Self-evaluation in

burnout syndrome

Faced daily with the pain and suffering of others, nurses are called on to give comfort, solace, and support even when their own resources for doing so are depleted.

Nurses are particularly vulnerable to burnout resulting in an ‘erosion of spirit and a general demoralization under conditions perceived as highly stressful’

(Muldary, 1983)

Stress can be a threat or challenge to the integrity and survival of the organism

Palliative care staff had distress scores twice as high as nurse on two other units in the same hospital (Rogers et al.)

-3 months after opening of palliative care unit, the nurses had distress scores comparable to a group of newly widowed women, and almost twice as high as those found in women newly diagnosed with breast cancer (Lyall et al.)

Further description by nurses about feeling of helplessness in care of palliative patients:

“What’s wrong! Why are all these patients dying? Is it in fact some of the patient might have been murdered by someone within the hospital, then the panic urges the staff to make sense of the situation”

“I hate the feeling that I’m not able to do anything. I want to be able to give patients more sense of hope. When I see a hopeless patient, I can’t think back to the thousands of other successes that I’ve had”

“Everyday when I go home I think about all the things I didn’t do or all the things I did wrong. I never feel that I’ve done a good job.”

Common Stressors in Oncology & Palliative Care

Patient related:-difficult client e.g. Anger, demanding-unresolved case problem e.g. family conflict, depression, causing experience of incompetence -over identification with client-triggering of personal spiritual distress by death & suffering

Non-patient related:-heavy workload / inadequate resources-role ambiguity / conflict / competition-team communication problems e.g. different approach & values, lack of mutual recognition & trust-problems in system setting e.g. compromised with medical care-managerial issues e.g. education demands, inappropriate assignment, rigid or unfair policies- personal illness / problem

A Self-Diagnosis Instrument for Burnout (Pines & Aronson)

1 2 3 4 5 6 7Never Once in a Rarely Sometimes Often Usually Always great while

_________ 1. Being tired_________ 2. Feeling depressed_________ 3. Having a good day_________ 4. Being physically exhausted_________ 5. Being emotionally exhausted_________ 6. Being happy_________ 7. Being “wiped out”_________ 8. “Can’t take anymore”_________ 9. Being unhappy_________ 10. Feeling run-down

Con’t of :A Self-Diagnosis Instrument for Burnout 1 2 3 4 5 6 7Never Once in a Rarely Sometimes Often Usually Always great while

_________ 11. Feeling trapped_________ 12. Feeling worthless_________ 13. Being weary_________ 14. Being troubled_________ 15. Feeling disillusioned and resentful_________ 16. Being weak and susceptible to illness_________ 17. Feeling hopeless_________ 18. Feeling rejected_________ 19. Feeling optimistic_________ 20. Feeling energetic_________ 21. Feeling anxious

Computation of score:

Add the values you wrote next to the following items: 1,2,4,5,7,8,9,10,11,12,13,14,5,6,17,18,21= A

Add the values you wrote next to the following items: 3,6,19,20 = B , subtract B from 32 = C

Add A and C = D

Divide D by 21 = your burnout score

The syndrome of Burnout

A syndrome of physical & emotional exhaustion involving the development of:

1.negative self-concept2.negative job attitudes

3. loss of concern & feelings for a client (Pines & Masloch)

Symptoms of Burnout (Cohen et al.,1994):-fatigue-physical and emotional exhaustion-headaches-gastrointestional disturbances-weight loss-sleeplessness-depression-boredom-frustration-low morale / demoralizaton-job turnover-impaired job performance (decreased empathy, increased absenteeism)

影響人的信念及價值觀

童年背境 社會文化

人生經歷 宗教信仰

Personal variables affecting stress reactions

- demographic- personality e.g. locus of control- social support- previous stressors- concurrent stressors

Ways to manage stress

Arnold’s model of dealing with burnout

Awareness Balance

Hope Choice

Goals Detached concern

Free will Altruistic egoism

Developing awareness

-admitting the stressful event to make it from intangible into concrete & manageable

instead of

-suppression to maintain ‘professional image’

Self know don’t know

Others know

don’t know

祖哈里窗 JOHARI WINDOW

Self know don’t know

Others know

don’t know

e.g. 1 認識自己不深、亦不為人認識

Self know don’t know

Others know

don’t know

e.g. 2 有較多自知之明、亦為別人認識

How about your window :

1. How is your ideal window?

2. How is your window now?

- Relaxation and self awareness exercise:

感受 身體

我

人際 理性

哭，不代表軟弱哭，不代表無能

Achieving Balance

- between wants & responsibilities

- among work, family, education, leisure & spiritual

activities

- by setting priorities

- by giving up or delegated to others

- spiritually renewing activities e.g. walk, reading

a favorite book, praying, meditating, spending

time with good friend

請停一停，看看你 ‘得着’ 與 ‘回饋’ 的平衡 :

Getting:

1. Who supports you at work, at home or amongst your friends?

2. Is there someone readily available for you to offload to when you need it? Who?

3. If appropriate, do you have regular and adequate supervision for the work you do? If not, how might you arrange for it?

4. How much time do you have to yourself in the average week? How do you spend that time?

5. How often do you take time to relax? What do you do?

6. What do you do when you are feeling very stressed?

7. Are you satisfied with the work you do and the people with whom you work?

If not, what makes it unsatisfactory?

Giving:

1. How much of your work week time is spent in stressful situations?

2. How much time do you spend attending to domestic and family considerations?

3. How much of your week do you spend giving to other people in one way or another?

4. In addition to everything else you do, are you having to cope with: small children, difficult adolescents, elderly parents, worrying illness in yourself or someone you love, financial problems, relationship problems, other particularly stressful difficulties?

5. Have you been recently bereaved by death, divorced, separated, made redundant or moved house? If any of these things have ever happened to you are you aware of continuing strong feelings?

Making Choices

- to do or not to do

- to see whether it beyond our ability to control

- Accept limitation – “ 接受病人的不接受” :

- 海星的故事

• 天為生命定壽元 人為生命賦意義

• 孔子：明知不可以為而為之

• 如心菩薩的故事

Developing Detached Concern

- Detach from concern about how our performance affects the past (what could have been) or future (if onlys). Focus on here and now and is intent on making the most out of present moment

“ 若我只得幾小時生命，我會繼續擦我的地板”- One practical strategy is the ability to laugh at ourselves and to avoid taking ourselves too seriously

- Sense of humor

- don’t take things personal easily

Practicing Altruistic Egoism

- 休息；為了走更遠的路！

Exercising Free Will

- avoid quick involvement or escape

- avoid for satisfying others

Developing Goals

- realistic with understanding of potential

- exploring resources & cooperation of others

Team building: developing skills to help a team member to function as a member of this particular team

(Vachon)

Fostering Hope:

- expectations give direction to our actions and ways of interacting (be a director instead of just actors only

- fitting into the larger life, meaning beyond ourselves

Herth Hope Index:

Strongly StronglyAgree Agree Disagree disagree 4 3 2 1

1. I believe that each day has potential _____

2. I have specific possible short, intermediate or long range goals _____3. I can see a light in a tunnel ____

_4. I have a sense of direction _____5. I have a faith that gives me comfort ____

_6. I am able to give and receive caring and love _____7. I am scared about the future _____8. I can see the positive outlook on life _____9. Life has value and worth ____

_10.I can recall happy / joyful times _____11.I feel all alone _____12.I have a deep inner strength _____

Question to be used by the nurse to help maintain or restore balance and wholeness

- How do my ordinary activities of daily life fit into my life goals?

- What is missing or what needs to be eliminated to help me achieve balanced wholeness?

- Why is it that I put so much stock in the words and ideas of others and have so little faith in the legitimacy of my own?

- Who defines me – myself or others?

Arnold, E. (1989)

• “STRESSED”

reverse

• “DESSERTS”

End