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PubMed2006

The relationship between the Big Five personality factors and burnout: a study among volunteer counselors.

In the present study of 80 volunteer counselors who cared for terminally ill patients, the authors examined the relationship between burnout as measured by the Maslach Burnout Inventory (C. Maslach, S. E. Jackson, & M. P. Leiter, 1996) and the 5 basic (Big Five) personality factors (A. A. J. Hendriks, 1997): extraversion, agreeableness, conscientiousness, emotional stability, and intellect/autonomy. The results of 3 separate stepwise multiple regression analyses showed that (a) emotional exhaustion is uniquely predicted by emotional stability; (b) depersonalization is predicted by emotional stability, extraversion, and intellect/autonomy; and (c) personal accomplishment is predicted by extraversion and emotional stability. In addition, some of the basic personality factors moderated the relationship between relative number of negative experiences and burnout, suggesting that personality may help to protect against known risks of developing burnout in volunteer human service work.

Burnout, Professional↗
PubMedDate not supplied

Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses.

BACKGROUND: Recent literature defines lateral violence as nurses covertly or overtly directing their dissatisfaction inward toward each other, toward themselves, and toward those less powerful than themselves. Newly licensed nurses are an identified group that is vulnerable to lateral violence during their socialization to nursing practice. The use of cognitive rehearsal, an applied cognitive-behavioral technique, was used as an intervention and the theoretical underpinning for this study. METHOD: Twenty-six newly licensed nurses hired by a large acute care tertiary hospital in Boston, Massachusetts, participated in an exploratory descriptive study. They were taught about lateral violence in nursing practice and the use of cognitive rehearsal techniques as a shield from the negative effects of lateral violence on learning and socialization. Small laminated cueing cards with written visual cues for the appropriate responses to the most common forms of lateral violence were provided. One year later, videotaped focus groups designed to collect qualitative data about the applied intervention were conducted. RESULTS: Twenty-six newly licensed nurses in three different focus groups were videotaped responding to six open-ended questions designed to elicit information on their experience with lateral violence, use of cognitive rehearsal as an intervention, and the overall socialization process. CONCLUSIONS: Knowledge of lateral violence in nursing appeared to allow newly licensed nurses to depersonalize it, thus allowing them to ask questions and continue to learn. The learned cognitive responses helped them confront the lateral violence offender. Confrontation was described as difficult but resulted in the resolution of the lateral violence behavior. Overall, the retention rate in this study population was positively affected.

Attitude of Health Personnel↗
PubMed2000

A comparison of persons with early-versus late-onset panic attacks.

BACKGROUND: Although some evidence suggests a bimodal age at onset of panic attacks, the literature comparing subjects with early versus late onset is limited. Previous work suggests that people with late-onset panic attacks may have fewer panic symptoms and exhibit less avoidance. This study sought to compare late-onset panic attacks and early-onset panic attacks with regard to (I) comorbidity, (2) health care utilization, and (3) illness behaviors and coping. METHOD: This community-based study involved interviewing randomly selected adults for the presence of DSM-III-R panic attacks. If panic attacks were confirmed, subjects were asked questions concerning panic characteristics, psychiatric comorbidity, symptom perceptions, illness attitudes, coping, and family characteristics. Subjects reporting early-onset panic (panic onset < 50 years of age) were compared with those reporting late onset (onset > or = 50 years of age). Significant univariate analyses were controlled for differences in age, panic duration, and socioeconomic status by using analysis of covariance and logistic regression. RESULTS: Subjects with late-onset panic attacks (N = 9) utilized the mental health sector less, but were more likely to present to family physicians for their worst panic. Patients with late-onset panic felt that choking and numbness more strongly disrupted function, but felt less strongly that either depersonalization or sweating disrupted function. Subjects with late-onset had fewer comorbid conditions and lower Symptom Checklist-90 scores. Late-onset subjects also had less hypochondriasis and thanatophobia while coping less through avoidance or wishful thinking. CONCLUSION: Late-onset panic attacks are associated with less mental health utilization, lower levels of comorbidity, less hypochondriasis, and a greater number of positive coping behaviors.

Adaptation, Psychological↗
PubMed2005

Dissociation and posttraumatic stress 1 year after the World Trade Center disaster: follow-up of a longitudinal survey.

BACKGROUND: We conducted a 1-year follow-up of an original mail survey of early reactions to the World Trade Center disaster. METHOD: Of the 75 subjects originally surveyed, 58 (77%) responded. The survey included measures of dissociation (Dissociative Experiences Scale, Cambridge Depersonalization Scale, Clinician-Administered Dissociative States Scale), post-traumatic stress (Impact of Event Scale-Revised), social support (Interpersonal Support Evaluation List-short form), and a life quality measure (Quality of Life Enjoyment and Satisfaction Questionnaire-short form). We hypothesized that dissociative versus posttraumatic symptoms at follow-up could be dissected on the basis of early reactions. RESULTS: Responders and nonresponders did not differ in baseline characteristics. Exposure was not associated with dissociation or posttraumatic stress at follow-up. Of distress, dissociation, and posttraumatic stress at baseline, baseline dissociation was the strongest predictor of outcome dissociation while baseline posttraumatic stress was the strongest predictor of outcome posttraumatic stress. Of 4 peritraumatic distress factors generated in the original survey, "loss of control" and "guilt/shame" were significantly related to dissociation and posttraumatic stress at outcome, while "helplessness/anger" was only associated with posttraumatic stress at outcome. Lesser improvement in posttraumatic stress over the first year was significantly related to less social support and greater comorbid dissociation. Interim social support was associated with better life quality and fewer symptoms at outcome. CONCLUSION: There was evidence for partly independent pathways toward dissociation versus posttraumatic stress 1 year after the disaster. Feelings of guilt and shame, and persistent dissociation, were poor prognostic factors, while social support had a powerful ameliorating influence.

Adult↗
PubMed1996

[Construction, reliability and validity of Feelings of Unreality Inventory].

The present research assumed that a feeling of unreality is the defining characteristic of depersonalization phenomena. In Survey 1, two scales were constructed: the State Feelings of Unreality Scale for measuring a feeling of unreality as a transitory state and the Trait Feelings of Unreality Scale for assessing individual differences in disposition to experience that state. Both scales had high internal consistency. The Trait Feelings of Unreality Scale had sufficient test-retest reliability. In Survey 2, the Trait Feelings of Unreality Scale was found to be moderately correlated to level of maladjustment. Survey 3 showed that those higher in State Feelings of Unreality experienced greater negative affect. The results of Surveys 2 and 3 supported the construct validity of the Trait Feelings of Unreality Scale and the State Feelings of Unreality Scale, respectively.

Adolescent↗
PubMed1997

A Copernican revolution in clinical ethics: engagement versus disengagement.

Spiritual fulfillment in the professional role of occupational therapy practitioner is hindered by the ethical consideration of maintaining an objective client-therapist relationship. Objectivity is a disengaged perspective that depersonalizes human relationships. It operates on the tacitly performed, reductionistic assumption that all truth can be structurally represented and verified. However, to obtain meaning from truth is to adequately interpret experience through dialogue. Meaningful experiences are hermeneutical in nature and require engaged, sympathetic relationships to be spiritually manifested.

Empathy↗
PubMed2006

Comparing self-reported burnout of pharmacy students on the founding campus with those at distance campuses.

OBJECTIVES: To compare burnout among students: (1) assigned to the founding campus and those assigned to distance campuses and (2) in different academic years of the curriculum. The third objective was to determine the relative ability of each factor to predict burnout among pharmacy students. METHODS: Students in Gainesville (founding campus) and the Jacksonville, Orlando, and St. Petersburg distance campuses were surveyed using the Maslach Burnout Inventory. Internet-based survey methods were used to evaluate the emotional exhaustion, personal accomplishment, and depersonalization domains. Students responded using a Likert-type scale (1 = do not feel this way to 7 = feel this extremely strongly). RESULTS: Among 18 items, 8 significant differences were revealed. Within the emotional exhaustion domain, Gainesville students responded that they were more likely to "feel fatigued in the morning" (p < 0.001), "burned out" (p = 0.001), "used up" (p = 0.02), "frustrated" (p = 0.02), and "emotionally drained" (p < 0.02) compared to the distance students. Gainesville students had the highest average score on the item "I feel as though I treat my student colleagues impersonally" (p = 0.02). Academic year was the best predictor of burnout. Campus assignment was significant for emotional exhaustion, with the highest levels occurring on the founding campus. CONCLUSIONS: With few exceptions, students at the founding campus in Gainesville reported more emotional burnout than students attending classes at the distance campuses.

Adult↗
PubMed2006

Dissociation, hardiness, and performance in military cadets participating in survival training.

The present study examined the relationship between peritraumatic dissociation, hardiness, and military performance in Norwegian Navy officer cadets (N = 80) after a simulated prisoner of war (POW) exercise. The cadets reported symptoms of peritraumatic amnesia, depersonalization, and derealization in response to a mild stress experience (time point 1) and exhibited a significant increase in such symptoms when subsequently exposed to a highly stressful experience of being placed in a mock POW camp (time point 2). Symptoms of peritraumatic dissociation were significantly and negatively related to performance, and predicted between 16 and 26% of the variance between subjects. A subscale of the personality hardiness measure (i.e., the subdimension of challenge) was negatively associated with peritraumatic dissociation in response to both the mild stress situation and the more stressful POW exercise in study subjects. Hardiness was not significantly associated with military performance scores. The present data indicate that individual differences in attribution style and in a propensity to dissociate significantly affect military performance during exposure to high stress situations.

Adaptation, Psychological↗
PubMed1995

The evaluation of a burnout workshop for community nurses.

This study evaluates the effects of a burnout workshop that was conducted for community nurses (N = 64). The workshop included relaxation training, didactic and cognitive stress management, interpersonal skills training, and the enhancement of a more realistic professional role. The nurses' symptom levels (i.e., emotional exhaustion, tedium, psychological strain, and somatic complaints decreased significantly. However no significant changes were observed in the attitudinal component of burnout: the nurses' negative attitudes toward their recipients (depersonalization) and toward their performance on the job (reduced personal accomplishment) did not decrease. In addition, personality (i.e., the nurses' level of reactivity) played a moderating role: low reactive nurses who, by definition, are rather resistant to stress benefited more from the workshop than did high reactive nurses who are less resistant to stress. Since no control group was included, the results of this study are tentative and should be confirmed by future research.

Adaptation, Psychological↗
PubMedDate not supplied

Stress, job satisfaction, coping, and psychological distress among emergency medical technicians.

INTRODUCTION: Although several studies link job-related stressors with adverse reactions among emergency medical technicians (EMTs), more standardized research is needed, since much remains unknown about stress responses, coping styles and their consequences for EMTs. This paper presents the results of two studies. Study I investigated the relation between job-related stressors, job satisfaction, and psychological distress, while Study II investigated how coping is related to occupational burnout, job-related stress, and physiological arousal. HYPOTHESIS: Study I: Those EMTs experiencing greater job-related stressors are less satisfied with their jobs and more psychologically distressed. OBJECTIVE, STUDY II: To obtain preliminary information about which coping strategies are associated with greater feelings of stress and burnout and more intense autonomic nervous system reactivity. METHODS: For both studies, EMTs from a large, urban, public EMS organization in the southern United States were asked to participate. Study I: Subjects completed an informed consent document, a demographics questionnaire, a measure of job stress (the Stress Diagnosis Inventory), a measure of job satisfaction (Job-in-General), and a measure of psychological symptomatology (Symptom Checklist-90, Revised). Pearson product-moment correlations were computed between the measures. Study II: Subjects completed an informed consent document, a demographics/information sheet, the Maslach Burnout Inventory (MBI), and the Ways of Coping Scale (WOCS). They then completed 30 days of monitoring using the Daily Stress Inventory (DSI) and the Daily Autonomic Nervous System Response Inventory (DANSRI). Pearson product-moment correlations were computed between the measures. RESULTS: Study I: Those EMTs who experienced greater job-related stress also were significantly more dissatisfied with their jobs, more depressed, anxious, hostile, and endorsed greater global psychological distress. Study II: The Depersonalization subscale on the MBI correlated significantly with the following WOCS subscales: Accepting Responsibility, Confrontive Coping, Distancing, and Escape/Avoidance. Emotional Exhaustion on the MBI correlated significantly with Confrontive Coping, Escape/Avoidance, and Social Support, while data obtained on the 40 subjects who completed the daily monitoring revealed that DSI-Impact, DANSRI-Number, and DANSRI-Impact scores each correlated significantly with Accepting Responsibility, Confrontive Coping, and Escape/Avoidance. CONCLUSION: A significant portion of an EMT's job satisfaction and psychological well-being is associated with the degree to which they are experiencing job-related stress, and, furthermore, this distress level appears to be clinically elevated. This implies that in-service programs and psychological support services designed to help EMTs manage their job-related stress may improve job satisfaction and decrease psychological distress. The coping styles most consistently associated with maladaptive outcomes were: Accepting Responsibility, Confrontive Coping, and Escape/Avoidance. Thus, subjects who were more likely to handle stress with self-blame, aggression, hostility, and risk taking or with wishful thinking, escape tendencies, and avoidance were more likely to endorse more negative outcomes.

Adaptation, Psychological↗
PubMed1999

[Dependence and obsession].

Alcoholism, especially the urge to drink and relapse from abstinence, is deeply associated with obsession. And also alcoholics on abstinent 10 years or more are still higher on the obsessive-compulsive symptom dimension more than the depression and interpersonal sensitivity. Obsession was introduced by Kraepelin in 1915 and has been studied extensively since. When a person with obsession becomes exhausted with chronic rumination accompanied suspicion, he or she is driven to impulsive acts like alcoholics, and develops a personality disorder that displays persistent abnormal activities. Impulsive-compulsive spectrum characterizes by dimensions of risk-aversive/risk-seeking and harm-avoidant/harm- minimizing behaviors. Disorders on the compulsive end of the spectrum include obsessive-compulsive disorder, hypochondriasis, body dysmorphic disorder, anorexia nervosa an depersonalization. Mixed compulsive and impulsive disorders include Tourette's disorder, trichotillomania, pathologic gambling, sexual compulsions and alcoholism. Disorders on the impulsive end of the spectrum include borderline personality disorder and antisocial personality disorder. Using 123I-IMP SPECT, regional cerebral blood flow significantly decreased in alcoholics without Korsakoff sign (WAIS FIQ 90 or over) than alcoholics with Korsakoff signs (WAIS FIQ 89 or under) and control on the frontal lobe and thalamus. Recent model of obsessive-compulsive pathophysiology demonstrating that cortical regions have different effects on the direct and indirect pathways, indicates that the the different effects of serotonergic agents in the cortex alone could result in a change in balance between the direct versus indirect basal ganglia pathway. This article reviews alcoholism and obsession, ego dystonic and ego syntonic, approach-avoidance conflict, a recent biological approach to alcoholics and a spectrum for obsession.

Alcoholism↗
PubMedDate not supplied

Case study discussions contribute to total patient care.

When staff attitudes toward patients in a busy radiology department were becoming somewhat depersonalized, the director of education and training and the department's supervisors put together an educational program to reorient staff members to total patient care. The case study approach taken allowed staff to pinpoint problems and then recommend ways to improve the quality of the department.

Attitude of Health Personnel↗
PubMedDate not supplied

The competitive edge--group or solo practice?

Although the general public has viewed the introduction of automation into business activities as depersonalizing, the Laconia Clinic addressed the issue of the patient/clinic relationship with a program of personalization through automation. In answer to competition from solo practitioners, the clinic developed an automated information traffic system combined with personal interaction.

Computers↗
PubMedDate not supplied

CEO's challenge: balance fiscal solvency, service to poor.

Competitive practices and the prospective payment system are among factors challenging Catholic health care facilities' commitment to serve the poor and elderly and to provide individualized care. To concentrate their mission on services to the marginated and thus alienate other payer groups through inability to compete in either services or price is fiscal suicide. Sponsors and CEOs of Catholic facilities are exploring creative solutions to this dilemma: Revising the mission statement. The facility may restate its goals--e.g., to provide an "adequate" level of care and technology, rather than "the best care possible;" Changing delivery methods to focus on outreach services, ambulatory care centers, surgicenters, etc.; Finding new ways of providing charity care through endowment, trust, foundation, and unrelated business income. Corporate restructuring to generate income and protect the facility's asset base is being widely studied. Because many congregations sponsor several institutions, Catholic health facilities are well positioned to enter multi-institutional systems and participate in networking as a means to save money and to market services. Catholic health care facilities must form a nationwide system of influence in the growing public policy debate about access to and rationing of health care. Before these issues are resolved; Catholic facilities will continue to feel pressure to provide services beyond their means. The chief executive officer has four particular tasks during this period: To use an entrepreneurial approach to generate funds to support the facility's mission activity; To guide the board of trustees to accept multi-institutional arrangements; To raise legislators' and citizens' awareness of the institution's fiscal challenges; To motivate the institution's staff to provide individualized, compassionate care in spite of the depersonalizing effects of DRGs.(ABSTRACT TRUNCATED AT 250 WORDS)

Catholicism↗
PubMed1987

In vitro technology: a threat to the covenant.

The meaning of human sexuality, according to Catholic moral theology, can be appropriately expressed only within the confines of the marital covenant. Children in this moral perspective are created within the sphere of the marital embrace, which is expressive of conjugal intimacy and procreative power. In vitro fertilization and other artificial reproductive methods, which carry the risk of procreating new life beyond the sphere of marriage, therefore pose significant ethical questions concerning respect for life, the integrity of marriage, and the need to guide technological mastery with wisdom. Some ethicists suggest that in vitro technology may be permissible if embryo wastage is not significantly greater than during normal reproduction. Other moralists, however, recommended stronger protections for nascent life. The human embryo, they caution, should not become an object to be manipulated or used as a means to an end, even though the goal is to alleviate infertility. Concern for depersonalization, one of the chief reasons for Catholic moral teaching's objection to artificial insemination by donor, also applies to the new reproductive technologies. Ethicists have reached a wide consensus on this point, agreeing that procreation should not be divorced from the context of martial intimacy. As society deals with the problems of infertility and advances its technology, those who are involved in the new reproductive methods must also explore the ethicl issues concerned. One possible resource would be a broad-based ethics committee to advise couples, medical professionals, infertility clinics, and other agencies about the risks and possibilities of new research. Hospital ethics committees also could help resolve complex issues.(ABSTRACT TRUNCATED AT 250 WORDS)

Advisory Committees↗
PubMed1999

Improving quality of life for people with chronic conditions: the example of t'ai chi and multiple sclerosis.

CONTEXT: The greatest needs of people with chronic conditions are long-term care, maximized independence, and improved quality of life. With conventional medicine becoming increasingly expensive, depersonalized, and unable to adequately meet such needs, many with chronic conditions are seeking health promotion strategies to effectively manage their symptoms. OBJECTIVE: An 8-week t'ai chi program was conducted to explore psychosocial and physical benefits for those with multiple sclerosis. DESIGN: Nonrandomized, noncontrolled pilot study. SETTING: American College of Traditional Chinese Medicine, San Francisco, Calif. PATIENTS: 19 patients with multiple sclerosis. INTERVENTION: T'ai chi. MAIN OUTCOME MEASURES: Walking speed (distance = 25 ft), hamstring flexibility, and psychosocial well-being as measured by the Medical Outcomes Study 36-item Short-form Health Survey. RESULTS: Walking speed increased by 21% and hamstring flexibility increased by 28%. Patients experienced improvements in vitality, social functioning, mental health, and ability to carry out physical and emotional roles. CONCLUSIONS: This pilot program was conducted entirely on a volunteer basis and led to the implementation of several additional t'ai chi classes for people with multiple sclerosis across the United States. T'ai chi and other health promotion programs offer help toward achieving the goals of increasing access to services, maximizing independence, and improving quality of life for people with chronic disabling conditions.

Chronic Disease↗
PubMedDate not supplied

[Psychiatrist's burnout. A survey].

INTRODUCTION: This work seeks to know the state of the Burnout syndrome among Spanish psychiatrists' with the purpose of having some national reference values. It also sought to elucidate the sociodemographic and work-related variables which can influence the burnout syndrome. METHODS: A survey (which includes sociodemographic, work-related variables and the Maslach Burnout Inventory) is applied to a sample of psychiatrists assisting at the National Congress of Psychiatry held in Valencia. The statistical analysis comprises parametric, non parametric and multivariate methods. RESULTS: The results of the three subscales included in the Maslach Burnout Inventory is offered along their relationship with the sociodemographic and work-related variables studied. The multivariate analysis shows that only the variable sex can influence the probability of obtaining high scores in the depersonalization subscale. CONCLUSIONS: The scores obtained in the three subscales of the of Maslach Burnout Inventory are higher than those published to date. These prior studies were carried out with autonomous samples. The possible relationship of these high scores with the current spanish situation is considered.

Adult↗