Gina Gessner RN BSN CMSRN - Georgetown University to feelings of anxiety, depression, subjective...

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  • Gina Gessner


  • Objectives  The learner will be able to define

    burnout and its relationship to workplace stress.

     The learner will be able to explain the effects of workplace stress and burnout on the healthcare professional.

     The learner will describe different coping methods and understand the difference between problem based coping methods, avoidance focused coping and emotion based coping methods.

     The learner will be able to identify their personality type and determine if it predisposes one to workplace stress and burnout.

     The learner will be able to identify methods which are proven to reduce workplace stress and reduce burnout among nurses and other healthcare professionals.

  • Stress Definition of Stress: Stress is defined as “a dynamic and reciprocal relationship between the person and the environment” however more emphasis is on how it is perceived by the person experiencing it (Healy & McKay, 2000, p. 682).

    -For example, getting two admissions at once may be perceived by a new graduate nurse as extremely stressful when an experienced nurse may perceive it as only mildly stressful.

  • Burnout Much research was done on burnout in the early

    eighties by a predominant researcher, Christina Maslach. Maslach defines burnout as, “a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do ‘people-work’ of some kind” (1981, p.99).

    3 components

  • Burnout  Emotional Exhaustion:

    Emotional resources have been “used up”

     The major component of burnout

     Synonymous with “compassion fatigue”

     Provider feels frustrated and irritable

     Give an example of someone who has experienced emotional exhaustion

  • Burnout  Depersonalization- “Workers may display a detached and

    an emotional callousness, and they may be cynical toward co-workers, clients, and the organization” (Cordes & Doughtery, 1993, p. 623).

    - Believe people are deserving of their health problems

    - Highly correlated with emotional exhaustion

    - These people commonly withdraw and take longer breaks

    - Common in all human services professions

    - Give example

  • Burnout  Diminished Personal Accomplishment – This refers to

    an individual’s feelings of decreased or insufficient progress in accomplishing his or her job or in interacting with others (Zenners, et. al., 2000).

     Can characterize the entire self negatively.

     Contemplates leaving their professional all together.

     Give an example

  • 5 Stages of burnout. (Spinetta, et. al., 2000)

  • Why is Burnout so serious?

  • How is stress related to burnout?  “Burnout is a prolonged response to chronic emotional

    and interpersonal stressors on the job” (Maslach, Shauflei & Leiter, 2003, p.323).

     “Burnout is a response to overload” (Maslach, Shauflei & Leiter, 2003, p.409).

     Related to experienced work load, role ambiguity and time constraints

  • The effects of workplace stress  Mental Disorders: The APA states stress has been

    shown to cause irritability, anger, nervousness, and lack of motivation. Stress exposure over time is linked to feelings of anxiety, depression, subjective fatigue, reduced confidence and self esteem (Burgess, 2010).

     Physical Disorders: “fat storage, blood pressure elevation, agitation, suppression of sex hormones, accelerated blood clot formation, compromised immune system, increased serum triglyceride and cholesterol levels” (Antai-Otong, 2001). Research has also shown that nurses who are exposed to continual levels of stress are more likely to eat poorly, smoke cigarettes and abuse alcohol and drugs (Burke, 2000).

     Spiritual Disorders  - lack of meaning

    - questioning life's purpose - feeling empty inside - diminished sense of faith - less time spent praying or meditating - less time spent in nature - feeling isolated and disconnected from others

     (Psychological Wellness Institute, 2009, om_content&view=article&id=49&Itemid=59)

     Decreased Work Productivity: Correlations have been found between stress and error rates (Sutherland and Cooper, 1990). Additionally, less overall teamwork was seen in situations where stress is prevalent as well as general dissatisfaction (Burgess et al., 2010).

     Absenteeism: Legitimate sickness and absence rates of employees go up substantially in stressful environments (Burgess, et. al., 2010). Due to the evidence of stress and effects on the body and mind, it is no surprise that people experience more illness and there is likely to be a factor of avoidance in absenteeism. Stressful work situations also made it more challenging to recruit experienced staff and some people choose to leave healthcare all together (Burgess, et. al. 2010).

  • Discuss with each other what methods you use to cope with stress and burnout and what you think is most effective.

  • Table 3. Brief COPE description of coping dimensions (Burgess, et. al., 2010) Problem-focused


    Emotion Focused Coping Avoidance Focused Coping

    Active coping– Take actions to make the

    situation better. Religion– Finding comfort in spiritual beliefs.

    Self-distraction– Doing some other

    activity to avoid thinking about the


    Planning– Use of a strategy to solve the

    problem. Venting– Verbally expressing negative feelings

    Substance use– Use of alcohol or drugs to

    make self feel better.

    Positive reframing– Trying to see things

    in a different light Self blame– Blaming self for what has happened

    Behavioural disengagement– Giving up

    trying to cope

    Acceptance– Learn to live with the


    Humour– Making jokes about the situation. Denial– Saying to self ‘This isn't


    Using emotional support– Getting

    comfort from someone else.

    Using instrumental support– Seeking

    information and advice

  • The Big Five trait factors and illustrative scales From: Burgess, et. al, 2010, p. 133

    Characteristics of the high scorer

    Trait Scales Characteristics of the low score

    Worrying, nervous, emotional insecure, inadequate, hypochondriacal

    Neuroticism (N) Assess adjustment versus emotional instability. Identifies individuals prone to psychological distress, unrealistic ideas, excessive cravings or urges and maladaptive coping responses

    Calm, relaxed, unemotional, hardy, secure, self-satisfied

    Sociable, active, talkative, person-orientated, optimistic, fun-loving, affectionate

    Extraversion (E) Assess quantity and intensity of inter-personal interaction, activity level; need for stimulation and capacity for joy

    Reserved, sober, un- exuberant, aloof, task- orientated, retiring, quiet

    Curious, broad interests, creative, original, imaginative, untraditional

    Openness (O )Assess proactive seeking and appreciation of experience for its own sake; toleration for and exploration of the unfamiliar

    Conventional, down-to- earth, narrow interests, un- artistic, un-analytical

    Soft-hearted, good- natured, trusting, helpful, forgiving, gullible, straightforward

    Agreeableness (A) Assess the quality of one's inter-personal orientation along a continuum from compassion to antagonism in thoughts feelings and actions

    Cynical, rude, suspicious, uncooperative, vengeful, ruthless, irritable, manipulative

    Organized, reliable, hardworking, self disciplined, punctual, scrupulous, neat, ambitious, persevering

    Conscientiousness (c)Assess the individual's degree of organizational persistence, and motivation in goal- directed behavior, contrasts dependable, fastidious people with those who are lackadaisical and sloppy

    Aimless, unreliable, negligent, lazy le, lazy, careless, le, weak-willed, hedonistic

  • Are you neurotic?  Are you neurotic?  “‘Venting’, defined as the verbal expression of negative emotions and feelings, is considered to be an

    emotion-focused coping strategy. The personality trait of neuroticism correlated positively with venting, (rs = 0·36, p < 0·02) indicating that individuals who reported highly on the neuroticism scale were more likely to verbally express their feelings” (Burgess, et. al., 2010, p.135).

     “Our study revealed a significant association between neuroticism and venting; which is considered to be an emotion-focused coping strategy. The positive effect of venting was revealed in a recent study by Bosson et al. (2006). Using an experimental design which featured a mixed method survey of 120 participants, they concluded that sharing negative attitudes (venting) had a positive effect on inter- personal closeness. Venting may therefore be a strategy that ICU nurses should be encouraged to develop as a means of coping and therefore avoiding excessive stress”

     Neurotic personality types are more likely to experience stress by respond