Burnout and the conservation of resources theory

This thesis examines, within the framework of the Conservation of Resources Theory, the development of burnout in a sample of Victorian nurses over a nine-month period. Results showed that work characteristics demonstrated different associations with burnout and that COR theory was partially successful as an explanatory framework.

Work context, personal control, and burnout amongst nurses

While situational factors such as high workloads have been found to be predictive of burnout, not all people in the same work context develop burnout. This suggests that individual factors are implicated in susceptibility to burnout. We investigated the relationships between care type (acute/chronic), neuroticism, control (primary/secondary), and symptoms of burnout (exhaustion, cynicism, and reduced professional efficacy) amongst 21 chronic care nurses and 83 acute care nurses working in a public hospital in regional Australia. Similar levels of burnout symptomatology and neuroticism were found in each group of nurses, and neuroticism was found to be associated with exhaustion, cynicism, and reduced professional efficacy in the total sample of nurses. Our prediction that primary control would protect against burnout symptoms in acute care nurses was supported only for professional efficacy, and the prediction that secondary control would protect against burnout in chronic care nurses was not supported.

The phenomenon of resilience in crisis care mental health clinicians

The purpose of this study, undertaken in 2003, was to explore the phenomenon of resilience as experienced by Australian crisis care mental health clinicians working in a highly demanding, complex, specialized and stressful environment. For the purpose of this research, the term 'resilience' was defined as the ability of an individual to bounce back from adversity and persevere through difficult times. The six participants for this study were drawn from Melbourne metropolitan mental health organizations – the disciplines of nursing, allied health and medicine. A number of themes were explicated from the participants' interview transcripts – Participants identified the experience of resilience through five exhaustive descriptions, which included: 'The team is a protective veneer to the stress of the work'; Sense of self; Faith and hope; Having insight; and Looking after yourself. These exhaustive descriptions were integrated into a fundamental structure of resilience for clinicians in this role. The study's findings have the potential to inform organizations in mental health to promote resilience in clinicians, with the potential to reduce the risk of burnout and hence staff attrition, and promote staff retention and occupational mental health.

Managing behavioural symptoms of dementia : Effectiveness of staff education and peer support

This study was designed to investigate the impact of staff education on the behaviour and quality of life of residents with dementia and on staff members' attitudes about working with people with dementia and level of burnout. Staff from three aged care facilities participated in the study (n = 52). These facilities were randomly assigned to one of two intervention groups or a control group. Staff assigned to the intervention groups received an eight-week behaviourally-based programme. Staff from one aged care facility also participated in a peer support group designed to reinforce educational material and facilitate positive changes among staff members. Behavioural symptoms displayed by residents (n = 76) in each of the facilities were also assessed. Assessments were conducted at pre-intervention, post-intervention, three- and six-month follow-up. The results of this study indicated that education or peer support was not associated with an improvement in resident behaviour or quality of life. Education or peer support also did not impact on staff members' level of burnout. There was, however, a change in staff members' attitudes about working with people with dementia. Possible explanations for these findings and implication for further research are considered.

Injury and burnout in Australian athletes

The relationship between injury and burnout in a sample of 264 local to international Australian athletes (124 men and 140 women) was studied. Injury can be a stressful experience for athletes; coupled with the demands of rehabilitation, it could increase feelings of burnout. Experiencing more than one injury could have a cumulative effect on feelings of burnout. Alternatively, for some athletes the break from training or competing caused by an injury could alleviate burnout symptoms. Participants completed a demographic questionnaire and a modified version of the Maslach Burnout Inventory. Independent sample t tests indicated that currently injured athletes (n = 150) had significantly lower mean Burnout scores than currently uninjured athletes (n = 113). Small, but statistically significant, positive correlations were found between number of injuries and Burnout scores. Possible explanations are that injury provides a temporary break from intense sporting involvement and, thus, lower scores on Burnout, but multiple injuries might have a cumulative effect on burnout.

Burnout in physicians : a case for peer-support

Background: It is well documented that doctors experience a high level of stress in their profession, and that this can lead to physical, psychological, and emotional harm, in particular, burnout. Overseas (especially in the UK and USA), research investigating the levels of stress, burnout, and associated psychiatric morbidity in health professionals, across many specialities, has been carried out with a view to prevention of these adverse outcomes.

Aims: To assess the level of burnout in a sample of New Zealand physicians, the associated work and personal characteristics, and the need for development of a support peer supervision or support system.

Methods: Questionnaires that measured a number of work and personal characteristics, including the Maslach Burnout Inventory, the General Health Questionnaire, and additional questions regarding mistakes, and need for support, were sent to 83 physicians in the Waikato and Bay of Plenty areas. Analysis involved descriptive statistics, with t-tests for comparison with other studies, Pearson Product-Moment correlations between variables and analysis of variance where appropriate.

Results: Of the 50 respondents, 28% experienced high levels of two or three aspects of burnout (emotional exhaustion, depersonalization, low personal accomplishment). Emotional exhaustion correlated with a greater need for support. Most respondents favoured a one-to-one support system.

Conclusion: This study highlights the presence of significant workplace difficulties for physicians and the need to develop a preventative support system for the protection of physicians and the patients in their care.

Syphilis and AIDS : historical and social comparisons

Drawing on the literatures of history, sociology, epidemiology, and microbiology, this thesis compares syphillis with human immunodeficiency virus, with special reference to the social and historical factors likely to be relevant to the control or eradication of acquired imune dificiency syndrom (AIDS). The sudden appearance of a new disease causing suffering and death in a community, engenders apprehension and fear which is often manifested as hysteria against, and vilification of, those who have the disease. This fear is greatly increased should the disease be sexually-transmitted. Syphilis in a venereal form, occured in Europe toward the end of the 15th Century. Initially it was an acute, fulminating disease which rapidly spread through Europe and Asia. Attempts to control the disease have gone through periods of either partial successes or massive failures and have ended in frustration for the authorities. When the syndrome of acquired immune deficiency (AIDS) was first reported, it was seen in Western countries in homosexual men. However, as non-homosexual community members and children became infected, it became apparent to authorities that a pandemic was accurring. Within a few years, the disease was identified worldwide. Isolation of the virus (HIV-1), and development of test for detection of carriers, plus restoration of clean blood and blood-product supplies, have reassured the community to some extent. The history of syphilis shows that neither the epidemiological medical, nor the economic political approaches to disease control work, although there are positive aspects resulting from both. It is social responses that will offer the most hope in the long term for the control of AIDS and other sexually-transmitted diseases.

Sticking around : why and how some social workers stay in the profession

Although much is known about why social workers leave the profession, much less is known about what enables some social workers to remain working in highly stressful situations for many years and retain a passion for their work. Based on in-depth interviews with six Australian social workers with at least 10 years practice experience, factors associated with retention included self-awareness, a sense of perspective, having a strong professional identity, a sense of humour, the ability to recognise and respond to the emotional impact of the work, clear separation of work and home, and a mental interlude of some intermediate activity between leaving work and arriving home. Whereas previous research has depicted job change as a sign of burnout, for participants in this study changing jobs was regarded as a preventive measure which enabled them to continue in social work.

The dying town syndrome : a survey of urban development in the Western District of Victoria,1890-1930

The experience of urban settlement in the Western District of Victoria suggests that the pattern of growth and decline in small towns is tied to the pattern of land use. This, in turn, is determined by the economic and technological factors which influence farm management and practices. At times, these factors have encouraged urban development and small towns have flourished. For the most part, however, these forces have not been conducive to sustaining long-term growth and prosperity and small towns, have been trapped in a cycle of growth and decline.

Cognitive functioning in chronic fatigue syndrome and the role of depression, anxiety and fatigue

Objective: This study was designed to investigate the role of depression, anxiety, and fatigue in Chronic Fatigue Syndrome (CFS) sufferers' objective and subjective cognitive performance. Methods: Twenty-three CFS sufferers and 23 healthy control participants were compared on objective and subjective assessments of cognitive performance. Depression, anxiety, and fatigue were also evaluated. Results: CFS sufferers did not demonstrate any impairment in objective cognitive functioning compared to the control group, and objective performance was not related to their higher levels of depression or their level of fatigue. Depression scores only accounted for a small amount of the variance in CFS sufferers' lower subjective assessment of their cognitive performance compared to control participants. There were no differences between the groups on anxiety scores. Conclusion: The results are discussed in terms of the heterogeneity of the CFS population and the complex interaction of symptomatological factors that characterise CFS.

Association of genetic vatiation within UBL5 with phenotypes of metabolic syndrome

The BEACON gene was initially identified using the differential display polymerase chain reaction on hypothalamic mRNA samples collected from lean and obese Psammomys obesus, a polygenic animal model of obesity. Hypothalamic BEACON gene expression was positively correlated with percentage of body fat, and intracerebroventricular infusion of the Beacon protein resulted in a dose-dependent increase in food intake and body weight. The human homolog of BEACON, UBL5, is located on chromosome 19p in a region previously linked to quantitative traits related to obesity. Our previous studies showed a statistically significant association between UBL5 sequence variation and several obesity- and diabetes-related quantitative physiological measures in Asian Indian and Micronesian cohorts. Here we undertake a replication study in a Mexican American cohort where the original linkage signal was first detected. We exhaustively resequenced the complete gene plus the putative promoter region for genetic variation in 55 individuals and identified five single nucleotide polymorphisms (SNPs), one of which was novel. These SNPs were genotyped in a Mexican American cohort of 900 individuals from 40 families. Using a quantitative trait linkage disequilibrium test, we found significant associations between UBL5 genetic variants and waist-to-hip ratio (p = 0.027), and the circulating concentrations of insulin (p = 0.018) and total cholesterol (p = 0.023) in fasted individuals. These data are consistent with our earlier published studies and further support a functional role for the UBL5 gene in influencing physiological traits that underpin the development of metabolic syndrome.

The limits of medicine and the social consequences for sufferers of chronic fatigue syndrome

Chronic fatigue syndrome (CFS) appears to be made up of several clusters of illness categories acting alone or in tandem to cause the decline of health through; fatigue/exhaustion, sensitivity/allergies, pain, general muscle and joint pains, cognitive impairment and gastrointestinal problems. This study investigated how patients interpret, evaluate and respond to the complex and varied symptoms of chronic fatigue syndrome. Data were collected from persons with CFS using a survey (n=90) and an interview (n=45). The researchers investigated how chronic fatigue syndrome is diagnosed by medical practitioners, how the label of CFS is determined and the social consequences for the patient. The results confirm the limited ability of the biomedical paradigm to diagnose adequately and treat effectively 'socially constructed' and medically ambiguous illnesses like CFS. In the absence of a legitimated regime of medical treatment for CFS, a range of often expensive treatments are employed by CFS sufferers, from formal use of pharmaceutical drugs through to 'alternative' therapies, including herbal, vitamin, homeopathic, esoteric meditative techniques, spiritual healing and general counselling are taken in no particular order.

Associations of TV viewing and physical activity with the metabolic syndrome in Australian adults

Aims/hypothesis We analysed a sample of Australian adults to determine the strength of associations of TV viewing and participation in physical activity with the metabolic syndrome.

Methods This population-based cross-sectional study included 6,241 adults aged ge35 years who were free from diagnosed diabetes mellitus and self-reported ischaemic disease and were not taking lipid-lowering or antihypertensive drugs. The metabolic syndrome was defined according to the 1999 World Health Organization criteria. Participants self-reported TV viewing time and physical activity time for the previous week.

Results The adjusted odds ratio of having the metabolic syndrome was 2.07 (95% CI 1.49–2.88) in women and 1.48 (95% CI 0.95–2.31) in men who watched TV for >14 h per week compared with those who watched le7.0 h per week. Compared with those who were less active (<2.5 h per week), the odds ratio for the metabolic syndrome was 0.72 (95% CI 0.58–0.90) in men and 0.53 (95% CI 0.38–0.74) in women who were active (ge2.5 h per week). Longer TV viewing (>14 h per week) was associated with an increased risk of insulin resistance, obesity and dyslipidaemia in both men and women. A total physical activity time of ge2.5 h per week was associated with a reduced prevalence of both insulin resistance and dyslipidaemia in both sexes and reduced prevalence of both obesity and hypertension in women.

Conclusions/interpretation Increased TV viewing time was associated with an increased prevalence of the metabolic syndrome, while physical activity was associated with a reduced prevalence. Population strategies addressing the metabolic syndrome should focus on reducing sedentary behaviours such as TV viewing, as well as increasing physical activity.