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HEALTH AND WELLNESS 1/2014
WELLNESS AND TEAM
CHAPTER V
Department of Psychiatric Nursing Faculty of Nursing and Health Sciences
Medical University of Lublin
Zakład Pielęgniarstwa Psychiatrycznego
Uniwersytetu Medycznego w Lublinie
RENATA MARKIEWICZ
Professional burnout among psychiatric nurses
- analysis of factors
Wypalenie zawodowe wśród pielęgniarek psychiatrycznych
- analiza czynników
Key words: professional burnout, nursing, socio-demographic factors, the scale of
professional burnout
Słowa kluczowe: wypalenie zawodowe, pielęgniarki, czynniki socjodemograficzne,
skala wypalenia zawodowego
Professional burnout is a discomfort experienced in relation to work, it is the dif-
ference between the resources available to the person and the costs which the work
incurs during its execution [2]. The cause of loss of resources is the chronic stress
and the lack of skills which could be used to alleviate the stress [1]. Significant
scope of responsibilities at work, fatigue, high expectations, interpersonal conflicts
are just some of the factors that contribute to the cascade of stress reactions which in
turn lead to emotional problems and disorders in the daily functioning of an individ-
ual [6]. And although every person has different personality traits, everyone experi-
ences stress in a similar way when exposed to it. Stress in a greater or lesser extent
limits our intellectual capacity and has an impact on our well-being, both mental and
physical, causing a variety of disease states [11]. This adverse influence is present
especially among employees performing medical professions [3]. It can cause a
number of undesirable behaviors as a result of which mistakes, negligence, inade-
quate assessment of patients and wrong perception of patients’ problems may occur.
Staff employed in psychiatric wards is a particularly high-risk group [1,8]. It is in
HEALTH AND WELLNESS 1/2014
Wellness and team
54
such institutions where the (physical, psychological) burden is two times greater
than in other work contexts. In analyzing various factors it is worth identifying those
that have a negative impact and contribute to the development of burnout syndrome
as well as those that protect against it. Their recognition will allow executing both
measures reducing the occurrence of existing threats and promoting positive behav-
iors which decrease the risk of the development of the syndrome.
This paper presents an analysis of socio-demographic variables and analysis of
the relationships between professional burnout scales which may have an impact on
the development of burnout syndrome.
MATERIAL AND METHODS
The study presents an analysis of the socio-demographic variables and the analy-
sis of the relationship between the scales of professional burnout in nurses working
in the Mazowieckie Specialistyczne Centrum Zdrowia w Pruszkowie. Participation
in the study was voluntary. The survey was conducted in July 2012, based on the list
which contained closed-ended questions. The obtained data were analyzed quantita-
tively and statistically basing on the Spearman's rank correlation coefficient, Mann–
Whitney U test and a chi-squared test.
RESULTS
The analysis of the results were divided into two parts. The first part examined
the relationship between socio-demographic variables and the level of the individual
scales of burnout, that is:
1) active professional burnout: emotional involvement in work, stigmatizing the
mentally ill, overload of responsibilities at work, experiencing negative emo-
tions related to work, supererogation, a need to be perfect, the assessment of
the employer;
2) warning signals of passive professional burnout in the sphere of: psychologi-
cal activity, activity, somatic disorders, interpersonal relations;
3) passive full-blown professional burnout in the sphere of: psychological activ-
ity, activity, somatic disorders, interpersonal relations. The second part exam-
ines the relationship between the individual scales of professional burnout.
CHARACTERISTICS OF RESPONDENTS
The study involved 60 people. The vast majority were women (95%), most of
them aged 35 to 49 years. 53.3% of the nurses surveyed had secondary vocational
education while 6.7% had higher education with specialization. Married individuals
accounted for 68.3% of the respondents while the nurses having children constituted
81.7% of all the people surveyed. 66.7% of the nurses evaluated the relationships in
their families as good. 70% of respondents rated their financial situation as good.
The vast majority of nurses indicated that they like their job (88.3%). Permanent
employees constituted 90% of the people. The biggest share in the group of re-
Renata Markiewicz
Professional burnout among psychiatric nurses - analysis of factors
55
spondents were people with job seniority in the psychiatric ward exceeding 22 years
(70%) while the smallest share was formed by the individuals with job seniority in
the range of 0-4 years (17%). 70% respondents answered that the place they work in
was the place of their own choice. Only for 16.67% of the people surveyed the
choice of their workplace was arbitrary. 78.3% of nurses were those who quickly
adapted to working in the psychiatric ward (up to 1 month) and only 11.67% said
they had difficulty with adaptation (up to 3 months). Most of the nurses surveyed
took basic training regarding the applicable safety rules in the workplace (51.7%).
Professional training related to the introduction to work in the psychiatric ward was
attended by 43.3% of the nurses.
I. ANALYSIS OF SOCIO-DEMOGRAPHIC VARIABLES
To determine whether the age of the respondents is related to the level of profes-
sional burnout, Spearman's correlation analysis was performed. The analyses re-
vealed no statistically significant relationships. It was also examined whether wom-
en differ from men in terms of the levels of individual scales of professional burn-
out. For this purpose, the analysis was carried out with the use of the Mann–Whitney
U test. The analysis showed that women (M = 1.8) had a higher level of emotional
involvement in their work in comparison with men (M = 1.1): Z = 2.02; p = 0.043
(tab.1).
Table 1. Descriptive statistics for the level of emotional involvement in work, grou-
ped by gender Gender Average Standard deviation
Women 1,84 0,68
Men 1,05 0,27
Chart 1. The level of emotional involvement in work, grouped by gender
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
2
Women Men
HEALTH AND WELLNESS 1/2014
Wellness and team
56
For the remaining professional burnout scales no statistically significant differ-
ences between men and women were noticed. It was verified if among people of
different marital status there are differences in the level of their professional burn-
out in different scales. The analysis was performed with the use of Kruskal-Wallis
test, which showed no statistically significant differences between the analyzed
groups. Using the Spearman's rank correlation, the relationship between the place of
residence and the financial situation of respondents on one hand and professional
burnout level on the other hand was analyzed (tab. 2).
Table 2. The Spearman's rank correlation coefficient between the age of respondents
and the level of professional burnout
Professional burnout scale Spearman's rank correlation
coefficient
Statistical
significance
Overload of duties at work 0,26 0,044
Warning signals of passive professional
burnout in the sphere of activity 0,29 0,027
The analyses showed that there was a relationship between the place of residence
of the nurses surveyed and a predisposition to develop the professional burnout
syndrome. People who live in smaller towns were more overburdened with duties at
work and had a higher level of warning signals of passive professional burnout in
the sphere of activity.
Also, the Spearman's correlation analysis showed a statistically significant rela-
tionship between the financial situation of respondents and the degree to which they
are overburdened with duties at work: rho = 0,44; p < 0,001. As the research
shows, an individual’s worse evaluation of their material situation has an impact on
the overload of duties at work.
It was examined whether the level of education of respondents was significantly
connected with the level of professional burnout. The Spearman's rank correlation
showed a significant relationship: rho = -0,37; p < 0,001. This means that the level
of education of nurses surveyed has an impact on their work with the mentally ill.
Individuals with higher education show respect and understanding towards those
people and therefore run a lower risk of developing the burnout syndrome. On the
other hand, the analysis by means of the Mann–Whitney U test showed no statisti-
cally significant differences between respondents having and not having children in
terms of professional burnout level in the individual scales and the respondents’
perceived relationships in the family.
It was studied whether the persons employed on the basis of permanent con-
tracts differ in terms of professional burnout from those employed on the basis of
fixed-term contracts (tab.3).
Renata Markiewicz
Professional burnout among psychiatric nurses - analysis of factors
57
Table 3. Descriptive statistics for the level of warning signals and passive full-blown
professional burnout in the sphere of interpersonal relations, divided according to
the type of employment
Sphere of interpersonal
relations Employment Average
Standard
deviation
Warning signals of pro-
fessional burnout
Permanent 0,98 0,61
Fixed-term 0,48 0,41
Fullblown professional
burnout.
Permanent 0,69 0,52
Fixed-term 0,31 0,51
The analysis by means of the Mann–Whitney U test showed that persons em-
ployed for an indefinite period had higher levels of warning signals and a greater
degree of full-blown professional burnout in the sphere of interpersonal relations,
respectively: Z = 2,10; p = 0,036 and Z = 2,07; p = 0,038 in comparison with indi-
viduals employed on the basis of fixed-term contracts.
Chart 2. The level of warning signals and passive full-blown professional burnout
in the sphere of interpersonal relations, divided according to the type of employment
This was followed by the Spearman's correlation analyses between the level of
burnout in respondents, their total work experience and job seniority in the psychiat-
ric ward. The analyzes showed that the longer (total) work experience of respond-
ents, the higher their level of emotional involvement in work (rho = 0.27, p = 0.037)
and the higher their level of responsibilities overload at work (rho = 0.31, p = 0.016
). Similar results were obtained in relation to persons employed in psychiatric wards
(rho = 0.28, p = 0.031).
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
1
Permanent Fixed term Permanent
Fixed term
Warning signals of professional burnout
Full-blown professional
burnout
HEALTH AND WELLNESS 1/2014
Wellness and team
58
Also, the analysis conducted with the use of the Kruskal-Wallis test showed sta-
tistically significant differences between the individuals who deliberately chose their
place of employment and the level of passive full-blown professional burnout in the
sphere of interpersonal relations: chi2(2) = 7,06; p = 0,029 (tab.4).
Table 4. The average level of passive full-blown professional burnout in the sphere
of interpersonal relations, divided according to the reason for choosing a place of
work Reason Average Standard deviation
Person’s own choice 0,58 0,55
Arbitrary 1,01 0,41
Other reasons 0,57 0,37
The individuals who began working in the psychiatric ward “by accident” had
higher levels of passive full-blown professional burnout in the sphere of
interpersonal relations compared to those who consciously made the choice concern-
ing their place of work.
Chart 3. The level of passive full-blown professional burnout in the sphere of inter-
personal relations, divided according to the reason for choosing a place of work
Correlation analysis showed no statistically significant relationship between the
level of professional burnout and the length of the period of adaptation to work in a
psychiatric ward.
0
0,2
0,4
0,6
0,8
1
1,2
Person’s own choice Arbitrary Other reasons
Reason for choosing a place of work
Renata Markiewicz
Professional burnout among psychiatric nurses - analysis of factors
59
In order to check whether there is a relationship between the respondents’ appre-
ciation of the their own job and the level of professional burnout, the Spearman's
correlation analyses were performed(tab.5).
Table 5. Spearman's rank correlation coefficient between the persons’ liking their
own job and the level of professional burnout
Passive full-blown profes-
sional burnout
Spearman's rank
correlation
coefficient
Statistical
significance
In the sphere of psychological
activity 0,29 0,024
In the sphere of activity 0,33 0,011
The analyzes showed that the less the respondents appreciated their job (no satis-
faction) the higher was their level of the passive full-blown professional burnout in
the sphere of psychological activity and in the sphere of activity.
In order to check whether there is a relationship between the level of training
which the respondents have attended before starting to work on the ward and the
level of professional burnout, the Spearman's correlation analyses were performed
(tab.6).
Table 6. Spearman's rank correlation coefficients between the level of training
which the respondents attended before starting to work on the ward and the level of
professional burnout
Professional burnout scale Spearman's rank
correlation coefficient
Statistical
significance
Active professional burnout
Emotional involvement in work 0,04 0,736
Stigmatizing the mentally ill -0,28 0,033
Overload of responsibilities at work -0,04 0,757
Experiencing negative emotions related to work -0,27 0,041
Supererogation, a need to be perfect 0,06 0,651
Assessment of the employer 0,24 0,062
Warning signals of passive professional burnout
In the sphere of psychological activity -0,31 0,019
In the sphere of activity -0,25 0,059
In the sphere of somatic disorders -0,32 0,013
In the sphere of interpersonal relations -0,31 0,017
Passive full-blown professional burnout
In the sphere of psychological activity -0,31 0,016
In the sphere of activity -0,31 0,015
In the sphere of somatic disorders -0,37 0,004
In the sphere of interpersonal relations -0,28 0,030
HEALTH AND WELLNESS 1/2014
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60
The analyses showed that the individuals who received professional training be-
fore starting to work on the ward showed more understanding towards mentally ill
people, had a lower level of experiencing negative emotions associated with the
work, lower level of warning signals of passive professional burnout (in the spheres
of psychological activity, somatic disorders and interpersonal relations) and lower
level of passive full-blown professional burnout in each of the studied spheres.
II. THE ANALYSIS OF RELATIONSHIP BETWEEN PROFESSIONAL
BURNOUT SCALES
In the remaining part of the paper it was examined whether there are connections
between the active burnout scales and passive burnout scales, both with regard to
warning signs and a full blown burnout (tab.7)
Tab. 7. Spearman's rank correlation coefficients between the active burnout scales
and passive burnout scales
Passive professional burnout Sphere Active professional burnout
WA1 WA2 WA3 WA4 WA5 WA6
Warning signs
Psychological activity 0,51* 0,39* 0,20 0,47* 0,11 -0,20
Activity 0,53* 0,32* 0,29* 0,49* 0,06 -0,19
Somatic disorders 0,45* 0,30* 0,17 0,48* 0,14 -0,17
Interpersonal relations 0,45* 0,31* 0,14 0,46* 0,17 -0,20
Full-blown
professional burnout
Psychological activity 0,44* 0,31* 0,19 0,56* 0,21 -0,28*
Activity 0,37* 0,26* 0,16 0,60* 0,12 -0,24
Somatic disorders 0,44* 0,44* 0,31* 0,57* 0,04 -0,13
Interpersonal relations 0,42* 0,25* 0,13 0,50* 0,19 -0,18
* p < 0,05
WA1 Emotional involvement in work, WA2 Stigmatizing the mentally ill, WA3
Overload of responsibilities at work, WA4 Experiencing negative emotions related
to work , WA5 Supererogation, a need to be perfect, WA6 Assessment of the em-
ployer
The correlation analyses showed positive connections between emotional in-
volvement in work, the level of warning signals and the level of full-blown profes-
sional burnout in all analyzed spheres. As can be seen from the analysis, the burden
related to stigmatizing the mentally ill in the environment as well as the negative
Renata Markiewicz
Professional burnout among psychiatric nurses - analysis of factors
61
emotions felt in connection with work have an impact on the development of profes-
sional burnout syndrome, both in terms of warning signs and symptoms associated
with the full-blown burnout syndrome.
Positive attitude of employers to employees substantially reduces the develop-
ment of this syndrome (mainly in the sphere of psychological activity). This was
followed by the Spearman's correlation analyses between the level of warning sig-
nals and passive full-blown professional burnout in different spheres (tab. 8).
Table 8. The correlation coefficients between the level of warning signals of passive
professional burnout and the passive full-blown professional burnout in different
spheres Full-blown pro-
fessional burnouts
in the spheres
Warning signs in the spheres
Psychological activ-
ity Activity
Somatic disor-
ders
Interpersonal
relations
Psychological
activity - 0,92* 0,85* 0,86*
Activity 0,92* - 0,77* 0,80*
Somatic disorders 0,85* 0,77* - 0,82*
Interpersonal
relations 0,86* 0,80* 0,82* -
* p < 0,05
The correlation analyses have shown a statistically significant relationship be-
tween the level of the warning signals and the level of full-blown professional burn-
out in all analyzed spheres. This means that the warning signals of professional
burnout syndrome in different spheres of life essentially contribute to the develop-
ment of the full-blown-syndrome.
CONCLUSIONS
1. Gender, place of residence, financial situation and the level of education have an
impact on the development of burnout syndrome among the nurses surveyed.
Marital status and having children do not have this type of impact.
2. Stigmatizing the mentally ill, experiencing negative emotions at work, overload
of responsibilities at work, many-years’ job seniority and arbitrary selection of
the place of employment are the cause of burnout syndrome among nurses work-
ing in psychiatric wards.
3. Positive attitude of employers to employees, nurses’ performing official duties
with passion as well as professional training prevent the development of burnout
syndrome. The employer’s goodwill and providing employees with opportunities
of personal development, improving the employees’ professional skills and
broadening their professional qualifications are undoubtedly the elements which
are strongly recommended to be continued.
4. The analysis of negative factors is the basis for the conclusion that there is a need
to provide personnel with training courses on the techniques of reducing stress,
HEALTH AND WELLNESS 1/2014
Wellness and team
62
educate the public in respect of mental health, and adequately determine re-
quirements for particular job positions, taking into consideration personal pre-
dispositions of employees. Some of the alternative activities worth considering
are: self-diagnosis, psychological support for staff and the introduction of de-
briefing procedures.
DISCUSSION
The paper presents an analysis of the socio-demographic situation and an analy-
sis of the factors of individual scales of occupational burnout that may affect the
development of occupational burnout among nurses. The work is divided into two
parts. The first one examines relationships between socio-demographic variables and
the level of individual scales of occupational burnout which are related to:
1) active occupational burnout: emotional involvement in work, stigmatization
of the mentally ill, being overburdened with duties, experiencing negative
emotions related to work, excessive sense of duty, sense of perfection, the as-
sessment of the employer;
2) warning signs of passive occupational burnout and a full-blown burnout syn-
drome in the above-mentioned areas.
The second part examines relationships between individual scales.
The study has been conducted among 60 nurses working in psychiatric wards in
Mazowieckie Specjalistyczne Centrum Zdrowia1 in Pruszków.
The analysis shows that sex, place of residence, financial situation and education
influence the development of burnout syndrome in the studied group of nurses. Neg-
ative impact is also exerted by the following factors: stigmatizing the mentally ill
and, as a result, perceiving care providers (nurses) in a similar way, experiencing
negative emotions, being overburdened with duties, considerable job seniority and
choosing the place of employment in a random way. These negative factors may be
transferred to the relationships in family and atmosphere at home. These assump-
tions are confirmed in the study by Lewandowska, who states that 25% of nurses
experience problems in family relationships due to the situation in the workplace
[5].
On the other hand, in their studies Płotka et al [7] agree that the most over-
whelming factors related to the risk are: personal security - 71.7%, barely visible
effects of work - 68.3%, inadequate remuneration system - 63.3%, helplessness and
limited possibilities to help some patients - 56.7%, as well as working at nights -
56.7%.
1 The center does not have an official English name but its Polish name could be translated as Ma-
zowiecki Specialist Health Center.
Renata Markiewicz
Professional burnout among psychiatric nurses - analysis of factors
63
The mentioned factors undoubtedly influence the health condition (both mental
and physical) of the nursing staff and sometimes contribute to serious health prob-
lems.
The research conducted by Markiewicz [7] shows that in the studied group of
nurses, the most common warning signs in the psychological sphere include the
sense of overwork - 35%, in the sphere of activity: lack of eagerness to work - 25%
and the overall feeling of fatigue - 20%, in the field of somatic disorders: sleep prob-
lems - 22% while in the sphere of interpersonal relationships: lack of patience - 12
%. Similar results have been obtained in the studies by Lewandowska et al, who
mention the following physical symptoms of occupational burnout: fatigue and
overwork - 79%, pain in the spine - 57% and the following mental symptoms: irrita-
bility - 46%, worse mood - 46 %, lack of motivation to work - 35% and sleep disor-
ders - 16% (Lewandowska 2009). Grzywa et al mention also headache - 47%, pain
in the spine - 44% and irritability - 17% [4].
The analysis of negative factors is the basis for the conclusion that there is a need
of: personnel training courses aiming at the reduction of stress, education of the
public in the field of mental disorders and adequate determination of the require-
ments for particular job positions taking into account personality predispositions of
employees. From among a variety of alternative activities it is worth considering
psychological support and assistance in crisis situations related to work. Undoubted-
ly, favorable attitude of the employer, providing employees with opportunities of
personal development, improvement and development of professional qualifications
are the elements that should be strongly encouraged.
REFERENCES
1. Anczewska M. Stres i wypalenie zawodowe u pracowników psychiatrycznej
opieki zdrowotnej. Instytut Psychiatrii i Neurologii, Warszawa 2006.
2. Dudek B., Koniarek J., Szymczak W. Stres związany z pracą a teoria zachowania
zasobów Stevana Hobfolla. Medycyna nr 58 (4),317-325, 2007.
3. Fengler J. Pomaganie męczy, Gdańskie Wydawnictwo Psychologiczne, Gdańsk
2001.
4. Grzywa T., Cieślik A. Praca pielęgniarki w oddziale psychiatrycznym zamknię-
tym a zespół wypalenia zawodowego, Ann UMCS nr 58 (13), 2003.
5. Lewandowska A., Litwin B. Wypalenie zawodowe jako zagrożenie w pracy
pielęgniarki. Roczniki Pomorskiej Akademii Medycznej, Szczecin 2009.
6. Litzke S., Schuh H. Stres, mobing i wypalenie zawodowe. Gdańskie Wydawnic-
two Psychologiczne, Gdańsk 2006.
7. Markiewicz R. The symptoms of burnout syndrome among nurses working in
psychiatric wards. Health and Wellness, Wydawnictwo NeuroCentrum, Lublin,
nr 3,101-113, 2013.
8. Maslach C. Wypalenie w perspektywie wielowymiarowej. [in:] Sęk H.(ed.) Wy-
palenie zawodowe. Przyczyny i zapobieganie, PWN, Warszawa 2004.
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9. Płotka A., Pitek A., Makara-Studzińska M. Stres a zespół wypalenia zawodowe-
go. Pielęgniarstwo, nr 5 (40), 26-30, 2000.
10. Terelak J. Psychologia stresu, Oficyna Wydawnicza Branta, Bydgoszcz 2001.
11. Uszyński M. Stres i antystres - patomechanizm i skutki zdrowotne, Wydawnic-
two MedPharm Polska, Wrocław 2009.
ABSTRACT
Nurses working in psychiatric wards constitute “a bridge between the world of
the patient's psychotic experiences and the outside world”. Therefore society often
perceives them through the prism of the patient. This perception is a stress factor,
though it is not the only essential component of nurses’ work. Among other factors
are: significant workload, excessive requirements, improper communication, inter-
personal conflicts, lack of opportunities for personal development. There are, how-
ever, also the factors that relate to situations occurring outside work. Undoubtedly,
these include living conditions, level of education, place of residence, family situa-
tion, financial situation. They also can also form stressful situations, which conse-
quently may be an indirect cause of burnout syndrome. The present study analyzed
the socio-demographic situation of the respondents and factors from individual
scales of professional burnout. Basing on the results, an attempt has been made to
single out the threatening factors and alternatives have been presented.
STRESZCZENIE
Pielęgniarki zatrudnione w oddziałach psychiatrycznych stanowią ,,pomost łą-
czący świat przeżyć psychotycznych pacjenta ze światem zewnętrznym” stąd częste
postrzeganie ich przez społeczeństwo poprzez pryzmat pacjenta. Takie postrzeganie
stanowi czynnik stresujący, chociaż - nie tylko on jest w pracy pielęgniarek istotny.
Wśród innych wymienić należy: obciążenie obowiązkami, nadmierne wymagania,
niewłaściwą komunikację, konflikty interpersonalne, brak możliwości osobistego
rozwoju. Istnieją jednak i takie czynniki, które dotyczą sytuacji występujących poza
pracą. Niewątpliwie należą do nich: warunki materialne, poziom wykształcenia,
miejsce zamieszkania, sytuacja rodzinna, sytuacja finansowa. One również mogą
stanowić sytuacje stresujące, które w konsekwencji mogą być pośrednią przyczyną
rozwoju zespołu wypalenia. W prezentowanej pracy analizie poddano sytuację so-
cjodemograficzną badanych oraz czynniki z poszczególnych skal wypalenia zawo-
dowego. Na podstawie uzyskanych wyników dokonano próby wyodrębnienia czyn-
ników zagrażających oraz zaprezentowano alternatywne rozwiązania.
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