Agri-14880-Experimental and Clinical Studies-Tertemiz
Agri-14880-Experimental and Clinical Studies-Tertemiz
Agri-14880-Experimental and Clinical Studies-Tertemiz
doi: 10.14744/agri.2019.14880
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ORIGINAL ARTICLE
Özet
Amaç: Palyatif bakım çalışanları acı, ızdırap, ölüm, keder, yas gibi yükü ağır kavramlarla sürekli temas halindedir. Palyatif çalı-
şanlarında bakım süreçlerine eşlik etmeleri nedeniyle tükenmişlik sendromunun görülmesi daha sıktır.
Gereç ve Yöntem: Çalışmaya palyatif bakım çalışanları ile dahiliye ve nöroloji servisi çalışanları olarak toplam 47 kişi katıldı.
Katılımcılar palyatif bakım çalışanları (Grup P) ve dahiliye ve nöroloji servisinde çalışanlar (Grup A) kabul edildi. Çalışmaya katı-
lanlara Maslach tükenmişlik ölçeği, BECK anksiyete depresyon ölçeği ve Stres Belirtiler Ölçeği kullanıldı.
Bulgular: Kırk yedi sağlık çalışanı ölçekleri doldurmayı kabul etti. Her iki grupta da duygusal tükenme ve duyarsızlaşma puanı
yüksek, kişisel başarı puanı ise düşük olarak bulundu. BECK anksiyete depresyon ölçeğine göre orta düzeyde anksiyete bulgu-
su mevcuttu. Ancak bilişsel-duyusal, fizyolojik ve ağrı yakınmaları ile stres belirtileri Grup A’da daha yüksekti.
Sonuç: Tükenmişlik, sağlık çalışanlarının karşı karşıya olduğu önemli bir sorundur. Özellikle palyatif bakım biriminde çalışan
sağlık personelinde stres belirtileri ile bilişsel-duyusal, fizyolojik ve ağrı yakınması daha fazladır. Tükenmişlik nedenlerinin dü-
zeltilmesine yönelik yapısal düzenlemeler yapılması çalışan sağlığını olumlu etkileyecektir.
Anahtar sözcükler: Beck Anksiyete Ölçeği; tükenmişlik; palyatif bakım; Maslach Tükenmişlik Envanteri; Stres Değerlendirme Ölçeği.
Correspondence: Dr. Oktay Faysal Tertemiz. Balıkesir Atatürk Devlet Hastanesi, Palyatif Bakım Servisi, Balıkesir, Turkey.
Phone: +90 - 312 - 202 42 77 e-mail: [email protected]
© 2020 Turkish Society of Algology
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death and grief.[2] As the number of patients requir- The present study aimed to reveal the differences in
ing palliative care increases day by day, the chal- the signs of burnout and stress between palliative
lenges and stress experienced by healthcare workers care workers and those working in neurology and
grows even larger, and this leads to physical, psycho- internal disease clinics.
logical and emotional challenges among healthcare
workers that if left untreated, may result in burnout. Materials and Methods
[3]
Burnout syndrome was first described by Herbert
The study was initiated after approval was obtained
Freudenberg,[4] and Maslach and Leiter later extend-
from the local ethics committee (registration no:
ed the description to define three dimensions of
2017/103), and was conducted as a single-center
burnout, being: emotional burnout, desensitization
study including individuals aged between 18 and
and lack of personal success in the workplace.[5] In 60 years, who were employees in the palliative care
addition to the negative effects on the professional, units, internal disease clinics or neurology clinics
family and social lives of workers, burnout syndrome of Balikesir Ataturk City Hospital. All subjects par-
can also have negative consequences on physi- ticipating in the study provided written informed
cal health, and in this regard, it represents a social consent. Those who refused to participate in the
and economic problem that is associated with high study, those who worked in the relevant clinics
costs. This syndrome is particularly common among for less than two months, and physicians were ex-
healthcare professionals working in clinics with a cluded from the study. The study included nurses,
high rate of mortality.[6] Negative effects have been midwifes, housekeeping personnel and healthcare
reported in nurses who provide care to moribund personnel. Physicians responsible for palliative
patients, who have reported feeling unprepared, care were excluded from the study, as they were
particularly due to a lack of knowledge.[7] Burnout is involved in the planning of the study. Data regard-
one of the most common problems among health- ing the age, gender, profession, years at work and
care providers working in oncology clinics, and regular medication use of the participants was re-
managers of oncology units should be aware of the corded.
potential for the development of burnout syndrome
among their workers.[8] The subjects participating in the study were divided
into two groups. Group P included palliative care
The Maslach Burnout Inventory evaluates burnout in workers, and Group A consisted of workers in the
three dimensions, including Emotional burnout (EB), internal disease and neurology clinics. The subjects
reflecting personal overload; desensitization (DS), who agreed to participate in the study completed
defined as an insensitive and careless approach to the Maslach burnout inventory, the BECK anxiety de-
those in care; and personal success (PS), related to pression scale and SAM. The Group P consists of 25
the sufficiency and success in problem solving.[9] The personnel and Group A consists of 22 personnel.
Maslach Burnout Inventory consists of 22 questions,
with answers reported on a scale of 0–4.[10] The valid- The statistical analysis was performed using SPSS
ity and reliability of the Turkish scale havebeen dem- for Windows Release 22.0 software. Qualitative data
onstrated previously.[11] The BECK anxiety depression was compared with a Chi-Square test, and para-
scale is used to determine the frequency of anxiety metric data was checked for normal distribution
signs. There are 21 categories of signs, each con- with a Kolmogorov-Smirnoff test. Normally distrib-
sisting of four options, and each item is scored on uted data was compared with a Student t-test, and
a scale of 0–3.[12] The Turkish adaptation of the scale a Mann-Whitney U-test was used to compare the
has been assessed, and validated.[13] The Stress Ap- abnormally distributed data. A repeated measures
praisal Measure (SAM) is a four-item Likert-type mea- variance analysis or Friedman test was used to com-
surement tool consisting of 38 questions (1=Never, pare measurements recorded continuously from the
2=Occasionally, 3=Frequently, 4=Always). Based on baseline. Parametric data was presented as mean
a factor analysis performed by Hovardaoglu, the and standard deviations, and non-parametric data
scale assesses three factors: cognitive-sensorial, was presented as percentages (%). P values of <0.05
physiological and pain complaints.[14] were considered statistically significant.
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Are signs of burnout and stress in palliative care workers different from other clinic workers?
The mean EB, DS and PS scores measured from the Figure 1. Comparison of total score of SAM, and scores for cog-
nitive-sensorial, physiological and pain complaints between the
Maslach Burnout Inventory were not statistically
two groups.
significantly different between the two groups. The Group P: Palliative care unit workers; Group A: Workers in internal diseases
mean EB, DS and PS scores in Group P were 30±9, and neurology clinics; SAM: Stress appraisal measure total score; PCS: Pain
complaint score; PhCS: Physiological compliant score; CSCS: Cognitive-senso-
11±4 and 30±5, respectively, and in Group A, the rial complaint score; mean±SD; *p<0.05.
mean EB, DS and PS scores were 33±8, 10±3 and
30±4, respectively.There were no statistically signifi- scale indicated a moderate level of anxiety in both
cant differences between the two groups. groups, while cognitive-sensorial, physiologic and
pain complaints, as well as signs of stress, were more
The mean scores from the BECK anxiety depression pronounced among the palliative care workers.
scale in Group P and A were 19±12 and 17±11, re-
spectively, and was not statistically significant. Burnout is generally considered to be a syndrome
that presents with emotional burnout, desensitiza-
Among the factors measured by SAM, the cognitive- tion and a decrease in the sense of personal success.
sensorial complaint scores were 30±8 and 25±6, the
[5]
Workers suffering from burnout and a lack of com-
physiologic complaint scores were 18±4 and 15±3, passion may have a negative influence in units pro-
viding care to patients who require compassionate
and the pain complaint scores were 17±4 and 14±3,
care, and this may result in symptoms of emotional
in Groups P and A, respectively. The total scores of
burnout anddecreases in job performance.[1]
SAM were calculated as 74±18 and 62±13 in Groups
P and A, respectively. The cognitive-sensorial, physi-
Signs of burnout, which can manifest as interper-
ological and pain complaint scores and the overall
sonal sensitivity, depression, hostility and paranoid
SAM score were significantly higher in Group P than
thoughts are common among healthcare profes-
in Group A (Fig. 2).
sionals. Global Severity Index and Positive Symp-
tom Total index scores among healthcare workers
Discussion was elevated.[15] Burnout syndrome may lead to
EB scores were elevated and DS scores were at mod- such physical symptoms as chronic exhaustion and
erate level in both groups of workers, and the differ- gastrointestinal complaints; emotional signs like
ences were not statistically significant. PS scores, on apathy, desensitization and irritability; social ef-
the other hand, were found to be increased in both fects, such as isolation and loss of interest in pre-
groups. The scores of the BECK anxiety depression viously enjoyed activities; an absence of spiritual
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awareness; reluctance to provide care to certain pa- among palliative care personnel was found to be
tients, a reduced willingness to come to work and lower than among intensive care unit personnel.[18]
low performance.[16]
While the reduced level of desensitization was a
Due to the increase in life expectancy with medi- rather positive finding of thisstudy, the same can-
cal improvements, the number of patients with ad- not be said for emotional burnout. The difference in
vanced incurable diseases is continuously on the these findings may be attributable to the differences
rise, which increases the need for palliative care.[3] in cultural values and judgments, as well as the per-
The expectations and demands from healthcare pro- sonal lives of the participants or their working condi-
viders can be rather high in palliative care units, and tions. The relatively high scores in personal success,
the risk of burnout is known to be higher in workers on the other hand, may be related to the willingness
interacting with moribund patients.[17] Rizo-Baeza re- of the workers to carry out their jobs and their self-
ported previously that working for more than eight perception as being successful.
hours a day, having a single parent, moderate or high
levels of workload, occupational quality of life defi- Moreover, the fact that palliative care workers pro-
ciency and low level of self-care were factors that in- vide care to patients with various long-term and
crease the prevalence of burnout syndrome among difficult-to-treat diseases in the fields of internal
palliative care workers.[6] Psychological, emotion- diseases and neurology may have led to the similar
aland spiritual relief is also decreased if the workers Maslach and BECK results, and these outcomes may
perceive their workplace as being over-challenging also be affected by the continuous on-the-job train-
and demanding.[3] Previously reported incidences of ing and experience-sharing meetings undertaken by
burnout syndrome among palliative care workers palliative care workers.
have varied between 16 and 62% in literature,[18,19]
and this wide range may be attributed to differences The causes and outcomes of burnout should be
in the investigated sub-groups, working conditions evaluated on an individual basis, and personnel who
and cultural differences. experience burnout should be supported both insti-
tutionally and personally. Patient-specific treatment
Görgülü et al. Examined the burnout levels of all should be planned that may include stress manage-
the staff of the hospital (doctors, nurses, contract ment, medical treatment or psychotherapy.
staff, cleaning, cooking, and maintenance). The EB is
25.79, the DS is 11.40, PS is 24.30 calculated.[20] The In addition to these options, regular training an-
scores in our study were higher than in this study. dmedical treatments are applied in our hospital;
This shows that burnout is more severe. A correlation whereas Cognitive Behavioral Therapy (CBT) and
has been identified between emotional overload EMDR (Eye Movement Desensitization and Repro-
and the BECK depression scale.[21] cessing) have not been tried to date. For the follow-
ing steps, studies can be planned to reduce burnout
In the present study, signs of burnout were noted and stress through EMDR.
in both groups, although the scores of cognitive-
sensorial complaints, physiologic complaints, pain Despite the negative findings, it was satisfying to
complaints and total scores obtained from SAM note that personal success scores were high in this
were found to be increased among palliative care study, and this may be attributable to the fact that
workers. Moreover, according to the BECK Anxiety- the study participants performed their jobs with
Depression Scale, signs of moderate anxiety were compassion and considered themselves successful.
present in both palliative care workers and the work-
ers in internal disease and neurology clinics. This study has a number of limitations. First of all, the
number of subjects included in this study was lim-
In a study comparing the level of burnout among ited, and they may provide biased answers when fill-
intensive care unit and palliative care unit workers ing out thequestionnaires. That said, this may have
found higher levels of burnout among intensive little influence on the findings, as the questionnaires
care unit personnel. Additionally, the risk of burnout were not applied during face-to-face interviews. Ad-
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Are signs of burnout and stress in palliative care workers different from other clinic workers?
ditionally, this study did not categorize the partici- 2. O’Mahony S, Gerhart JI, Grosse J, Abrams I, Levy MM. Post-
pants based on their occupations, meaning thatthe traumatic stress symptoms in palliative care professionals
seeking mindfulness training: Prevalence and vulnerabil-
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Ethics Committee Approval: The Balıkesir University 14. Hovardaoglu, S. Stres Belirtileri İle Durumsal ve Sürekli
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Conflict-of-interest issues regarding the authorship or
chopathology in palliative care unit health professionals.
article: None declared.
Palliat Support Care 2018;16(3):286–97. [CrossRef ]
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has received no financial support. 2015;45(7):48–51. [CrossRef ]
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