3.  Define burnout  Assess burnout symptoms  Describe early warning signs  Discuss contributing factors  Discuss resolution and resilience

4.  Burnout is physical, emotional or spiritual exhaustion brought about by sustained stress without adequate adjustment.  Burnout is otherwise know as exhaustion or when the bodily reserves used in the stress response have been used up.

5.  Excessive prolonged stress  Feeling of overwhelm  Feeling of unable to meet constant demands

6.  Burnout is not a diagnostic category  International diagnostic classification criteria do not consider burnout as a disease  burnout as such is not a valid reason for sickness absence

7. Negative consequences for employees (lack of interest in work – existential doubts) Consequences for clients (low quality of service) High costs for organizations Its excessive spread (around 20% of the employees) Important social problem but still unclear concept

8.  Impaired performance  Poorer patient care  Professional problems:  Lawsuits  Suspensions  License revocation  Leave profession  Relationship difficulty  Physical problems  Addictions  Anxiety, depression, suicide

9. Healthcare professionals are at increased risk for professional burnout.

10.  A recent survey showed that 1 in 2 US physicians has symptoms of burnout.  This likely is rooted in the care delivery system rather than the personal characteristics of few susceptible individuals. Arch Internal Med, 2012

11.  Stress can be described as a circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person.

12. “our reaction to events, environmental or internal, that tax or exceed our adaptive resources.”

14. Excited Relaxed Ah! Uh Oh! Normal

15. Excited Relaxed Uh Oh! Breakdown Uh Oh!

16. Stage 1: Stress Arousal Stage 2: Energy Conservation Stage 3: Exhaustion

17.  Persistent irritability  Persistent anxiety  High blood pressure/heart problems  Inability to concentrate/forgetfulness  Insomnia  Headaches  Bruxism

18.  Late for work/turning work in late  Procrastination  Three-day weekend  Social withdrawal  Increase in coffee, tea, cola, alcohol

19. Substance abuse (so treated usually as symptoms):  more alcohol and drugs,  poor eating, more or less than before,  drinking more coffee  if smoking - more cigarettes Developing or worsening of bad habits - instead of giving help and relief, diminishes one’s physical resilience.

20.  withdrawal from or even breakdown of meaningful and important relationships and friendships  withdrawal from pleasant activities – because of tiredness and lack of motivation  working more but less effectively and worse Instead of helping, diminishes one’s psychological resilience.

21. Chronic:  Sadness  Depression  Stomach/bowel problems  Mental/physical fatigue  Headaches

22.  Desire to drop out of society  Move away from friends, work, family  Possible suicide ideation

23. Causes or of burnout  job characteristics work demands / challenges, work relationships, employee-patient relationships, role ambiguity / conflict  organizational characteristics workplace infrastructure, rewards/punishments linked to job performance, staff support  personal characteristics such as age, gender, and coping skills.

24. AccountantArtist Auto Mechanic Forester Low-Stress Occupations High-Stress Occupations Hospital manager Physician (GP) Psychologist School principal Police officer Police Dispatcher Air Traffic Controller Waiter/waitress Medium-Stress Occupations

25.  excessive or high workloads,  the emotional demands of dealing with sick patients and their families and with patients whose behaviors are difficult  lack of staff support,  uncertainty concerning treatment, conflict with other nurses, supervisors and medical staff,  dealing with death and dying,  management difficulties,  issues involving patient care,  concerns about technical knowledge and skills

26. Job Resources Support Autonomy + Feedback Coaching Job Demands Workload Emotions Intimity Work-Home Burnout Engagement - + Client Satisfaction Efficiency + - Source: Taris, Bakker et al. (in prep.)

27. Impaired health Low motivation Impaired health Motivation Health Low motivation Health Motivation L H L H JOB RESOURCES JOB DEMANDS

31. WELLNESS Intellectual Physical SocialEmotional Spiritual Professional

32. Burnout and Personality NeuroticismNeuroticism Low extraversionLow extraversion Low hardinessLow hardiness External locus of controlExternal locus of control Low self-esteemLow self-esteem Type A personalityType A personality

33.  More critical self  Pushed vs. pulled to goal  Unrealistic goals  Results focused vs. journey  Self attack: unmet goals  Fear failure/disappointing  Procrastinate  Defensiveness  Low self esteem

34.  In 1981, Maslach and Jackson defined occupational burnout syndrome as a syndrome of maladaptive response to stress  emotional exhaustion,  depersonalization  reduced personal accomplishment.

35. Depersonalization Reduced Personal Accomplishment Physiological,psychological, and behavioral consequences EmotionalExhaustion Interpersonal and Role-Related Stressors

36.  Emotional exhaustion - also called compassion fatigue, it represents the first stage of burnout and plays a central role in the burnout process.  Depersonalization - follows emotional exhaustion and is identified by the treatment of others as objects rather than people.  Reduced personal accomplishment - the final component of job burnout which refers to the decline in one's feelings of competence and success.

37. HighModerateLow Emotional exhaustion 27 or over17-260-16 Deperson- alization 13 or over7-120-6 Personal accomplishment 0-3132-2839 or over

38.  Increased:  Physical symptoms & illness  Relationship difficulties  Negative thoughts  Eating, spending, smoking, drinking, gambling, unprotected sex  Decreased:  Pleasure with relationship & activities  Exercise, nutrition, socializing, laughing

39.  Depression and burnout are not identical, although their symptoms may be overlapping  At individual level burnout may form a part of the aetiology of depression  More research is needed on the relationship between burnout and mental disorders

40. Depression Depressive mood Unhappiness, displeasure Weight loss Fearfulness Sleeping problems (wake up early) Guilt feelings Suicide thoughts Indecisiveness Attribution of the problem: sickness General Low vitality Burnout Anger, aggression Low pleasure No weight symptoms No fearfulness Sleeping problems (difficulty to fall asleep) Guilt feelings No suicide thoughts Indecisiveness (complaint) Attribution of the problem: work Work-related Moderate vitality

41. Stress Test Self Assessment Exercise How often do you… 1. find yourself with insufficient time to do things you really enjoy? 2. wish you had more support/assistance? 3. lack sufficient time to complete your work most effectively?

42. Stress Test Self Assessment Exercise 4. have difficulty falling asleep because you have too much on your mind? 5. feel people simply expect too much from you? 6. feel overwhelmed?

43. Stress Test Self Assessment Exercise 7. find yourself becoming forgetful or indecisive because you have too much on your mind? 8. Consider yourself to be in a high- pressure situation?

44. Stress Test Self Assessment Exercise 9. feel you have too much responsibility for one person? 10. feel exhausted at the end of the day?

46. “The key is not to avoid stress altogether but to manage stress in such a way that we avoid the negative consequences of stress”  Manage yourself  Manage your reaction to stressors  Manage the amount of stress

47.  Know Yourself  Know your limitations  Gage your reactions, learn to take each day one step at a time  Become a “Stress Expert”, know about Stress and how it affects your mind and body.  Don’t do nothing, if you think you are getting burned out and have the symptoms speak to someone about it!

48. Find; What aspects of work are most gratifying? (relationships, teaching, research, program development) How do professional demands affect us? How do we view the rewards of our work?

49.  Learn what causes you stress  Learn how to recognize effects of stress in yourself  Develop coping strategies and self care techniques to conquer stress  Physical self care  Emotional and Cognitive Self care  Relational Self-Care  Spiritual Self Care

50. Change of thinking Do you want to be helping? If you appreciate help as a virtue, let other people be helpful for you If you forget, that you are a human being, consider: you use your own body and mind to help others, so you are kind of helping tools – you take care of your machines and domestic tools, don’t you?

51.  Cultivate Relationships  Set Boundaries, priorities, education, keeping an open mind  Take time out for yourself  Eat/Exercise  Ask for help  Acknowledge your emotions  Stress Reduction techniques( music, medication, journaling)  Mentoring/Peer Support  Group Support  Promote self-awareness, create a place to retreat/unwind  Explore professional and personal goals

52.  Cultivate Relationships  Set Boundaries, priorities, education, keeping an open mind  Take time out for yourself  Eat/Exercise  Ask for help  Acknowledge your emotions  Stress Reduction techniques( music, medication, journaling)  Mentoring/Peer Support  Group Support  Promote self-awareness, create a place to retreat/unwind  Explore professional and personal goals

53.  Talking to peers, others  Journaling  Taking time off  Balancing professional life with personal life  Maintain a good team, promote teamwork  Grieving for our patients, attending memorials David F. Giansiracusa MD, Palliative Care Update, Sustaining Our Ability to Provide Palliative Care

54.  Supportive verbal group modalities  Psychodrama / play therapy / art therapy  Recreational music  Exercise

62.  Jerome Stone author of Minding the Bedside: Nursing from the Heart of the Awakened Mind Minding the Bedside: Nursing from the Heart of the Awakened Mind