Burnout in the nursing profession - a danger (not) to be taken seriously?
Method: An investigation of the data bases PubMed, Gerolit and DIMDI was performed from February 2010 to June 2010. Inquiries by hand were done in the libraries of the University of Vienna and the medical hospital of the general hospital of the city of Vienna.
Results: Time pressure, lack of support from colleagues and superior, a work pace too high and night shifts are the main indicators for care attendants feeling exhausted and consequently not capable any more. Teachers are also especially susceptible to get sick with burnout, as dealing with problem students, classes with too many students, lack of appreciation and demanding expectations from parents make some pedagogues feeling spent after one year in their job, thinking about a job change. There are several therapies which can be used to reduce the risk of a burnout. Most of all, relaxation techniques like autogenous training or progressive muscle relaxation have proven themselves to be especially successful.
Conclusion: Reduced working hours, more support from colleagues and the inclusion of relaxation exercise into the daily routine can help to prevent burnout, or reduce symptoms of a burnout already present.
TABLE OF CONTENTS
2.2 Literature research
3.1 The probability to get sick with burnout
3.2 Proofs of effectiveness of possible therapies for the reduction of the burnout risk
3.3 Summary of the results
4 Discussion with limitation
5 Outlook for the practice
6 List of tables and figures
The term “burnout” was created by the German-Amercican psychoanalyst Herbert J. Freudenberger in 1974, for the condition of “being burned out” (Vollmer, 1996, S. 12), but first only as a term for the psychic and physical depletion of “helpless helpers”. In the beginning, it was only for the condition of volunteers of help organizations like “free clinics”, therapeutic living communities, crisis intervention centres, or brothels, too. The term burnout is in much greater use in the USA, and also better known, than in Europe. The cultural difference is that in the USA nowadays, everybody speaks of “being burned out” in all kinds of situations of displeasure and dissatisfaction. In Europe, however, the term “stress” is often used synonymously (Vollmer, 1996, p. 14f.).
Freudenberger (1974, p. 19) explains burnout as a process of self-emptying and meant primarily the depletion of one´s own physical and psychic reserves. Additionally, he defined it as an “emotional state accompanied by excessive stress and ultimately impairing personal motivations, attitudes and behaviour.”
Burnout became a scientific term for the first time in 1976, when the American social psychologist, Christina Maslach, tried to systematically define burnout. For this purpose, she developed the Maslach Burnout Inventory (MBI) to determine the frequency and intensity of perceived burnout (Vollmer, 1996, p. 17). MBI is a method used still today to measure burnout. According to Maslach, burnout is a syndrome resulting most of all from exhaustion, depersonalization and reduced productivity (ibid.).
Many different tries for a definition can be found in the literature, which will not be referred to in the following as this would go beyond the scope of a bachelor´s thesis.
A generally valid definition of this term is, because of these different views, rather hard to give. Nevertheless, all these different tries for a definition show also accordance in the literature. According to Moser (2001, p. 7), the common ground is burnout being an internal psychological experience which includes emotions, expectations, attitudes and motives, and always a negative experience for the individual person. These could be for instance negative consequences, problems and/or inconveniences. Burnout is therefore to be understood as a kind of energy wear and tear, which, because of an internal or external (family, work, etc.) excessive demand leads to an exhaustion of the individual person and robs it of its mechanism to cope with the situation.
Although burnout is still not recognized in Europe as an illness, it is especially interesting that this term occurs under point Z.73.0 of the International Classification of Diseases (ICD 10) as a state of total exhaustion and is mentioned under the headline “factors which can influence the state of health and lead to a recourse to the health system (Meyer, 1994, p. 12).
The symptoms of burnout vary from person to person. Freudenberger (1974, p. 19, original in German) describes them as follows: “As physiological indications, exhaustion and weariness (accompanied by headache, sleeplessness, stomach pain etc.) occur, on the behavioural level, increased anger, irritation and frustration are visible. Also a kind of megalomania, when e.g. a person thinks to be the only one to bring about changes, while colleagues would not able to do that. The use of tranquilizers increases. Opinions become rigid, stubborn and inflexible. Changes and progress are blocked, because the person is too tired for new adaptations.”
Vollmer (1996, p. 60f.), on the other hand, names, among others, the following signs and symptoms people suffering from burnout have: great resistance to go to work, feeling of failure, anger and bad mood, guilt and blame, discouragement and indifference, negativism, isolation and retreat, to feel the whole day tired and exhausted, frequent looking-at-the-clock, loss of positive emotions, stereotyping clients, being unable to concentrate on, or listen to, clients, sleep disorders, avoiding discussions with colleagues about work, frequent colds and flus, rigidness in thinking and resistance to changes, mistrust and paranoia, frequent absence from the workplace.
Burisch (1994, p. 36) developed out of the various symptom images used worldwide seven super-categories:
1. Warning symptoms of the initial phase
2. Reduced effort
3. Emotional reactions, allocations of guilt
6. Psychosomatic reactions
He understands the term symptomatology rather in a way that the occurrence of a symptom also always increases the probability of occurrence of other ones at the same time. Therefore, the emergence of burnout has to be understood by an imbalance of the demands of the work activity and the available resources to meet these demands. If this imbalance continues to exist, the individual person gets stressed as a consequence, which shows in exhaustion, tension and irritability. A very strong form of this burnout process is present most of all if the working persons distance themselves from the work stress, retreat and become cynical (Moser, 2001, p. 17). If one looks now at the symptoms and burnout categories named above, the question comes up if persons have to have certain traits to be considered as more endangered to get sick with a burnout syndrome than other people.
Vollmer (1996, p. 73f.) points out in this aspect that it depends on the respective individual how a problem gets viewed, and, most of all, dealt with subsequently.
This always depends on the personal motivation of a person. In addition, however, the behaviour and the someone´s personal attitude can change during life. A nurse, for instance, can feel burned out because she only works nightshifts for months, while another nurse is basically not burdened by that. Experts believe that people with a distinct sense of responsibility and duty are more endangered by burnout than people who do not possess this property (Moser, 2001, p. 23). Someone who, for instance, only has to focus on functions, tasks and facts, has an easier time than persons having to do with other people. Vollmer (199, p. 75) lists the following typical traits of people endangered by burnout:
- “People tending to fearfulness are more susceptible than brave ones.
- A lower self-esteem represents a greater risk than the awareness of being valuable.
- Someone who walks his or her way of life consequently according to self- made rules is more immune than someone who is easily irritable and knocked off course.
- The worried ones, those rather tending to depressions, are more hit than those who think positively.
- Burnout personalities have difficulties to make healthy and mature compromises on the level of adults. Either things have to happen according to their will, or they give in.
- They idealize their job and have of themselves the highest expectations of competence.
- They often have a deeply seated negative image of their fellow human beings and suppressed aggressive emotions against persons whom they vehemently put themselves out for.
- Not infrequently, a tendency for ruthlessness is covered up by friendliness and gentleness.”
Burnout can be divided into several phases. It is not a process which leads from day to the other to a condition where people feel burned out, but stretches sometimes over a very long period of time and progresses individually different. According to Burisch (1994, p. 23), a burnout symptom can develop within a couple of months. On the one hand, there are people who can burn out in less than a year. On the other hand, other people have greater stamina and need longer to reach a state of total exhaustion.
Freudenberger and North (1992, p. 32) speak about a burnout cycle and divide the twelve stages as follows:
Stage 1: the compulsion to prove oneself
Stage 2: increased effort
Stage 3: subtle neglect of one´s own needs
Stage 4: suppression of conflicts and needs
Stage 5: reinterpretation of values
Stage 6: increased denial of problems which have occurred
Stage 7: retreat
Stage 8: observable changes in behaviour
Stage 9: depersonalisation/loss of the feeling for the own personality
Stage 10: inner emptiness
Stage 11: depression
Stage 12: total burnout - exhaustion
As it could be determined, the burdens of the every-day job life bring people increasingly to their limit. Especially affected are those who earn their living in irregular working hours or shift service. Many of these employees name hustle and deadline pressure as stress-inducing factors (F.A.Z. Institute, 2009, p. 4). An important criterion for dealing with stressful situations lies in getting compensation in family or in doing sports (Spachtholz, 2005, p. 109). There are people, however, how can stand up to the pressure coming from what is expected from them. The consequences are inner and physical fatigue, a kind of helplessness, feeling powerless and desperation spreading among affected persons (Künzler et al., 2010, p. 197ff.).