Burnout research最新文献

The aims of this study were 1) to show that the use of different cut-off scores available in the literature can lead to erroneous conclusions, adding to the emerging literature highlighting the problems associated with its use, and 2) to propose an alternative technique − Cluster Analysis − to assess the risk of burnout as well as to identify profiles at risk of burnout.

Burnout was measured among 664 French psychologists using the French-Canadian version of the Maslach Burnout Inventory (Dion & Tessier, 1994). Our participants were classified as high on each dimension of the MBI using different cut-off scores available in the literature and using the Cluster Analysis method.

The study showed that the use of cut-off scores can indeed be misleading as conclusions may be very different according to the cut-off used. Cluster analysis allowed us to highlight four distinct burnout risk profiles: “High risk of burnout”, “Risk of burnout through high emotional exhaustion”, “Risk of burnout through low personal accomplishment”, and “No risk of burnout”. Several variables appeared as predictors of occupational burnout such as working in a company or having several different types of contracts, showing the discriminative power of clusters. Finally, a discussion is proposed on the meaning of the identified clusters and the use of this analysis in research and practice.

A person-oriented approach was applied to identify profiles of study engagement and burnout (i.e., exhaustion, cynicism, inadequacy) in higher education in a large and representative sample of 12,394 higher education students at different phases of their studies in universities and polytechnics in Finland. Four profiles were identified: Engaged (44%), engaged-exhausted (30%) inefficacious (19%) and burned-out (7%). The engaged students had the most positive engagement accompanied with the least burnout symptoms compared to other groups. The engaged-exhausted students experienced emotional exhaustion simultaneously with academic engagement. The inefficacious group had heightened experience of inadequacy as a student. The burned-out students showed very high cynicism and inadequacy and very low academic engagement compared to the other groups. Of these groups, the engaged students tended to be in the earlier stages in their studies, whereas the burned-out and inefficacious students had been studying the longest. The pattern suggests that students starting out with high engagement and that burnout becomes more common later in the academic career. Supporting demands-resources model, the covariates reflecting the demands were higher and those reflecting resources were lower among the burned-out and inefficacious students compared to the engaged students.

Wellbeing of the healthcare workforce is now recognized as an important fourth component of the Quadruple Aim. Given the crisis level of burnout in physicians, national organizations have urged immediate attention to the challenge, demanding measurement and action to mitigate and prevent the phenomenon.

Seeking to understand whether a statewide approach to burnout would be feasible, Minnesota launched a collaborative to assess and establish an action framework around physician and advanced practice professional (APP) burnout in 2016. A modified Mini Z survey tool was used to assess prevalence and drivers of burnout across a census of physicians and APPs from healthcare organizations across Minnesota.

Three-quarters of healthcare systems in Minnesota participated (56 sites/systems, representing 104 unique hospitals). Of the 13,693 physicians and APPs invited, 43% responded. Baseline levels of burnout suggest emotional exhaustion and stress are slightly higher among physicians than APPs; 34% of statewide respondents reported emotional exhaustion – 36% of MD/DOs and 31% of APPs. Approximately three in five respondents reported feeling a great deal of stress because of their job. Conversely, over three-quarters of respondents reported being satisfied with their job and engaged with their work.

We propose a socio-ecological framework for acting on burnout, using a data-driven quality improvement paradigm enabled by a statewide coalition, to ensure that continued efforts do not rest solely at the feet of individuals or systems. Despite high burnout levels, engagement and satisfaction with work are also high, suggesting there is still hope for stemming the tide of burnout.

Objective

Using a quantitative diary design, the purpose of this paper is to gain insight in the workplace violence phenomenon by examining whether within-person fluctuations in fear of future violence is linked to within-person levels of burnout. In addition, authors investigated whether this relationship was stronger for those low in job control. Finally, psychological violence was proposed as a cross-level moderator of the relation between fear of future violent events at work and burnout.

Methods

A diary study was conducted among 40 doctors on duty. Participants completed a general questionnaire and a diary booklet (one diary every 10-working days; 40 × 5 = 200 occasions).

Results

Multilevel analyses showed that fear of future violence was linked to emotional exhaustion and cynicism. Job control did not moderate the relationship between fear of future violence and cynicism but moderated the relationship between fear of future violence and emotional exhaustion. In addition, the experience of psychological violence did not moderate the relationships of fear of future violence with either emotional exhaustion or cynicism.

Conclusions

Our findings provided additional evidence that not only being the target of violent behaviors may take an emotional toll. When a worker experiences fear of future violent events at work, heshe tends to experience stronger levels of emotional exhaustion and cynicism. Job control plays a fundamental role, buffering the way that a person perceives workplace conditions and the choice of coping strategy.

Purpose

To provide knowledge about the recovery process during rehabilitation and two years later by exploring the manifestation of agency and spheres of meaning in the narratives of participants in a national rehabilitation course.

Material and methods

The subjects of the study were four participants in a national rehabilitation course, whose burnout levels had decreased between the initial and follow-up periods of the course. Semi-structured interviews on two occasions and an electronic questionnaire 1.5 years post rehabilitation comprised the main material. In addition, the BBI -15 (Bergen Burnout Indicator) and DEPS-screen were used.

Results

Thematic narrative analysis revealed highly individual and heterogeneous paths of recovery. The first parts of the narratives demonstrated a high degree of proxy and collective agency. As recovery progressed personal agency was strengthened. The spheres of meaning participants attached to their stories also varied, with the rehabilitation course and the professionals involved being viewed as morally good. Three major common themes were identified: 1) the benefits of the rehabilitation course; 2) supervisor support; and 3) personal factors.

Conclusions

Burnout and recovery are not the consequence of work-related or individual-related factors alone, but rather the outcome of a combination of these. Regardless of common factors, the process and the degree of recovery may vary. The most beneficial path was observed when personal agency was high and was reinforced by a supportive job environment and favourable personal factors.

Objective

Empathy and burnout are two related yet distinct constructs that are relevant to clinical healthcare staff. The nature of their relationship is uncertain and this review aimed to complete a rigorous, systematic exploration of the literature investigating the relationship between burnout and empathy in healthcare staff.

Design

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.

Data sources

Search terms (Burnout OR Burn-out OR “Burn out”) AND (Empathy OR Empath*) enabled identification of studies investigating burnout and empathy in healthcare staff, using five electronic data bases (MEDLINE, PsycINFO, CINAHL Plus, PubMed, and SCOPUS). Manual searching amongst reference lists of eligible articles was also completed.

Review methods

Databases were searched for studies published in the English language, from inception to February 2017. Key inclusion criteria were: 1) participants who were nurses or medical professionals, 2) full written manuscript in English, 3) use of the Maslach Burnout Inventory to assess burnout and a standardized outcome measure for empathy, 4) quantitative methodology exclusively.

Results

Ten eligible studies were reviewed. Of those, seven were conducted in countries where English was not the first language. Eight of the studies provided empirical support for a negative relationship between empathy and burnout. One study provided support for a positive relationship between burnout and empathy. One study reported contradictory evidence with positive and negative correlations between different subscales of the empathy and burnout measures. In general, the quality of the studies was assessed to be good. However, some of the studies failed to provide information pertaining to sample size, with the reporting of data less than adequate from one study.

Conclusions

There was consistent evidence for a negative association between burnout and empathy. This review avoided a common English-speaking country bias of some areas of the literature. Given that all of the studies reviewed were cross sectional, further research is necessary to establish causality.

Despite an increase in interest in issues related to burnout in medical education and mandates from the national residency accrediting body, available literature is sparse in pediatrics, a medical discipline that requires special empathy and compassion, as well as enhanced communication skills to effectively care for children and their families. Burnout prevalence ranges from 17 to 67.8% of pediatric residents in recent studies. There is little that details the pathogenesis of burnout in these residents and little that compares them with those in other medical disciplines. This comprehensive literature review describes all that is published on burnout and burnout interventions since 2005 in pediatrics and other primary care oriented specialty residents, as well as key papers from pre-2005. This review, with its focus on the available information and evidence-based intervention strategies, identifies four areas for focus for future interventions and directions. It should serve as a useful resource to program directors, medical educators and graduate medical education leadership who are committed to preventing and/or treating burnout in their residents and molding these young physicians to be able to maintain resilience through their careers. This review should also be useful to investigators exploring burnout in other health care professionals.

Background

The aim of this cross-sectional study was to develop an evidence-based systematic Medical Error Checklist (MEC) for self-reporting of medical errors. In addition the study examined the comparative influence of individual, structural, and organizational factors on the frequency of self-reported medical errors.

Research design

A three-step process was followed in order to develop three checklists, for internists, surgeons and pediatricians respectively. The Maslach Burnout Inventory (MBI), the Utrecht Work Engagement Scale (UWES) and the teamwork-subscale of the Hospital Survey on Patient Safety Culture (AHRQ) were used in order to measure physicians’ levels of burnout, job engagement and teamwork respectively. A total of 231 doctors working in a large teaching hospital in Greece participated in the study (response rate: 49.8%).

Results

Internal reliability coefficients were high for all three checklists. Gender, age, clinical experience, and working hours were not related to medical errors in any of the medical specialties. In surgeons, medical errors were negatively related to engagement (R² = 0.210, p = 0.004), while teamwork and depersonalization were the only predictive factors of frequency of medical errors, in both pediatricians and internists (R² = 0.306 p < 0.001).

Conclusions

The Medical Error Checklists developed in this study advance the study of medical errors by proposing a comprehensive, valid and reliable self-assessment tool. The results highlight the importance of hospital organizational factors in preventing medical errors.