, an integrative and relational model of psychotherapy for the treatment of borderline personality disorders. Participants were administered the Maslach Burnout Inventory (MBI), the Service Engagement Scale (SES) and the Group Environment Questionnaire (GEQ) before (T0) and after (T1) CAT training, and at 1-month follow-up (T2). A significant decrease were found, at T2, on the MBI Emotional Exhaustion scores, the SES Availability subscale, the GEQ Attraction to Group-Social and Group Integration-Social, while the MBI-Personal Accomplishment scores increased from baseline.The results of this study suggest that a CAT-based training can facilitate team cohesion and patient engagement with a service and reduce burnout levels among mental health team members dealing with 'difficult' patients.

[Analysis of burnout and job satisfaction among nurses based on the Job Demand-Resource Model]

PURPOSE

The purpose of this study was to examine burnout and job satisfaction among nurses based on Job Demand-Resource Model.

METHODS

A survey using a structured questionnaire was conducted with 464 hospital nurses. Analysis of data was done with both SPSS Win 17.0 for descriptive statistics and AMOS 18.0 for the structural equation model.

RESULTS

The hypothetical model yielded the following Chi-square=34.13 (p = <.001), df=6, GFI=.98, AGFI=.92, CFI=.94, RMSR=.02, NFI=.93, IFI=.94 and showed good fit indices. Workload had a direct effect on emotional exhaustion (β = 0.39), whereas supervisor support had direct effects on emotional exhaustion (β = -0.24), depersonalization (β = -0.11), and low personal accomplishment (β = -0.22). Emotional exhaustion (β = -0.42), depersonalization (β = -0.11) and low personal accomplishment (β = -0.36) had significant direct effects on job satisfaction.

CONCLUSION

The results suggest that nurses' workload should be decreased and supervisor's support should be increased in order to retain nurses. Further study with a longitudinal design is necessary.

Being satisfied at work does affect burnout among psychiatrists: a national follow-up study from New Zealand

BACKGROUND

Burnout and job satisfaction in psychiatrists has been an area of considerable interest. Longitudinal studies on the subject are lacking, rendering it difficult to establish whether burnout changes with time or whether low job satisfaction may predict high burnout with time in psychiatrists.

AIMS

This longitudinal study of burnout and job satisfaction in a cohort of New Zealand psychiatrists was conducted to examine if initial scores on the Job Diagnostic Survey (JDS) predicted scores on the Maslach Burnout Inventory (MBI) three years later and vice versa.

METHODS

Three questionnaires (a socio-demographic questionnaire, the JDS and the MBI) were sent to all registered psychiatrists in 2008, which included all those who had participated in a study three years earlier. Scores on these three questionnaires were compared for those who had participated in both studies.

RESULTS

The overall number of psychiatrists reporting a high level of emotional exhaustion (EE) did not change across the two phases. The number of psychiatrists reporting high levels of depersonalization (DP) increased from 31 (13%) to 45 (20.2%); the mean DP score for the cohort significantly increased by 17.5% (p < .01). Those reporting reduced personal accomplishment (PA) increased from 90 (37.7%) to 98 (43.9%); the mean PA score for the cohort significantly reduced by 14.5% (p < .001). Low scores on skill variety, task Identity, and feedback of the JDS were significantly correlated with high EE scores three years later, whereas low scores on skill variety were significantly correlated with high scores on DP, and low scores on task significance and feedback were correlated with low scores on PA three years later.

CONCLUSIONS

Paying attention to aspects of job satisfaction may assist us in developing specific interventions for psychiatrists who may score high on different dimensions of burnout.

Do transactive memory and participative teamwork improve nurses' quality of work life?

Improvement in nurses' quality of work life (QWL) has become a major issue in health care organizations. We hypothesized that the level of transactive memory (defined as the way groups collectively encode, store, and retrieve knowledge) and participative teamwork (an organizational model of care based on vocational training, a specific service's care project, and regular interdisciplinary staffing) positively affect nurses' QWL. This cross-sectional study enrolled 84 ward-based psychiatric nurses. We assessed transactive memory, participative teamwork, perceived organizational justice, perceived organizational support, and QWL using psychometrically reliable and valid scales. Participative teamwork and transactive memory were positively associated with nurses' QWL. Perceived organizational support and organizational justice fully mediated the relationship between participative teamwork and QWL, but not between transactive memory and QWL. Improved transactive memory could directly improve nurses' QWL. Improved participative teamwork could improve nurses' QWL through better perceived organizational support and perceived organizational justice.

The factors associated with the burnout syndrome and fatigue in Cypriot nurses: a census report

Background

Fatigue and burnout are two concepts often linked in the literature. However, regardless of their commonalities they should be approached as distinct concepts. The current and ever-growing reforms regarding the delivery of nursing care in Cyprus, stress for the development of ways to prevent burnout and effectively manage fatigue that can result from working in stressful clinical environments.

Methods

To explore the factors associated with the burnout syndrome in Cypriot nurses working in various clinical departments. A random sampling method taking into account geographical location, specialty and type of employment has been used.

Results

A total of 1,482 nurses (80.4% were females) working both in the private and public sectors completed and returned an anonymous questionnaire that included several aspects related to burnout; the MBI scale, questions related to occupational stress, and questions pertaining to self reported fatigue. Two-thirds (65.1%) of the nurses believed that their job is stressful with the majority reporting their job as stressful being female nurses (67.7%). Twelve point eight percent of the nurses met Maslach’s criteria for burnout. The prevalence of fatigue in nurses was found 91.9%. The prevalence of fatigue was higher in females (93%) than in males (87.5%) (p = 0.003). As opposed to the burnout prevalence, fatigue prevalence did not differ among the nursing departments (p = 0.166) and among nurses with a different marital status (p = 0.553). Burnout can be associated adequately knowing if nurses find their job stressful, their age, the level of emotional exhaustion and depersonalization. It has been shown that the fatigue may be thought of as a predictor of burnout, but its influence is already accounted by emotional exhaustion and depersonalization.

Conclusion

The clinical settings in Cyprus appear as stress generating environment for nurses. Nurses working both in the private and public sector appear to experience low to severe burnout. Self-reported fatigue interferes to the onset of emotional exhaustion and depersonalization.

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

BACKGROUND

The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants.

METHODS

93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses.

RESULTS

The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate.

CONCLUSIONS

The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

Job satisfaction among Iranian hospital-based practicing nurses: examining the influence of self-expectation, social interaction and organisational situations

AIM

The influence of self-expectation, social interaction, and organisational situation on job satisfaction among nurses is examined.

BACKGROUND

Understanding determinants and correlates of job satisfaction are important factors that help to reduce the problem of nurse attrition.

METHODS

Utilizing the Hybrid Model of concept development, job satisfaction was examined in three phases: (1) the theoretical phase, a working definition and the dimensions of job satisfaction were established; (2) the fieldwork phase, a qualitative semi-structured interview was employed to capture participants' perceptions of the concept; and (3) the analytical phase, the experiences of nurses were evaluated using the conceptual model.

RESULTS

The results indicate that personal beliefs, rather than social interaction or organisational situation, constitute the core of job satisfaction.

CONCLUSIONS

Despite the variety of dissatisfaction factors rooted in social interaction and organisational situation, participants achieved the highest job satisfaction when trusting in self-value systems and the spiritual value of their job objectives.

IMPLICATIONS

Intervention is needed to increase organisational and professional support for nurses. However, highlighting the sacred and spiritual value of the nursing profession, which is rooted in religious values and culture, provides additional reinforcement for enhancing the job satisfaction among this segment of health care providers.

Qualified and Unqualified (N-R C) mental health nursing staff--minor differences in sources of stress and burnout. A European multi-centre study

BACKGROUND

Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.

METHODS

A total of 196 nursing staff --124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds--working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).

RESULTS

(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.

CONCLUSION

The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).

A Pilot Study of Psychotherapist Trainees' Alpha-Amylase and Cortisol Levels During Treatment of Recently Suicidal Clients With Borderline Traits

Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortisol (C) analyses immediately before and after sessions with 2 selected clients. On average, samples were collected for the same therapist-patient dyad throughout the year-long study to ensure that data reflected therapist responses across stages of treatment. Therapists also completed a working alliance questionnaire and rated perceived session difficulty immediately after each selected session. Contrary to expectations, therapists demonstrated elevated levels of stress as measured by AA and C at presession relative to postsession levels. Greater session difficulty was related to more pronounced declines in AA, whereas a stronger working alliance was linked to more pronounced reductions in C. Results suggest that physiological stress responses while working with recently suicidal clients with borderline traits occur primarily in terms of session anticipatory anxiety, whereas AA and C changes may be affected differently by factors such as session difficulty and working alliance. This is a pilot study, limited by its sample size, but the design, findings, and inclusion of physiological measures present an initial step in an essential line of research.

Job satisfaction and burnout among staff working in community-based personality disorder services

AIMS

To examine levels of burnout among staff working in community-based services for people with personality disorder (PD) and to explore factors which add to or lower the risk of burnout among people working in such services.

METHODS

In-depth interviews with staff working at 11 dedicated community-based personality disorder services in England together with a cross-sectional staff survey using the Maslach Burnout Inventory.

RESULTS

Levels of burnout were generally lower than those reported in previous studies among mental health workers and levels of personal accomplishment were higher. Staff reported positive as well as negative experiences of working with people with PD. Strong team-work, clear leadership and opportunities for reflective practice were thought to protect staff from burnout.

CONCLUSIONS

The low levels of burnout we found may reflect the early stage of the development of these services. However, it is also possible that working with people with PD does not in itself lead to burnout, especially when services are organized to share and contain work-related anxiety.

The relationship between staff members' working conditions and patients' perceptions of the treatment environment

BACKGROUND

The psychosocial climate of inpatient units has proved to be related to both patient satisfaction and outcome.

AIMS

The aims of the study were twofold: to study the relationship between patient and staff satisfaction, and to study the relationship between the patients' perception of the treatment environment and the perceived working conditions of the staff.

METHOD

A total of 129 different patients completed the Ward Atmosphere Scale (WAS) and a General Satisfaction Index (GSI) at 11 time points between 1981 and 2000. Staff members completed the Working Environment Scale-10 (WES-10) and the GSI. Z-scores were calculated to describe the fluctuations in the WAS, WES-10 and the GSI subscale scores.

RESULTS

The study revealed a strong correlation between patient satisfaction and staff satisfaction. Staff satisfaction correlated significantly with the WAS subscales of Practical orientation and Staff control. Furthermore, the study revealed a significant correlation between patient satisfaction and staff members' perception on the WES-10 subscale of Self-realization.

CONCLUSION

This exploratory study revealed that the working conditions of staff are related to both patient satisfaction and the patients' perceptions of the treatment environment. A satisfactory working environment for psychiatric staff members seems important for the quality of care perceived by patients.

Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms

The aim of the study was to investigate how starting to use dialectical behavioural therapy (DBT) in the work with young self-harming women showing symptoms of borderline personality disorder affected the psychiatric professionals (n = 22) experience of occupational stress and levels of professional burnout. The study was carried out in relation to an 18-month clinical psychiatric development project, and used a mix of quantitative and qualitative research methods [a burnout inventory, the Maslach burnout inventory-General Survey (MBI-GS), free format questionnaires and group interviews]. The result confirms previous reports that psychiatric health professionals experience treatment of self-harming patients as very stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients. The teamwork and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some therapists felt also improved their handling of other work stressors not related to DBT. The inventory for professional burnout, the MBI-GS, showed no significant changes over the 18-month period, although there was a tendency for increased burnout levels at the 6-month assessment, which had returned to baseline levels at 18 months.

Burnout and job satisfaction in New Zealand psychiatrists: a national study

OBJECTIVES

To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population.

METHOD

In phase one of the study a postal survey was mailed out to every practising psychiatrist on record as well as all doctors working in psychiatry without specialist qualifications (MOSS). Three questionnaires were used: a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI) and a Job Diagnostic Survey (JSS). Regression analysis was performed on returned data sets using socio-demographic characteristics as explanatory variables and score components of the MBI and JDS as the outcome measures.

RESULTS

The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores.

CONCLUSIONS

This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout.

Expressed emotion and burnout: the experience of staff caring for men with learning disability and psychosis in a medium secure setting

This study examines the level of expressed emotion (EE) and burnout in staff caring for people with learning disabilities on a medium secure unit. The study aims to develop a baseline measure of EE and burnout in staff on the unit to be used for future service evaluation and to underpin interventions in the developing service based on psychosocial interventions. Ten staff participated in an audiotaped interview and completed a questionnaire. The Five Minute Speech Sample and Maslach Burnout Inventory were completed. High EE was evident in 31% of responses based on critical comments and negative relationships. Expressed emotion was higher in male staff and in Health Care Support Workers. No staff met all components for high burnout, but low personal accomplishment, high emotional exhaustion and high depersonalization were evident for some staff. There is evidence of high EE and some elements of high burnout within the staff team. A significant relationship was found between the level of high EE and the depersonalization element of burnout.

Burdensome situations in everyday nursing: an explorative qualitative action research on a medical ward

Everyday nursing care is under marked constraint in the current healthcare environment due to decreasing time resources and competing financial demands. Burden along with stress and burnout is increasing. Stress not only does occur on the individual and organizational level, as has been studied, but also is a significant factor at the team level, particularly with regard to interactions at this level. This project aimed at eliciting nurses' view on burden; identifying areas for intervention on team level; and evaluating the interventions implemented at this level. Focus groups were conducted with 2 nursing teams (n = 36). Data were analyzed with Atlas Ti, Version 4.2. On the basis of the results of the focus groups, interventions were developed and implemented observing the tenets of problem-based learning and evidence-based nursing. Verbal feedback was used to evaluate the impact of the interventions on the nursing team. Fourteen themes were identified for each ward as areas for improvement. Oral evaluation of the group-specific interventions revealed a benefit for the nursing team as a whole. Findings indicate that team actions played an important role when addressing stressful nursing situations. To improve stressful nursing situations, team action needs to be considered.