CHAPTER ONE: INTRODUCTION
1.1 Background to the Study
The term “burnout” was identified thirty years ago to describe a state of fatigue and frustration among health and service workers arising from excessive demands on their resources. According to Maslash & Leiter (2008) is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimension of exhaustion, cynicism and inefficacy. Leiter & Maslash (2009) also saw it as a cumulative negative reaction to constant occupational stressors relating to the misfit between workers and their desired jobs. with this understanding it can be deciphered that burnout is a psychological syndrome response to chronic stressors in the work place that leads to, physical & emotional exhaustion, cynicism and detachment and feelings of ineffectiveness and lack of accomplishment. Exhaustion is mainly related to an individual’s experience of stress, which is in turn related to a decline in emotional and physical resources.
According to Leiter & Maslack (2003). “The experience of exhaustion reduces worker’s initiative while progressively limiting their capacity for demanding work” while cynicism refers to a detachment from work in reaction to the overload of exhaustion, and the burnout component perceived professional inefficacy refers to the feelings of ineffectiveness and lack of achievement productivity at work and also lack of confidence in one’s work. Most workers in the health sector have encountered occupational stressors in their working environment that often makes them care professionals such as the Doctors, Nurses, lab scientists, pharmacists, social workers and psychologists (Leiter & Malash 2009).
When an individual is psychologically burned out due to occupational stress and depression, frustration set in the working environment and this affects the individuals psychological, physical and mental wellbeing. The nation of wellbeing is examined in two aspects, those being subjective wellbeing and psychological well-being, subjective well-being corresponds to the hedonistic view predicting the individual’s elusion from pain and approach to pleasure, while psychological well-being corresponds to ensuring the individuals personal development and realizing one’s potentials, going beyond the search of pleasure which include psychological and spatial health (Shanhun, 2010).
In recent years increasing attention has been paid to the phenomenon of burnout particularly in human service professions, psychological burnout appears to be a response to interpersonal stressors on the job, in which an overload of contact with people result in changes in attitudes and behaviors towards them (Schaufeh, Leiter & Maslash 2008). Burnout can show up as poor job performance, impersonality with patients and lack of motivation. Health problems such as high blood pressure, insomnia, depression or addiction can also be sign of burnout and it’s as a result most people in the health care professions carry their job home with them; it’s good to really care about your patients. But if you don’t know how to distance yourself at times, it will be a problem “(Synder,2007).
Also burnout which is as a result of prolonged stress in the work place, is globally considered as a risk factor for worker’s health and safety. More specifically the health care, sector is a constantly changing environment, and the working conditions in the hospitals are increasingly becoming demanding and stressful .Several studies; studies focusing on the health sector have shown that health care professionals are exposed to a variety of severe occupational stressors, such as time pressure, low social support at work, a high work load, uncertainty concerning patient treatment and predisposition to emotional responses due to exposure to suffering, frustration, depression anxiety and anger, and in this case health care workers are at a high risk of experiencing severe distress, burnout and both mental and physical illness . (Peterson, Demerouts, Bergstom, Samielsson, Asbsg, & Nigren, 2008).
According to Demerouti, Bakker, Nachrainer & Schaufele (2001), the syndrome of burnout is more prevalent among human service providers. The two core dimensions of burnout can be distinguished as emotional exhaustion and depersonalization. Burnout is a syndrome characterized by emotional exhaustion that results in depersonalization and decreased personal accomplishment at work. The emotional exhaustion clinicians may develop a sense of cynical detachment from work and view people, especially patients as objects, such that clinicians no longer feel effective at work because they have lost sense of their ability to contribute meaningfully in the past few years, the growing prevalence of burnout syndrome among health care personal has gained attention as potential threat to health care quality and patient safety.
Burnout is common among health care workers and the characteristics of the health care environment contributing work processes, role conflict and poor relationship between groups and with leadership, when these are combined with leadership and personal disposing factors and the emotional intensity of clinical work, they put clinicians at risk. Burnout is viewed as a threat to patient’s safety because depersonalization is presumed to result in poorer interaction with patients, clinicians aremore likely to subjectively rate patient’s safety lower in their organization and to admit having mistaken or delivered standardized care at work.
Burnout complaints among nurses have not been consistently related to occupational species stressors such as confrontation with death and dying and interactions with difficult situations. More specifically, psychological burnout has three syndromes which are emotional, depolarization and a reduced sense of personal accomplishment that can occur among individuals who work with people in some capacity. As described above, burnout is studied in three different types, “emotional” this refers to over extended and drained by one’s contact with other people” depersonalization “this refers to an unfeeling and callous response towards people who are usually the recipients of one’s service or care and reduced personal accomplishment” this refers to a deadline in one’s feeling of competence and successful achievement in one’s work with people. These three aspect of syndrome have been the causes and outcomes.
Burnout individuals simultaneously experience high levels of chronic fatigue, and distance themselves emotionally and cognitively from their work activities employees with higher levels of burnout are more likely to experience a hold range of psychological and physical health problems including anxiety, depression, sleep disturbance, memory impairment (Peterson, Demerouts, Bergstom, Samielsson, Asbsg, & Nigren, 2008). Consequently, burnout employees are likely to display one or more withdrawal behaviours such as lateness, absence or turnover according to (Maslach, Schaufeli & Leiter 2001). Clinically, burnout employees may get justified absence leaves from work. However other burnout employees remain at work which leads to a form, existence more psychological and physical health problems, and this influences their behavior at work in a significant way.
(Picco, 2017) emphasizes on occupational burnout which is characterized by exhaustion, lack of enthusiasm and motivation, feeling of ineffectiveness which may also have the dimension of frustration or cynicism, and as a result reduces efficacy within the workplace. Bakker, Demerouti & Sanzvergel (2014), emphasizes on the antithesis of burnout engagement which is characterized by energy involvement and efficacy, (the opposite of exhaustion, cynicism and inefficacy). According to Bakker et al (2014), the causes of burnout are generally divided into two categories situational factors and individual factor situational factors include job demands and lack of job resources. Job demands are aspects of the job demands and lack of job resources. Job demands are aspects of the job that requires strenuous effort, (Demerouti et al, 2001). Therefore, job demands are associated with psychological and physical costs, such as an increased heart rate and fatigue such symptoms may set the ground for the experience of burnout, because job demands lead to employees to feel exhausted and to psychologically distance themselves from work (Bakker Schaufeli, Sixma, Bosvveld & Van Dierendonck, 2000).
Role ambiguity, role conflict, role stress, stressful events, workload and work pressure are among the most important job demands that cause burnout (Akercon, 2011). Individual factors which are concerned with both socio-economic status and personality variables have been analyzed as creating a predisposition to suffer from burnout symptoms.
Also (Leiter & Maslach, 2005) maintained that the sources of burnout at work are lack of control which entails that there is high job demands in combination with low control and that there is a disconnection between the workers care value and the care values of the organization, the next sources of burnout is insufficient reward which entails that the workers may feel being taken for granted not recognized and under compensated, this entails demanding employees to engage in more work activities, one employee can carry out the work in which three or more people are supposed to carry out and they are not properly rewarded for, this can lead to burnout, work overload is another source of burnout which entails that the workers workload is too much, too complex or too important to be ignored. Maslach, Schaufeli, & Leiter (2001), burnout can be caused by stressors in which a person is unable to cope with fully. Occupational burnout often develops slowly and may not recognized until it has become severe, when one’s expectation about a job and its reality differs burnout can begin, how pressure is dealt with, determine how much stress someone feels and how close they are to burnout. One individual can experience few stressors, but be unable to handle the pressure well and thus experience burnout. Another person however can experience a far greater number of stressors but affectively deal with them and avoid burnout. According to Sorenson & German (2013), the most recent Gallup survey on employee engagement entails that 50% of worker’s report being not engaged, while another 20% report being actively disengaged. Another source of burnout is unfairness which entails that employees are treated unfairly, that there is a culture of favoritism, assignment fashion and discussed behind closed doors.
Breakdown of community is a source of burnout which entails that workers have to work with patronizing colleagues, and that there is no mechanism or conflict resolution and that feed-back is non-existence (MC Pherson, Smith-Lovin & Brashears, 2006). The perception of an inequitable work environment might also lead to burnout, in addition to the work environment in the industries ,some personal characteristics or individual differences also, appear to predict burnout, these include both demographical and dispositional variables.
Alarcon, Eschleman, & Bowling (2009), found out that four of the big five factors of personality, which are emotional stability, extraversion, conscientiousness and agreeableness were consistently negatively related to each of the three dimensions of burnout. Further, individuals high in self-efficacy, optimism and self-esteem were better able to deal with job demands, most likely because they believe they have control over their work environment, and therefore are more likely to proactively solve problems and seek resources when facing job demands, one possible explanation for the negative link between burnout and performance is that exhausted employees lack the concentration needed to perform well, and therefore make more mistake. One problem that is evident from the literature and follows logically from observation is that burnout coincides with impaired job performance and that burnout predicts increased job demands overtime (Bakka et al, 2014). Several studies have been attributed to psychological burnout such as expectation, self-concept, self-esteem and self-actualization (Den, 2001).
This study considers variables such as personal functioning and behavior among health workers. Due to high rate of health workers encountering psychological burnout arising from occupational stress, anger, frustration, depression and sadness in the health sectors, the purpose of this study is focusing on how to cope and function maximally so that it would not lead to burnout. One of the variables of interest that can influence psychological burnout is personal functioning. It has to do with adaptive coping strategies and healthy way of dealing with stress. The subjective assessment of personal functioning is that some people believed that it is best not to think about a troublesome issue, thought, feelings as getting upset about it may only make the issue worse. In some instances, this will be true depending on how you react to situations, inability to deal with stress, anxiety, or troubling issues as it arises to feel a whole range of emotions about any given situations is healthy but it is what you do in reaction to this emotion however can be unhealthy.
According to Sarafino, (2012), stress is when an individual perceives a discrepancy between the physical or psychological demands of a situation and the resources of his or her psychological or social systems. There are many ways of coping with stress, their effectiveness depends on the type of stressors, the particular individual involved and the circumstances. There are two types of coping responses which are emotional focused and problem focused. Emotional focused coping involves trying to reduce the negative emotional responses associated with stress such as embarrassment, fear, anxiety, depression, and frustration.This may only be the only realistic option when the source of stress is outside the person’s control. Problem focused coping ,target the cause of stress in practical ways which tackles the problem or stressful situation that is causing stress, problem focused strategies aim at removing or reducing the causes of the stressors including problem solving, time management and obtaining instrumental social support.
Personal functioning and Psychological burnout
The ability of health workers to adapt and make use of coping skills is very beneficial to them , coping occurs in response to psychological stress which is usually triggered in an effect to maintain mental health and emotional well-being coping strategies are the behaviors, thoughts and emotions that can be used to adjust the environment by health workers. The inability of the health workers to employ the different coping skills that will help them to cope and adapt to the changes and the unwelcome situations that they encounter in their working environment may bring about burnout, but if health workers make use of different coping skills that will help them adapt to the changes they faced in their working environment, such may hinder the occurrence of burnout and may help them to function personally.
The coping strategies in which the health workers should adapt include self-control, sharing emotions with other co-workers when they face stressful situations and also when they are depressed. Self-control entails engaging in positive thinking, tolerance and forced acceptance, using positive thinking to overcome negative thoughts when health workers make use of this coping strategy, it may help them in reducing tension and stress. Other coping strategies health workers may use to reduce tension and stress include ignoring negative feelings, and thoughts. workers may use these to reduce tension and stress, an also ignoring negative feelings thought stopping and avoiding stressful situations. If the health workers can cope in other to bring about a positive personal functioning, it may be helpful because work stress depression, anxiety and fear are the major predictors that can make health workers to be psychological burnout. Research has shown that burnout is accompanied with diverse types of problems which can affect the health workers physical and psychological well-being as well as their health conditions. The ability of the health workers to cope with occupational stressors would hinder the occurrence of burnout but the inability of the health workers to cope with occupational stressors may trigger the occurrence of burnout.
Behavior type and Psychological Burnout
Unwelcome situations can make health workers not to be happy and prolong encountering of this unpleasant and frustrating situations in the work environment can trigger burnout which, affects the health workers well-being, psychologically and psychically. The inability of the health workers being faced with challenging situations in the work environment to regulate their emotions positively can lead to burnout thus behavior type goes a long way to determine whether burnout will occur among health workers if the environment does not correspond with their personality but when the health workers are able to use different coping strategies to cope with stress and unwelcome situations despite their behavior type, it can hinder the occurrence of burnout among health workers.
Thornton & Ryckman (2011), maintained that the ability of health workers to cope with day to day functioning in the worker place irrespective of their behavior type will hinder the occurrence of burnout in response to chronic emotion strain in daily interactions with clients. Human providers may feel emotionally over stretched and drained by the interactions with other people. A way of coping with this is emotionally distancing oneself from them. Decrease involvement and also by reducing empathy. This detached attitude or depersonalization may vary from nurses concerning their patients as impersonal objects. As a result, human service professionals are unable to perform adequately which in turn may result in a decline in the feelings of professional efficacy.
Since health workers with type A behavior are more competitive, aggressive, they always want to achieve a lot in a short period of time, and when they are not able to achieve what they thought of achieving in a short period of time they will be sad and long encountering of this would lead to burnout compared to those with type B behavior, but if the health workers despite their type of behavior employed the different coping skills, it would go a long way to hindering the occurrence of burnout.
1.2 Statement of Problem
The negative impact of psychological burnout on individuals has remained prevalent throughout history. Increasing demands of our time make job burnout a major factor that most employees have to contend with, the inability of the health workers, to cope, with stress and unwelcome situation in their working environment and their inability to function personally have become a major factor that triggers burnout, in our everyday life one requires motivation to carryout various degree of tasks. One of the most important factors that lead one to his or her goals is motivation drive. Thus to be motivated is a constant need when health workers are motivated in terms of paying them salary to match their desire and also lowering work overload like health workers carring out a job which is supposed to be carried out by two or five people, when all these is compromised for it would lower the experience of burnout, for every individual there is a driving force.
In fact, it’s not just a single factor, but a combination of factors that lead people to achieve and alien. Health workers working in health sector are properly motivated in terms of rewards such as paying them salary that match their desire, and also lower the rate of encountering workload because when an individual with type A behavior pattern do not accomplish what the desire to achieve in a speculated time they desire they would be depressed, sad, angry and long experience of these unpleasant and unwelcoming situations would leads to the experience of burnout and it can even make them develop hypertension and coronary heart disease.
To what extent will personal functioning determine burnout among public health workers?
To what extent will type A and B behavior determine burnout among public health workers?
To what extent will personal functioning and behavior type lead to burnout among public health workers?
1.3 Purpose of Study
The general aim is to examine if personal functioning and behavior type will influence burnout among public health workers.
While the specific aim of the work is as follows:
To examine, if personal functioning will lead to burnout among public health workers.
To examine; if behavior type would lead to burnout among public health workers.
To determine if personal functioning and behavior type can jointly lead to burnout.
1.4 Significance of the Study
Burnout is common among public health care workers. Characteristics of the health care environment, including time pressure, lack of control over work processes, role conflict, and poor relationships between groups and with leadership, combine with personal predisposing factors and the emotional intensity of clinical work to put clinicians at high risk, until recently estimates for the prevalence of burnout ranged from 10%-70% among nurses and 30% – 50% among physicians, nurse practitioners, and physician assistants. In late 2015, a study conducted by the Mayo Clinic, in partnership with the American Medical Association, found that more than half of American physicians now have at least one sign of burnout, a 9% increase from the group’s prior results in a study conducted 3 years earlier. Burnout is viewed as a threat to patients safety because depersonalization is presumed to result in poorer interactions with patients.
Clinicians with burnout are more likely to subjectively rate patient safety lower in their organizations and to admit to having made mistakes or delivered substandard care at work. Thus a number of influential organizations, including the American Medical Association and the Mayo Clinic, have highlighted burnout as a priority. This Annual perspective summarizes studies published in 2015, with a particular focus on the relationship between burnout and patient safety and interventions, and probable causes and victims burnout among clinicians. Specially the significance of this study will be as follows:
The findings of this study will be of importance to employees during selection and placement, so as to place and hire applicants whose behavior type are well matched to the available job in order to avoid job burnout; which in turn leads to low productivity and high worker turn over.