Psychological stress in nurses' relationships with HIV-infected patients: the risk of burnout syndrome

Grace Under Pressure: Resilience, Burnout, and Wellbeing in Frontline Workers in the United Kingdom and Republic of Ireland During the SARS-CoV-2 Pandemic

The coronavirus pandemic has necessitated extraordinary human resilience in order to preserve and prolong life and social order. Risks to health and even life are being confronted by workers in health and social care, as well as those in roles previously never defined as "frontline," such as individuals working in community supply chain sectors. The strategy adopted by the United Kingdom (UK) government in facing the challenges of the pandemic was markedly different from other countries. The present study set out to examine what variables were associated with resilience, burnout, and wellbeing in all sectors of frontline workers, and whether or not these differed between the UK and Republic of Ireland (RoI). Individuals were eligible if they were a frontline worker (in health and social care, community supply chain, or other emergency services) in the UK or RoI during the pandemic. Part of a larger, longitudinal study, the participants completed an online survey to assess various aspects of their daily and working lives, along with their attitudes toward their government's handling of the crisis, and measurement of psychological variables associated with heroism (altruism, meaning in life, and resilient coping). A total of 1,305 participants (N = 869, 66.6% from the UK) provided sufficient data for analysis. UK-based workers reported lower wellbeing than the RoI-based participants. In multivariate models, both psychological and pandemic-related variables were associated with levels of resilience, burnout, and wellbeing in these workers, but which pandemic-related variables were associated with outcomes differed depending on the country. The judgment of lower timeliness in their government's response to the pandemic appeared to be a key driver of each outcome for the UK-based frontline workers. These findings provide initial evidence that the different strategies adopted by each country may be associated with the overall wellbeing of frontline workers, with higher detriment observed in the UK. The judgment of the relatively slow response of the UK government to instigate their pandemic measures appears to be associated with lower resilience, higher burnout, and lower wellbeing in frontline workers in the UK.

Burnout and its relationship to empathy in nursing: a review of the literature

Compassion and empathy are viewed as important by both nurses and patients. The positive emotions that nurses feel as a result of compassionate and empathic practice are known as compassion satisfaction, whilst the negative consequences are known as burnout and compassion fatigue. Empathy has two distinct components: emotional empathy, which involves feeling the emotions of another, and cognitive empathy, which relates to self-regulation of the emotion felt. The purpose of this literature review is to examine the relationship between burnout and empathy in the nursing literature. The results suggest that the relationship between these constructs is complex, and an ability to self-regulate emotions during empathic engagement may reduce the risk of burnout. The implications for nurses, health care organisations, educators and health care policy makers are discussed. This review provides insight into how adaptive empathic engagement may reduce the risk of burnout.

How caring for persons with HIV/AIDS affects rural nurses

Prior research findings about caregiving for persons with HIV/AIDS indicate that caregiving impacts nurses in three separate domains: personal self as a nurse in practice; interactions with the nurse's family members, friends, and colleagues; and interactions with persons with HIV/AIDS. However the impact caregiving for persons with HIV/AIDS has on rural nurses has not been extensively explored. A qualitative study of rural registered nurses' experiences of caring for persons with HIV/AIDS was conducted to determine how caregiving affects registered nurses in rural areas. Content analysis was used to analyze rural registered nurses' written comments about their experiences of caring for persons with HIV/AIDS. Themes identified from the nurses' accounts of instances of caregiving were the perceived risk of acquiring the virus, a lack of concern about HIV/AIDS, and a need for ongoing continued education about the care of persons with HIV/AIDS.

The gains and pains of being a cancer support group leader: a qualitative survey of rewards and challenges

Rewards derived from leading a cancer support group are poorly understood yet may be crucial to offset the challenges and difficulties of this role. This study sought to obtain the views of a representative sample of Australian cancer support group leaders (CSGLs) concerning the perceived rewards and challenges of their role. All CSGLs identified by the state-based Cancer Councils were invited to participate by postal questionnaire. Qualitative methods were used to analyze responses to open-ended questions concerning rewards and challenges. A total of 300 CSGLs returned the questionnaire (response rate = 66%) with 272 providing qualitative comments. Four parallel themes emerged from the qualitative analysis: (i) Personal, (ii) Relationship, (iii) Group, and (iv) Community rewards and challenges. These were integrated into a model depicting key positive and negative aspects of the CSGL's role, to provide direction for future training and ongoing support of CSGLs.

HIV/AIDS and the workplace: perceptions of nurses in a public hospital in South Africa

AIM

The purpose of this article is to report a study of the perceptions and experiences of nurses caring for people living with HIV/AIDS in the public health sector in South Africa.

BACKGROUND

The number of people living with HIV/AIDS in South Africa has escalated at an alarming rate. Many people being hospitalized are HIV positive, and hence nurses are in more regular and prolonged contact with people suffering from HIV/AIDS than is the case in other working environments. Although studies focusing on nurses' experiences of caring for patients with HIV/AIDS have been done in numerous countries, little is known about nurses' views in Africa, and South Africa in particular. To ensure quality care for patients with HIV/AIDS, it is important to understand nurses' experiences of nursing HIV-positive patients and how they may influence their attitudes towards these patients.

METHOD

A qualitative approach was used, the primary method of data collection being in-depth interviews. These interviews were conducted with 35 nurses at a public hospital in the Gauteng province of South Africa in 2002-2003.

FINDINGS

Seven themes were identified: helplessness, emotional stress and fatigue, fear, anger and frustration, occupational-related concerns, empathy, and self-fulfilment.

CONCLUSIONS

Increased understanding of the stresses and rewards experienced by these nurses can contribute to policy development in this area. It is also important to provide appropriate preregistration and continuing education and support for nurses working in this field, and to ensure that the working environment is adequate in terms of resources.

Workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health of Japanese hospital nurses

Role stress has always been a concern for nurses and health care administrators. Most research, however, on role stress in nurses has taken place in Western cultures. Limited research in the area has taken place in Asian cultures and particularly in the country of Japan. Since the role of the hospital nurse in Japan is vastly different from the role of the hospital nurse in Western cultures and select Asian cultures, it is unclear what part workplace stressors, coping mechanisms and demographic characteristics play in the physical and mental health of Japanese hospital nurses. Therefore, this study chose to examine, in Japanese hospital nurses: (a) the relationships among various workplace stressors, 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 both physical and mental health. Data were obtained from 310 nurses who completed four questionnaires. Numerous significant correlations were found among the variables. Workload and number of people living in the household were found to be the best predictors of physical health. The best predictors of mental health were likelihood to leave the current nursing position, lack of support in the workplace, and escape-avoidance coping.

Interpersonal conflict, social support, and burnout among home care workers in Japan

To examine associations between interpersonal relationships in work settings and burnout, a cross-sectional survey was conducted on home care workers in Sapporo, Japan, by using the Maslach Burnout Inventory (MBI) and scales of interpersonal conflict and social support developed by the authors. Questionnaires were distributed among 303 subjects and returned by 243 subjects (80%). Complete answers were obtained from 106 subjects and were used for analysis. In multiple regression analyses, conflict with clients and their families significantly related to emotional exhaustion and depersonalization of the MBI (p<.05). Supervisory conflict significantly related to emotional exhaustion (p<.05), whereas coworker conflict significantly associated with depersonalization (p<.01). It is suggested that conflicts with clients' families, as well as clients, are important indicators for emotional exhaustion and depersonalization of home care workers.

Stress and satisfaction among employees in AIDS service organizations in New York

In recent years, employees in AIDS service organizations have witnessed a number of changes and challenges in their work, ranging from shifts in the population primarily affected by HIV disease, treatment advances and its implications, and changes in administrative factors such as cuts in funding, reorganization, and changes in job function. This study examined the motives, stressors, and rewards of employees in AIDS service organizations in New York City. The main reasons for choosing to work in this field were a desire to help and having experienced the loss of some-one to AIDS. A large number of respondents had been working in the AIDS field for 5 or more years and perceived the level of stress to be mild to moderate. They reported that the rewards of this type of work outweighed the stressors, and the level of job satisfaction was very high.

Stressors and rewards for workers in AIDS service organizations

The primary objective of this study was to examine the impact of recent advances in the treatment of HIV/AIDS on AIDS service providers. The study surveyed the motivations, stressors, and rewards of workers employed in AIDS service organizations. Employees of AIDS service organizations play a valuable role in providing services to people with HIV/AIDS, and their motives and attitudes about their jobs are significantly related to the quality of care provided to clients. A total of 180 employees from nine AIDS service organizations in New York City completed a self-administered questionnaire. The questionnaire consisted of demographic, motivation, stressor, and reward items. This ethnically diverse sample consisted of social service workers (56%), administrative workers (22%), health care workers (18%), and other workers (4%). Forty-two percent of respondents had been working in the AIDS field for 5 or more years. The main reasons for choosing this line of work were a desire to help others, followed by having experienced the loss of a loved one to AIDS. Overall, respondents rated the level of stressors in their jobs as moderate. The main category of stress was "lack of support" (referring to the availability of resources and support for clients). The most important individual stressors were societal attitudes towards AIDS, salary, client deaths, and administrative duties. The most highly valued reward factor associated with AIDS caregiving was "personal effectiveness." Overall, the rewards of AIDS caregiving outweighed the stressors, for respondents. Implications of these findings for administrators of AIDS service organizations are discussed.

Psychological stress among hospital doctors caring for HIV patients in the late nineties

To assess stress and satisfaction related to HIV medical work and its impact on psychological wellbeing, a cross-sectional study was undertaken among the population of doctors caring for HIV/AIDS patients in French hospitals. They were sent a questionnaire on demographic and professional characteristics along with three additional scales: the Consultants Mental Health Questionnaire with three components - stress, satisfaction and responses to job stress; the Maslach Burnout Inventory; and the GHQ-12 (General Health Questionnaire). A total of 670 physicians responded anonymously (65.4% participation). For 45% of respondents, HIV/AIDS represented less than 25% of their activity. Three dimensions were extracted by multivariate analysis from the stress scale (overload, social relationships at work, patients/family distress) and four dimensions from the satisfaction scale (work content, patients/family, peer recognition, work environment). Length of time working in HIV/AIDS, and proportion of clinical work in HIV/AIDS were not related to either stress or satisfaction. Only participation in NGOs increased the level of stress. Stress was not related to time spent in clinical work, neither to HIV work. Satisfaction derived from work decreases with time in direct contact with patients and is mainly related to the position in hospital. Eleven per cent sought help from professionals for psychological problems. Stress derived from patients suffering was not related to any psychological outcomes. Work overload and stress derived from social relationships at work are the main predictors of psychological distress, emotional exhaustion and depersonalization, while the moderator effect of satisfaction is weak. In the late nineties, the amount of HIV work did not appear as a specific feature of hospital medical work.

Literature review of role stress/strain on nurses: an international perspective

The presence of role stress/strain among nurses has been of concern throughout the world. However, to date, no one has conducted, from an international perspective, a literature review of research on the topic. This article assesses research from 17 countries, identifies the major areas of focus in the studies, compares and contrasts the findings, summarizes the state of the science on role stress/strain on nurses and makes recommendations for future research.

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.

Relation between immune variables and burnout in a sample of physicians

OBJECTIVES

To evaluate in a group of physicians the relation between burnout, demographic or job characteristics, anxiety, and immune variables.

METHODS

Seventy one physicians of all grades were recruited among different departments to a cross sectional survey. The Maslach burnout inventory, scales of emotional exhaustion, depersonalisation, and personal accomplishment, the trait scale of anxiety inventory (STAI-Y2), and a questionnaire on personal and professional characteristics were administered. The immune profile included quantitative (number (%) of lymphocytes and subsets) and functional (natural killer cytotoxicity) measures.

RESULTS

With a model of stepwise multiple regression analysis, emotional exhaustion was significantly affected by both personal (marital, sex) and job characteristics (qualification, working activity), whereas only patient contact explained a portion of variation in depersonalisation. Furthermore, trait anxiety was found to predict the Maslach burnout inventory scores. After correction for potential confounders, physicians who scored high levels of personal accomplishment showed significantly higher numbers of total lymphocytes, T cells (CD3), T helper cells (CD4), and T suppressor cells (CD8) than those who scored low levels. No other correlation was found between burnout and immune variables.

CONCLUSIONS

In our group of relatively young physicians a high degree of personal accomplishment was associated with an increase in the number of peripheral lymphocytes, particularly T subsets. The meaning of this is not clear, although it could be speculated that to evaluate oneself positively, particularly with regard to work with patients in the health services, might help to stimulate the immune system. By contrast, there is no evidence that to work hard, to feel tired from work, and to have a cynical reaction towards patient care is related to immunosuppression.

The language of mentoring in a health care environment

In this article, 4 models were tested on the relations among mentoring, job expectations, job reward value, job involvement, and organizational commitment of hospital nurses. In the model with the best fit to the data, mentoring and job expectations were positively related to job reward value. Organizational commitment and job involvement were increased by job reward value. A direct effect on organizational commitment was found for mentor assistance in learning skills. Specific methods used by mentors to convey supportive communication to their protégés included encouraging them to do their best, helping them gain additional training, providing support and encouragement when others criticize, helping deal with jealousy, and providing protégés with needed information. Nurse mentors were admired for standing up to administration and for challenging unfair decisions, thoughtless actions, and lack of respect on the part of administrators, doctors, and patients. Nurses indicated that working hard and not having anyone notice, being frequently criticized and rarely rewarded, and being exposed to serious diseases were particularly challenging and stressful aspects of nursing. Implications of this study for nurses and those working in health care environments are that mentoring and organizational commitment may be avenues for increasing the degree to which nurses feel that their job is rewarding.