The most significant health issue currently facing critical care nurses is burnout syndrome among the critical care nurses. This condition is a psychological state resulting from prolonged exposure to job stressors. The condition is characterized by a loss of interest and energy in ones job. When nurses and other service professionals experience burnout syndrome, they have decreased motivation for reporting to work the next day.
Burnout is commonly associated with work-related emotional and interpersonal stressors and is measured in three general scales; depersonalization, emotional exhaustion, and a lack of perceived personal accomplishment (Boyle, 2011). Health care professionals who fell overloaded, isolated, or unappreciated are at risk of both burnout and emotional fatigue. Compassion fatigue in this context involves excess identification and empathy with a patients suffering where the nurse is unable to maintain a healthy balance between empathy and objectivity. This excessive empathy results in a depletion of the caregivers emotional resources ultimately leading to a withdrawal from patient care and disengagement with the patients. Some symptoms of this condition include sleep disruption, headaches, cardiovascular disease, increased blood pressure, immune dysfunction, as well as anger, irritability, fatigue, and depression.
This situation is serious since ICUs are characterized by very high levels of work related stress and tensions all of which increase the risk for burnout syndrome. Research has shown severe burnout syndrome by the Maslach Burnout Inventory is present in 50% of all critical care physicians and about 33% of all critical care nurses which makes it a fairly widespread phenomenon. The studies have shown that in physicians, burnout syndrome mostly happens to those with a high number of working hours, measured by number of night shifts and duration since the last vacation. Nurses, on the other hand, experience, burnout syndrome resulting from end-of life related characteristics and ICU organization. An additional factor identified as a cause for burnout syndrome are ICU conflicts regarding the best procedures for patient care.
Socio-Environmental factors affecting Burnout Syndrome
The intensive care unit is a specialized area in a hospital for critically ill patients. This environment is highly mechanized, has a high nurse patient ration, and often, the work is stressful and demanding. Since the inception of the ICU, literature has identified it as a highly stressful environment. The use of state of the art medical technology such as artificial respirators, oxygen sensors, suction machines, and infusion pumps for critically ill patients makes it an emotionally charged atmosphere. These machines, combined with the patients noises makes nurses to remain hyper alert and may even affect them when they are off duty.
Another reason for the high prevalence of burnout syndrome among nurses is the constant environment of death and dying. ICU nurses face death on a daily basis. This may be unusually hard on their emotions as some patients may fail to recover and the nurse, or medical professional would experience a sense of failure. Furthermore, the attitudes towards death can be complex for each individual and are influenced by a persons fears, anxieties, and personal attitudes. Some patients in the ICU can also linger for long periods either before death or recovery thereby forming a bond with the nurse and their relatives. All of these are emotional stressors especially considering the nurse is already working in a stressful environment and becomes more taxing with emotional family members blaming the medical staff for not doing enough when a patient fails to recover. This kind of emotionally taxing work has many associated challenges. The nursing staff have to provide effective care to patients and their emotionally distraught families with little to no formal training on how to do so (Meier & Beresford, 2006). It is hard for nurses to enable patients to maintain a sense of composure in the face of death as it is emotionally draining. This situation is worse when the patient is emaciated, under pain, has open sores, or convulsions. Wenzel et al., (2011) conducted a study which concluded that the responsibility associated with giving treatments to patients that negatively affected the patients quality of life, even temporarily, resulted in increased caregiver stress and feelings of powerlessness and hopelessness.
The third factor causing burnout syndrome are the long working hours and common staff shortages. In most medical institutions, the medical personnel are far less than the number of patients. This is especially true for qualified nurses and doctors who work in the hospital ICUs. The staff shortage results in long working hours and increased shifts which mean that the nurses are away from their families for long stretches of time. Sometimes, nurses have to skip breaks or work overtime to ensure that everything runs smoothly which results in a situation where the nurse is exhausted both mentally and physically. Additionally, the heavy workload usually leads to high staff turnover rates thus increasing the workload for the existing staff thus resulting in a never ending cycle of new staff constantly experiencing burnout and resigning.
Another factor identified as contributing to burnout among critical care nurses is disillusionment. In most cases, nurses working in the ICU are usually in conjunction with qualified doctors who handle all the technical aspects of a patients care. However, in most cases, the nurses decision making capacity is severely limited especially in conducting invasive procedures related to a patients treatment.
Consequences of Burnout
Burnout among both physicians and nurses is associated with lower effectiveness at work, reduced commitment to the job, and decreased job satisfaction. It is also associated with an intention to leave ones job. In recent studies in France, most of the health care professionals surveyed with a high level of burnout stated their intention to leave their jobs (Embriaco et al., 2007). Among these nurses, there were also symptoms of depression and poor quality of private life which eventually resulted in absenteeism and eventually job turnover. High levels or burnout are also associated with decreased level of patient satisfaction and increased strain on professional relations through the professionals causing greater personal conflict and disrupting normal tasks.
From past studies, the performance of an ICU and the hospital in general depends on several factors such as the organizations cultural context, managerial practices, individual wellbeing, job satisfaction, and the intention to quit (Embriaco et al., 2007). Therefore, predicting and preventing burnout syndrome is of top priority to a health care institution so as to continue providing quality patient care and have effective treatment outcomes. With an exception of certain demographic factors, most working conditions and professional relationships can be improved through the reduction of stressors. In the past, individual strategies have been employed with limited success. These strategies include relaxation, stress inoculation training, rational emotive therapy, teambuilding, training in interpersonal and social skills, and medication. All of these strategies are aimed at enhancing the capacity of workers to cope with their job demands.
Critical Social Theory
The critical social theory is a school of thought that stresses the importance of performing reflective assessments and critiques of society through the application of knowledge from the humanities and social sciences. Originally devolved by Karl Marx and popularized by the Frankfurt school of thought. Critical social theory is increasingly used in nursing and health care in general to guide the review and improvement of health care practices. In nursing, the critical social theory implies that once a theory is imparted or a policy enacted, it should be put into practice and continually aim to improve it by considering feedback. That is, the application of the social theory to nursing implies that they should break their professions nature of docility, and submissiveness and instead speak up to help improve the practice. In this context, the nurses can now consider the social cultural contexts of a patient to offer appropriate health care. This translates into them being able to understand the social inequalities related to health and then transforming these situations through innovative application of the existing health care knowledge which reflects in greater equity in health care.
The critical social theory provides a philosophical framework for viewing phenomena in their sociopolitical contexts. One important aspect of this theory is the assumption that knowledge acquisition and understanding allows people to liberate themselves from exploitation and thus create opportunities for affecting change. One offshoot of this theory is the theory of communicative action which posits that discourse takes place within the setting of collective cultural traditions. Communicative action is the process of achieving understanding through discourse. This theory is based on the assumption of an ideal situation where discourse is unconstrained and undistorted by power. Therefore, in communicative action, participants within a particular culture make statements in attempting to reach consensus. As this process continues, the participants have two choices in that they can either accepting their traditions unchallenged or grabbing the opportunity to change their traditions through reinterpretation. This theory is especially applicable to the nursing profession where even though theory shows the need for a global perspective, it is often constrained by the traditional models of health care delivery.
Solutions to Health Care Issue
While Burnout Syndrome may seem like the norm for healthcare situations, a look at the consequences shows that medical professionals should make it a priority concern when deciding on managerial practices and decisions. Recent studies show that burnout and work stressors in acute care are not universal and that staff in the acute care section can actually experience less burnout as compared to their colleagues in other disciplines. They have also show that the presence of emotional stressors and heavy workload as the main causative factors of Burnout Syndrome. Conflicts in professional relationships and sub optimal team work results in significant barriers to the provision of medical care. The relationship between the nurses and doctors in the ICU may be a significant source of stress especially when there are unclear role definitions and non-functional communication processes.
Power and Peace Process
Chinns (2015) power and peace process refers to a way of working with other people cooperatively and equitably in ways that nurture each individual and strengthen the group as a whole which facilitates dealing with conflict in a context of mutual understanding and peace. This approach has been used successfully in many groups worldwide which include classrooms, volunteers, and even families.
The process begins with the principles of solidarity where the group forms shared commitments and values which form the foundation for all the other parts of the process. The next stage is the check in where each person shows an ability and commitment to join in the process and state their expectations for the group. The third step in the process is the concept of rotating leadership where everyone can participate as both a follower and a leader. In the discussion, the person currently speaking is the leader while the others are the followers. The participants share s...
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