Burnout and ‘stress of conscience’ among healthcare personnel

Abstract

Title. Burnout and 'stress of conscience' among healthcare personnel Aim. This paper reports a study examining factors that may contribute to burnout among healthcare personnel. Background. The impact on burnout of factors such as workload and interpersonal conflicts is well-documented. However, although health care is a moral endeavour, little is known about the impact of moral strain. Interviews reveal that healthcare personnel experience a troubled conscience when they feel that they cannot provide the good care that they wish -and believe it is their dutyto give. Methods. In this cross-sectional study, conducted in 2003, a sample of 423 healthcare personnel in Sweden completed a battery of questionnaires comprising the Maslach Burnout Inventory, Perception of Conscience Questionnaire, Stress of Conscience Questionnaire, Social Interactions Scale, Resilience Scale and a personal/work demographic form.Results. Regression analysis resulted in a model that explained approximately 59% of the total variation in emotional exhaustion. Factors associated with emotional exhaustion were 'having to deaden one's conscience', and 'stress of conscience' from lacking the time to provide the care needed, work being so demanding that it influences one's home life, and not being able to live up to others' expectations. Several additional variables were associated with emotional exhaustion. Factors contributing to depersonalization were 'having to deaden one's conscience', 'stress of conscience' from not being able to live up to others' expectations and from having to lower one's aspirations to provide good care, deficient social support from co-workers, and being a physician; however, the percentage of variation explained was smaller (30%). Conclusion. Being attentive to our own and others' feelings of troubled conscience is important in preventing burnout in health care, and staff need opportunities to reflect on their troubled conscience. Further research is needed into how a troubled conscience can be eased, particularly focusing on the working environment.

Social support in the workplace for physicians in specialization training

“…The results showed that the physicians in specialization training perceived many functions of social support in their work. Considering earlier studies [11–13,18,19], it is not surprising that the stress-management function strongly emerged in the data. In several earlier studies, a covariation was revealed between physicians’ coping skills and social support [6–12]; this connection was recognized by the physicians in training as well.…”

“…It can prevent psychiatric symptoms and common mental disorders [14,15] and has a protective function against possible suicidal intentions [16,17]. Low social support from co-workers is associated with emotional exhaustion [18,19]. Interestingly, when there are low co-worker support and limited possibilities to control one’s job, physicians are more likely to experience poor psychological well-being than other healthcare professionals [20].…”

Ethics and Values in Clinical Practice: Whom Do They Help?

“…Work overload and exhaustion are 2 such impediments and are well-recognized contributors to burnout. 9,12 Incongruence of values, as studied by Leiter et al, 13,14 and moral strain, as studied by Glasberg et al, 15 are other means or pathways to burnout that are less well recognized. These occur when health care professionals sense a lack of alignment between their own values and those they perceive to be the values of various health care-related organizations or groups with which they are associated.…”

“…Glasberg et al 15 have emphasized that health care is a moral undertaking. Health care professionals they have studied experience "[a] troubled conscience when they feel that they cannot provide the good care they wish-and believe is their duty-to give."…”

“…Nonetheless, when the perception of a lack of professional values or unethical care occurs, internal conflicts develop in many health care professionals. Physicians and other health care professionals may find it difficult to reconcile their values with what they perceive to be false, misleading, or hypocritical values of the health care organization, [13][14][15] a situation that illustrates the concept of incongruence of values. The actual values of the larger health care entity, from the physicians' or health care professionals' perspective, may have little to do with professional values such as beneficence, justice, or autonomy.…”