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PubMed1998

Work place characteristics, work stress and burnout among Dutch dentists.

Work stress among dentists has been described several times, indicating a diversity of causes of stress. Professional burnout among dentists has been the subject of empirical study only occasionally. The aim of the present study was to investigate which occupational factors are related to levels of burnout among Dutch dentists. A distinction was made between actual work place characteristics and experienced pressure from specific aspects of dental work. With a response rate of 75%, a representative group of 709 Dutch general dental practitioners responded to a questionnaire containing a Dutch version of the Maslach Burnout Inventory (MBI-NL), the Dentists' Experienced Work Stress Scale (DEWSS), and a collection of items on work place conditions. No actual work place condition could be demonstrated to be correlated with high burnout levels. Lack of career perspective appeared to be the stress factor most strongly related to burnout. Mean burnout levels of all dentists were found to be favourable in comparison with Dutch norm scores: dentists showed less Emotional Exhaustion, less Depersonalization, and more Personal Accomplishment. It is concluded that the relation between lack of career perspective and burnout should stimulate serious attention for career planning among dentists.

Adult↗
PubMed1996

The biomedical construction of ageing: implications for nursing care of older people.

This paper reports on an existential phenomenological study carried out in a care of elderly people setting in a 1000-bed hospital in the United Kingdom. Fourteen participants were interviewed, each on several occasions. Two themes derived from these narratives are discussed, revealing negative experiences which are related to feelings of powerlessness. These two themes, routine geriatric style and segregation, are shown to arise from the history and culture of the wards and are shown to result in care deprivation and depersonalization. Patients' individual needs are ignored as they become the objects of inflexible routines within health care practice. In order to understand the situation, the history of care of older people and the biomedical construction of ageing are examined. It is concluded that what is needed is a wider social and political movement which opposes ageism and challenges ageist stereotypes. In addition, in health care there is a need for a review of the routine geriatric style of care and of segregation based on age and a social gerontology programme for nurse education.

Activities of Daily Living↗
PubMed1999

Burnout and AIDS care-related factors in HIV community clinical nurse specialists in the North of England.

Burnout in Acquired Immune Deficiency Syndrome (AIDS) care nursing is well described in the literature from a hospital based perspective. No studies into the effects of AIDS care and burnout have been carried out within the community setting. A two-stage, mixed method study was carried out. In Stage one 30 Clinical Nurse Specialists in human immunodeficiency virus (HIV)/AIDS from the North of England completed the Maslach Burnout Inventory (MBI) and the AIDS Impact Scale. For Stage two five practitioners were selected randomly for semi-structured interview. Burnout morbidity was significant. Sixty-six per cent of informants scored as moderate or high burnout cases on the emotional Exhaustion and Personal Accomplishment subscales of the MBI. Only three per cent scored as cases on the depersonalization subscale. Links between the close involvement of practitioners with clients, death of clients, isolation, stigma and discrimination and the availability of support and supervision were identified as significant factors in AIDS care within this population that contributed to stress and burnout. Paradoxically, informants found the close relationships with clients, the autonomy of isolation and the exclusive nature of AIDS care positive aspects of their practice. The role of support and supervision in facilitating the continuance of a close empathic and therapeutic relationship and the prevention of an over-involved, isolated and stressful relationship is proposed as a way forward.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Effort-reward imbalance and burnout among nurses.

This study among a sample of 204 German nurses tested the hypothesis that an imbalance of high extrinsic efforts spent (i.e. job demands) and low extrinsic rewards obtained (e.g. poor promotion prospects) are associated with the burnout syndrome: the depletion of nurses' emotional resources. The results of a series of analyses of variances confirmed this hypothesis, by showing that those nurses who experienced an effort-reward imbalance (ERI) reported higher levels on two of the three core dimensions of burnout (i.e. emotional exhaustion and depersonalization) than those who did not experience such an imbalance. Moreover - as additionally hypothesized - significant interaction effects indicated that burnout (i.e. emotional exhaustion and reduced personal accomplishment) was particularly prevalent among those nurses who experienced ERI and put relatively high intrinsic effort into their jobs, as reflected by their strong tendency to be personally in control over job conditions.

Adult↗
PubMed2001

Leadership, organizational stress, and emotional exhaustion among hospital nursing staff.

STUDY'S RATIONALE AND OBJECTIVES: We examined the effect of work stressors and head nurses' transactional and transformational leadership on the levels of emotional exhaustion experienced among their staff. METHODOLOGICAL DESIGN AND RESEARCH METHODS: A questionnaire was sent to all nurses of a university hospital. Usable returns were received from 625 nurses, giving a response rate of 39.2%. Data were treated using correlational analyses and multiple regression. The latter modelled stressors and leadership as predictors of nurses' reported emotional exhaustion. MEASURES: Work stressors were assessed using the Nursing Stress Scale (NSS) which comprises 34 items divided into three subscales (referring to stress from the physical, psychological, and social environment), and the role ambiguity (three items) and conflict (three items) scales. Leadership was measured with the Multifactor Leadership Questionnaire. RESULTS: In regression analyses, work stressors as a whole were found to explain 22% of the variance in emotional exhaustion whereas leadership dimensions explained 9% of the variance in that outcome measure. Stress emanating from the physical and social environment, role ambiguity, and active management-by-exception leadership were significantly associated with increased levels of emotional exhaustion. Transformational and contingent reward leadership did not influence emotional exhaustion. LIMITATIONS: A limitation of this study is that it considered only the emotional exhaustion dimension of burnout. Also, as data were cross-sectional in nature, conclusions regarding the direction of causality among variables cannot be drawn. CONCLUSIONS: This study provided, for the first time, a test of the influence of leadership on burnout among nurses, taking into account the role of work stressors. Future research is needed to examine if the effects reported herein can be replicated using the two other dimensions of burnout (depersonalization and reduced personal accomplishment).

Adult↗
PubMed2002

Attitudes toward patient aggression amongst mental health nurses in the 'zero tolerance' era: associations with burnout and length of experience.

UK government policy now officially encourages an attitude of 'zero tolerance' towards aggression against health care staff. This study examines levels of such tolerance amongst a group of mental health care staff and associations between tolerance and other occupational and stress factors. Thirty-seven staff completed a Tolerance Scale (from the Perceptions of Aggression Scale) and the Maslach Burnout Inventory. Tolerance for aggression was higher amongst more experienced staff (P < 0.01) and high tolerance was associated with low emotional exhaustion, low depersonalization and high personal accomplishment (P < 0.01). Some staff endorse positive statements about patient aggression and a tolerant attitude may be linked to low burnout. Nurse attitudes to patient aggression therefore are complex and do not necessarily equate with an approach of 'zero tolerance'.

Adaptation, Psychological↗
PubMed2003

Changes in practice at the nurse-doctor interface. Using focus groups to explore the perceptions of first level nurses working in an acute care setting.

A unique combination of factors has recently triggered a rapid change in the clinical practice of nurses in the UK. This study was carried out to explore the consequences of changing practice at the nurse-doctor interface, as perceived by first level nurses working in an acute care setting in the UK. Qualitative data were collected using focus group interviews and analysed thematically. Findings suggest that role change to these nurses is represented by a 'shift' in the practice of technical activities from junior doctors and a corresponding delegation of nursing activity to care assistants. It is suggested that the wholesale incorporation of technical interventions into the role of the nurse without an increase in the number of qualified nurses is turning nursing back to a task system of care delivery. This has the potential to depersonalize patients and reduce work satisfaction for nurses.

Focus Groups↗
PubMed1999

Chronic intoxication by doxycycline use for more than 12 years.

We report the clinical case of a 12-years' intoxication by doxycycline. A patient with a depersonalization and derealization syndrome took 1 g doxycycline per day. In addition to hepatocellular necrosis with cholestasis, nephrotoxicity, leukopenia, anaemia and skin hyperpigmentation he suffered from hitherto unreported adverse cardiac events as intermittent supraventricular tachycardia and sporadic Wenckebach heart block. Despite a long period of self-medication these side-effects were reversible.

Adult↗
PubMed2003

Understanding and motivating health care employees: integrating Maslow's hierarchy of needs, training and technology.

AIM: This paper applies Maslow's Hierarchy of Needs Model to the challenges of understanding and motivating employees in a rapidly changing health care industry. BACKGROUND: The perspective that Maslow's Model brings is an essential element that should be considered as the health care arena is faced with reorganization, re-engineering, mergers, acquisitions, increases in learning demands, and the escalating role of technology in training. EVALUATION: This paper offers a new perspective related to how Maslow's Model, as used in business/organizational settings, can be directly related to current workforce concerns: the need for security and freedom from stress, social belongingness, self-esteem, self-actualization, altered work/social environments, and new opportunities for learning and self-definition. KEY ISSUES: Changes in health care will continue at an accelerated pace and with these changes will come the need for more and more training. The use of technology in training has heightened access, faster distribution, innovation and increased collaboration. However, with this technology come attendant challenges including keeping up with the technology, the increased pace of training, depersonalization, and fear of the unknown. The Maslow model provides a means for understanding these challenges in terms of universal individual needs. CONCLUSION: How does one motivate employees in the face of increased demands, particularly when they are being asked to meet these demands with fewer resources? The answer is, in large part, to make the employee feel secure, needed, and appreciated. This is not at all easy, but if leaders take into consideration the needs of the individual, the new technology that provides challenges and opportunities for meeting those needs, and provides the training to meet both sets of needs, enhanced employee motivation and commitment is possible.

Attitude of Health Personnel↗
PubMed2000

Stressors, moderators and stress outcomes: findings from the All-Wales Community Mental Health Nurse Study.

The All-Wales Community Mental Health Nurse Stress Study was the largest study undertaken in the UK to date to investigate stress, burnout and coping amongst the CMHN workforce. The aim of the study was to examine the variety, frequency and severity of stressors, to describe coping strategies used to reduce work-based stress, and to determine stress outcomes. Questionnaires were sent out to 614 CMHNs from ten NHS Trusts throughout Wales. The response rate was 49% (n = 301). The measures used included the Maslach Human Services Survey, the CPN Stress Questionnaire, the Psychnurse Methods of Coping Questionnaire, the Rosenberg Self-Esteem Scale and the General Health Questionnaire GHQ-12. Community mental health nurses indicated that trying to maintain a good quality service in the midst of long waiting lists, poor resources, and having too many interruptions while trying to work in the office were particularly stressful items. The coping strategies that CMHNs utilized the most were having a stable home life and looking forward to going home at the end of the day, having outside interests and hobbies and talking to people that they got on well with. Forty per cent of CMHNs tended to view themselves negatively, feeling that others did not hold much respect for them. The GHQ-12 measure indicated that 35% of CMHNs had crossed a threshold of psychiatric caseness. Measured against a normative sample of mental health workers, 51% of CMHNs were experiencing high levels of long-term emotional exhaustion. Twenty-four per cent were suffering from high levels of depersonalization burnout and were not relating well to clients, whilst 14% were experiencing severe long-term feelings of lack of personal accomplishment. The results from the study provided us with a picture of stress and coping in CMHNs in Wales. Addressing these factors may help to reduce levels of experienced stress and burnout.

Adult↗
PubMed1998

The expressive psychopathology of the Japanese poet, Sakutaro Hagiwara.

Sakutaro Hagiwara is a famous Japanese poet from the early part of this century. His debut collection of poems, 'Tsuki ni Hoeru', contains a number of works characterized by the strange and abnormal impression they convey. The various and characteristic psychotic symptoms exhibited by this poet have been the subject of much discussion and pathographic description. However, it seems that there have been few considerations as to the meaning of such poetic expression for Sakutaro. In the present study, the relationship between his internal psychopathology and such forms of expression was examined. Furthermore, the influence of the contemporary fin de siècle art and the significance of the choice of poetry as his medium of expression was considered. It was found that his earliest psychopathological problems, such as anthropophobia (which could well be viewed as having been engendered by the particular Japanese cultural climate of that time) and systemic depersonalization, both led to his own anxiety about existence; expressing himself through the medium of poetry was a kind of self-healing act for Sakutaro, who had been suffering seriously from feelings of inadequacy and self-doubt.

Famous Persons↗
PubMed2002

Vulnerability and security in seriously ill patients in intensive care.

The purpose of this research was to gain an understanding of the experience of being a seriously ill patient in an intensive care unit (ICU). Fourteen former patients, aged 17-71 years old, who had been in ICU 3-53 days, participated in focus group interviews 3-6 months after discharge. The focus groups met 3 times each for 1.5 hours, resulting in 13-14 hours of audiotaped discussions. The transcribed data were qualitatively analysed to identify themes representing participants' experiences. Vulnerability emerged as a central concept that captured the identified themes. The data reveal that patient vulnerability while in ICU was related to extreme physical and emotional dependency. Lack of information and depersonalizing care were associated with fear, anxiety and increased vulnerability. Lack of sleep and rest also contributed to patient fear and anxiety. Vulnerability decreased when patients were kept informed of what was occurring while in ICU, received care that was personalized to their individual needs, and when their families were present. The results of this study suggest that ICU patients' vulnerability may be decreased by the security that they experience when they are adequately informed about what is happening, and when nursing and medical care is personalized to their individual needs.

Adolescent↗
PubMed1976

[Altered states of consciousness induced by N,N-dimethyltryptamine (DMT)].

In a controlled study on 38 volunteers the effects of 250 mcg/kg N,N-Dimethyltryptamine (DMT) i.m. were assessed. 26 subjects received DMT and 12 placebo. The altered states of consciousness and the somatic changes were measured by several questionnaires administered after the experiment. In spite of the low dose as compared to previous studies significant differences to placebo were found in the following syndromes of altered states of consciousness: visual hallucinations rep. illusions, impairment of memory and attention, changes of body image, depersonalization syndrome, derealization syndrome, euphoric state, anxious-depressive state and delusion. The somatic side effects were mainly subjective respiratory troubles, dizziness and weakness.

Adult↗
PubMed2001

[Progressive muscle relaxation (PMR) according to Jacobson in a department of psychiatry and psychotherapy - empirical results].

267 patients admitted to a psychiatric hospital, who were taking part in PMR treatment from 10/98 to 9/00, were questioned about their experiences. Analysis of the data reveals a division into three groups: 1(st) patients with positive effects 69 %, 2(nd) patients with negative effects showing a deterioration of symptoms 15 %, 3(rd) patients with nonspecific reactions 16 %. Marked difficulties are found in patients with major depressive disorder, especially those with a distinctive feeling of emptiness and disturbance of body sense. Difficulties are also found in patients with personality disorders, who respond with depersonalization and/or dissociative phenomena. Alternative therapeutic methods (body movement therapy, self-awareness training) or PMR in a modified way (single setting) should be employed for those patients.

Combined Modality Therapy↗
PubMed2003

[The burn-out syndrome and restoring mental health at the working place].

This paper reviews the scientific concepts and the clinical aspects of the burn-out syndrome. According to recent studies, up to 25 % of the German working population appear to suffer from what the Amercan physician and psychoanalyst, Herbert Freudenberger, has designated in 1974 as "burn-out syndrome". Characteristic features of this syndrome are emotional exhaustion, depersonalization and low personal accomplishment. People affected by the burn-out syndrome may suffer from depressive or anxious symptoms, from sleep disorders, chronic pain syndromes, or functional disorders of the cardiovascular or gastrointestinal system. Primary causes of the burnout syndrome include high demand combined with low influence, a high level of engagement without sufficient rewards or gratification, and a low level of social support. Preventive measures against burn-out include Balint-like supervision groups. In cases of a fully developed burn-out syndrome, affected persons should undergo either psychotherapy or a multimodal psychosomatic therapy.

Burnout, Professional↗
PubMed2005

Use of nonprohibited hallucinogenic plants: increasing relevance for public health? A case report and literature review on the consumption of Salvia divinorum (Diviner's Sage).

INTRODUCTION: : We want to call attention to a mint plant, called diviner's sage ( Salvia divinorum), originally used in shamanic ceremonies of the Mazatec Indians of Mexico. On numerous websites of the internet, this ancient herbal drug and its extracts are offered as a legal means of widening individual awareness. Regarding its dose-response relationship, the active ingredient, salvinorin A, is one of the most potent naturally occurring hallucinogens. Laws on controlled substances, except for Finland, Denmark and Australia, do not prohibit cultivating, consuming or dealing with Salvia divinorum. Ingestion by smoking, vaporising or chewing, induces a short-lived inebriant state with intense, bizarre feelings of depersonalization. This article wants to be a signal for physicians or psychotherapists to take Salvia into consideration, when exploring young people for drug use. METHODS: We report the individual perceptions of a young man consuming Salvia divinorum. We review the scarce scientific literature and consider relevant internet websites. DISCUSSION: We define open issues for further investigations and try to discuss why Salvia divinorum may be of interest for teenagers and young adults in Europe.

Adult↗
PubMed2000

Losing touch with the healing art: dermatology and the decline of pastoral doctoring.

Technological advance in society and medicine has brought tremendous improvements and convenience but also a degree of depersonalization. The personal and pastoral aspects of medical practice, which are probably more important in helping patients toward health than we realize, are becoming increasingly stifled by health care systems which are increasingly "scientific," technological, and "efficient." Clinical practice in dermatology requires pastoral as well as technical skills, art as well as science, and yet the balance of current medical culture increasingly favors and encourages "science" over "art." In dermatology, this bias is evident in a reductionist focus of research, the move towards evidence-based medicine and the emergence of teledermatology. Although all these developments are extremely important and valuable, their effect on the doctor-patient relationship needs to be considered carefully. Increasingly rapid scientific advance is paradoxically providing diminishing returns for patients and the healing art is still very much in demand.

Dermatology↗
PubMed2001

Burnout among American surgeons.

BACKGROUND: The long-term consequences of stress on the surgeon are unknown. One manifestation of stress is burnout. The purpose of this study was to measure the prevalence of burnout in actively practicing American surgeons. METHODS: The Maslach Burnout Inventory and a questionnaire of our own design were sent to 1706 graduates of various University of Michigan surgical residencies (1222) and members of the Midwest Surgical Association (484). The response rate was 44%. Responses from 582 actively practicing surgeons were the sample used for analysis. RESULTS: Thirty-two percent of actively practicing surgeons showed "high" levels of emotional exhaustion, 13% showed "high" levels of depersonalization, and 4% showed evidence for low personal accomplishment. Younger surgeons were more susceptible to burnout (r = -0.28, P <.01). Burnout was not related to caseload, practice setting, or percent of patients insured by a health maintenance organization. Important etiologic factors were a sense that work was "overwhelming" (r = 0.61, P <.01), a perceived imbalance between career, family, and personal growth (r = -0.56), P <.01), perceptions that career was unrewarding (r = -0.42, P <.01), and lack of autonomy or decision involvement (r = -0.39, P <.01). A strong association was noted between burnout elements and a desire to retire early (r = 0.50, P <.01). CONCLUSIONS: Burnout is an important problem for actively practicing American surgeons. These data could be used to modify existing surgical training curricula or as an aid to surgical leadership when negotiating about the surgical work environment.

Adult↗