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Burnout syndrome in the helping professions.

Burnout can be defined as a long-term reaction to occupational stress which involves, particularly, the helping professions. The main aim of this study was the assessment of burnout in a sample of professional and voluntary health care workers and comparison of the two samples on scores from the Maslach Burnout Inventory. Analysis suggests a significant difference in mean scores for Emotional Exhaustion of volunteers vs professional workers. Some evidence has supported the hypothesis of a fourth dimension, called Behavioral Exhaustion, in the burnout syndrome.

Adult↗

Mission position.

Many primary care trusts do not see sexual health as a priority, preferring simply to meet national targets. Genito-urinary medicine clinics do not have the capacity to attack waiting times. Rather than just a medical model, health promotion workers, youth and voluntary should work together.

Adolescent↗

Burnout: psychobabble or valuable concept?

Freudenberger (1974) chose the term "burnout" to describe a syndrome of exhaustion, disillusionment and withdrawal in voluntary mental health workers. It has since aroused considerable interest in all the helping professions (Table 1) with the publication of more than 300 papers and a dozen books in the last 5 years. This suggests that burnout is a major problem in human services today.

Burnout, Professional↗

[Peripheral circulatory responses to sustained handgrip in workers using vibrating tools].

In order to study the effects of static force such as a handgrip in detail, the peripheral circulatory function and the autonomic nervous function of workers who used chain-saws were examined in a handgrip test at 30% of maximum voluntary contraction (30% MVC). Workers using chain-saws were divided into three groups: group A without any symptoms, group B with numbness and/or pain but without Raynaud's phenomenon and group C with Raynaud's phenomenon. The results obtained were as follows: 1. The finger blood flow (FBF) of all groups significantly decreased during the handgrip and significantly increased after the end of the handgrip as compared with the initial value. There was a tendency for the FBF decrease of group C to be less than that of group A. 2. The mean value of both maximum FBF decrease and maximum FBF increase during handgrip tests fell in alphabetical order (A, B, C). The maximum FBF increase of group C was significantly less than that of group A. 3. The finger skin temperature (FST) of each group significantly fell during the handgrip but there was no significant difference among the three groups. FST returned to the level of the initial value one minute after the end of the handgrip, and significantly rose two minutes and three minutes after the end of the handgrip as compared with the initial value. 4. Both the systolic blood pressure and the diastolic blood pressure of all groups significantly rose during the handgrip but there was no significant difference among the three groups. Concerning the maximum rise of diastolic blood pressure, which is an indicator of autonomic nervous function, there was no significant difference among the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Fingers↗

Health care professionals with AIDS: public health or public relations concern?

Testing--whether voluntary or mandatory--for HIV among workers is one of the biggest concerns at this time in the health care industry. While most health officials and governing bodies agree that the risk of transmission from worker to patient is negligible, many believe that voluntary testing is beneficial. The question is, beneficial to whom--the patient, the worker, or the employing agency or facility?

Acquired Immunodeficiency Syndrome↗

Characteristics of the part-time work force. Analysis of the March 1993 Current Population Survey.

The purpose of this Issue Brief is to present a comprehensive description of part-time work and part-time workers. The report describes trends in part-time employment; characteristics of part-time workers; health, pension, and other benefits available to part-time workers; and the advantages and disadvantages of part-time work to employers and employees. The report also identifies public policy issues stemming from the increase in the number of part-time workers. The number of part-time workers increased from 10.8 million to 20.7 million between 1969 and 1993, an increase of 91.7 percent, representing 24.6 percent of the growth in the work force. Full-time employment rose 51.4 percent, from 59.2 million to 89.6 million, representing 75.4 percent of new entrants. While the part-time work force increased 91.7 percent between 1969 and 1993, growth as a proportion of the total work force has been minimal, rising from 15.5 percent in 1969 to 18.8 percent in 1993, a 3.3 percentage point increase over this 24-year period. Voluntary part-time workers represented 70.6 percent of all part-time workers in 1993, compared with the 29.4 percent classifying themselves as involuntary part-time workers. Between 1969 and 1993, the voluntary part-time work force grew from 9.0 million to 14.6 million, an average annual increase of 2.0 percent. The involuntary part-time work force increased from 1.8 million to 6.1 million, an average annual increase of 5.2 percent. Of the 28.9 million part-time workers in 1992, 71 percent received health insurance from one or more private sources. More than one-half (52 percent) received coverage through an employment-based plan, and 19 percent through another private source. By comparison, 81 percent of full-time workers received coverage from a private source: 73 percent through an employment-based plan and 8 percent from another private source. Just over one in five, or 21 percent, of part-time workers were uninsured; 16 percent of full-time workers were without health insurance. While the likelihood of a part-time worker being uninsured is 5 percentage points higher than for full-time workers, there are more full-time workers uninsured (16.4 million full-time workers were uninsured in 1992, compared with 5.9 million part-time workers).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

[Impact of an educational manual on knowledge and attitudes of rheumatic patients and health care workers].

BACKGROUND: Education may induce voluntary behavioral changes in patients that lead to an improvement in health status. AIM: To assess the impact of the educational manual "Aches and Pain" on knowledge and attitudes of patients with chronic rheumatism and paramedics, using an instrument with 40 asseverations extracted from the manual. PATIENTS AND METHODS: Seventy seven patients and 42 paramedics were studied. The assessment instrument was responded before and after reading chapters of the manual, selected by the authors. Knowledge was quantified according to the number of correct answers. Adaptation to disease, optimism and self help capacity were the evaluated attitudes, using a five point scale. RESULTS: The study was completed by 48 patients and 42 paramedics. Knowledge improved from 19.9 +/- 5.3 to 25.6 +/-6.15 correct answers in the former and from 23.6 +/- 4.9 to 30.3 +/- 5.5 in the latter (p < 0.001). In patients there were improvements in the degree of adaptation to disease from 3.6 +/- 0.9 to 4.0 +/- 0.8 and in self-help capacity from 4.0 +/- 0.8 to 4.3 +/- 0.8; optimism did not improve significantly. CONCLUSIONS: The educational manual had an impact on knowledge and improved rheumatic patient's attitudes towards the disease.

Adult↗

Factors influencing uptake of influenza vaccination among hospital-based health care workers.

BACKGROUND: Vaccination of health care workers against influenza has been shown to lower mortality among elderly patients, but uptake of voluntary vaccination among health care workers remains low. AIMS: Factors influencing uptake of vaccination were examined among a cross-section of health care workers based in an NHS Trust. METHODS: A structured, self-administered questionnaire was mailed to a random sample of health care workers based in the acute services sector of a UK National Health Service Trust, 6 months following a voluntary immunization programme implemented as part of the Scottish Executive Health Department winter planning arrangements for 2000-2001. The programme was promoted using posters in clinical areas and a single leaflet given to all staff through a paycheck advice note. RESULTS: Five hundred and fifty-one health care workers (53%) responded to the questionnaire and influenza vaccination was accepted by 150 (28%). The occupational health poster strongly influenced the decision to accept vaccination [odds ratio (OR) = 11.01; 95% confidence interval (CI) = 2.13-56.80; P < 0.0001]. Other significant influences included female sex (OR = 9.11; 95% CI = 1.26-65.72) and perceived risk of contracting flu without the vaccine (OR = 7.70; 95% CI = 1.44-41.05). Misconceptions regarding the purpose of the vaccination campaign were common and concern regarding possible side-effects was a deterring factor for vaccination uptake. CONCLUSION: Our study showed that visual material displayed throughout the workplace strongly influenced the acceptance of influenza vaccination. Future campaigns should also emphasize the positive benefits to patients of health care worker immunization, with readily accessible information regarding side-effects available from all sources.

Adult↗

Effects of cigarette smoking on pulmonary function in asymptomatic asbestos workers with normal chest radiograms.

A comprehensive health screening program consisting of standardized health and occupational history questionnaire, blood chemistry profile, complete blood count, urinalysis, chest radiograph, and pulmonary function testing was organized for the Asbestos Workers Union Local Number 1 in St. Louis, Missouri. The program was available on a voluntary basis to all the workers in the Union. One hundred and thirty-five male caucasian workers or 44% of the membership volunteered to participate and all the data were used in this study. All blood chemistry profiles and urinalysis results were within normal limits. Twenty-two of the asbestos workers had radiologic pulmonary abnormalities as well as severe pulmonary function impairment. The remaining 113 workers were divided into subgroups based on the number of years of exposure to asbestos and their smoking history. Although asymptomatic, workers with more than 20 years exposure to asbestos had significantly decreased pulmonary functions compared to those with less than 20 years exposure. When smokers and nonsmokers were compared, an additive effect between smoking and asbestosis was observed. This study also discovered that significant decreases in pulmonary functions occur early in the exposure to asbestos.

Adult↗

[Effects of shift work on the quality of sleep and psychological health based on a sample of professional nurses].

UNLABELLED: Impact of shiftwork on sleep and psychological health. OBJECTIVE: The purpose of the present study was to evaluate the impact of a rapid shiftwork system on sleep parameters and on psychopathological status among a sample of nurses. We hypothesize that in this type of shiftwork system, the rapid and continuous rotation of shifts doesn't lead to a lasting alteration of circadian rhythm but to a transitory increase of psychological disturbances after the night shift. METHODS: The population studied was the permanently employed staff of a public hospital in Modena. We recruited fifty-five workers. Participation was entirely voluntary. Every subject was given a self-administered questionnaire divided into three sections. Section I consisting in a base-line evaluation (sociodemographic data, use of psychotropic substances, General Health Questionnaire and Maslash Burnout Inventory). Sections II and III providing an evaluation of sleep and psychopathological parameters (Sleep Diary and Symptom Questionnaire) in two different moments during the shiftwork: respectively after the night following the night shift (corresponding to the end of the shift cycle), and after the night following the last day off (corresponding to the beginning of a new shift cycle). RESULTS: There were no significative differences in sleep parameters between the two moments of assessment. Regarding psychopathological features we found a reduction of SQ-Somatization (P = 0.002), SQ-Anxiety (p = 0.006) and SQ-Hostility (p = 0.075) subscale score at the end of the shift cycle. CONCLUSIONS: We confirm this type of shiftwork as not causing alterations of sleep parameters. We explain the improvement in psychopathological symptoms noted at the end of the shift cycle with the favourable psychological attitude of workers in the perspective of time off. The present data suggest that the psychological attitude of workers may play an important role in the clinical expression of psychopathological features.

Adult↗

A labor perspective of workplace violence prevention. Identifying research needs.

BACKGROUND: During the past decade, labor unions have contributed to efforts to increase awareness of the importance of workplace violence as an occupational hazard. Research by the National Institute for Occupational Safety and Health and the U.S. Department of Justice have bolstered these efforts. This research revealed that workplace violence is the second leading cause of traumatic-injury death on the job for men, the leading cause of traumatic-injury death on the job for women, and accounts for some 2 million nonfatal injuries each year in the United States. LABOR PERSPECTIVE: Ten years ago, the debate focused on whether workplace violence is an occupational hazard or strictly a police and criminal justice issue. Labor unions have joined with occupational safety and health professionals in recognizing that workplace violence is a serious occupational hazard that is often predictable and preventable. They have advocated that employers establish multidimensional violence-prevention programs. CONCLUSION: Although the nature of workplace violence varies from industry to industry, implementation of the federal Occupational Safety and Health Administration (OSHA) Violence Prevention Guidelines for Health Care and Social Service Workers and for Late-Night Retail Establishments is a high priority to unions in the affected industries. Labor wants employers to invest in protecting workers from violence through voluntary programs and state legislation, and it supports the promulgation of a mandatory federal OSHA standard. To that end, intervention research can play a key role in demonstrating effective, technically and economically feasible prevention strategies

Homicide↗

Building bridges: towards integrated library and information services for mental health and social care.

This research focuses on identifying the information needs of health professionals, social workers and staff from voluntary agencies, who work together in the provision of services for people with a mental illness. The aim is to provide a fully integrated library and information service for mental health and social care. A number of recent government reports have prompted this research. These have culminated in the publication of the National Service Framework for Mental Health. It was decided to conduct a qualitative study using 17 semistructured interviews with individuals and multi-professional groups. A thematic analysis highlighted a number of key themes including: information need, information seeking behaviour and information flows. Results have indicated that because of the dispersed nature of mental health services, across primary and secondary care, and from statutory and non-statutory organisations, information technology is viewed as the only realistic vehicle to provide the required information. As specialist mental health trusts are configured, covering wider geographical areas, this can only increase the reliance on information technology, for information access and information sharing.

Adult↗

Anterior shoulder reconstruction: prognostic variables.

To evaluate factors that have prognostic relevance to the outcome of anterior shoulder stabilization procedures, a retrospective review of 282 serial anterior repairs was carried out. All patients were contacted by questionnaire to provide updated outcome information. Twenty-nine patients were lost to follow-up, leaving 253 shoulders in the series. Surgical outcome was based on the Rowe scores derived from the responses to the follow-up survey. At a mean follow-up of 8.7 years, 5 factors were found to have a negative influence on the result of surgery, on the basis of multivariate analysis. These were the presence of a workers' compensation issue, a voluntary instability pattern, a prior instability surgery, shorter periods of postoperative immobilization, and the age of the patient. Factors that were found to have no statistically significant relationship to the result were the sex of the patient, the presence of a Hill-Sachs lesion, the type of instability, the presence of a labral tear, and the experience of the surgeon. Knowledge of these factors can help guide surgical decision making.

Adolescent↗

Quality indicators for primary care mental health services.

OBJECTIVES: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement. DESIGN: Modified two-round postal Delphi questionnaire. SETTING: Geographical spread across Great Britain. PARTICIPANTS: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations). MAIN OUTCOME MEASURES: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care. RESULTS: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304). CONCLUSIONS: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

Attitude of Health Personnel↗

Attitudes of healthcare workers in U.S. hospitals regarding smallpox vaccination.

BACKGROUND: The United States is implementing plans to immunize 500,000 hospital-based healthcare workers against smallpox. Vaccination is voluntary, and it is unknown what factors drive vaccine acceptance. This study's aims were to estimate the proportion of workers willing to accept vaccination and to identify factors likely to influence their decisions. METHODS: The survey was conducted among physicians, nurses, and others working primarily in emergency departments or intensive care units at 21 acute-care hospitals in 10 states during the two weeks before the U.S. national immunization program for healthcare workers was announced in December 2002. Of the questionnaires distributed, 1,165 were returned, for a response rate of 81%. The data were analyzed by logistic regression and were adjusted for clustering within hospital and for different number of responses per hospital, using generalized linear mixed models and SAS's NLMIXED procedure. RESULTS: Sixty-one percent of respondents said they would definitely or probably be vaccinated, while 39% were undecided or inclined against it. Fifty-three percent rated the risk of a bioterrorist attack using smallpox in the United States in the next two years as either intermediate or high. Forty-seven percent did not feel well-informed about the risks and benefits of vaccination. Principal concerns were adverse reactions and the risk of transmitting vaccinia. In multivariate analysis, four variables were associated with willingness to be vaccinated: perceived risk of an attack, self-assessed knowledge about smallpox vaccination, self-assessed previous smallpox vaccination status, and gender. CONCLUSIONS: The success of smallpox vaccination efforts will ultimately depend on the relative weight in people's minds of the risk of vaccine adverse events compared with the risk of being exposed to the disease. Although more than half of the respondents thought the likelihood of a bioterrorist smallpox attack was intermediate or high, less than 10% of the group slated for vaccination has actually accepted it at this time. Unless new information about the threat of a smallpox attack becomes available, healthcare workers' perceptions of the vaccine's risks will likely continue to drive their ongoing decisions about smallpox vaccination.

Adult↗

Participatory/problem-based methods and techniques for training in health and safety.

More knowledgeable and trained people are needed in the area of occupational health, safety, and environment (OSHE) if work-related fatalities, accidents, and diseases are to be reduced. Established systems have been largely ineffective, with few employers taking voluntary measures to protect workers and the environment and too few labor inspectors available. Training techniques using participatory methods and a worker empowerment philosophy have proven value. There is demonstrated need for the use of education for action, promoting the involvement of workers in all levels of decision-making and problem-solving in the workplace. OSH risks particular to women s jobs are virtually unstudied and not addressed at policy levels in most countries. Trade unions and health and safety professionals need to demystify technical areas, empower workers, and encourage unions to dedicate special activities around women s jobs. Trained women are excellent motivators and transmitters of safety culture. Particular emphasis is given to train-the-trainer approaches.

Journal Article↗

Managing cancer: the role of holiday taking.

BACKGROUND: The primary objective of this paper is to consider whether holiday taking may have a role to play post-diagnosis/treatment, within the rehabilitation process for cancer patients. METHOD: A qualitative study was undertaken. Informants consisted of cancer patients (n=24), their family members (n=13) and friends (n=2), consultants (n=2) pediatric oncology nurses (n=2), social workers (n=2), a voluntary services coordinator (n=1), and a play specialist (n=1). All were accessed through four facilitators at Christie Hospital, National Health Service Trust, Manchester, United Kingdom. Data were collected via interviews, telephone discussions, letters, personal accounts, and health diaries between January 2000 and March 2001. Questions were asked regarding the perceived effects of travel during serious illness, travel propensity, and factors inhibiting full participation. RESULTS: Benefits to health and well being, particularly of a sociopsychological nature, were identified. Such benefits impacted upon personal health, social effectiveness, personal identity, self-image, independence, future career prospects, and personal behavior. Factors inhibiting travel included the side effects of treatment, other peoples' reactions to the visible signs of cancer (e.g., hair loss, surgical scars), inflated insurance costs, a lack of holiday information sources, and communication issues (e.g., language barriers). CONCLUSIONS: Holiday taking offers a vehicle for transcending illness, even if only for a short period of time. Travel offered a range of therapeutic opportunities as well as providing a necessary means of escapism. Promoting travel as part of the rehabilitation process may well generate more intrinsic benefits than are currently appreciated. Such benefits may also be of broader application to patients facing other similarly complex illnesses.

Adaptation, Psychological↗