The Pathophysiology of Burnout

Introduction 

Many people get into the nursing profession with the impression that they are going to make a difference in the world by getting people better. Unfortunately, it is not always that black and white, nurses do not always have the privilege of experiencing events to their moral, emotional, or spiritual ideations of patient outcome and treatment. Those that work in locations with regular exposure to trauma, death, and dying face greater emotional distress than those that do not. Facing these daily challenges and providing care that goes against one’s moral beliefs can trigger emotional and spiritual exhaustion, which leads to burnout and compassion fatigue when there is inadequate coping and resilience.

Burnout What is Burnout? Burn out is analogous to a disorder, that is caused by emotional exhaustion; which manifests into job dissatisfaction and decreased productivity (Russell, 2016). 

The pathophysiology of burnout is a result of moral distress that leads to emotional and spiritual turmoil due to daily exposures of trauma, death, and dying. The stress of moral responsibility to the patient and their family while carrying out a plan of care with the perception of moral wrongdoing can elicit burnout. With poor coping mechanisms to address the emotional and spiritual needs of the nurse and the strain of a fast-paced environment related to caring for trauma patients daily impairs professional satisfaction from their work. To achieve this, the nurse needs to be resilient when they feel their morality is questioned by working on their psyche (Rushton, Schroeder, & Donohue, 2015). Burnout prevention Burnout is found to be related to coping strategies. Those that report lower levels of personal accomplishment in their work had higher levels of burnout. 

Co-worker relationships have a significant influence on burnout and it was found in the study that ED and Intensive Care Nurses tend to have negative relationships with each other which sets the stage for poor work environments and more time spent in direct patient care leading to higher levels of burnout (Hinderer, VonReuden, Friedmann, McQuillan, Gilmore, Kramer, & Murray, 2014). So, cultivating good co-worker relationships will set a better work environment for support resources that correlate with the wellbeing of the nurses. When burnout is high patient satisfaction is low (Hinderer, VonReuden, Friedmann, McQuillan, Gilmore, Kramer, & Murray, 2014). Those suffering from more moral distress have higher levels of burnout. When unable to manage stress, anxiety, depression, and social dysfunction feel powerless and evaluate themselves as inefficient and a failure leading to reduced job satisfaction which leads to diminished work effectiveness and increased levels of burnout and stronger feelings of self-resignation. To combat burnout issues of moral distress, need to be confronted for proper support of psychological empowerment improving perceptions (Ozbas & Tel, 2015). 

Increase in burnout can result in the nurse to provide less supportive and compassionate care (Russell, 2016). Compassion fatigue What is compassion fatigue Compassion fatigue is a result from direct multiple exposures to the trauma of others. Nurses like many others, when exposed to a traumatic event, will experience residual effects, but with the exception that trauma nurses are repeatedly exposed to trauma in high-stressed environments daily in their work environment (Russell, 2016). Obsorn et al. refers to these exposures as critical incidents that cause strong emotional reactions that can interfere with the ability of function. The many variables that contribute to the reaction are: previous exposures to incidents, length of time of exposure, the severity of the exposure, and perception of the event (Osborn, et al., 2014 2076). It creates a detachment from themselves and the care that they provide impairing rapport with patients (Russell, 2016). 

Hinderer et al. study Chronic unacknowledged stress causes us to avoid meaningful interactions with patients leading to feelings of failure, increased poor outcomes and errors and the desire to quit out jobs or profession. The leading cause is having a lower emotional self-awareness, caring for challenging patients, futile care, work environment stressors, personal experience triggers compassion fatigue. The Emergency Nurses Association indicates that compassion fatigue is correlated with nurse burnout leading increased sick days used and nurses leaving the profession. Compassion fatigue causes consequences that impact the workplace and ma lead nurses to have psychological and physiological signs and symptoms, witnessing traumatic multiple times increases the sympathetic nervous system response to high stress situations. The response translates into mental, physical, emotional distress for the nurse. From all the human pain, trauma, tragedy that nurses strive to alleviate patients and their family members can deplete one’s ability to recover from the events. 

When a nurse reaches this point, it becomes impossible to treat patients and themselves with compassion. Some of the signs of compassion fatigue are anxiety, poor judgment, restless, lack of compassion or numbness, depression, or avoidance. Compassion fatigue prevention Personal/environmental characteristics, coping strategies, and exposure to traumatic events determine the level compassion fatigue. Their study found with stronger support systems, use of exercise and meditation, positive co-worker relationships have higher satisfaction. The need to develop self-care strategies assist in avoiding compassion fatigue. (Hinderer, VonReuden, Friedmann, McQuillan, Gilmore, Kramer, & Murray, 2014). The ENA states that a nurse needs to combat compassion fatigue through self-care mindfulness self reflection. Personal hobbies is correlated with increased compassion satisfaction and decreased compassion fatigue. Mindfulness stress decreasing tenique, self reflection to remember what drew us into nursing is another wa to stay grounded in psotivie thinking. 

A healthy work environement is believed to be beneficial for patient safey and gives a support system for nurses. How to combat burnout/compassion fatigue Studies have found a significant association between skipped, shortened, or interrupted breaks or lunches increased patient to nurse ratio was found to increase burnout and emotional exhaustion of nurses (Russell, 2016). Resilience helps mitigate moral distresses and burnout, adapt coping strategies to minimize distress with external activities, developing problem solving skills, prayer, physical exercise help lessen the impact of traumatic experiences. Cultivating self-efficacy, hope has been found to protect against burnout and moral distress (Rushton, Schroeder, & Donohue, 2015). 

According to the Academy of Medical Surgical Nurses, resiliency helps nurses cope with their stressful work environment and minimizes the moral distress caused by emotional exhaustion and burnout. Resiliency helps the nurse respond better during stressful situations because ineffectively dealing with the physical emotional or mental stress leads to nursing burnout. Burnout affects how the nurse feels about a job which impacts the patient and facility with compassion fatigue and turnover rates. Work environment has a significant impact on a nurse’s resiliency. Personal traits also affect the ability of a nurse to bounce back from stress to help with resiliency with mindfulness, stress reduction, relaxation techniques, time management, organizational skills, cognitive reframing, critical reflection, conflict resolution, emotional intelligence team building. The American Nurses Association reports that new nurses feel overwhelmed and are unprepared to cope with the psychological, social, and spiritual needs of their patients. Thus, placing them at a high risk of burnout. 

The direct adverse effect is the impact on productivity and engagement in the workplace. The way to combat this is through resilience and motivation eve Self-care-plan Adequate sleep and rest, caring for self-outside of work, be able to separate work from home, reach out to support system. Proper self-care will in turn project a better quality of care. Overall taking time away from the unit to take care of myself so I can be better equipped to care for their patients. Conclusion The nursing profession is known to be a high burn out job. It has been found that nurses who work in high stress units have a higher chance of burnout and compassion fatigue. Nurses outlook, personality, and performance all impact their patients. Burnout and compassion fatigue has been found to decrease in quality of care provided by that nurse. New grads are also ones that were found to result in burnout and compassion fatigue sooner, and longer termed nurses have better resilience. 

Understanding the causes of burnout and compassion fatigue can enable nurses to take necessary preventive steps to resist this through recognizing the development of burnout and compassion fatigue (Hinderer, VonReuden, Friedmann, McQuillan, Gilmore, Kramer, & Murray, 2014). When nurses experience burnout it results in a substandard quality of care to the patients (Russell, 2016). Overcoming burnout and compassion fatigue cannot be achieved from just one intervention. Addressing and strengthening ones psyche and reliance requires multiple coping strategies, and realizing if things do not go as planned, then it needs to be changed but the goal should always remain the same. Basic psychologic care such as a well-balanced diet, rest, exercise and maintaining good health is important for a healthy psyche. It is important to establish a life outside of work by creating hobbies and having friends and resources that are not work related. My plan to combat burnout and compassion fatigue This provides a good foundation to be healthy psychically and mentally.

I established my plan to combat burnout and compassion fatigue from my multiple years in the healthcare field through trial and error, I have found what works for me and I will continue to implement that plan. It is important to take care of ourselves and realize it is ok to be selfish sometimes. As nurses we are continually giving ourselves to our patients and their families, it is a profession of giving whether it be care, compassion, or knowledge; and remembering the reasons why we entered the profession and not losing that through hard days is key. Remembering the ones we helped get better, the handful of thankyou letters or kind words of appreciation from past and present patients to remind us of our purpose and use that to keep us grounded to why we chose to be nurses in the first place. Breakup the monotony of work with vacations. It is important to recharge and remove oneself from work for an extended period. Having a vacation no less than twice a year to free ones mind of work and responsibilities so we can return refreshed and ready for the challenges of work. The vacation will rejuvenate ones physical and psychological stress. Having a support person to speak to is an important asset to have. 

Did you like this example?

291

12