Interventions Against Burnout in Mental Health Nursing

interferences Against Burn erupt in noetic wellness c atomic number 18 forAre raisingal interventions effective in reducing the relative incidence of burnout among ami commensurate wellness nurses?A critical look into of the literary worksAbstr run downplay thither is frequently evidence to attach burnout with noetic wellness treat, exclusively bound empirical evidence that examines the mend of educational interventions on the incidence of burnout in psychical wellness nurses.Aim The aim of this literature appraise was to critic entirelyy judge the literature relating to educational interventions associated with burnout in cordial wellness nursing recitation selective and comparative analysisMethod The anticipate strategy affect the use of nearly(prenominal) electronic schoolingbases, and a subroutine library search to gateway relevant journals. Search terms and inclusion/ ejection criteria ar identified. Evaluative criteria (Price 2003) were ap plied to a critical analysis of the literature.Findings on that point is limited empirical seek in this atomic number 18a some of it is prophetical rather than evaluative.Conclusions Despite the paucity of info, in that location atomic number 18 some pie-eyed arguments for the use of educational interventions to reduce the incidence of burnout in genial wellness nurses. There be entailments for further look to be carried out in this area.BackgroundBurnout is defined as a state of stirred up exhaustion, attach to by a mind of low self- worth (Peveler et al 2000), urgency of motivation and a physical as well as stirred, sense of ill- wellness (Malach-Pines 2005). It tends to involve an insidious transition of cumulative accent (Morrisette 2002a). Burnout is some often associated with human- service ( financial aiding) professions (Ekstedt and Fagerberg 2005) and frequently, it is those who urinate a high level of loading to their transaction, who are most at ris k (van Dierendonck D et al 2005).There is much evidence indoors the literature that links cordial health nursing with burnout ( Barling 2001 Coffey 1999 Duquette et al 1994 Edwards et al 2000 Fagin et al 1995 Happell et al 2003 Harper and Minghella 1997 Kipping 2000 Prosser et al 1999a Onyett 1997 Wykes et al 1997). Although burnout is associated with distinct types of nursing (Nolan and Smojkis 2003) kind health nurses in particular, are reported to be at high risk (Nolan et al 1999 Thomsen et al 1999a). Suggested reasons for this high level of vulnerability to underline and burnout are that the profession attracts volume who wee-wee a predisposition to mental health difficulties themselves (Guppy and Gutteridge 1991) and that working with masses with severe mental illness is so breedful that a stagecoach of transference sack up occur between the patient and health master (particularly if the latter is in getd) (McLeod 1997). The directionors associated with mental hea lth nursing are further crypticalen if certain factors are present, such as low self- esteem strange demands of home- life, inadequate coping mechanisms (Thomsen et al 1999b) and a lack of job satisfaction, which is oddly associated with hospital, rather than community nurses (Prosser et al 1999b).Many sources propose that burnout is prevent able-bodied (Burnard P 1999 Figley C 2002 J cardinals 2003 Morrisette 2002b Taormina and Law 2000). It is all important(predicate) thitherfore, to raise awareness of prevention strategies. It is doable that these could be incorporated into educational syllabuss and it is suggested that failure to do so undersurface provide in informally learned negative behaviours leading to maladaptive coping strategies (Thompson 2003).AimThe aim of this literature review is to critically prize the literature relating to educational interventions associated with burnout in mental health nursing victimization selective and comparative analysis.Metho dThe search strategy involved the use of the Athens Access Management System in secern to access such entropybases as The British care for Index, CINAHL, the Cochrane library, Evidence- based medicine (EBM) reviews, Embase psychiatry, internurse.com, Medline, Ovid, PsycINFO, Pubmed, ScienceDirect and blow up database. The University library was also use in order to conduct a hand search of such relevant journals as The ledger of psychiatrical and psychogenic Health breast feeding The International journal of Mental Health Nursing Mental Health Nursing Journal of Psychosocial Nursing and Mental Health Services, Journal of advanced Nursing International Journal of Nursing Studies Nurse Researcher and Nursing Research.The search terms and keywords employ were burnout and mental strain in combination with mental health nursing mental health nurses nurses education nurse education educational activity (as it was found that this word was used kinda a lot within the literature) and prevention. The search surgical process highlighted the search terms that were most effective in accessing the relevant information apply trial and error some another(prenominal)wise referred to as a process of screening (Fink 2005a)The inclusion criteria were papers dating back to 1990, the rationale world that a lot of work on burnout was conducted during the 1990s some of it in relation to mental health nursing, which is subdued being cited by make authors search articles addressing the forms of stress and burnout as they relate to mental health nursing research articles linking burnout with nursing, prevention and education as there is limited peculiar(prenominal) information on educational interventions to prevent burnout in mental health nursing, therefore some transferable principles were applied. For the same reason (shortage of particularised information) research articles from other countries were non excluded. Both quantitative and qualitative studies we re include. projection criteria were any papers published before 1990 any articles not indite in the English language any articles not specifically addressing stress and burnout and articles nearly stress and burnout that are not link up to nursing.Evaluative criteria altered from the framework developed by Price (2003) were broadly applied to a critical analysis of the literature. These criteria are Do the papers address my dubiousness? Is the content accessible and comprehensible? Are the research results valid, reliable and reliable? Are there any gaps within the literature and Are there any competing perspectives/ contradictions within the literature? These criteria were supplemented by selective reference to have techniques used, strengths and weaknesses of the research designs, methods of data collection and analysis, ethical aspects and presentation issues (Fink 2005b).FindingsA pass off theme that emerged from the literature in relation to burnout within the helping professions is the concept of emotional childbed, and that education and training can help to make tidy sum more than aware of this phenomenon and to develop strategies to manage it. Emotional crunch is a form of dissonance when the practiti bingler feels under pressure not to pageantry the emotions which are engendered by the nature of their work (Brotheridge and Grandey 2002). There are both levels of emotional labour surface or deep acting (Ashkanasy et al 2006). Surface acting is when the practitioner adopts a behaviour that belies their true emotions whereas deep acting is when they struggle to feel the emotion that is expected of them.Mann and Cowburn (2005) conducted a accept that aimed to increase understanding about the links between components of emotional labour and stress in mental health nursing. 35 mental health nurses finishd questionnaires which yielded information relating to 122 nurse- patient fundamental interactions. Three different published research i nstruments were integrated into the questionnaire the Emotional Labour Scale, the Emotional Labour Inventory (both of which associate more directly to nurse- patient interactions) and the Daily Stress inventory which turn to more general areas of stress. The use of tried- and- tested research instruments helps to ensure cogency and dependableness of the determinations. Published research tools have often been refined several times, with the need to have excellent reliability and validity (Giles 2002). The data was analysed by using Pearsons correlations and multiple regression techniques. The detectives concluded that emotional labour is dogmaticly correlated with both the stress that arises from interactions with patients, as well as other sources of stress that the usurpation of emotional labour is dependent upon the intensity of the interaction and the range of emotions projectd by means ofout the interaction, and that surface acting is a more important predictor of emot ional labour than deep acting. Only one psychiatric unit was involved in the study with a relatively low response rate of 29% low response grade can introduce bias and uncertainty into a study (Smeeth 2002). What constitutes a satisfactory response rate varies according to the nature of the research, til now a 60% response rate business leader be considered to be wide-cut, and a 50% response rate to be adequate (Sim and Wright 2000) although more researchers accept that any response rate over 40% can yield meaningful results. The authors acknowledge that generalisability of the results is limited. interestingly it was the non- cooperation of the unit in general that adversely affected the response rate because of a lack of tractability regarding access to respondents which influenced the methodology, in that it was not mathematical to obtain qualitative data relating to the lived experiences of mental health nurses in relation to emotional labour which capacity have been mo re meaningful, and an unwillingness to allow the researchers to follow- up non- responders. There is an implication here for nurses to become more research aware and for healthcare organisations to stir and support research- mindedness.The intelligence and conclusion are interesting and relevant to the link between education and burnout in relation to mental health nursing. age acknowledging the limitations of the study, the authors do however stress that the findings have important implications for nurse education in that skills training for performing emotional work should be tending(p) a higher priority that an increased focus be located on facilitating self- awareness skills to enable mental health nurses to become more introspective about their steps, so that they can develop effective techniques for traffic with them. However this study does not have the s struggle to be able to empirically demonstrate that educational interventions are effective in preventing burnout. The determine of developing impudent educational strategies in relation to addressing emotional labour (in addition to other issues) for student mental health nurses was more understandably demonstrated by Turner et al (2004). The solve of the study was to evaluate a pilot client attachment scheme for student mental health nurses. The rationale for client attachment is that it enables students to form therapeutic relationships with unmarried clients. This type of educational experience differs from the more traditional route of progressing through different placements. The methodology involved the use of semi- structured interviews to gain the perspectives of students (12), their supervisors (22) and clients (2). Although this is a trivial example, the design was qualitative and a depth of meaningful information was obtainable, particularly from the students and the supervisors. The data was organised using thematic analysis, although this was not potential with the client dat a as there were only cardinal clients and although they gave precise positive feedback, the amount of information was very limited. Service user familiarity in mental health research is a relatively new and developing concept (Telford and Faulkner 2004). This study is relevant to the discussion because it highlighted that different educational burn upes can more effectively promote reflective skills among mental health nurses, which in turn can provide a tool for dealing with emotional labour. The researchers literature review revealed that some mental health student nurses report sources of stress as including not feeling part of a team, and dealing with distressing incidents involving clients. These factors lead to emotional containment, causation cut motivation and increased stress. The client attachment scheme goes some way to addressing these issues by providing more continuity and increased supervision for mental health student nurses. Although the scope and generalisa bility of this study is limited, it flags up important indicators for channelises to be made to the student nurse curriculum that will provide students with the skills to blemish and deal with, emotional labour, which should impact upon more effective stress worry and prevention of burnout.Another study which concludes that heightens should be made to the mental health student nurse curriculum in relation to stress counseling was conducted by Kilfedder et al (2001). They contend that antecedent studies on burnout in nursing contain several methodological inadequacies, and so set out to design a more theoretical study. The study sample was drawn from nurses assiduous in a Scottish National Health Service (NHS) reliance which provided both acute and continuing care mental health serve in both hospital and community settings. 510 nurses returned questionnaires (a response rate of 48.8%). A total of 12 published fliers were used, together with one purpose- designed measure whi ch related to non- occupational stressors. The others related to such aspects as social support, occupational stress, burnout and coping strategies. As previously highlighted, the use of published measures can enkindle reliability and validity. A range of statistical tests were used to analyse the data. high gear levels of emotional exhaustion, depersonalisation and burnout were reported and low levels of personal accomplishment. The researchers concluded that not only should a core part of the nursing curriculum be devoted to stress charge and coping skills, but also that prudence training should incorporate leadership skills that facilitate stress care and that all nurses should be provided with training that equips them to develop coping mechanisms. Education is very much seen by the researchers as an essential part of a comprehensive approach to prevention, which should be emphasised more than the current tendency towards picking up the pieces after the event. This study is quite intricate which tends to affect its accessibility, however its findings have important implications for stress management in mental health nurses.Sharkey and Sharples (2003) evaluated a accomplishment pack on risk management, developed for use with clinical mental health teams with emphasis on the impact the pack had on team members stress. The learning pack was made up of six sections, from distributively one one corresponding with a facilitator- led workshop. Participants were expected to carry out some reading and learning activities between workshops. Interestingly the authors constitute two aspects of risk management that are potential stressors the potential risks of the job such as dealing with violence and having to get to grips with the concept of risk management as a relatively new concept, and the systems involved. The researchers adopted a quasi- data-based approach, using pre and post measures, taken eight weeks before and after the learning intervention, in order to be able to measure any change in relation to work- related stress among the participants, as a result of undermentioned the educational programme. The researchers highlighted difficulties with not being able to conduct a controlled experiment which might have affected the outcome, as it was not possible to be certain that any change was attributable to the educational intervention, as opposed to other factors. Sampling was self- selective which might also have affected the findings, as having volunteered the participants indicated a level of motivation which could have squeeze on the effectiveness of the learning programme. The sample (42) was drawn from two mental health locality teams, which included mental health nurses. The pre and post measures used were the Occupational Stress Indicator and the Healthcare- related Work Pressure Scale. Again, these are tried and tested published instruments, the use of which should contribute to the validity and reliability of the fi ndings. These yield quantitative data which was analysed using descriptive statistics, the paired t -test and the Wilcoxon signed rank test. Once again, it might have been of value to intermingle qualitative with quantitative measures, in order to gain an understanding of the participants experience of stress qualitative methods allow researchers to overcome the assumptions inherent in fixed- cream questionnaires, although these also have their value for example, in relation to information about prevalence (Cummings and Galambos 2004). All 42 participants masterlyd the pre measures( although only 32 started the programme and 27 completed it) together with the post measures. It would have been interesting to identify why almost half of the original sample did not complete the programme whether workload and/ or stress issues contributed to this level of attrition. However it was suggested that quite intensive time commitment was required to complete the programme which might have b een an inhibitory factor and there could be implications for redesigning the programme so that it can be accessed more flexibly by participants. Responses were not down in the mouth down into professional stems- this also might have yielded some important differences. In relation to the Occupational Stress Indicator, comparing pre and post gain indicated that there was a general decrease in many sources of stress. Interestingly lower means at post measures were observed for the job satisfaction sub exfoliation which indicated reduced satisfaction. The researchers suggest that this could be due to increased knowledge and expectations as a result of the learning intervention whether this development could be a source of stress in itself is not speculated upon even though different studies have reported a relationship between stress and reduced job satisfaction (Koslowsky 1998). Scores for the Healthcare- related work pressure scale all show a lowering of item means at post measure. Overall the researchers concluded that the learning intervention brought about positive changes in relation to the work- related stress of the participants in some cases the impact was significant. It is suggested that the ways in which educational interventions can bring about change is by enabling participants to gain knowledge and skills within the safe surroundings of the classroom. A positive outcome of this study is that the learning pack has been modified, avocation feedback from the pre and post measures together with evaluations from the participants, and is now in use.Ewers et al (2002) evaluated the effect of Psychosocial Intervention Training (PSI), using a controlled experiment, in reducing burnout rates in mental health nurses working in solid units, having identified that this assemblage is particularly at risk of developing clinical burnout syndrome. The hypothesis was that if nurses gained a better understanding of clients illnesses and develop more skills to b e able to help clients, then they would experience lower levels of burnout within their clinical roles. A self- selecting sample of 20 volunteered to do the PSI physical body, but these met pre- set inclusion criteria and equal all grades of staff and all wards. 10 subjects were allocated to the experimental PSI radical and 10 to the waiting list control group. Baseline measures of knowledge were taken, using a 30- item multiple choice questionnaire which had been used in previous studies of attitudes, using a measure developed by one of the researchers and of burnout, using the Maslach Burnout Inventory. It was not clarified whether the attitude measure had been tested for reliability and validity, whereas the other two measures are tried and tested. The experimental group received 20 days of PSI training. On completion of the course all subjects were asked to complete the measure of knowledge, attitudes and burnout. The facilitator had previously received advanced training in PS Is. The course includes both practical and theoretical assessment components and a minimum attending of 80% was required. The data was analysed using Fisher Exact tests and t tests. The results showed that there was a significant difference in the knowledge scores for each group, with an increase in the knowledge of the experimental group. The same applied to the measurement of attitudes, which it is assumed (although not made clear by the authors) refers to an increase in positive attitudes for the experimental group. Again, the same applied to the burnout measure this time the results are expressed more clearly in that the experimental group had move in a positive direction along the subscales measured by the Maslach Burnout Inventory. The limitations of this study are that the results might not be generalisable to other units as only one unit was involved in the study wherein specific factors might exist that contribute to the development of burnout. As with the previous study , the self- selecting nature of the participants might indicate that they were more highly motivated and more antiphonary to change. However, while acknowledging the methodological weaknesses, the researchers conclude that the significantly positive changes in knowledge, attitudes and burnout measures of participants within the experimental group are indicative of the value of educational interventions in reducing the incidence of burnout among mental health nurses working within secure units.Ho (2007) describes a study which lookd the value and meaning of a psychodynamic work discussion for mental health nurses, which is described as a method of working, learning and development in professional practice. A work discussion group can enable psychological and emotional containment for mental health nurses which can impact upon the prevention of burnout. While the work discussion group is a means of learning in itself, education about the psychodynamic processes involved is also neces sary in order to unlock the potential of the group. A qualitative design was used in order to be able to explore the feelings, experiences and perceptions of the participants, which seems highly appropriate within a study of this kind. data was collected from a focus group of 6 mental health nurses ranging from staff nurse to ward manager level. This is quite a small sample, however this is often more acceptable within qualitative research as depth rather than breadth of information is being sought. It is principally considered that the ideal composition of a focus group is between 6-12 people, however when the nature of the subject could be emotionally charged or sensitive, it is best-loved to limit the size of the group to 5 or 6 (Polit and Beck 2004). The data was analysed using Bulmers framework, a technique derived from grounded theory in order to define meaning through focus groups. This article is quite complex but comprehension has been facilitated by the presentation, in tables and boxes, of the categories and themes within which the discussion was structured. The purpose of the focus group (which was not immediately made clear) was not to act as a work discussion group but to explore the potential for its value with mental health nurses, and the group appeared to be in the main responsive to the concept. The author concludes that mental health nurses could benefit from this approach, but would need encouragement and education and that the use of the work discussion group could be integrated into nurse education. The researcher acknowledges that the potential use of this approach postulate to be explored further, with larger samples from a wider area.Lee (2005) evaluated the effectiveness of a stress management training intervention for care assistants working in a residential home for the elderly many of whom had dementia, having cited research which links condole with for people with dementia with work- related stress. The study took place with in one residential home. The training consisted of a three- day programme that aimed to create and save an effective work environment by managing stress and stressful situations. The researcher provides an outline of the course content but does not state how many participants there were or how she measured the effectiveness of the programme, despite including sections headed methods and findings. She reports that the stress management training reduced the care assistants levels of stress and improved their ability to cope with potentially stressful situations. She also concluded that the age or experience of the care assistants did not have an impact on their stress levels or coping ability, which did not concur with the findings of a different study. This is a ailing written research article the lack of detail reduces its value. However abandoned the paucity of research related to educational interventions for mental health workers, it still adds to the existing body of knowledg e. An interesting development is that the researcher subsequently contacted 21 residential homes and found that only 3 provided training interventions related to stress management.ConclusionsAn extensive review of the literature has revealed that there are gaps in the literature relating to educational interventions to reduce the incidence of burnout in mental health nurses this finding is supported in a review by Edwards and Burnard (2003), who concluded that while there is evidence that stress is a problem for mental health nurses, research on interventions to address this, is insufficient. Many articles on this subject are literature reviews, drawing on broad- based research in related areas, with a definite lack of empirical studies, and these reviews have not been included here. It has been necessary to include studies which predict that educational interventions will reduce the incidence of burnout in mental health nurses as well as those which evaluate existing interventions (which are very few). There are implications for further research into this important area. However there are some interesting and rich conclusions that can be drawn from the existing literature.A synthesis of this review of the literature yields the following outcomesThere is a link between emotional labour and burnout, and adopting strategies (including educational) to enable mental health nurses to recognise and deal with emotional labour (including self- awareness and reflective skills) should impact upon the prevention of burnout.Educational interventions aimed at reducing the incidence of burnout should take place both within pre fitting programmes and as part of continuing professional development (CPD).Educational interventions are an important part of a comprehensive strategy to reduce the incidence of burnout among mental health nurses.As well as focussing on stress management, educational interventions can also be used to lift knowledge and skills (relating to for exam ple, risk management and helping skills) which in turn, positively impact upon stress levels and coping skills.A range of educational approaches should be explored in relation to stress management, allowing for innovation and flexibility, to facilitate access for mental health nurses, who may feel inhibited by such factors as discharge patterns, workload or lack of resourcesReferencesAshkanasy N, Zerbe W and Hartel E. 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