Factors contributing to the development of burnout in oncology nursing

Psychological Well-Being amongst Cancer Palliative Care Professionals working in Bengaluru, India

Objectives:

Increased levels of psychological distress and burnout in cancer palliative care professionals have implications on their psychological well-being, quality of patient care they provide and for their employing organisations. There is a dearth of studies on psychological well-being with no published study available on psychological well-being amongst cancer palliative care professionals in India. The aim of the present study was to assess psychological well-being amongst cancer palliative care professionals.

Materials and Methods:

The study was cross-sectional and quantitative which was carried out at four cancer palliative care centers (one hospice and three hospitals) in Bengaluru city of India. The tools sociodemographic and professional datasheet and psychological well-being (PWB-20) scale were administered with 65 participants (Mean Age = 32.5, SD = 11.78). Purposive sampling method was used to recruit the participants working full-time at respective centers after obtaining permissions and ethical approvals. Descriptive, correlational, and inferential analysis of the quantitative data was carried out based on normality of the distribution.

Results:

The results revealed above average levels of self-acceptance and engagement and growth, below average levels of mastery and competence, while average levels of positive relations and PWB (total score). Significant differences in PWB domains based on age (P < 0.05) and self-care practices (P < 0.05) were seen. Sense of engagement and growth was found to be positively correlated with age and income earned per month (P = 0.01).

Conclusion:

Findings from the present study suggest that cancer palliative care professionals had moderate levels of PWB with implications in training and future research.

Recruiting breast cancer patients for mHealth research: Obstacles to clinic-based recruitment for a mobile phone app intervention study

BACKGROUND

Nearly half of newly diagnosed breast cancer patients will report clinically significant symptoms of depression and/or anxiety within the first year of diagnosis. Research on the trajectory of distress in cancer patients suggests that targeting patients early in the diagnostic pathway could be particularly impactful. Given the recent rise of smartphone adoption, apps are a convenient and accessible platform from which to deliver mental health support; however, little research has examined their potential impact among newly diagnosed cancer patients. One reason is likely due to the obstacles associated with in-clinic recruitment of newly diagnosed cancer patients for mHealth pilot studies.

METHODS

This article draws from our experiences of a recently completed pilot study to test a suite of mental health apps in newly diagnosed breast cancer patients. Recruitment strategies included in-clinic pamphlets, flyers, and direct communication with clinicians. Surgical oncologists and research staff members approached eligible patients after a medical appointment. Research team members met with patients to provide informed consent and review the study schedule.

RESULTS

Four domains of in-clinic recruitment challenges emerged: (a) coordination with clinic staff, (b) perceived burden among breast cancer patients, (c) limitations regarding the adoption and use of technology, and (d) availability of resources. Potential solutions are provided for each challenge.

CONCLUSION

Recruitment of newly diagnosed cancer patients is a major challenge to conducting mobile intervention studies for researchers on a pilot-study budget. To realize the impact of mobile interventions for the most vulnerable cancer patient populations, health researchers must address barriers to in-clinic recruitment to provide vital preliminary data in proposals of large-scale research projects.

Burnout syndrome and its association with anxiety and fear of medical errors among intensive care unit physicians: A cross-sectional study

Burnout is a work-specific syndrome with high incidence among intensive care unit personnel. Although several risk factors have been proposed, data regarding the association of anxiety and burnout among intensive care unit physicians are scarce. The aim of this study is to investigate the incidence of burnout and its association with state and trait anxiety and other sociodemographic, behavioural and occupational-related parameters, among intensivists. A population of intensive care physicians was evaluated using the self-completed Maslach Burnout Inventory and the State-Trait Anxiety Inventory Form Y, and data regarding sociodemographic and occupational-related variables were also recorded. From the 98 intensive care physicians addressed, 80 returned fully completed questionnaires; 26.9% of them presented with high emotional exhaustion, 37.5% with high depersonalisation and 41.5% with low personal accomplishment scores. Trait anxiety, fear of having committed a medical error and self-reporting difficulty when having to act accurately were independently associated with high burnout. In conclusion, burnout is common among intensivists and is associated with specific behavioural characteristics and personality traits, but not with work-related factors.

Predictors of stigma in a sample of mental health professionals: Network and moderator analysis on gender, years of experience, personality traits, and levels of burnout

Background.

Stigma is one of the most important barriers to help-seeking and to personal recovery for people suffering from mental disorders. Stigmatizing attitudes are present among mental health professionals with negative effects on the quality of health care.

Methods.

Network and moderator analysis were used to identify what path determines stigma, considering demographic and professional variables, personality traits, and burnout dimensions in a sample of mental health professionals (n = 318) from six Community Mental Health Services. The survey included the Attribution Questionnaire-9, the Maslach Burnout Inventory, and the Ten-Item Personality Inventory.

Results.

The personality trait of openness to new experiences resulted to determine lower levels of stigma. Burnout (personal accomplishment) interacted with emotional stability in predicting stigma, and specifically, for subjects with lower emotional stability lower levels of personal accomplishment were associated with higher levels of stigma.

Conclusions.

Some personality traits may be accompanied by better empathic and communication skills, and may have a protective role against stigma. Moreover, burnout can increase stigma, in particular in subjects with specific personality traits. Assessing personality and burnout levels could help in identifying mental health professionals at higher risk of developing stigma. Future studies should determine whether targeted interventions in mental health professionals at risk of developing stigma may be effective in stigma prevention.

Relationship between personality traits and burnout in oncology nurses

INTRODUCTION

Nurses burnout is a serious problem which can affect their health, the quality of patient care, and health institutions. Personality traits affect level of nurse burnout, and burnout characteristics vary depending on nurses' personality traits. The present study assessed burnout levels in order to determine stages of burnout in oncology nurses and to analyze the relationship between burnout and demographic characteristics and personality traits.

METHODOLOGY

This is a cross-sectional study performed on 106 oncology nurses working in Baghaei Hospital affiliated to Ahvaz Jundishapur University of Medical Sciences in Iran. The main personality traits were assessed using the NEO Five-Factor Inventory (NEO-FFI) and anxiety and depression employing a clinical educational questionnaire. The Maslach Burnout Inventory (MBI) was utilized to determine burnout levels, the t-test to compare the means, and Pearson correlation to evaluate correlations between personality traits and the different dimensions of the MBI.

FINDINGS

About 32.1% of the oncology nurses present in this study were in the most severe phase of burnout. Depersonalization and emotional exhaustion had a significant positive correlation with anxiety and depression, whereas personal accomplishment had a negative correlation with anxiety and depression.

CONCLUSION

A significant number of the oncology nurses experienced the most severe stage of burnout. Given the effects of personality traits on burnout dimensions, they should be taken into account to prevent the burnout syndrome.

Staff Stress, Work Satisfaction, and Death Attitudes on an Oncology Palliative Care Unit, and on a Medical and Radiation Oncology Inpatient Unit

Professional caregivers for cancer patients are at high risk for work-related stress, but it is not clear how this relates to exposure to death and dying, and to professional satisfaction. This study compares work-related stress and staff satisfaction on an academic acute palliative care unit (PCU) with that on a medical and radiation oncology inpatient unit (OIU) at the same cancer centre. PCU staff tended to report less work stress-particularly related to terminal care—than those on the OIU, and higher work satisfaction and team support. PCU staff were more likely to perceive their work experience as having “positively altered their attitude to death” (p=0.007). These results show that a supportive team environment can exist on an academic PCU and suggest that support currently offered to PCU staff in terms of caring for terminally ill patients should also be extended to those working in general oncology settings.

Exploring the relationships among personality traits, burnout dimensions and stigma in a sample of mental health professionals

A sample of mental health professionals (n = 215) from six Community Mental Health Services was examined using a short version of the Attribution Questionnaire-27, the Maslach Burnout Inventory and the Ten Items Personality Inventory to detect possible associations among stigma, burnout dimensions and personality traits. The role of demographic and professional variables was also explored. Perception of workplace safety resulted to significantly affect attitudes toward patients. The concern about being assaulted and a low level of Personal Accomplishment were both related to avoidant attitudes, while the presence of procedures for managing the violent patient was associated with a higher level of Personal Accomplishment. Conversely, Emotional Stability and Openness to new experiences were inversely correlated with burnout dimensions and avoidant attitudes, respectively. Overall, our study supports the view of a significant association among some dimensions of stigma, burnout and personality factors. In particular, avoidant attitudes toward patients may be influenced by Personal Accomplishment and Openness to new experiences.

Facilitating a staff support group on an oncology ward: some observations

Aims and method

In this paper an experience of facilitating a weekly support group for nursing staff on an oncology ward is described. A brief overview of burnout among oncology nurses is followed by a description of the processes by which the support group was established.

Results

Some of the functions that the group has come to provide and recurring themes are highlighted along with a more theoretical understanding of the nature of groups within institutions.

Clinical implications

Support groups can help prevent isolation and demoralisation.

Anxiety and Depression in Staff of Mental Units: The Role of Burnout

One of the most investigated areas is the study of job stress and anxiety and its effects on the professionals' mental health status. The purpose of this study was to research the levels of anxiety and depression in staff that works in mental units and if burnout is related with these mental health parameters. The sample consisted of 217 mental health care professionals from mental health care units of all over Greece. The Greek version of the Symptoms Rating Scale for Depression and Anxiety (SRSDA) questionnaire was used to evaluate the levels of anxiety and depression and the Greek version of Maslach's Burnout Inventory (MBI) were used. Descriptive statistics were initially generated for sample characteristics. General linear models with MBI dimensions as independent variables and the anxiety and depression subscales of SRSDA as dependent variables were used to determine the relation between burnout and mental health parameters. Statistics were processed with SPSS v. 19.0. Statistical significance was set at p = 0.05. The average age of the sample was 39.00 ± 8.19 years. Regarding gender the percentage of men was 24.88% (N = 54) and of women 75.11% (N = 163). The means for the subscales of SRSDA were 4.91 ± 4.87 for Anxiety, 6.21 ± 5.92 for Depression Beck-21 and 2.83 ± 3.41 for Depression Beck-13. The results of general linear models are shown that Emotional Exhaustion and Depersonalization are statistically correlated with Anxiety and Depression Subscales of SRSDA. Burnout plays an important role in anxiety and depression levels of the staff that works in mental health units all over Greece.

Music therapy for palliative care: A realist review

OBJECTIVE

Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation.

METHOD

We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works.

RESULTS

A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation.

SIGNIFICANCE OF RESULTS

Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.

Demographics and Personality Factors Associated with Burnout among Nurses in a Singapore Tertiary Hospital

Background. The aim of the study was to evaluate the prevalence and extent of burnout among nurses in Singapore and investigate the influence of demographic factors and personal characteristics on the burnout syndrome. Methods. A cross-sectional survey design was adopted. All registered nurses working in Singapore General Hospital were approached to participate. A questionnaire eliciting data on demographics, burnout (measured using the Maslach Burnout Inventory, MBI), and personality profile (measured using the NEO Five-Factor Inventory, NEO-FFI) was used. Results. 1830 nurses out of 3588 responded (response rate: 51%). Results from 1826 respondents were available for analysis. The MBI identified 39% to have high emotional exhaustion (EE, cut-off score of >27), 40% having high depersonalization (DP, cut-off score of >10), and 59% having low personal accomplishment (PA, cut-off score of <33). In multivariable analysis, age, job grade, and neuroticism were significantly associated with each of the 3 components of the MBI. Staff nurses less than 30 years with high to very high neuroticism were more likely to experience high EE, high DP, and low PA. Conclusion. Younger nurses in Singapore are at increased risk of burnout. Personality traits also played a significant role in the experience of burnout.

Factors associated with mental health status of medical residents: a model-guided study

Residency is a stressful period in a physician's development, characterized by long work hours, time pressure, and excessive work load, that can exert negative effects on residents' mental health. Job burnout and negative work-home interference may play a major role in residents' mental health problems. The present study used the job demands-resources model as a theoretical framework to examine the way in which job demands (e.g., workload, emotional demands) and job resources (e.g., supervisor support, job autonomy) were associated with residents' mental health. From a pool of 290 medical residents, 264 (91 %) completed the questionnaires. Applying structural equation modeling techniques, the results showed that greater emotional exhaustion (β = -.65, SE = .09, p < .001) and more work-home interference (β = -.26, SE = .10, p < .05) were related to poor mental health. Specific job demands (i.e., high workload) and particular job resources (i.e., low opportunities for professional development and low supervisor support) were related to poor mental health not directly but only indirectly, via emotional exhaustion or work-home interference. Thus, through work-related emotional exhaustion, the impact of work conditions might be transmitted to and interfere with non-work related domains such as family life, as well as with domain-unspecific aspects of well-being, such as mental health and psychological distress. Implications of the results and suggestions for future research and practice are outlined.

A comparison of burnout among oncology nurses working in adult and pediatric inpatient and outpatient settings

PURPOSE/OBJECTIVES

To investigate differences in burnout among oncology nurses by type of work setting, coping strategies, and job satisfaction.

DESIGN

Descriptive.

SETTING

A metropolitan cancer center.

SAMPLE

A convenience sample of 74 oncology nurses.

METHODS

Participants completed a demographic data form, the Nursing Satisfaction and Retention Survey, and the Maslach Burnout Inventory.

MAIN RESEARCH VARIABLES

Burnout, coping strategies, job satisfaction, and oncology work setting (inpatient versus outpatient and adult versus pediatric).

FINDINGS

The participants most often used spirituality and coworker support to cope. Emotional exhaustion was lowest for youngest nurses and highest for outpatient RNs. Personal accomplishment was highest in adult settings. Job satisfaction correlated inversely with emotional exhaustion and the desire to leave oncology nursing.

CONCLUSIONS

The findings support that the social context within the work environment may impact emotional exhaustion and depersonalization, and that demographics may be more significant in determining burnout than setting.

IMPLICATIONS FOR NURSING

The findings raise questions of whether demographics or setting plays a bigger role in burnout and supports organizational strategies that enhance coworker camaraderie, encourage nurses to discuss high-stress situations, and share ways to manage their emotions in oncology settings.

KNOWLEDGE TRANSLATION

Spirituality and coworker relationships were positive coping strategies among oncology nurses to prevent emotional exhaustion. Nurses who rely on supportive social networks as a coping mechanism have lower levels of depersonalization. Age was inversely related to emotional exhaustion.

Physician burnout and patient satisfaction with consultation in primary health care settings: evidence of relationships from a one-with-many design

Physician burnout, as a prolonged response to chronic emotional and interpersonal stressors on the job, has been associated with suboptimal patient care and deterioration in the patient-provider relationship. Although prior studies have identified a range of factors associated with decreased patient satisfaction, most have been conducted in tertiary care settings, with staff burnout examined at the hospital unit-level. To examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting, a cross-sectional survey was conducted in Western Greece. Using a one-with-many design, 30 physicians and 300 of their patients, randomly selected, responded to the survey. Results showed that patient satisfaction correlated significantly with physician emotional exhaustion (r = -.636, p < .01) and physician depersonalization (r = -.541, p < .01). Mixed-effects multilevel models indicated that 34.4% of total variation in patients' satisfaction occurred at the physician level, after adjustment for patients' characteristics. Moreover, physician emotional exhaustion and depersonalization remained significant factors associated with patient satisfaction with consultation, after controlling for patient and physician characteristics. Patients of physicians with high-exhaustion and high-depersonalization had significantly lower satisfaction scores, compared with patients of physicians with low-exhaustion and low-depersonalization, respectively. Future studies need to explore the mechanisms by which physician burnout affects patient satisfaction.

Revealing the Meaning of the Mourning Process of Pediatric Nurses Facing the Death of Cancer Patients

Objetivo: develar el significado del duelo en enfermeras(os) que enfrentaron la muerte de niños con cáncer. La muerte de un niño(a) por cáncer genera un gran impacto en el equipo de enfermería, lo que produce impotencia, frustración y pena, que pueden llegar a causar Burnout. Método: se utilizó la investigación cualitativa fenomenológica basada en Husserl; se recogió la experiencia de diez enfermeras(o) oncológicas(os) pediátricas que enfrentaron la muerte de pacientes con cáncer bajo su cuidado. Los datos se obtuvieron de junio a noviembre del 2011 con entrevistas en profundidad grabadas y transcritas literalmente. El análisis fenomenológico se realizó según el método de Streubert. Resultado: los testimonios entregados develaron tres unidades de significado: las enfermeras vivencian la muerte de un paciente a través del transitar entre su propia forma de enfrentar la muerte y el cuidado profesional que otorgan. Con ello aparece un aprendizaje de vida dado por la comprensión de lo que es trabajar en oncología y los vínculos que establece en este ámbito. Esto permite desarrollar un cuidado con un sello particular. Conclusión: el estudio concluye que las enfermeras experimentan el duelo como un proceso dinámico al que atribuyen sentido a través de la entrega de un cuidado amoroso.

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 experience of burnout across different surgical specialties in the United Kingdom: a cross-sectional survey

BACKGROUND

We used a cross-sectional e-mail survey to assess the prevalence of psychological morbidity across different surgical specialties and identify predictor variables of burnout in surgeons.

METHOD

The survey was sent to 1971 surgeons from 127 National Health Service (NHS) hospital trusts across the United Kingdom. Burnout prevalence and mood were assessed using the Maslach Burnout Inventory-General Survey and Profile of Mood States (POMS), respectively. Demographic and POMS factors were investigated as predictors of burnout using linear and stepwise regression analyses.

RESULTS

Responses to the survey were received from 342 surgeons (17% response rate). One-third of 313 respondents showed high mean levels of burnout on exhaustion (2.32; standard deviation [SD], 1.62) and cynicism (2.34; SD, 1.44) subscales. Some specialties worked significantly more hours per week (F[8, 252] = 2.89; P = .004), but burnout prevalence did not differ significantly between specialty, grade, age, gender, hours worked per week, or years spent in post. The number of years in specialty (β = -0.17; P = .003) independently predicted surgeons' scores on exhaustion. POMS factors significantly predicted burnout, where fatigue (β = 0.58; P < .001) was the best predictor of exhaustion scores, depression (β = 0.28; P < .001) the best predictor of cynicism, and vigor (β = 0.29; P < .001) the best predictor of professional efficacy. Management issues were cited as contributing to psychological morbidity.

CONCLUSION

UK surgeons show high levels of cynicism and exhaustion burnout irrespective of their specialty, grade, or hours worked per week. Surgeons' mood profiles significantly predicted burnout, indicating the POMS could be used as part of an assessment for preventive interventions. NHS management and infrastructure are highlighted as influences on surgeons' psychological health.

Comparison of experienced burnout symptoms in specialist oncology nurses working in hospital oncology units or in hospices

OBJECTIVE

This study aimed to clarify the differential contributions of situational and individual factors to burnout symptoms experienced by two independent groups of specialist oncology nurses working in oncology hospital units or in hospices.

METHOD

The study involved a group of specialist oncology nurses working in hospital oncology units (n = 59) and a group of specialist oncology nurses working in hospices (n = 33). Participants were invited to provide demographic data, and indicate the clinical setting in which they worked and their work experience; the Italian versions of the Maslach Burnout Inventory (MBI) (a measure of burnout symptoms), the Hospital Anxiety and Depression Scale (HADS) (a measure of anxiety and depression), and the Attachment Style Questionnaire (ASQ) (a measure of relational style) were then administered.

RESULTS

The two groups of nurses were well matched for age, work experience, and levels of anxiety and depression. Regarding their relational style, the two groups only differed significantly on two subscales of the ASQ (i.e. "Confidence" and "Relationships as Secondary"). The two groups significantly differed in the levels of all burnout symptoms investigated (emotional exhaustion, depersonalization, and personal achievement), with nurses working in hospital units showing higher levels of burnout symptoms. Interestingly, multivariate regression analyses showed that the institutional factor (clinical setting in which nurses worked) clearly emerged as the only factor that influenced the level of all burnout symptoms, whereas the contribution of individual factors was less significant.

SIGNIFICANCE OF RESULTS

These findings help to clarify the differential contributions of institutional and individual factors to burnout symptoms in specialist oncology nurses, and corroborate the need for interventions to contain nurses' burnout symptoms.

Burnout syndrome in Cypriot physiotherapists: a national survey

BACKGROUND

Burnout in the healthcare workers is formally defined as a state of physical, emotional and mental exhaustion caused by long-term involvement in situations that are emotionally demanding.

METHODS

Using a random stratified sampling method and taking into account geographical location, specialty and type of employment, 172 physiotherapists working both in the private and public sectors completed an anonymous questionnaire that included several aspects related to burnout; the MBI scale, questions related to occupational stress, and questions pertaining to self image.

RESULTS

Almost half (46%) of the 172 participants believed that their job is stressful. Approximately 57% of the physiotherapists who worked in the public sector and 40% of those who worked in the private sector (p = 0.038) reported that their job is stressful. In total, 21.1% of participants met Maslach's criteria for burnout. The point prevalence of burnout was as follows: (1) 13.8% of those who worked in the public sector and 25.5% of those in the private sector (2) 22.2% of males and 20% of females (3) 21.6% who were married, 18% who were single and 33.3% who were separated. Gender was found to be associated with the level of personal accomplishment (chi-squared test; p = 0.049), as 17.8% of men compared with 24.3% of women reported high personal accomplishment. The number of years of working as a physiotherapist correlated negatively (r = -0.229, p = 0.004) with the total depersonalization score. Regression analysis showed that the perception that the job is stressful (p < 0.001) and the low salary (p = 0.016) were significant predictors of high emotional exhaustion scores, while age group (p = 0.027) predicted high scores of depersonalization and the employment sector (p = 0.050) as well as the low salary predicted high personal accomplishment scores.

CONCLUSIONS

Burnout levels in physiotherapists in Cyprus ranged from low to moderate.

Job Burnout, Health-Related Quality of Life, and Sickness Absence in Greek Health Professionals

This study examined how job burnout was associated with sick-leave absence and quality of life in a sample of 487 nurses working in the National Health Care System. Burnout was measured with the Maslach Burnout Inventory, while quality of life was measured with Short-Form Health Survey (SF-36). Data on sick leaves were collected from hospital personnel records. Logistic regression indicated that levels of burnout (emotional exhaustion) were significant predictors of short-term (but not long-term) sickness absence. Long-term sickness absence could be predicted by poor physical health. The findings indicate that burnout not only may negatively impact on quality of life of health-care providers, but also may influence short sick leaves. Implications for the implementation of absence reduction programs are discussed.

Coping and Resilience Factors in Pediatric Oncology Nurses CE

It is well established that pediatric oncology is perceived as a setting that is personally and professionally demanding. Many sources acknowledge the development of conditions, such as burnout, compassion fatigue and vicarious traumatization, as a result of being continuously subjected to highly stressful circumstances in a professional capacity. There are a myriad of individual and collaborative factors that are known to mediate stress in the oncology setting. One such factor is resilience. The purpose of this literature review is to investigate what is known about coping and its relationship with resilience in assisting pediatric oncology nurses to manage work-related stressors. From the themes identified within the reviewed studies, it is clear that the applicability of resilience in pediatric oncology nursing has not been thoroughly investigated. The literature suggests that the presence of resilience among pediatric oncology nurses is possible. What is not known is whether there is a link between this resilience and ability to cope with the stressors of pediatric oncology.

Effect of music therapy on oncologic staff bystanders: A substantive grounded theory

Objective:

Oncologic work can be satisfying but also stressful, as staff support patients and families through harsh treatment effects, uncertain illness trajectories, and occasional death. Although formal support programs are available, no research on the effects of staff witnessing patients' supportive therapies exists. This research examines staff responses to witnessing patient-focused music therapy (MT) programs in two comprehensive cancer centers.

Method:

In Study 1, staff were invited to anonymously complete an open-ended questionnaire asking about the relevance of a music therapy program for patients and visitors (what it does; whether it helps). In Study 2, staff were theoretically sampled and interviewed regarding the personal effects of witnessing patient-centered music therapy. Data from each study were comparatively analyzed according to grounded theory procedures. Positive and negative cases were evident and data saturation arguably achieved.

Results:

In Study 1, 38 staff unexpectedly described personally helpful emotional, cognitive, and team effects and consequent improved patient care. In Study 2, 62 staff described 197 multiple personal benefits and elicited patient care improvements. Respondents were mostly nursing (57) and medical (13) staff. Only three intrusive effects were reported: audibility, initial suspicion, and relaxation causing slowing of work pace. A substantive grounded theory emerged applicable to the two cancer centers: Staff witnessing MT can experience personally helpful emotions, moods, self-awarenesses, and teamwork and thus perceive improved patient care. Intrusive effects are uncommon. Music therapy's benefits for staff are attributed to the presence of live music, the human presence of the music therapist, and the observed positive effects in patients and families.

Significance of results:

Patient-centered oncologic music therapy in two cancer centers is an incidental supportive care modality for staff, which can reduce their stress and improve work environments and perceived patient care. Further investigation of the incidental benefits for oncologic staff witnessing patient-centered MT, through interpretive and positivist measures, is warranted.

[Effect of psychosocial work environment and job satisfaction on burnout syndrome among specialist physicians]

OBJECTIVES

To describe the prevalence of burnout syndrome according to medical specialty and to examine the impact of work psychosocial risk factors, job satisfaction and professional characteristics on burnout syndrome among specialist physicians throughout Spain.

METHODS

A cross-sectional survey was carried out among 1,021 Spanish physicians. The outcome variables were the 3 dimensions of burnout syndrome: emotional exhaustion, depersonalization, and personal accomplishment. The explanatory variables were work psychosocial risk factors and job satisfaction evaluated by a stress scale specifically designed for physicians. Adjusted odds ratios and their 95% confidence intervals were calculated by logistic regression.

RESULTS

The probability of high emotional exhaustion and depersonalization were greater in physicians exposed to a high level of contact with suffering and death and to a negative impact of work on home life. The probability of high emotional exhaustion was greater among physicians with a high work overload. The risk of low personal accomplishment was higher among physicians with low professional satisfaction and those without training activities. Dissatisfaction with relationships with patients and relatives had a negative effect on the 3 dimensions of burnout.

CONCLUSIONS

Psychosocial work environment and job satisfaction have a negative effect on burnout syndrome, especially on emotional exhaustion and depersonalization.

Factors Associated With Work Stress and Professional Satisfaction in Oncology Staff

Cancer care professionals work in a stressful environment, but it is not clear what factors contribute to this stress. We surveyed 60 oncology personnel on an inpatient unit and a palliative care unit regarding levels of perceived work stress and its potential contributors. Logistic regression analyses were performed to determine predictors of staff stress. A total of 63% of staff reported experiencing ``a great deal'' of stress at work, which was predicted by greater perceived workload (odds ratio = 32.2; P < .0001), insufficient time to grieve patients' death (odds ratio = 9.75; P = .0007), lack of institutional support (odds ratio = 0.16; P = .009), perceived lack of resources (odds ratio = 0.06; P = .007), and lack of control over the choice of workplace (odds ratio = 0.10; P = .03). Measures to address work-related stress should be included in the planning of cancer programs.

Associations on Dimensions of Burnout and Family Support for a Sample of Greek Nurses

To assess correlations for perceived family support with burnout in Greek nurses, the Julkunen Family Support Questionnaire and the Maslach Burnout Inventory were administered to nurses (22 men and 88 women; M age = 35.6 yr., SD = 5.7 yr.; M work experience = 12.2 yr., SD = 6.2 yr.). The correlation was positive but low for family support and sense of personal accomplishment by women; all the other correlations were low, accounting for very small variance.

Communication skills of health-care professionals working in oncology--can they be improved?

Communication skills' training has been placed high on the agenda by the National Institute of Clinical Excellence guidelines and the National Health Service in the UK. The paper reviews the importance of good communication skills in cancer care for the patient and describes research that has identified ways in which health-care professionals (HCP) can improve their communication with patients. The evidence as to why there is a lack of facilitative skills is reviewed along with what skills are required in order to improve communication with patients. The paper describes evidence of increased facilitative skills post-training, discusses whether there is evidence of transfer of these skills into clinical practice and how this might be best achieved. To conclude, research evidence would support the fact that training in communication skills needs to provide the best possible outcomes for HCP and their patients. Patient concerns, needs and preferences need to be elicited and the impact of concerns identified, so that the HCP can appropriately tailor their information giving, advice, treatment and plan of care.

Burnout, staff support, and coping in Pediatric Oncology

GOALS OF WORK

The goals of the study were the following: (1) to study the rate of burnout of the staff in Pediatric Oncology and compare it with that of a group of staff in other pediatric specialties, (2) to find out if job satisfaction, role clarity, staff support, and ways of coping are related to the burnout of these two groups, and (3) as a secondary aim, to identify other parameters, i.e., profession, experience, having children, etc., which might affect burnout, staff support, and ways of coping.

MATERIALS AND METHODS

The study group (n = 58) consisted of the staff of two Pediatric Oncology units and a Bone Marrow Transplantation unit, and the control group (n = 55) consisted of the staff of two Pediatric departments and one Pediatric Orthopedics department. The Maslach Burnout Inventory, the Staff Support Questionnaire, the Shortened Ways of Coping Questionnaire-Revised, and the Social Readjustment Scale were used.

MAIN RESULTS

No differences were found in burnout between Pediatric Oncology staff and that of other specialties, the existing staff support, and the ways of coping. Decreased role clarity and wishful thinking, as a way of coping, were positively correlated to emotional exhaustion, whereas a negative correlation of the lack of role clarity existed with personal accomplishment. Not having children and less experience increased burnout in both groups studied.

CONCLUSIONS

The hospital management and the heads of departments should be knowledgeable of ways to prevent burnout in their staff. Strategies targeting role clarity and wishful thinking are useful toward this goal.

Stress and coping in hospice nursing staff. The impact of attachment styles

Previous research suggests that the attachment style developed during childhood informs adult attachment styles, which in turn affects adult relationships and responses to stress. This study considers the sources of stress in hospice nurses and addresses the potential impact of their attachment styles on stress and coping experiences. Adult attachment style, stress and coping were measured in 84 nurses recruited from five hospices. The results supported previous research regarding the most common sources of stress in this nursing group. The study found partial support for the hypothesis that nurses with insecure attachment styles experience more stress than securely attached nurses. Hospice nurses with a fearful or dismissing attachment style were found to be less likely to seek emotional social support as a means of coping with stress than hospice nurses with a secure or preoccupied attachment style. Supervision, support and career-long training for nurses in hospices are recommended. Further research is needed to clarify the involvement of attachment style in hospice nurse stress and coping experiences.

Burnout syndrome in critical care nursing staff

RATIONALE

Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff.

OBJECTIVES

To identify determinants of BOS in critical care nurses.

METHODS

We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data.

MEASUREMENTS AND MAIN RESULTS

Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96-0.99; p=0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52-0.91; p=0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56-0.97; p=0.03); (3) quality of working relations (1-10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16-1.30; p=0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86-0.98; p=0.02) or physicians (OR, 0.81; CI, 0.74-0.87; p=0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04-1.85; p=0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01-1.29; p=0.04).

CONCLUSION

One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.

Caregiver stress and burnout in an oncology unit

Purpose:Caring for patients with cancer can be taxing for front-line health care providers. The growing intensity of treatment protocols, in conjunction with staff shortages, reduced hospital stays, and broader pressures on the health care system may exacerbate these challenges, leading to increased risk for burnout. This article reviews the research literature regarding the prevalence of burnout and psychosocial distress among oncology providers, examines multifactorial occupational and personal determinants of risk, and considers intervention strategies to enhance resilience.

Methods:Literature review of empirical peer-reviewed studies focusing on prevalence and correlates of burnout among oncology physicians and nurses.

Results:Findings from a number of studies using validated measures and large samples suggest that prevalence rates for burnout and psychosocial distress are high among oncology staff, though not necessarily higher than in non-cancer-practice settings. A growing database has examined occupational (e.g., workload) and demographic (e.g., gender) factors that may contribute to risk, but there is less information about personal (e.g., coping) or organizational (e.g., staffing, physician–nurse relations) determinants or multilevel interactions among these factors. Oncologist burnout may adversely affect anticipated staff turnover. Other important endpoints (biological stress markers, health status, patient satisfaction, quality-of-care indices) have yet to be examined in the oncology setting. Intervention research is at a more rudimentary phase of development.

Conclusions:Burnout and distress affect a significant proportion of oncology staff. There is a need for additional conceptually based, longitudinal, multivariate studies regarding burnout and its associated risk factors and consequences.

Effects of Cognitive Adaptation on the Expectation-Burnout Relationship Among Nurses1

Burnout has traditionally been thought to result from unrealistically high expectations although research has provided only equivocal support. We explored the impact of cognitive adaptation disposition, including mastery, optimism, and self-esteem, on the expectations-burnout relationship. Nurses (N = 341) who were recruited at professional conferences completed questionnaires that assessed cognitive adaptation, burnout, and initial and current expectations of control. As expected, cognitive adaptation predicted fewer unmet expectations of control, which in turn predicted lower burnout. In addition, optimism and self-esteem predicted lower burnout regardless of perceived initial expectations, whereas mastery lessened the negative consequences of initially high expectations on burnout.

Burnout, psychological morbidity, job satisfaction, and stress: a survey of Canadian hospital based child protection professionals

AIMS

(1) To measure the prevalence of burnout, psychological morbidity, job satisfaction, job stress, and consideration of alternate work among multidisciplinary hospital based child and youth protection (CYP) professionals; (2) to understand the relations between these variables; and (3) to understand the reasons for leaving among former programme members.

METHODS

Mailed survey of current and former members of all Canadian academic hospital based CYP programmes. Surveys for current members contained validated measures of burnout, psychological morbidity, job satisfaction/stress, and questions about consideration of alternate work. Surveys for former members examined motivation(s) for leaving.

RESULTS

One hundred and twenty six of 165 current members (76.4%) and 13/14 (92.9%) former members responded. Over one third (34.1%) of respondents exhibited burnout while psychological morbidity was present in 13.5%. Job satisfaction was high, with 68.8% finding their job "extremely" or "quite" satisfying, whereas 26.2% found their job "extremely" or "quite" stressful. Psychological morbidity, job satisfaction, and job stress were not associated with any of the demographic variables measured, but burnout was most prevalent among non-physician programme members. Almost two thirds of current members indicated that they had seriously considered a change in work situation. Former members indicated that burnout and high levels of job stress were most responsible for their decision to leave and that increasing the number of programme staff and, consequently, reducing the number of hours worked would have influenced their decision to stay.

CONCLUSIONS

Current levels of burnout and the large proportion of individuals who have contemplated leaving the service suggest a potential crisis in Canadian hospital based CYP services.

Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims

OBJECTIVES

To investigate the long term psychological sequelae of treating multiple victims of traumatic incidents, such as violent crime and motor vehicle accidents, and to assess staff exposure to violent patients in the emergency department.

METHODS

A self administered questionnaire booklet was distributed to all full time and part time staff working within the Johannesburg Hospital Trauma Unit during September 2002. Participation was voluntary. The questionnaire was specifically designed for the study as no relevant, validated questionnaire was found to be suitable. Psychological assessment comprised two standardised measures, the impact of event scale-revised and the Maslach burnout inventory.

RESULTS

Thirty eight staff members completed the questionnaire, a response rate of 90%. Over 40% of respondents had been physically assaulted while at work and over 90% had been verbally abused. Staff reported a significant level of post-traumatic symptoms, evaluated by the impact of event scale-revised (median = 17.5, range = 0-88), as a result of critical incidents they had been involved in during the previous six months. At least half of the respondents also reported a "high" degree of professional burnout in the three sub-scales of the Maslach burnout tnventory-that is emotional exhaustion, depersonalisation, and personal accomplishment.

CONCLUSIONS

Preventative measures, such as increased availability of formal psychological support, should be considered by all trauma units to protect the long term emotional wellbeing of their staff.

The relationship between job stress, burnout and clinical depression

The definition and phenomenological features of 'burnout' and its eventual relationship with depression and other clinical conditions are reviewed. Work is an indispensable way to make a decent and meaningful way of living, but can also be a source of stress for a variety of reasons. Feelings of inadequate control over one's work, frustrated hopes and expectations and the feeling of losing of life's meaning, seem to be independent causes of burnout, a term that describes a condition of professional exhaustion. It is not synonymous with 'job stress', 'fatigue', 'alienation' or 'depression'. Burnout is more common than generally believed and may affect every aspect of the individual's functioning, have a deleterious effect on interpersonal and family relationships and lead to a negative attitude towards life in general. Empirical research suggests that burnout and depression are separate entities, although they may share several 'qualitative' characteristics, especially in the more severe forms of burnout, and in vulnerable individuals, low levels of satisfaction derived from their everyday work. These final issues need further clarification and should be the focus of future clinical research.

Caring for dying children: a comparative study of nurses' experiences in Greece and Hong Kong

The purpose of this transcultural descriptive study was to explore the subjective experiences of 63 oncology and critical care nurses who provide care to dying children in Greece and Hong Kong. Semistructured interviews were conducted with 39 Greek and 24 Chinese nurses who described their experiences and responses to the dying process and death of children. The data were analyzed qualitatively and quantitatively, and nurses' responses were compared for their work setting (oncology versus critical care) and their ethnic background (Greek versus Chinese). Findings revealed that most nurses experience a sense of helplessness when caring for a dying patient and difficulties in their communication with the child and parents during the terminal phase of the disease. The large majority acknowledge that the impending or actual death of a patient elicits a grieving process, which is characterized by a fluctuation between experiencing and avoiding loss and grief. Greek and Chinese nurses differ in their expression of their grief and how they attribute meaning to childhood death. Despite the suffering caused by multiple deaths, nurses report significant rewards from caring for chronically and acutely ill children, and the majority are satisfied with their job, despite the difficulties they encounter, in both countries, mostly as a result of shortage in personnel and cooperation problems with physicians.

Burnout versus depression and sense of coherence: study of Greek nursing staff

We assessed the relationships between burn out, depression and sense of coherence (SOC) using the Maslach Burnout Inventory, Beck's depression inventory and Antonovsky's SOC questionnaire in a large sample of 17 male and 62 female Greek nurses. Analysis showed that SOC in nursing staff was correlated with burnout (BO) and depression, while the latter was correlated to a lesser degree with BO. The relationship of BO with depression seems to be the result of the relationship between depression and SOC. Thus, we could hypothesize that the degree of SOC renders persons either vulnerable or resistant to both depression and BO, though further studies are warranted. In the hospital setting, the intervention by specialized personnel in order to assist nursing staff with BO may be an appealing option. Further, prevention programs aimed at helping individuals prone to BO could also be envisaged.

Caring for the caregiver in oncology and palliative care

OBJECTIVES

To review the stressors and manifestations of stress present in oncology and palliative care settings and elucidate successful coping strategies.

DATA SOURCES

Review articles and research reports.

CONCLUSIONS

Professional care of advanced cancer patients and their families confronts nurses with a variety of challenges and stressors. Multiple strategies have been described in the literature to assist professionals to cope with stressful aspects of clinical practice. Research is needed to test the efficacy of these strategies.

IMPLICATIONS FOR NURSING PRACTICE

Personal coping strategies and the development of supportive collaborative relationships within the work environment are essential to the enhancement of self-esteem and professional effectiveness.

Burnout in nursing staff: a clinical syndrome rather than a psychological reaction?

The aim of this study was to investigate the relationship between the development of burnout in the nursing staff and traits of personality, as well as sociodemographic and professional characteristics. Maslach Burnout Inventory and Eysenck Personality Questionnaire were used to evaluate all the members of the nursing staff of General Hospital AHEPA. Data on sociodemographic and professional characteristics of the staff were gathered as well. The analysis showed that there is a complex interaction of the measured characteristics of the sample that leads to the development of burnout. The model of burnout development is not only nonlinear, that is, different variables play a different role in each level of burnout development, but also points to a discontinuity between 'normal' attitude towards work and true burnout. This suggests the possibility that burnout is a true clinical syndrome with neurotic features rather than a magnification of normal tiredness from work.