By Dr. Stefano Casali
What is Burn-Out?
Some authors identify it with the specific work stress of helping professions, others state that burn-out differs from stress due to depersonalization, which it gives rise to, which is characterized by an attitude of indifference, malevolence and cynicism towards the recipients of own working activity (AA.VV, 1987.).
Burn-out can also be understood as a particular strategy adopted by the operators to counteract the condition of work stress determined by an imbalance between work demands / needs and available resources. (Agostini L.et Al.1990; Cherniss C., 1986).
Subject to Risk
The concept of burn-out (literally burned, exhausted, erupted) was introduced to indicate a series of phenomena of fatigue, attrition and unproductiveness of work recorded in workers included in professional activities of a social nature (Bernstein Gail; Agostini L, 1990). This syndrome was first observed in the United States in people who had different professions of help : nurses, doctors, teachers, social workers, policemen, psychiatric hospital operators, childcare workers.
Currently there is no universally shared definition of the term burn-out. Cherniss (Cherniss, 1986), with " burn-out syndrome " defined the individual response to a work situation perceived as stressful and in which the individual does not have adequate resources and behavioral or cognitive strategies to cope with it.
Events
According to Maslach (Maslach, 1992; Maslach C., Leiter P., 2000), burn-out is a set of psychological and behavioral manifestations that can arise in operators who work in contact with people and who can be grouped into three components : emotional exhaustion, depersonalization and reduced personal fulfillment.
Emotional exhaustion
Emotional exhaustion is the feeling of being emotionally drained and canceled out of one's work, due to an emotional drying up of the relationship with others.
depersonalization
Depersonalization is an attitude of estrangement and rejection (negative and rude behavioral responses) towards those who request or receive professional service, service or care. (Contessa G., 1982).
Reduced personal achievement
The reduced personal fulfillment concerns the perception of one's own inadequacy at work, the fall of self-esteem and the feeling of failure in one's work.
Symptoms
The subject affected by burn-out manifests
- non-specific symptoms (restlessness, sense of tiredness and exhaustion, apathy, nervousness, insomnia),
- somatic symptoms (tachycardia, headaches, nausea, etc.),
- psychological symptoms (depression, low self-esteem, guilt, feeling of failure, anger and resentment, high resistance to going to work every day, indifference, negativism, isolation, feeling of immobility, suspicion and paranoia, rigidity of thought and resistance to change, difficulties in relations with users, cynicism, a guilty attitude towards users). (Pellegrino F, 2000. Rossati A., Magro G., 1999.).
Complications and Consequences
This situation of distress often leads the person to abuse alcohol or drugs.
The negative effects of burnout do not only involve the individual worker but also the user, who is offered an inadequate service and less humane treatment.
Causes
Individual variables, socio-environmental and labor factors contribute to the burn-out. For the onset of burn-out, socio-organizational factors may be important, such as the expectations connected to the role, interpersonal relationships, the characteristics of the work environment, the organization itself of the work (Sgarro M., 1988.). In addition, the relationships between master data variables (gender, age, marital status) and onset of burn-out were studied. Among these, age is the one that gave rise to more discussion among the different authors who dealt with the subject. Some argue that advanced age is one of the main burn-out risk factors while others believe that burnout symptoms are more frequent in young people, whose expectations are disappointed and crushed by the rigidity of work organizations. (Cherniss C., 1986; Contessa G., 1982.). Among the specialists, those most at risk for burnout are those who work in general medicine, occupational medicine, psychiatry, internal medicine and oncology. The results therefore seem to indicate a polarization between "higher burn-out specialties", where chronic, incurable or dying patients, and "lower burn-out specialties" are often dealt with, where patients have a more favorable prognosis.
Phases leading to Burnout
The onset of the burn-out syndrome in health professionals generally follows four phases .
- The first phase ( idealistic enthusiasm ) is characterized by the motivations that led the operators to choose a work of assistance type: that is conscious motivations (to improve the world and themselves, safety of employment, carry out a less manual work and of greater prestige) and unconscious motivations (desire to deepen self-knowledge and to exercise a form of power or control over others); these motivations are often accompanied by expectations of "omnipotence", simple solutions, general and immediate success, appreciation, improvement of one's status and others.
- In the second phase ( stagnation ) the operator continues to work but realizes that the work does not fully satisfy his needs. In this way we move from an initial super-investment to a gradual disengagement.
- The most critical phase of the burn-out is the third ( frustration ). The dominant thought of the operator is that he is no longer able to help anyone, with a profound sense of uselessness and non-compliance of the service with the real needs of the user; as additional frustration factors there is the poor appreciation both of the superiors and of the users, as well as the conviction of inadequate training for the type of work performed. The frustrated subject can assume aggressive attitudes (towards himself or towards others) and often puts into practice escape behavior (such as unjustified withdrawals from the ward, prolonged pauses, frequent absence due to illness. The gradual emotional disengagement resulting from frustration, with passage from empathy for apathy, constitutes the fourth phase, during which we often witness a real professional death (Rossati A., Magro G.1999; Maslach C., 1992).
