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PS2120: Workplace Stress & MH - Coggle Diagram
PS2120: Workplace Stress & MH
Issue
The Issue
Issues affect one another in gradient
Media representation
Public perception
Public expectation
When Media Helps (Liede et al., 1997-2016)
Angeline Jolie effect
Caused increase in women seeking genetic testing
But no increase in treatment (masectomy)
May be because vulnerable individuals w. genetic history already knew & already had interventions/regular testing
Influx was influencer effect
Angelina Jolie Effect
Article about Jolie's experience with finding out had gene w. risk of cancer
As had history of ovarian/breast cancer to seek medical testing
Women who read article encouraged to seek genetic testing
Led to massive influx people
When Media Detrimental (Paor, 2017)
Finding health risk often not mean patient will go on to develop health problem in question
Can report false +
Increases self-referral to GP
No real protective space to receive life changing results
Need to examine law & regulations
Issue of Demand (BPS, 2019)
More demand + Less funding & resources
Services stretched & under resources
Excessive workload & workplace demands
23 & Me
Sending blood to undisclosed facility
Results came through letter
List of conditions predisposed to
Pressure on GP to provide further testing
But often caused by human error in sample
Not actually vulnerable (false +)
Public Perception (Corrigan, 2012)
media perceptions - affect patient outcomes
Patient already in state of certain demands, not aware of parameters to get treatment, leads to anger
From appreciation & respect to antipathy & resentment
Educational & contact-based intervention can reduce - attitudes
Generaliseable in Western & Eastern cultures (Morgan et al., 2018; Xu et al., 2017)
Prevelence
All clinicians felt not able to show compassion & care due to targets set by organisation
31% report medium levels of burnout
15.4% report high levels of burnout
PTSD in Covid (Durand et al., 2019)
71.5% in China
60.2% in USA
Causes (Maharek et al., 2019)
Increase in emotional distress, conflicts & patient care
Lead to increased risk in developing symptoms of depression
Concepts of Work Related Stress
Second Victimhood (Albert Wu, 2000)
Bring attention to needs of healthcare professional involved in medical error
Certain level of exposure to it
Directly involved
In same room where it happens
Can cause self-blame
Associated Risks
Involved directly/indirectly w. patient safety incident
Can vary from one-off to multiple events
Being female
More years in practice
Critique
Women overrepresented
Gender diff in social stigma (encouragement to talk)
More years in practice
Many healthcare professional will experience at least 1 traumatic event in career (more years in role = more risk)
Criticised for being insensitive to patient (Wu, 2020)
Take away from patient & their families trauma & distress to put on healthcare professional
6-Stage Process (Scott et al., 2010)
Identification
Intrusive
Support search
Concern
Survival
Identification
What happened & why
Perpetuate blame culture
Intrusive
Intrusive thoughts, isolation, internal inadequacy
Come under PTSD-like symptoms
Those involved cannot talk about what goes on
Problematic in how process event
Support Search
Supervisor/colleagues
Concern
About repercussions (employment or legal)
Survival
Considering leaving, surviving, moving forward, analysing
Burnout
Chronologically one of first models to identify workers experience distress
But also means it may be outdated
Venn Diagram Model of Burnout
Emotional exhaustion
Reduced personal accomplishment
Cynicism
Cynicism
Emotional detachment
Lack of empathy
Reduced Personal Accomplishment
Feelings of incompetence
Lack of personal achievement
Emotional Exhaustion
Depletion of emotional resources
Loss of energy
Physically
Emotionally
Risk Factors
High workload
Long working hours
Personality traits
Breaking bad news to patients
Insufficient communication
Insufficient reward
Trauma related work
Personality Trait Increases
Em increases
N increases (McManus et al., 2011)
Personality Trait Decreases
C & A (Gusafsson et al., 2009)
E & O (Hudek-Knezvic et al., 2011)
Breaking Bad News to Patients
Address topics like death & palliative care
Healthcare worker compared to interpreter (Birck, 2002)
Trauma Related Work (Johnson & Hunter, 1997)
Clinicians working w. sexual assault survivors
Higher levels emotional exhaustion only
Model of Burnout
2 main factors
Job demands (mental/emotional/physical)
Job resources (support/autonomy/feedback)
Interact w. subsequent factors
More strain
More motivation
Organisational outcomes
Strain = Less
Motivation = More
Critique
Focus predominantly in individual not organisation (Maslach & Leiter, 1997)
Nuanced individual differences not accounted for
Over simplified
Not unique to work
MBI criticised
Other risk factors that MBI not capture
Over Simplified (Salanova et al., 2005)
Blue collar vs white collar workers & key differences
MBI Criticised (McCammon, 2023)
For lack of consistency when reporting
Concept itself not capture fine-grained differences
Suggest is other factors at play
Researchers incorrectly provide high/medium/low cut off points as diagnostic criteria
Where has been discouraged w. not has no diagnostic validity so excluded from most recent tests
Other risk factors that MBI not capture
Other Risk Factors (Chuang et al., 2016)
Prevelence of burnout among ICU professionals ranged from 6-47%
Personality traits
Work experience in ICU
Work environment
Workload
Shit work
Ethical issues
End-of-life decision making
Not Unique to Work
Even those not in work can experience symptoms
Global Level
Literature suggest cannot be used on global level
Components that make people higher risk diff in diff cultures
China seen as good thing (indicates are hard worker so perceived by individual as good thing)
Loss of translation of questionnaires (not quite capture concept well)
Makes application of theory problematic
Trauma
Engaging empathically w. traumatic material
Own trauma
Other trauma, but must have close relationship w. other to - experience their trauma
Clients asked to describe traumatic experience in some significant level of detail
Intrusion, avoidance & increased arousal
Engaging w. Traumatic Material
Direct
PTSD (APA, 2000)
Indirect
Secondary trauma stress (Figley, 1995)
Compassion fatigue (Stamm, 2000)
Vicarious trauma (Perlman & Saakvitne)
Compassion Fatigue
Viewed as normal response when working empathetically
Problematic as normalised distress & exposure to trauma as nature of work
Can be applied to patient facing healthcare professionals working w. trauma
Potential issue when providing intervention
Comprises of secondary traumatic stress, burnout & compassion satisfaction
First time the + aspect of work been considered as needed to explain why stay in role despite trauma
Risk Factors
Prolonged exposure to high stress at work
Working w. trauma
Empathy
Too much
Lack of conceptualisation
Lack of support
Information provided to public
Model
Critique
Ambiguity in term
Role of empathy
No relationship w. empathy & satisfaction (Hunt et al., 2019)
Difficult to distinguish who actually at risk & conceptualise empathy
Survivor guilt has mediating role (O'Connor et al., 1997)
No relationship between empathy & CF among police officers working w. rape victims (Turgoose et al., 2017)
May be something about empathy at play, but not well-defined concept so difficult to investigate
Role of Empathy
Increased risk (Figley, 2002)
Others argued is problematic (Turgoose & Maddox, 2017)
Found to improve patient outcomes & increase satisfaction (Sabo, 2006)
Ambiguity in Term (Coetzee & Klopper, 2010)
Described as loss in ability to nurture
But adopted in various caregiving occupations & related to other terms like vicarious trauma, secondary traumatic stress & burnout
Leads to conceptual & methodological limitations
Vicarious Trauma (Pearlman & Saakvitne)
Repeated exposure
Develops gradually
Associated Risk Factors
Younger healthcare professionals (Bell et al., 2003; Jenkins & Baird, 2003)
Exposure to past trauma/past history of trauma (Knight, 2010)
Research found associations between working w. trauma & emotional exhaustion & avoiding coping strategies similar to burnout
Trauma focused work
No sig diff ot VT among clinicians when working w. survivors of trauma vs cancer patients vs general practice patients (Kadambi & Truscott, 2004)
No. hours per week
No. Hours Per Week
Increase in some trauma-related symptoms (Boeber & Regehr, 2006) in palliative & other end-of life care
But application of theory may capture something else
Increase in burnout not trauma (Birck, 2002)
Increase in trauma but no predictive relationships (Creamer & Liddle, 2005)
Explanation
May be that experience both trauma & burnout at same time
Increase in burnout & secondary trauma
Younger Healthcare Professionals
Possible explanation that not yet developed resilience strategies
Limitations to Exposure
But evidence base very ambiguous
Support (Boeber & Regher, 2006)
Against (Elwood et al., 2011)
Explanations why Prevalence Varies
Severe trauma but been able to seek professional help vs not been able to seek help
Associations
Difficult to differentiate
But treatment/intervention for burnout/trauma different
Risks not having needs met
Waste of time & resources, not help person, affects spread to personal & occupational level
Prevalence
Low levels secondary trauma (Adam & Riggs, 2008; Collins & Long, 2003)
Moderate to high (Bride et al., 2007; Conrad & Keller-Guenther, 2006)
Impact on Health Professionals
Impact
Patient care work intentions
Blurred boundaries means no escape from work
Doing work at home
Taking cases that resonate home
Working with a team
Pros if team offer a space
Cons if team not have space but hang over employee head that workers should keep w. professional development to retain job
Personal issues being impacted by work
Relationships
Sleep
Requirements in profession
CPD
Supervision
Measuring Work Related Stress
Perceived health outcomes vs hazardous work characteristics
Uses surveys
European Working Conditions Survey
Ask if work affected health in terms of stress
Self-Reported Work-Related Illness Survey
Consider stress, anxiety & depression combined
Limitations
When respondents asked if experiences extremely high levels of stress, prevalence consistent
Many items & questionnaires based on historical theoretical perspectives
Developed in 1970s/90s where organisations different
Validated w. groups that aren't healthcare professionals (like teachers)
Issues w. Measures
Lack of validation studies
Validation studies for specific populations
Inconsistency within scale
So should be aware of limitations & acknowledge potential pitfalls
Addressed w. other questionnaires/considering other factors
Lack of Validation Studies
State-Trait Anxiety Inventory (Spielberger et al., 1983)
Brief COPE 28 Item (Carver, 1997)
Validation Studies for Specific Populations
Revised Life Orientation Test (Sheier et al., 1994)
Among French population only
Inconsistency Within Scale
Interpersonal Reactivity Index (Alterman et al., 2003)
Dispute in construct validity in subscales
Responses from Organisations
Presence of W-R-Stress associated w. increased medical errors, health professionals remaining traumatised for extended periods, increased anxiety
Relationship between staff wellbeing
& staff-reported patient care perfroamce
& patient-reported patient experience
NHS acknowledge what helps & are shifting away from decreasing stress & toward increasing wellbeing (NHS commission 2019)
What Helps
Interventions featuring direct contact (Stubbs, 2014)
Effectively reduces stigma in healthcare students & professionals
Empathy based stress
Post traumatic growth
Empathetic enagement crucial to traumatic growth-related constructs
Role of Empathy
Defines as multidimensional quality involving cog & affective dimensions (Davis, 1983; Hojat et al., 2015)
By allowing one to walk in another's shoes
Foundational to build theraputic relationships & deliver optimal patient-centered care (Hojat et al., 2015; Kimzey et al., 2020) & build rapport (Dees et al., 2022)
Types of Empathy
Verbal
Non-verbal
Verbal Empathy
Direct communication
Ask about needs
Offer additional care
Non-Verbal Empathy
Engaged listening
Acts of kindness
Invest time
Empathy Based Strain
Process of trauma exposure combined w. experience of empathy
Can lead to strain
Affective empathy associated w. increase in compassion fatigue
Cog empathy not have same relationship
Relatively new area in research (Rauvola et all., 2019)
Examine relationship between concepts of work-related stress & enagaing empathetically w. trauma-related work
Model (Rauvola et al., 2019)
Empathy Based Stress
Process of trauma exposure of stressor combined w. experience of empathy (individually & contextually-driven affective reaction) that result in empathy-based strain (Ravola et al., 2019)
Some acknowledgement of compassion fatigue model
Individual differences in emotional regulation when working empathically (Ekman et al., 2015)
Post-Traumatic Growth
psychological change experienced as result of struggle w. highly challenging life circumstances ((Tedeschi and Calhoun 2004)
Some suggest traumatic stress & OGT two separate continuums (Zoellner and Maercker (2006)
Others suggest possible relationship w. two (Tedeschi et al., 2018)
Process (Tedeschi, 2017)
Personal strength
Having more confidence & see self as superior
New possibilities
Develop new interests, discover new opportunities
Relate to others
Have more compassion for others, be more open in expressing thoughts & feelings
Spiritual & existential change
Engage w. existential, philosophical/spiritual subjects & questions
Appreciation of life
Greater appreciation for life & all it has to offer
Associated Factors
Focus on how individual cog processes
Old assumptions challenges & new beliefs developed
Individual differences
Individual Differences
Exposure to historic trauma
Demographic variables (gender, age)
No consistency in research
Personality traits
O
Pre-trauma beliefs
Profession
Higher in nurses than social workers
Resilience at baseline level & during traumatic events (Nishi et al., 2016)
Can help increase engagement at work among healthcare workers
Multidimenisonal
Support multidimensional not just dichotomous
Healthcare organisations that effectively promote staff wellbeing by supporting & enhancing work resources supported by staff in high risk conditions
Esteem & material rewards/job control/social support
Not just reduce distress
Psychological wellbeing captures important components (Loukzadeh & Bafrooi, 2013)
Can help manage distress, particularly having purpose in life & self-acceptance
Humanistic Approach
Look how healthcare professional provides help
Help individuals recognise strengths, creativity & choice in here & now
Increase awareness to address underlying motives & defences
Dispositional
Dispositional
Focus on innate qualities within person
That exert major influence on direction of behaviour
Approaches to Organisation Interventions
Teach ethics & professionalism
Mindfulness
Group support
Application (Rider et al., 2018)
Examined 8 hospitals & recruited humanistic healthcare professionals
Ps reflect on interactions w. patients, perception of organisational factors to promote humanism, potential barriers
Helped by supportive colleagues, role models, engaged & relevant experienced leaders & time to build relationships w. patients key in medical humanism
Suggest Ps reflect on own process
Quality of treatment, whether unconscious biases are put on patient
Culture of Humanism
Responsibility of role model
Supportive leadership
Organised activities
Facilitative practice structure
Incongruence
Between core humanistic values & business climate in bureaucratic requirements
Help w. quality of care, & autonomy & sense of choice of patient
Promote engagement, wellbeing, & satisfaction
Not about getting rid of stress but using it
Requirements
Excellence
Congruence between expressed values & behaviour
Excellence
Clinical expertise
Collaboration & compassion
Awareness & acknowledgement of suffering of another & desire to relieve it
Altruism
Capacity to put needs & interests of another before own
Respect & resilience
Regard for autonomy & values of another person
Empathy
Ability to put oneself in another situation
Service
Sharing of own talent, time, & resources w. those in need
Give beyond what is requried
