Burnout in the ICU : potential consequences for staff and patient well-being

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Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ)

<p>Abstract</p> <p>Background</p> <p>Burnout is a mental condition defined as a result of continuous and long-term stress exposure, particularly related to psychosocial factors at work. This paper seeks to examine the psychometric properties of the Shirom-Melamed Burnout Questionnaire (SMBQ) for validation of use in a clinical setting.</p> <p>Methods</p> <p>Data from both a clinical (319) and general population (319) samples of health care and social insurance workers were included in the study. Data were analysed using both classical and modern test theory approaches, including Confirmatory Factor Analysis (CFA) and Rasch analysis.</p> <p>Results</p> <p>Of the 638 people recruited into the study 416 (65%) persons were working full or part time. Data from the SMBQ failed a CFA, and initially failed to satisfy Rasch model expectations. After the removal of 4 of the original items measuring tension, and accommodating local dependency in the data, model expectations were met. As such, the total score from the revised scale is a sufficient statistic for ascertaining burnout and an interval scale transformation is available. The scale as a whole was perfectly targeted to the joint sample. A cut point of 4.4 for severe burnout was chosen at the intersection of the distributions of the clinical and general population.</p> <p>Conclusion</p> <p>A revised 18 item version of the SMBQ satisfies modern measurement standards. Using its cut point it offers the opportunity to identify potential clinical cases of burnout.</p

Working conditions, work-life conflict and wellbeing in UK prison officers: the role of affective rumination and detachment

Although prison officers experience the working conditions associated with work-life conflict, little research has explored this issue. This study draws upon the work-home resources model (ten Brummelhuis & Bakker, 2012) to investigate relationships between working conditions (demands and experiences of aggression) and time-based, strain-based and behavior-based work-life conflict in UK prison officers (n = 1,682). Associations between working conditions, work-life conflict, and emotional exhaustion were also examined. Two recovery behaviors (affective rumination and detachment) were considered as potential moderators of associations between working conditions and emotional exhaustion. High levels of all work-life conflict dimensions were found which were related to working conditions and emotional exhaustion. Some evidence was found that higher rumination and lower detachment exacerbated the positive association between both job demands and aggression and emotional exhaustion. The implications of the findings for the wellbeing and professional functioning of prison officers are discussed, together with key areas for future research

Testing cross-lagged relationships between work-related rumination and well-being at work in a three-wave longitudinal study across 1 and 2 years

The aim of this three‐wave longitudinal study conducted among 664 Finnish employees was to examine the cross‐lagged relationships between various work‐related ruminative thoughts (affective rumination, problem‐solving pondering, lack of detachment from work) during off‐job time and employee well‐being (exhaustion, vigour). We tested normal, reversed, and reciprocal temporal relationships across 1 and 2 years using structural equation modelling. The analyses lent most support to the reversed temporal relationships, showing first that high exhaustion predicted low problem‐solving pondering 2 years later and second, that high vigour predicted low affective rumination both 1 and 2 years later. In addition, a normal temporal relationship was supported in one model, indicating that high affective rumination predicted high exhaustion 1 year later. Thus, our study suggests that affective ruminative thoughts, in particular, play a negative role in cross‐lagged relationships. On the basis of our results, occupational health interventions intended to reduce both affective work‐related rumination and exhaustion and to increase vigour at work are desirable.peerReviewe

Two-tier charging in Maputo Central Hospital: Costs, revenues and effects on equity of access to hospital services

<p>Abstract</p> <p>Background</p> <p>Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations.</p> <p>Methods</p> <p>A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures.</p> <p>Results</p> <p>The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital.</p> <p>Discussion</p> <p>While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around.</p> <p>Conclusion</p> <p>We conclude that the observed lack of transparency may create scope for an inequitable cross subsidy of private customers by public resources.</p

What happens when employees are furloughed? A resource loss perspective

Furloughs refer to placing employees on a temporary leave with no pay for the period of the leave. The current study draws from conservation of resources (COR) theory to examine how furloughs affect employees’ experiences of burnout, work–family conflict, and life satisfaction. Results gathered from 212 individuals show that being furloughed during the 2013 U.S. federal government shutdown was associated with perceived personal resource loss, which was related to decreased life satisfaction and increased work–family conflict and physical, cognitive, and emotional burnout 5 weeks after the shutdown ended. The relationships between furlough status and all outcomes were fully mediated by perceived resource loss. Our findings show that furloughs can and do negatively affect employees and that these effects last long after the furlough has ended

Community syndicalism for the United States: preliminary observations on law and globalization in democratic production

two structural labor crises for developed economies: 1) The channeling of substantial investment into non-productive, paper commodities, reducing growth of production for use and therefore reducing available aggregate job creation; and 2) The continued exportation of industrial jobs to other lower cost jurisdictions, and outsourcing, automation, just-in-time production, and speed-ups associated with global supply chains. As a result, local communities and regional populations have destabilized and even collapsed with attendant social problems. One possible response is Community Syndicalism – local community finance and operating credit for industrial production combined with democratic worker ownership and control of production. The result would increase investment directly for production, retain jobs in existing population centers, promote job skilling, and retain tax bases for local services and income supporting local businesses, at the same time increasing support for authentic political democracy by rendering the exploitive ideology of the Public/Private distinction superfluous. Slowing job exportation may reduce the global race to the bottom of labor standards and differential wage rates reducing the return to producers of value and increasing the skew of income distribution undermining social wages and welfare worldwide. Community Syndicalism can serve as moral goal in an alternative production model focusing incentives on long term stability of jobs and community economic base

Occupational stress in health professionals: a study with Portuguese Nurses

Este trabalho analisa o estresse ocupacional em 286 enfermeiros de hospitais e centros de saúde portugueses. Avaliaram-se as fontes de estresse, o burnout, os problemas de saúde física, a satisfação e a realização profissional. Os resultados apontaram 30% de enfermeiros com experiências significativas de estresse e 15% com problemas de exaustão emocional. As análises de regressão múltipla apontaram maior capacidade preditiva das dimensões de estresse na exaustão emocional, na saúde física, na satisfação e na realização profissional. As análises comparativas evidenciaram maiores problemas de stresse e reacções mais negativas ao trabalho nas mulheres, nos enfermeiros mais novos e com menor experiência, nos trabalhadores com contratos a prazo, nos profissionais que realizam trabalho por turnos e nos que trabalham mais horas.This work analyses occupational stress in 286 nurses from hospitals and health care centres in Portugal. The following dimensions were evaluated: stress, burnout, physical health problems, satisfaction and professional fulfilment. Results revealed significant stress experiences in 30% of the professionals, and emotional exhaustion problems in 15%. Multiple regression analysis pointed out stress as an important predictor of emotional exhaustion, physical health, satisfaction and professional fulfilment. Comparative analysis suggested more occupational stress and professional negative experiences in the following groups: female nurses, younger and less experienced nurses, those with short-term working contracts, nurses working on a shift-basis system, and nurses working during long hours.(undefined

Stress ocupacional e alteração do Estatuto da Carreira Docente português

Este estudo foi realizado com 1162 professores, tendo como objetivo analisar a experiência de stress e a síndrome de “burnout”, antes a após a alteração do Estatuto da Carreira Docente em Portugal. Assim, foram efetuadas duas avaliações em momentos temporais distintos, assumindo-se um plano transversal de recolha de dados (2004/2005, n=689 e 2008/2009, n=473). O protocolo de avaliação incluiu medidas de fontes de stress (Questionário de Stress nos Professores, Gomes, Silva, Mourisco, Mota, & Montenegro, 2006) e de “burnout” (Inventário de “Burnout” de Maslach – Versão para Professores, Maslach, Jackson, & Leiter, 1996; Maslach, Jackson, & Schwab, 1996, Adaptação de Gomes et al., 2006). Os resultados indicaram que a experiência de stress e de “burnout” aumentou entre as duas avaliações, verificando-se em 2008/2009 aumentos em áreas relacionadas com as pressões de tempo/excesso de trabalho e com o trabalho burocrático/administrativo e, inversamente, diminuições em áreas relacionadas com as diferentes capacidades e motivações dos alunos. Quanto à predição da síndrome de “burnout”, não se verificaram alterações substanciais nas variáveis preditoras nos dois momentos. Em síntese, os resultados indicaram aumentos nas exigências profissionais dos professores, mas não se pode afirmar que tal se deva às alterações do Estatuto da Carreira Docente uma vez que não observámos alterações no stress associado à carreira docente.(undefined

Stress ocupacional no ensino : um estudo com professores dos 3º ciclo e ensino secundário

Este trabalho foi realizado com 689 professores portugueses, a leccionarem nos terceiro ciclo e ensino secundário. Foram avaliados indicadores de stress, “burnout”, saúde física e satisfação profissional. Observaram-se valores significativos de stress ocupacional (perto de 40%), e de “burnout” (10% na exaustão emocional, 3% na baixa realização pessoal e 1% na despersonalização), vários problemas de saúde física e valores de insatisfação profissional perto dos 20%. As análises de regressão múltipla apontaram diferentes variáveis preditoras para as três dimensões do “burnout” (62% de variância explicada na exaustão emocional, 16% na realização pessoal e 13% na despersonalização). As análises discriminantes e “t-test” para amostras independentes demonstraram maior stress ocupacional nas mulheres, nos professores mais velhos, nos profissionais com vínculos profissionais mais precários, nos professores com mais horas de trabalho e com mais alunos em sala de aula. No final, apresentam-se as limitações do estudo e as implicações para a investigação futura.(undefined