Burnout and professional depression: related concepts?

Occurrence of Professional Burnout and Severity of Depressive Symptoms among Cardiac Nurses: A Cross-Sectional Study

Nurses with depression are not only likely to suffer themselves, but it may have an impact on their coworkers and potentially the quality of care they provide. This study aimed to determine the prevalence of depression and its association with burnout in cardiac nurses. A group of 400 cardiac nurses (361 women and 39 men) was enrolled. The standardized tools such as Maslach Burnout Inventory (MBI), Beck Depression Inventory (BDI), and Patient Health Questionaire-9 (PHQ-9) were used. A high level of professional burnout regarding emotional exhaustion was observed in 53.3% of nurses, high depersonalization in 52.5%, and low personal accomplishment in 72.8%. PHQ-9 and BDI were shown to correlate significantly and positively with all three MBI subscales (p < 0.05). High depressive symptoms and occupational burnout were correlated with depression (p < 0.05). In conclusion, nurses were found to have high levels of depression and professional burnout, which may have resulted in a negative impact on the quality of patient care. Identification of burnout in cardiac nurses is necessary to consider interventions to prevent stress and depression.

A Qualitative Reexamination of the Key Features of Burnout

Burnout is generally defined as a triad of emotional exhaustion, lack of empathy, and reduced professional accomplishment constructs. We sought to determine in an exploratory, qualitative study whether these three constructs adequately represent burnout. Participants who self-identified as experiencing burnout completed a questionnaire that asked about their experiences of the condition. A qualitative thematic analysis was undertaken to determine the primary symptom constructs nominated by participants. The thematic analysis resulted in 12 symptom clusters or "themes" being identified as putative burnout features, with several of these themes overlapping with features identified in our independent quantitative analysis. Although we found emotional exhaustion, lack of empathy, and reduced professional accomplishment to be commonly nominated symptoms of burnout, the distinctive presence of several additional themes suggests that the burnout syndrome comprises a broader set of symptom constructs than those currently accepted as the defining features of the condition.

Areas of work-life in Spanish hostelry professionals: explanatory power on burnout dimensions

Background

Researchers have studied for decades workplace stress and burnout to identify their relationship to health and wellness. This research has focused on stress levels in people, as well as on environmental and personal factors that contribute to experiencing stress or burnout. In addition to the burnout measurement questionnaires (MBI-GS), Leiter and Maslach designed a model to evaluate the areas of work environment that relate to this construct (Areas of Worklife Scale-AWLS).

The goal of the present research was to analyze the psychometric properties of a Spanish translation of the MBI (GS) and the AWLS with a Spanish-speaking population. This work makes a substantial contribution by addressing the need to use validated measures and methods when exploring the positive and negative aspects of organizations. These conditions provide a means to accurately evaluate the impact of interventions aimed to address stress and burnout.

Method

Cross-sectional study with self-report measures. The sample was comprised of 452 managers and employees (hotels, restaurants, catering) of Aragón (Spain). There were approximately equal numbers of women and men (45,4% vs. 54,6%). The average age of participants was 36.6 years (SD = 10.03). A battery of questionnaires was used: Socio-demographic and work characteristics, Scale of stress and health symptoms, Maslach Burnout Inventory-General Survey (MBI-GS), Areas of Worklife Scale (AWLS).

Results

The results showed optimal psychometric properties in both questionnaires, especially in terms of the predictive capacity of the AWLS in each of the MBI-GS dimensions.

Conclusions

The best explained dimension is that of emotional exhaustion. The manageable load variable is the one that most contributes to predicting burnout levels. For future interventions, the results confirm the need to verify the levels of each area of work, in order to focus on the most deteriorated ones.

Organizational Structure as a Determinant of Job Burnout

This exploratory study determined the impact of organizational structure, particularly participation in decision making, instrumental communication, formalization, integration, and promotional opportunity, on burnout among Pakistani pediatric nurses. Data were collected from pediatric nurses working for Punjab’s largest state-run hospital. The findings revealed that participation in decision making, instrumental communication, and promotional opportunity prevented burnout. Formalization contributed to burnout but integration was not related to burnout. Quite interestingly, except for supervisory status, most control variables for this study were not significantly related to emotional burnout. Hence, the hypothesis that organizational structure is a determinant of job burnout was accepted.

Burnout among Nurses

Results are presented of a cross-national study on burnout among 200 Polish and 183 Dutch female nurses. The reliablity and the factorial validity of the Maslach Burnout Inventory (MBI) is satisfactory in both countries. However, evidence for the content validity of the MBI is likewise equivocal in both samples. Polish nurses are significantly more burned out than their Dutch colleagues, even after controlling for differences in work situations in both countries. Subjective work stressors (i.e., uncertainty and a perceived imbalance between investments and outcomes in relationships with patients) contribute most strongly to bumout in Polish as well as in Dutch nurses. Personality characteristics and aspects of the work situation play a less prominent role. Although the work situation of Polish and Dutch nurses differs considerably, psychological variables-notably, experienced job stress-are likewise crucial in understanding burnout among nurses of both countries.

Burnout-depression overlap: a review

Whether burnout is a form of depression or a distinct phenomenon is an object of controversy. The aim of the present article was to provide an up-to-date review of the literature dedicated to the question of burnout-depression overlap. A systematic literature search was carried out in PubMed, PsycINFO, and IngentaConnect. A total of 92 studies were identified as informing the issue of burnout-depression overlap. The current state of the art suggests that the distinction between burnout and depression is conceptually fragile. It is notably unclear how the state of burnout (i.e., the end stage of the burnout process) is conceived to differ from clinical depression. Empirically, evidence for the distinctiveness of the burnout phenomenon has been inconsistent, with the most recent studies casting doubt on that distinctiveness. The absence of consensual diagnostic criteria for burnout and burnout research's insufficient consideration of the heterogeneity of depressive disorders constitute major obstacles to the resolution of the raised issue. In conclusion, the epistemic status of the seminal, field-dominating definition of burnout is questioned. It is suggested that systematic clinical observation should be given a central place in future research on burnout-depression overlap.

Structurational divergence theory as explanation for troublesome outcomes in nursing communication

Structurational divergence (SD) theory captures negative communication cycles resulting from interpenetration of incompatible meaning structures. It is estimated that 12-15% of practicing nurses suffer from a problematic level of SD. With a sample of 713 nurses (57 departments) in a large hospital, this study tests a model positing SD as a root explanation of nursing job satisfaction and turnover. A number of variables long presumed to be explanations for job satisfaction and turnover were hypothesized as mediators between SD and those outcomes. Path analysis showed support for burnout, role conflict, bullying, and organizational identification as useful mediators, explaining 68% of the variance in job satisfaction, and 45% in intentions to leave. The study also explores relationships between SD and hospital quality indicators. SD is a concern because it powerfully explains a number of poor outcomes and provides an underlying explanation for a number of factors that predict job satisfaction and turnover.

[Job stress and burnout among nurses and care workers in psychiatric wards]

OBJECTIVES

To demonstrate the actual state of job stress and burnout among nurses and care workers working in psychiatric wards by comparing them with those who serve in internal medicine wards.

METHODS

A survey was conducted of female ward nurses and care workers working at two psychiatric hospitals and two general hospitals in the Chugoku area using the brief job stress questionnaire and the Maslach burnout inventory-Japanese version. A total of 232 female nurses and care workers were analyzed, 125 from psychiatric wards and 107 from internal medicine wards.

RESULTS

Job stressors of stress due to workplace environment, job control, skill utilization, job aptitude and worthwhileness of working life were significantly greater in psychiatric wards than in internal medicine wards. Stress of quantitative and qualitative workloads, however, was significantly lower in psychiatric wards than in internal medicine wards. For job stress reaction, vigor was significantly lower in psychiatric wards than in internal medicine wards. For burnout, psychiatric wards scored significantly higher in depersonalization and reduced personal accomplishment compared with internal medicine wards.

CONCLUSIONS

Reviewing these results and their association with stress control policy in psychiatric wards, we suggest that three factors are important: maintaining working environment, enhancing conferences, and providing learning opportunities.

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.

Trait anxiety among Japanese massage practitioners with visual impairment: what is required in Japanese rehabilitation education?

This questionnaire-based study of Japanese massage practitioners with visual impairment ( n = 155, 126 males, 29 females, mean age = 41 years) found that measures of self-repression, helplessness and `daily hassles' were positively correlated to measures of trait anxiety. Also, trait anxiety was negatively associated with measures of self-esteem and perceived emotional support. Participants with moderate visual impairment (able to read print) showed significantly higher trait anxiety than those with severe visual impairment (those who read braille). Moreover, compared to sighted people in other medical professions, the participants in this study demonstrated higher levels of self-repression. Regarding onset of impairment, people with onset in adolescence had significantly higher self-repression scores than those with onset in adulthood. Overall, the results of this study are used to argue the importance of establishing social support systems in the workplace as well as incorporating psychological approaches with communication skills training in rehabilitation education for people with visual impairment.

Mental health and related factors among massage practitioners with visual impairment

The purpose of this study was to explore the mental health conditions and related factors among 155 visually impaired massage practitioners chosen from alumni lists of ten schools for the visually impaired in Japan. It was thought massage practitioners with visual impairment did not suffer burnout and depression because their mean scores indicated "no problem". However, their mean score for anxiety was high compared with previous studies. Gender and level of education showed no significant differences on anxiety and depression. Higher scores for anxiety and depression correlated inversely with age. Scores of depersonalization, anxiety, and depression were significantly higher and those of personal accomplishment lower for unmarried subjects compared to those who were married. Scores of emotional exhaustion, anxiety, and depression were significantly higher in persons who were able to read written text compared to those who read Braille only. Massage practitioners with visual impairment working at hospitals, medical clinics, and nursing homes revealed significantly higher daily client turnover, emotional exhaustion, and depersonalization compared to those who established their own massage clinics. It was thought that massage practitioners who were young and unmarried, had slight visual impairment, high client turnover, hectic relationships between clients, little autonomy at work, and worked at medical-related workplaces were prone to burnout. It is suggested that this group of massage practitioner requires periodic education about stress management techniques and more social support.

[Relationship between self-oriented perfectionism and depressive mood in the industrial society]

The purpose of this study was to investigate the relationship between self-oriented perfectionism and depressive mood in the industrial society. 380 workers in a construction company replied to a questionnaire, which consisted of a Beck depression inventory (BDI) and a multidimensional self-oriented perfectionism scale (MSPS). The results showed that concern over mistakes (CM) had a positive correlation with depressive mood in both younger and older age groups. Personal standard (PS) had a negative relation with depressive mood in younger age groups, but no statistical difference was seen in older age groups. We considered that the background for depressive mood differs in different age groups.

Moral stress and burnout: qualitative content analysis

The aim of the present study was to describe and interpret the narrative of an Australian nurse's experience of burnout. A qualitative content analysis was used for the text of the interview. The main findings of this study concern moral stress and burnout. Three themes were identified: shortcomings and health problems; hovering between suffering and desire; and responsibility for oneself. All themes are related to the nurse's identity, the nurse's personal experience of, and reflections on, ethical problems and the existential issues of suffering, and the responsibilities and difficulties nurses face. The findings are explained and discussed in light of several theories. In conclusion, nurses' needs have to be recognized. They need both emotional support and the right to receive systematic clinical supervision to help them reflect on their practical work and interpret the needs of patients.

Reflective practice and guided discovery: clinical supervision

This article explores the parallels between reflective practice as a model for clinical supervision, and guided discovery as a skill in cognitive psychotherapy. A description outlining the historical development of clinical supervision in relationship to positional papers and policies is followed by an exposé of the difficulties in developing a clear, consistent model of clinical supervision with a coherent focus; reflective practice is proposed as a model of choice for clinical supervision in nursing. The article examines the parallels and processes of a model of reflection in an individual clinical supervision session, and the use of guided discovery through Socratic dialogue with a depressed patient in cognitive psychotherapy. Extracts from both sessions are used to illuminate the subsequent discussion.

The burnout of nursing staff working with challenging behaviour clients in hospital-based bungalows and a community unit

The aim of this pilot study was to compare the burnout of nursing staff who worked with clients who displayed challenging behaviour in hospital-based bungalows and a community unit. Twenty-six and 12 nursing staff were randomly chosen from four hospital-based bungalows and a community unit. Staff assessed their clients' behaviour, using the Aberrant Behavior Checklist and were later interviewed, using a self-constructed Staff Questionnaire and the Maslach Burnout Inventory. The results showed that clients in the hospital-based bungalows were more severe in challenging behaviour than those in the community unit. The staff in the hospital-based bungalows were less satisfied with their salaries and enjoyed less their contact with clients. They complained more than the community unit staff and felt that their present training was inadequate. They were also more emotionally exhausted and experienced more depersonalization towards clients than the community unit staff. The level of personal accomplishment was, however, similar in the two groups. Correlations showed that there were significant associations between staff burnout and management issues rather than clients' behaviour, particularly in the hospital-based bungalow group.

Suicidal feelings and work environment in psychiatric nursing personnel

Suicidal feelings, attempted suicide and aspects of work environment and well-being in Swedish psychiatric nursing personnel were studied using a questionnaire. The questionnaire, containing 190 questions, was mailed to all 242 nurses and attendants working in psychiatric care at the department of psychiatry at Karolinska Hospital. Eighty-one percent (n = 197) returned the questionnaire. Suicidal feelings "last year" were lower than in the general population, but suicidal feeling and attempted suicide "earlier than last year" were much more common, and 13% reported that they had attempted suicide earlier in life. In order to study the possible association between work environment and suicide, a factor analysis was performed. Four factors were extracted and labelled: suicidality, quality of work, negative work environment and burn out/depression. The correlation between the factors suggests that negative work environment is associated with burn out/depression, which in turn is related to suicidality. No direct link was demonstrated between suicidality and work environment, and completed suicide was not investigated. The study provides some indirect evidence that a negative work environment may increase suicidal feelings.

Understanding Vicarious Traumatization

1. Close and prolonged work with victims of trauma and abuse can have serious psychological consequences for professionals. 2. The consequences to professionals can include development of anxiety, depression, intrusive thoughts, alienation, dissociative episodes, feeling of helplessness, paranoia, hypervigilance, and disrupted personal relationships. 3. The concepts of cognitive processing models and investigation into memory dynamics can offer understanding of vicarious traumatization, and may help define preventive measures and treatment options for this condition.

Factors related to nursing burnout: a review of empirical knowledge

It has been observed that nurses are at a high risk of burnout. The initiator variables of burnout appear to be numerous, tenacious, and not isolated; burnout is a complex phenomenon with multiple dimensions. In order to prevent psychosocial dysfunction and promote the mental health of nurses, the predominant factors contributing to nursing burnout should be clear. This article presents a literature review of the existing empirical knowledge regarding factors related to burnout in nurses. Among 300 documents on nursing burnout, 36 pertinent studies were retained. Amid these studies, 15 variables were selected, classified, and critically analyzed. It appears that the best correlates of nursing burnout are role ambiguity, workload, age, hardiness, active coping, and social support. Probable relationships and influences among these factors are discussed and may lead to a better understanding of mutual interactions between the personal and environmental factors contributing to nursing burnout. Implications for practice and further research are proposed.

Burnout and coping strategies among hospital staff nurses

This study examined the relationship between use of coping strategies and burnout among 150 randomly selected staff nurses from four hospitals. The instruments used were the frequency dimension of the Maslach Burnout Inventory (Maslach & Jackson 1981) and the Ways of Coping (Revised) (Folkman & Lazarus 1985). In the canonical correlation analysis, two significant canonical variate sets differentiated nurses on the dimension of burnout. Nurses who experienced increased levels of burnout used the coping strategies of escape/avoidance, self-controlling and confronting (P less than 0.001). Nurses who experience decreased levels of burnout used the coping strategies of planful problem solving, positive reappraisal, seeking social support, and self-controlling (P less than 0.003). Self-controlling coping, although present in both variate sets, was used to a lesser extent by nurses with decreased burnout levels. The positive relationship between planful problem solving and reduced burnout levels supports the theoretical framework of Lazarus. This framework asserts that during the appraisal process, persons evaluate the harmfulness of an event and their own coping resources. Persons with lower levels of burnout may perceive the event as amenable to change or they may perceive their coping resources as adequate. Either perception may promote the view that the situation is amenable to problem solving. Another rationale for the effectiveness of particular coping strategies may lie in the reactions that these strategies engender in others. The use of planful problem solving, seeking social support and positive reappraisal has been reported to result in the offering of greater social support than when confronting and self-controlling coping were used.(ABSTRACT TRUNCATED AT 250 WORDS)