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INFLUENCE OF
PERSONAL FUNCTIONING AND BEHAVIOUR TYPE ON BURNOUT AMONG PUBLIC HEALTH WORKERS
Abstract
The study
investigated influence of Personal functioning and Behavior type on burnout
among public health workers”. Two hundred and thirty-one (231) health workers
comprising of Hundred and one (101) males (44.5%) and Hundred and twenty-six
(126) females (55.5%) were selected from hospitals in Uyo metropolis.
Participants were selected using convenient sampling technique. Their age
ranged between 18 and 62 years with a mean age of 38 years. Maslach Burnout
Inventory -General survey (MBI-GS) developed by Maslach and Jackson, (1986),
Personal functioning Inventory (PFI) developed by John, Brien Wood, Pickering
and Decicco (2003), and Behaviour type inventory developed by Peter Omoluabi
(1997) Were the instruments used for the study. The study was a survey that
used a cross-sectional design. independent t-test, was used for data analysis.
Result revealed that public health workers with high level of personal
functioning did not report higher burnout (Mean=76.19) compared to public
health workers with low level of personal functioning (Mean=76.58), p>0.05,
t = -0.20. Result revealed that public health workers with Type A scored higher
on burnout (Mean=79.48) as compared with public health workers with Type B
behaviour (Mean=73.07) with p < 0.05 (t = 3.48). Result also revealed that
older public health workers scored slightly higher on burnout (Mean=77.06) as
compared with younger public health workers (Mean=75.67) with p > 0.05 (t =
0.74). It was concluded that high level of personal functioning and older health
workers did not predict burnout, type A behavior type predicts burnout am
public health workers in Uyo. Implications and recommendations were made on the
basis of the findings in this study.
CHAPTER ONE:
INTRODUCTION
1.1
Background to the Study
The term “burnout” was identified thirty
years ago to describe a state of fatigue and frustration among health and
service workers arising from excessive demands on their resources. According to
Maslash & Leiter (2008) is a prolonged response to chronic emotional and
interpersonal stressors on the job, and is defined by the three dimension of
exhaustion, cynicism and inefficacy. Leiter & Maslash (2009) also saw it as a cumulative
negative reaction to constant occupational stressors relating to the misfit
between workers and their desired jobs. with this understanding it can be
deciphered that burnout is a psychological syndrome response to chronic
stressors in the work place that leads to, physical & emotional exhaustion,
cynicism and detachment and feelings of ineffectiveness and lack of
accomplishment. Exhaustion is mainly related to an individual’s experience of
stress, which is in turn related to a decline in emotional and physical
resources.
According to
Leiter & Maslack (2003). “The experience of exhaustion reduces worker’s
initiative while progressively limiting their capacity for demanding work”
while cynicism refers to a detachment from work in reaction to the overload of
exhaustion, and the burnout component perceived professional inefficacy refers
to the feelings of ineffectiveness and lack of achievement productivity at work
and also lack of confidence in one’s work. Most workers in the health sector
have encountered occupational stressors in their working environment that often
makes them care professionals such as the Doctors, Nurses, lab scientists,
pharmacists, social workers and psychologists (Leiter & Malash 2009).
When an individual is psychologically
burned out due to occupational stress and depression, frustration set in the
working environment and this affects the individuals psychological, physical
and mental wellbeing. The nation of wellbeing is examined in two aspects, those
being subjective wellbeing and psychological well-being, subjective well-being
corresponds to the hedonistic view predicting the individual’s elusion from
pain and approach to pleasure, while psychological well-being corresponds to
ensuring the individuals personal development and realizing one’s potentials,
going beyond the search of pleasure which include psychological and spatial
health (Shanhun, 2010).
In recent years increasing
attention has been paid to the phenomenon of burnout particularly in human
service professions, psychological burnout appears to be a response to interpersonal
stressors on the job, in which an overload of contact with people result in
changes in attitudes and behaviors towards them (Schaufeh, Leiter & Maslash
2008). Burnout can show up as poor job performance, impersonality with patients
and lack of motivation. Health problems such as high blood pressure, insomnia,
depression or addiction can also be sign of burnout and it’s as a result most
people in the health care professions carry their job home with them; it’s good
to really care about your patients. But if you don’t know how to distance
yourself at times, it will be a problem “(Synder,2007).
Also burnout which is as a result of
prolonged stress in the work place, is globally considered as a risk factor for
worker’s health and safety. More specifically the health care, sector is a
constantly changing environment, and the working conditions in the hospitals
are increasingly becoming demanding and stressful .Several studies; studies
focusing on the health sector have shown that health care professionals are
exposed to a variety of severe occupational stressors, such as time pressure,
low social support at work, a high work load, uncertainty concerning patient treatment and
predisposition to emotional responses due to exposure to suffering, frustration,
depression anxiety and anger, and in this case health care workers are at a
high risk of experiencing severe distress, burnout and both mental and physical
illness . (Peterson, Demerouts, Bergstom, Samielsson, Asbsg, & Nigren,
2008).
According to Demerouti, Bakker,
Nachrainer & Schaufele (2001), the syndrome of burnout is more prevalent
among human service providers. The two core dimensions of burnout can be
distinguished as emotional exhaustion and depersonalization. Burnout is a syndrome
characterized by emotional exhaustion that results in depersonalization and
decreased personal accomplishment at work. The emotional exhaustion clinicians
may develop a sense of cynical detachment from work and view people, especially
patients as objects, such that clinicians no longer feel effective at work
because they have lost sense of their ability to contribute meaningfully in the
past few years, the growing prevalence of burnout syndrome among health care
personal has gained attention as potential threat to health care quality and
patient safety.
Burnout is common among health care
workers and the characteristics of the health care environment contributing
work processes, role conflict and poor relationship between groups and with
leadership, when these are combined with leadership and personal disposing
factors and the emotional intensity of clinical work, they put clinicians at
risk. Burnout is viewed as a threat to patient’s safety because
depersonalization is presumed to result in poorer interaction with patients,
clinicians aremore likely to subjectively rate patient’s safety lower in their
organization and to admit having mistaken or delivered standardized care at
work.
Burnout complaints among nurses have
not been consistently related to occupational species stressors such as
confrontation with death and dying and interactions with difficult situations.
More specifically, psychological burnout has three syndromes which are
emotional, depolarization and a reduced sense of personal accomplishment that
can occur among individuals who work with people in some capacity. As described
above, burnout is studied in three different types, “emotional" this
refers to over extended and drained by one’s contact with other people” depersonalization
“this refers to an unfeeling and callous response towards people who are
usually the recipients of one’s service or care and reduced personal
accomplishment” this refers to a deadline in one’s feeling of competence and
successful achievement in one’s work with people. These three aspect of
syndrome have been the causes and outcomes.
Burnout individuals simultaneously
experience high levels of chronic fatigue, and distance themselves emotionally
and cognitively from their work activities employees with higher levels of
burnout are more likely to experience a hold range of psychological and
physical health problems including anxiety, depression, sleep disturbance,
memory impairment (Peterson, Demerouts, Bergstom, Samielsson, Asbsg, & Nigren,
2008). Consequently, burnout employees are likely to display one or more
withdrawal behaviours such as lateness, absence or turnover according to
(Maslach, Schaufeli & Leiter 2001). Clinically, burnout employees may get
justified absence leaves from work. However other burnout employees remain at
work which leads to a form, existence more psychological and physical health
problems, and this influences their behavior at work in a significant way.
(Picco, 2017) emphasizes on
occupational burnout which is characterized by exhaustion, lack of enthusiasm
and motivation, feeling of ineffectiveness which may also have the dimension of
frustration or cynicism, and as a result reduces efficacy within the workplace.
Bakker, Demerouti & Sanzvergel (2014), emphasizes on the antithesis of
burnout engagement which is characterized by energy involvement and efficacy,
(the opposite of exhaustion, cynicism and inefficacy). According to Bakker et
al (2014), the causes of burnout are generally divided into two categories
situational factors and individual factor situational factors include job
demands and lack of job resources. Job demands are aspects of the job demands
and lack of job resources. Job demands are aspects of the job that requires
strenuous effort, (Demerouti et al, 2001). Therefore, job demands are
associated with psychological and physical costs, such as an increased heart
rate and fatigue such symptoms may set the ground for the experience of
burnout, because job demands lead to employees to feel exhausted and to
psychologically distance themselves from work (Bakker Schaufeli, Sixma,
Bosvveld & Van Dierendonck, 2000).
Role ambiguity, role conflict, role
stress, stressful events, workload and work pressure are among the most
important job demands that cause burnout (Akercon, 2011). Individual factors
which are concerned with both socio-economic status and personality variables
have been analyzed as creating a predisposition to suffer from burnout
symptoms.
Also (Leiter & Maslach, 2005)
maintained that the sources of burnout at work are lack of control which
entails that there is high job demands in combination with low control and that
there is a disconnection between the workers care value and the care values of
the organization, the next sources of burnout is insufficient reward which
entails that the workers may feel being taken for granted not recognized and
under compensated, this entails demanding employees to engage in more work
activities, one employee can carry out the work in which three or more people
are supposed to carry out and they are not properly rewarded for, this can lead
to burnout, work overload is another source of burnout which entails that the
workers workload is too much, too complex or too important to be ignored. Maslach, Schaufeli, &
Leiter (2001), burnout can be caused by stressors in which a person is unable
to cope with fully. Occupational burnout often develops slowly and may not
recognized until it has become severe, when one’s expectation about a job and
its reality differs burnout can begin, how pressure is dealt with, determine
how much stress someone feels and how close they are to burnout. One individual
can experience few stressors, but be unable to handle the pressure well and
thus experience burnout. Another person however can experience a far greater
number of stressors but affectively deal with them and avoid burnout. According
to Sorenson & German (2013), the most recent Gallup survey on employee
engagement entails that 50% of worker’s report being not engaged, while another
20% report being actively disengaged. Another source of burnout is unfairness
which entails that employees are treated unfairly, that there is a culture of
favoritism, assignment fashion and discussed behind closed doors.
Breakdown of community is a source of
burnout which entails that workers have to work with patronizing colleagues,
and that there is no mechanism or conflict resolution and that feed-back is
non-existence (MC Pherson, Smith-Lovin & Brashears, 2006). The perception
of an inequitable work environment might also lead to burnout, in addition to
the work environment in the industries ,some personal characteristics or
individual differences also, appear to predict burnout, these include both
demographical and dispositional variables.
Alarcon, Eschleman, & Bowling
(2009), found out that four of the big five factors of personality, which are
emotional stability, extraversion, conscientiousness and agreeableness were
consistently negatively related to each of the three dimensions of burnout.
Further, individuals high in self-efficacy, optimism and self-esteem were
better able to deal with job demands, most likely because they believe they
have control over their work environment, and therefore are more likely to
proactively solve problems and seek resources when facing job demands, one
possible explanation for the negative link between burnout and performance is
that exhausted employees lack the concentration needed to perform well, and
therefore make more mistake. One problem that is evident from the literature
and follows logically from observation is that burnout coincides with impaired
job performance and that burnout predicts increased job demands overtime (Bakka
et al, 2014). Several studies have been attributed to psychological burnout
such as expectation, self-concept, self-esteem and self-actualization (Den,
2001).
This study considers variables such as
personal functioning and behavior among health workers. Due to high rate of
health workers encountering psychological burnout arising from occupational
stress, anger, frustration, depression and sadness in the health sectors, the
purpose of this study is focusing on how
to cope and function maximally so that it would not lead to burnout. One
of the variables of interest that can influence psychological burnout is
personal functioning. It has to do with adaptive coping strategies and healthy
way of dealing with stress. The subjective assessment of personal functioning
is that some people believed that it is best not to think about a troublesome
issue, thought, feelings as getting upset about it may only make the issue
worse. In some instances, this will be true depending on how you react to
situations, inability to deal with stress, anxiety, or troubling issues as it
arises to feel a whole range of emotions about any given situations is healthy
but it is what you do in reaction to this emotion however can be unhealthy.
According to Sarafino, (2012), stress is
when an individual perceives a discrepancy between the physical or
psychological demands of a situation and the resources of his or her
psychological or social systems. There are many ways of coping with stress,
their effectiveness depends on the type of stressors, the particular individual
involved and the circumstances. There are two types of coping responses which
are emotional focused and problem focused. Emotional focused coping involves
trying to reduce the negative emotional responses associated with stress such
as embarrassment, fear, anxiety, depression, and frustration.This may only be
the only realistic option when the source of stress is outside the person’s
control. Problem focused coping ,target the cause of stress in practical ways
which tackles the problem or stressful situation that is causing stress,
problem focused strategies aim at removing or reducing the causes of the
stressors including problem solving, time management and obtaining instrumental
social support.
Personal functioning
and Psychological burnout
The ability of health workers to adapt
and make use of coping skills is very beneficial to them , coping occurs in
response to psychological stress which is usually triggered in an effect to
maintain mental health and emotional well-being coping strategies are the
behaviors, thoughts and emotions that can be used to adjust the environment by
health workers. The inability of the health workers to employ the different
coping skills that will help them to cope and adapt to the changes and the
unwelcome situations that they encounter in their working environment may bring
about burnout, but if health workers make use of different coping skills that
will help them adapt to the changes they faced in their working environment,
such may hinder the occurrence of burnout and may help them to function
personally.
The coping strategies in which the
health workers should adapt include self-control, sharing emotions with other
co-workers when they face stressful situations and also when they are
depressed. Self-control entails engaging in positive thinking, tolerance and
forced acceptance, using positive thinking to overcome negative thoughts when
health workers make use of this coping strategy, it may help them in reducing
tension and stress. Other coping strategies health workers may use to reduce
tension and stress include ignoring negative feelings, and thoughts. workers
may use these to reduce tension and stress, an also ignoring negative feelings
thought stopping and avoiding stressful situations. If the health workers can
cope in other to bring about a positive personal functioning, it may be helpful
because work stress depression, anxiety and fear are the major predictors that
can make health workers to be psychological burnout. Research has shown that
burnout is accompanied with diverse types of problems which can affect the
health workers physical and psychological well-being as well as their health
conditions. The ability of the health workers to cope with occupational
stressors would hinder the occurrence of burnout but the inability of the
health workers to cope with occupational stressors may trigger the occurrence
of burnout.
Behavior
type and Psychological Burnout
Unwelcome situations can make health
workers not to be happy and prolong encountering of this unpleasant and
frustrating situations in the work environment can trigger burnout which,
affects the health workers well-being, psychologically and psychically. The
inability of the health workers being faced with challenging situations in the
work environment to regulate their emotions positively can lead to burnout
thus behavior type goes a long way to
determine whether burnout will occur among health workers if the environment
does not correspond with their personality but when the health workers are able
to use different coping strategies to cope with stress and unwelcome situations
despite their behavior type, it can hinder the occurrence of burnout among
health workers.
Thornton & Ryckman (2011),
maintained that the ability of health workers to cope with day to day
functioning in the worker place irrespective of their behavior type will hinder
the occurrence of burnout in response to chronic emotion strain in daily
interactions with clients. Human providers may feel emotionally over stretched
and drained by the interactions with other people. A way of coping with this is
emotionally distancing oneself from them. Decrease involvement and also by
reducing empathy. This detached attitude or depersonalization may vary from
nurses concerning their patients as impersonal objects. As a result, human
service professionals are unable to perform adequately which in turn may result
in a decline in the feelings of professional efficacy.
Since health workers with type A behavior
are more competitive, aggressive, they always want to achieve a lot in a short
period of time, and when they are not able to achieve what they thought of
achieving in a short period of time they will be sad and long encountering of
this would lead to burnout compared to those with type B behavior, but if the
health workers despite their type of
behavior employed the different coping skills, it would go a long way to
hindering the occurrence of burnout.
1.2 Statement of Problem
The negative impact of psychological
burnout on individuals has remained prevalent throughout history. Increasing
demands of our time make job burnout a major factor that most employees have to
contend with, the inability of the health workers, to cope, with stress and
unwelcome situation in their working environment and their inability to
function personally have become a major factor that triggers burnout, in our
everyday life one requires motivation to carryout various degree of tasks. One
of the most important factors that lead one to his or her goals is motivation
drive. Thus to be motivated is a constant need when health workers are
motivated in terms of paying them salary to match their desire and also
lowering work overload like health workers carring out a job which is supposed
to be carried out by two or five people, when all these is compromised for it
would lower the experience of burnout, for every individual there is a driving
force.
In fact, it’s not just a single
factor, but a combination of factors that lead people to achieve and alien.
Health workers working in health sector are properly motivated in terms of
rewards such as paying them salary that match their desire, and also lower the
rate of encountering workload because when an individual with type A behavior
pattern do not accomplish what the desire to achieve in a speculated time they
desire they would be depressed, sad, angry and long experience of these
unpleasant and unwelcoming situations would leads to the experience of burnout
and it can even make them develop hypertension and coronary heart disease.
Research
Questions
To what
extent will personal functioning determine burnout among public health workers?
To what
extent will type A and B behavior determine burnout among public health
workers?
To what
extent will personal functioning and behavior type lead to burnout among public
health workers?
1.3 Purpose of Study
The general aim is to examine if
personal functioning and behavior type will influence burnout among public
health workers.
While the
specific aim of the work is as follows:
To examine, if personal functioning will lead
to burnout among public health workers.
To examine; if behavior type would lead to
burnout among public health workers.
To determine if personal functioning and
behavior type can jointly lead to burnout.
1.4 Significance of the Study
Burnout is common among public health
care workers. Characteristics of the health care environment, including time
pressure, lack of control over work processes, role conflict, and poor
relationships between groups and with leadership, combine with personal
predisposing factors and the emotional intensity of clinical work to put
clinicians at high risk, until recently estimates for the prevalence of burnout
ranged from 10%-70% among nurses and 30% - 50% among physicians, nurse
practitioners, and physician assistants. In late 2015, a study conducted by the
Mayo Clinic, in partnership with the American Medical Association, found that
more than half of American physicians now have at least one sign of burnout, a
9% increase from the group’s prior results in a study conducted 3 years
earlier. Burnout is viewed as a threat to patients safety because
depersonalization is presumed to result in poorer interactions with patients.
Clinicians with burnout are more
likely to subjectively rate patient safety lower in their organizations and to
admit to having made mistakes or delivered substandard care at work. Thus a
number of influential organizations, including the American Medical Association
and the Mayo Clinic, have highlighted
burnout as a priority. This Annual perspective summarizes studies
published in 2015, with a particular focus on the relationship between burnout
and patient safety and interventions, and probable causes and victims burnout
among clinicians. Specially the significance of this study will be as follows:
The findings of this study will be of
importance to employees during selection and placement, so as to place and hire
applicants whose behavior type are well matched to the available job in order
to avoid job burnout; which in turn leads to low productivity and high worker
turn over.
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