Emotional Components of Burnout - Essay Example

Nursing Burnout Introduction: Burnout is a kind of occupational phenomenon, which is essentially seen in job functions that are service oriented andresults from work situations that are both demanding and have an emotional component attached to it. Maslach et al, 1996, as quoted in Ilhan et al, 2008, p. 100, define burnout as “a syndrome of feelings of emotional exhaustion, depersonalization and reduced personal accomplishments”. The health care industry is one area, where the occupations are such that they provide service to those seeking healthcare services, with nursing a key element in the providing of the desired service from the healthcare service seekers. Professionals providing healthcare services with particular emphasis on the nursing profession are known to be a group of professionals with a high potential for developing burnout (Garrosa et al, 2008). The health care services environment that the occupation of nursing functions in, is an environment that makes high demands on energy levels and different levels of competencies, poses challenges to the personal values and faith, and despite best efforts frequent loss of life of the patients. All these experiences of can contribute to burnout in a nursing professional (Ewing & Carter, 2004). Burnout among nursing professionals can severely compromise the quality of health care that health care seekers receive leading to poor outcomes, making burnout among nursing professionals an issue of serious concern to the health care service sector and society (Sahraian et al, 2008). Prevalence of Nursing Burnout and its Significance: From Ilhan et al, 2008 come the figures that it is estimated that nearly forty percent of the nursing professionals suffer from burnout, with about twenty percent of hospital nursing staff planning to give up work within a span of one year. Garrosa et al, 2008, however, provide a lower estimate of the extent of burnout among nursing professionals at twenty-five percent. Irrespective of the variance on these figures, the significant feature that stands out is the high prevalence of nursing providing support to the general belief that the nursing profession is highly susceptible to burn out. Nursing professionals function in different areas of medicine and there has been evidence to suggest that there is a variance in the prevalence of burnout among the different areas of medicine that the nursing professionals function in. Sahraian et al, 2008, in their examination of the levels of burnout in the areas of internal medicine, surgery, psychiatry and burn wards and the factors that contribute to it, show that nursing professionals are prone to burnout. However, it is the nursing professionals operating in the field of psychiatry that demonstrate, the highest levels of burnout, followed by nurses in burn wards. The high level of contact involved in the care of patients in these wards with poor prognosis places high emotional demands and the authors suggest that this is the reason for the higher levels of burnout experienced by nursing professionals in psychiatric wards (Sahraian et al, 2008). Furthermore the findings of this study indicate that the prevalence of burnout is not the same in all the areas of nursing function, but varies depending in the demands put on nursing. The high levels of burnout among nursing professionals have a significant impact on healthcare services, with nursing being a cornerstone in the delivery of healthcare. Yet, this very corner is facing is a challenge of its own, with high levels of burnout among the nursing professionals threatening to exacerbate this challenge. According to Shirey, 2006, the current challenge that the nursing profession in the United States of America is facing, is the crippling shortage of nurses. Estimates suggest that as we enter the year of 2020 there will be a shortfall of twenty percent in the projected requirement of registered nurses, which translates into the staggering figure of 800,000 (Shirey, 2006). The situation becomes more alarming given that nearly a third of the current nursing force is above the age of fifty and by 2010 nearly 40% of the nurses will be over the age of fifty and heading towards retirement (Milliken, Clements & Tillman, 2007). Burnout reduces the efficiency and productivity of the available nursing workforce and in combination with the shortage of nursing professionals creates a working environment of overbearing workload and increased pressure at work, which increases the risk potential of burnout among the existing nursing workforce (Marjanovic, Greenglass & Coffey, 2007). Theoretical Basis of Burnout in Nursing: The concept of burnout goes back to the 1970s and from then on it has been studied in different occupations including nursing. Several theories have developed from the studies into burnout in human services personnel. These studies suggest two or more factors are involved in development of burnout in human services personnel. The more commonly accepted conceptualization of burnout by Maslach and Jackson (I981) gives three dimensions of emotional exhaustion, depersonalization, and reduced personal accomplishment to burnout, and has led to the three-scale Maslach Burnout Inventory-Human Services Survey (MBI-HSS), to measure burnout among human services personnel. Several studies have confirmed the three factor MBI-HSS, but some of the studies evaluating MBI-HSS among nursing professionals have failed to find empirical support for the MBI-HSS, leading to the development of other frameworks for burnout in nursing (Kanste, Miettunen & Kyngas, 2006). Going into further depth on the theoretical basis of burnout in nursing, Kanste, Miettunen & Kyngas, 2006, bring into relevance the two-factor structure of Green, et al, 1991, and the five-factor structure of Densten, 2001. In the two-factor structure the factors of emotional exhaustion and depersonalization get combined, leaving the personal accomplishment factor as a separate entity. In the five-factor model emotional exhaustion and personal accomplishment factors get further subdivided into two factors each, with the depersonalization factor remaining as such. Other critics of the three-factor model of suggested that for research purposes it is better to look at burnout as a unidimensional, combining all the factors into one Irrespective of these deviations in the structure of burnout in nursing, it remains that emotional exhaustion, depersonalization, and reduced personal accomplishment remain the core factors in theoretical basis of nursing burnout (Kanste, Miettunen & Kyngas, 2006). Expanding on the definition of burnout by Maslach et al, 1996, Ilhan et al, 2008, provide us with better insight into these three factors of burnout. From their perspective, emotional exhaustion may be construed as the combination of being emotionally overwhelmed, along with work exhaustion. The factor of depersonalization is the lack of feeling and impersonal reaction in the provision of service, care, treatment or instruction, while reduced personal accomplishments are the negative thoughts of reduced competency and the lack of a sense of achievement and satisfaction in the occupation and the people connected with the occupation (Ilhan et al, 2008). Burnout out has both physical and psychological aspects. The physical exhaustion that is felt due to emotional exhaustion stems from the fatigue that develops as energy is drained out by the emotional stress that is experienced by the individual. This progresses to a chronic stage, wherein the depersonalization aspect stars to take effect, which is seen as indifference in the job responsibilities and the tasks involved in the job responsibilities. From the perspective of nursing this means indifference to the various roles that a nursing professional performs in the providing of care to the patients. The end result of this is that there arises the feeling in the individual that nothing can be performed as required and there is no contribution by the individual at the workplace. This is then reflected in the lack of any satisfaction in the job function and a lack of a sense of any achievement. The result of is a drastic reduction in the efficiency and productivity of the individual and the reason why burnout is considered such a costly work place phenomenon (Sarmiento, Laschinger & Iwasiw, 2004). According to Ekstedt and Fagerberg, 2005, nursing is a profession that is at high risk for burnout because of several aspects of the working conditions of nursing professionals that result from organizational factors, conflict of roles and the ambiguity that exists in the role of a nursing professional and the reason why there is the need to understand nursing burnout for greater efficiency in the means employed to combat it. Contributory Factors of Nursing Burnout: Based on the evaluation of the perspectives of healthcare managers on the sources of nursing burnout, Glassberg, Norberg, and Soderberg, 2007, place the onus of the spurt of nursing burnout on the reorganization and downsizing that has become part of the health care system since the 1990’s. This downsizing and reorganization have led to frequent and unpredictable changes in the workplace of the nursing professional, due to the reduction in the expenditure available for nursing professionals and aspects of nursing care. Change is an essential to any organization, but from a nursing perspective there has been hardly any relief from the continuous change being experienced by the nursing professionals. This has led to the authors developing a model of factors influencing nursing burnout based on the downsizing and reorganization that has occurred. In this model downsizing and reorganization have had four consequences on nursing professionals, which are lack of peace of mind at work, inadequate levels of staffing, ambiguity in organization, and reduced influence on one’s work. In turn there has been an increase in the demands and responsibilities of the nursing professional, consisting of enhanced heterogeneous and advanced tasks, enhanced care demands, increased difficulty in prioritizing of tasks, heavy burden of carrying the ideal image the nursing profession, increased expectations from the health care sector, and enhanced demands from society and the private life. The combination of these two cascades impact on the nursing professional to bring about a feeling of lack of worth, which contributes to distrust between the management and the nursing personnel, disrespect among the nursing personnel themselves, and a reduced feeling of professional worth among the nursing professional. Such a situation leads to the spiraling sense of pessimism and inadequacy of burnout in the nursing professionals (Glassberg, Norberg & Soderberg, 2007). Montoro-Rodriguez and Small, 2006, suggest that there are four factors involved in nursing burnout, which can be taken as aspects of the organization that relate to salary and benefits, lack of recognition, supplies, and planning of patient care; aspects that relate to the unit-level organization consisting of work load, relationship between staff, supervision of the unit, management style, and job-related injuries; aspects of relationship with patients; and the aspects of the personal life of the nursing professional, which include gender, minority status, socio-economic status, family status, self-esteem, health and coping skills. This model of factors involved in nursing burnout encompasses the whole environment of a nursing professional. Such a wider perspective of the factors involved in nursing burnout is supported by the contributory factor provided by Garrosa et al, 2008. In this model the organizational and work place factors are essentially job stressors in that they add to the stress in the work place and make up the causal factors of burnout, while another set of factors in the form of socio-demographic variables and the personality factors make up the individual factors contributing to the vulnerability for burnout. It is this combination of causal factors along with vulnerability to burnout that lead to the burnout syndrome of emotional exhaustion, depersonalization, and lack of personal accomplishment. Bakker, Le Blanc and Schaufeli, 2005, add the dimension of spread of burnout among the nursing professionals through their post that burnout is contagious in nature and likely to spread from an affected nursing professional to other nursing professionals in the unit. Intensive care units require high levels of collaboration between the nursing professionals working in these units. Such enhanced levels of collaboration could lead to the spread of negative feelings, cynical attitudes, and impaired job behaviors of the affected nursing professionals. Testing this hypothesis among a large number of nurses working in various intensive care units the authors found that in keeping with earlier empirical studies burnout is contagious in these working environments and the remarkable feature was that this contagious effect of was seen in all the three components of the burnout syndrome of emotional exhaustion, depersonalization and, reduced personal accomplishment (Bakker, Le Blanc & Schaufeli, 2005). Another factor that aids in the spread of burnout to other nursing professionals is the verbal abuse that these professionals face from the nursing professionals in the different phases of burnout. There is evidence that shows that burnout in nursing causes the affected professionals to give went to their feelings through verbal abuse of their colleagues, who grin and bear it, but are put under stress due to it (Rowe & Sherlock, 2005). The response of nurses to burnout is impacted on significantly by their perception of stress and the factors involved in their responses to burnout. The vulnerability to burnout is influenced strongly by the personal characteristics and traits in an individual, as it is involved in the emotional, attitudinal, and behavioral responses of nurses to burnout. Nurses endowed with the personal characteristics of conscience, religious beliefs, personal philosophy, commitment, a sense of responsibility, and altruism have a better ability to cope with the work stressors and hence capable of resisting the implications of work stressors on them and their ability to deliver care to the patients. However, when the stress is persistent and continues to occur day in and day out, even those nurses with personal characteristics and traits that inhibit burnout may succumb to it (Rafii, Oskouie, & NIkravesh, 2004). Nurses interact with patients on a daily basis and this interaction can be a source of stress. The appraisal of patient characteristics had a strong influence on the attitudinal and behavioral responses of nurses. A positive appraisal led to improved relationships, while a negative appraisal resulted in poor relationship between the nursing professional and the patient. Cooperative patients, patients with a positive attitude to recovery, from the higher socio-economic classes, patients with higher educational levels, and patients who evoked the nurse’s sense of compassion brought about positive appraisals, while patients from lower socio-economic levels and addicts evoked a negative appraisal. A positive appraisal led to good relationship, while a negative appraisal resulted in a poor nurse-patient relationship. (Rafii, Oskouie, & NIkravesh, 2004). The quantum of social support available in the work environment in the form of supportive behavior of the head nurses, nursing administrators and coworkers influences the nurses’ response to burnout, with the support of the head nurse being the strongest influencing factor. Motivation and the desire to perform are enhanced when there is good social support available in the work environment. Social support from head nurses, nursing administrators and peers have the additional benefit of enabling nurses to endure and tolerate problems that they face and the stress at the work place. When such support is deficient there is a greater tendency for nurses to feel the stress in the work environment leading to burnout (Rafii, Oskouie, & NIkravesh, 2004). Conclusion: Burnout is an occupational hazard for those involved in the services sector. Health care service providers including nursing professionals are affected by burnout given the nature of their work and the changes that have occurred in the recent past that have added to the stress in the work environment. The nursing profession is going through challenging times and nursing burnout is compounding this challenge. Burnout has both physical and psychological dimensions to it, which are impacted upon by organizational aspects, work load at the unit level and support available, patient-nurse relationship and the personal characteristics of the nursing professional. Understanding nursing burnout is essential to finding the ways and means of tackling it and ensuring continued quality and standards of nursing care. (Word Count - 2612) Literary References Bakker, A. B., Le Blanc, P. M. & Schaufeli, W. B. (2005). Burnout contagion among intensive care nurses. 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