Moreno Martha Liliana1, Flowers Monica2*
1VA Nursing Academic Partnership (VANAP)-Florida International University, Miami VA Healthcare System, Miami, FL, USA
2College of Nursing and Health Sciences, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
*Corresponding Author: Monica Flowers, DNP, ARNP, FNP-BC, College of Nursing and Health Sciences, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th Street, AHC3-330, Miami, FL 33199, USA, Email: email@example.com.
Received Date: September 04, 2018 Accepted Date: September 20, 2018 Published Date: September 25, 2018
Citation: Moreno Martha Liliana, Flowers Monica (2018). Healthcare Professional’s Burnout and Measures to Alleviate Occupational Stress and Depression. POJ Nurs Prac Res. 2(1):1-5.
Copyright: © 2018 Flowers Monica, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Recent studies have indicated that high levels of stress, emotional fatigue, and depression significantly affect the work competency of healthcare professionals; and that more than a third of healthcare professionals across the world report one or more symptoms of burnout. Yet being in a field that requires urgency and long hours, it becomes imperative to develop strategies to alleviate such issues while improving the healthcare services offered to patients. The purpose of this literature review and analysis is to highlight how healthcare professional burnout occurs, explore measures to remediate these issues, and how meditation, as a stress reliever, is an effective method to reduce stress and anxiety levels among healthcare providers.
Keywords: Burnout, Stress, Depression, Meditation, Cortisol
Being in a field that requires urgency and long hours, healthcare professionals are constantly exposed to high levels of stress and emotional fatigue, which at times results in work-related depression. According to Arnsten, Murray, Taylor, and Connor (2015), recent studies have indicated that such factors (i.e., high levels of stress, emotional fatigue, and depression) significantly affect the work competency of healthcare professionals . Thus, there is a need to develop strategies to alleviate such issues while improving the healthcare services offered to patients.
An analysis of the literature in the Joanna Briggs Institute Evidence Based Practice (JBIEBP) Database using keywords healthcare provider, burnout, compassion, meditation; revealed 48 articles of which 17 were used for this literature review and analysis. The purpose of this article is to highlight how healthcare professional burnout occurs, explore measures to remediate these issues, and how meditation, as a stress reliever, is an effective method to reduce stress and anxiety levels among healthcare providers . It is the ethical and legal responsibility of healthcare employers and employees to ensure that stress levels are maintained at a minimum in order to prevent burnout and maintain the provision of quality healthcare.
Causes of Burnout among Healthcare Professionals
According to Romani and Ashkar (2014), the occurrence of burnout is common among healthcare professionals across the world. Studies conducted in the United States, Europe, United Kingdom and some Arab countries (e.g., Yemen, Qatar, and Saudi Arabia), revealed that 33-45.8% of physicians reported one or more symptoms of burnout . According to Swensen, Shanafelt, and Mohta (2016), the immediate causes of burnout among physicians include the following: long working hours, a demanding organizational culture that demands high levels of timeliness, moral distress in the working environment (when the physician must deal with both moral and ethical issues when taking care of their patients), high patient acuity, and/or compassion fatigue from dealing with both the patients and the concerned family members .
Healthcare professionals are more prevalent to burnout as compared to other professionals due to the immediate and consistent pressure at their work station . The pressures exerted on the healthcare worker to meet their professional requirements are emotionally and physically draining . Worker burnout is a result of working in fast-paced environments with dynamic technology, and at most times, dealing with life-death struggles. There are varying levels of burnout due to the differences in the intensity of the workplace. For example, healthcare workers in the ICU are more prone to burnout as compared to healthcare workers in the outpatient unit . In fact, ICU nurses record the highest rates affected by burnout among medical professionals. There are also exogenous factors that actively contribute to burnout, including conflicts between physicians in the ICU and other structural inefficiencies . To make matters worse, Arnsten et al. (2014) found a positive correlation between burnout and drug and alcohol abuse. Burnout is thus a psychological and physical state resulting from long exposure to depressing environments .
Furthermore, a growing body of research indicates that the stress hormone, cortisol, has a negative impact on the psychological and biological make-up of humans after prolonged exposure. Koh et al. (2015) found that high levels of cortisol, a reconstructive hormone produced in the prefrontal lobe of the human brain, leads to an increase in the prevalence of hypertension, depression, cancer, and diabetes . Koh et al.’s (2015) study also found that high stress levels lead to the secretion of cortisol and exaggerated releases of the hormone in turn impairs the immune system. Therefore, it can be surmised from the research that people who are exposed to highly stressful environments must learn to cope with the daily struggles so that their cortisol levels are maintained at an optimal level.
Symptoms of Burnout among Healthcare Professionals
The chart below shows the early warnings signs for burnout syndromes.
Figure 1: Early warning signs of burnout syndrome 
Romani and Ashkar (2014) also identified the following as symptoms of burnout: high emotional exhaustion, depersonalization or detachment, low personal accomplishment, and/or increased medical errors (general description) .
Given the high occurrence of burnout among healthcare professionals, stress management programs are recommended for all institutions. In medical facilities, these stress management programs range from patient-care centered programs to cognitive-behavioral therapy that focuses on the healthcare worker . Stress management programs aim to improve the care offered to patients by increasing the compassion amongst healthcare workers .
The Role of Transcendental or Vedic Meditation
Since burnout places the quality of life of both the healthcare worker and patient at risk, then it is important that healthcare professional apply behavioral interventions throughout their career because the culmination of stress occurs over time . Meditation is a form of holistic therapy sometimes incorporated into the medical field to aid war veterans, therapy patients, and most recently, in universities to help the faculty and students cope with high stress levels. Meditation is recommended for the improvement of the psycho-cognitive state of the human being. Furthermore, meditation aids by regulating the level of cortisol in the human body . In addition, regulating the amount of cortisol in the body controls the heart rate, blood pressure, and respiration levels .
Meditation works when an individual utilizes any technique to achieve a calm state both emotionally and mentally . According to studies conducted by Obasi et al. (2012), there is an apparent advantage of using meditation to reduce the number of new flu infections, as well as, reducing the prevalence of other illnesses. In their study, Obasi et al. (2012), supported the notion that meditation aids in improving quality of life. Meditation has shown reduction in prehypertension and currently, evidence suggests that meditation decreases stress and burnout [2,9].
Furthermore, meditation is an important aspect in treating stress because spirituality serves as an important buffer against professional burnout . Healthcare professionals who meditate regularly for spiritual purposes recorded lower depression levels and lower rates of psychological morbidity as compared to health workers who do not. Spiritual meditation helps the professionals find a balance between the moral and ethical obligations of their professions.
Meditation to build workforce resilience must begin at the early stages and should be fostered over time. Meditation, as a stress management technique, helps build resilience in employees who work in stressful work stations . Meditation aids in retraining the brain by teaching the concepts and skills necessary for moving from the reactive lower brain to the intentional higher brain . Through meditation, the health worker, or in this case, any other professional experiencing burnout can pay attention to real life experiences and reframe these experiences . Meditation induces feelings of gratitude, acceptance, compassion, and forgiveness . The principal goal for reducing the stress levels in the workplace is to enhance the feelings of joy, peace, and resilience among healthcare workers, which are essential attributes for handling patients .
Meditation aids in improving self-compassion. It is imperative that people are open to each other’s sufferings by acknowledging their feelings of caring and kindness towards both themselves and the people they care for . According to Arch et al. (2013), self-compassion takes into account the person’s ability to forgive themselves when they make a mistake or to acknowledge their inadequacy in handling all the issues in their lives. Self-compassion induces stability and self-worth [11,12]. Current studies have shown a positive correlation between reduced stress levels and the elevation of self-compassionate behavior . Alternatively, the promotion of self-compassion as the key determinant of happiness by Buddhist monks has increased the desire to meditate among many people.
In another study, Dunlop (2015) suggested several benefits of introducing meditation over other stress management techniques. First, it is the most cost-effective, especially for a large institution with many employees . Second, meditation ensures the general overall improvement of the person. In turn, healthcare workers are more compassionate both at their work stations and at home . Third, the development process is continuous and thus ensures continuity in a defined work culture . There is a direct correlation between reduced healthcare worker stress and reduced patient stress . Other innately compassionate cues such as maintaining eye contact with the patient while communicating with them will thus develop over time and are not technically infused.
Meditation is a technique for enhancing stress management. In research conducted by Magtibay, Chesak, Sood, and Coughlin (2017), meditation has proven effective among workers in stressful environments. Meditation improves the workers’ anxiety management, happiness, and resilience . Elder, Nidich, and Nidich (2014) suggested that the integration of Stress Management and Relaxation Techniques (SMART) alongside meditation is the optimum combination for alleviating workers’ stress. SMART advocates for people’s reconnection to their professional and personal purposes and meanings, finding emotional balance and cultivation of perpetual emotional intelligence, as well as improving both their physical and mental health .
The Role of Whole Health
Hubbling, Reilly-Spong, Kreitzer and Gross (2014) found evidence of low vulnerability, higher job satisfaction, and lower degrees of job stress among employees of institutions where the employers employ measures that counter stress development and burnout. In order to achieve this, employers must understand the scope of burnout, including the factors that increase potential burnout, and as such, it must be treated as an important corporate-social responsibility .
On the part of the employers, burnout-buffering strategies may include the following:
- Instituting systems and structures that promote mindfulness/meditation
- Improving on the professional counseling services around the facility
- Promotion of strategies that enhance healthy lifestyles 
- Encouraging the healthcare workers to take healthy breaks and meaningful vacations
- Promoting healthy diets around the facilities 
- Encouraging enough rest and sleep especially for ICU workers [10,17]
- Introducing or improving the cognitive behavioral therapy
- Creating effective support systems within the work environment that foster strong personal and professional relationships 
It is imperative that nurses and physicians feel that they work in a supportive environment. The levels of stress among healthcare professionals can be reduced significantly by offering around-the-clock counseling services to healthcare workers in highly stressed environments. It is the professional responsibility of both employers and employees to create and maintain a sustainable support system for each other. The “buddy system” is proven to be effective as healthcare professionals can ensure their colleagues are constantly encouraged and feel supported. It is crucial that the employer’s healthcare workers support each other . Employee recognition of the efforts by the healthcare workers is a burnout-buffering strategy driven towards ameliorating the professionals and the personal lifestyles of the healthcare workers . Healthcare workers must also hold each other accountable for their personal health and well-being.
How to Meditate
There are many types of meditation, called by various names, but they all teach fundamental principles. They all train the brain to become more conscious and to build awareness of how to have a relationship with one’s mind and your thoughts.
Meditation training can be started with just 5 minutes in the morning and five minutes in the evening (gradually increasing up to 15 minutes). One can medicate at work, while walking, seated with eyes open or closed, all that is needed is to be present.
When learning to meditate, one must try not to fight with the thoughts that come in. If the body itches in anyplace you can scratch while you are meditating. As your mind starts to wander, let those thoughts float by and try not to attach to anyone. If thoughts are distracting, bring the focus back to your breathing. Of upmost importance is that one becomes aware that the thoughts are coming, they are released, and one comes back to the meditation.
Burnout-buffering techniques, including meditation, ensure the development of personal self-reliance. In addition, the previous strategies ensure that the healthcare professional’s self-care is fostered and a positive outlook on life is maintained despite a stressful environment .
Undoubtedly, burnout is a common syndrome among many medical practitioners around the world. The effects of burnout, as highlighted in the previous discussion, are detrimental and often lead to medical errors that are dangerous both to the patients and the medical institution. However, a number of burnout-buffering techniques are available, and they present strategies aimed at improving the work-life balance among practitioners as well as improving their professional coping competencies .
With the current shortage of healthcare professionals, it is of upmost importance to maintain the current employee pool by improving their well-being . Moody et al. (2013) identified the need to have a consistent support system among healthcare workers and the need for healthcare workers to find balance in their daily and professional activities. Each healthcare worker must maintain their emotional and physical energies to prevent burnout with time-honored methods, including meditation . However, it is equally important that the institutional management encourages the holistic development of healthcare workers in the effort to reduce burnout rates and improve the healthcare services given to their patients.
It is the personal and professional responsibility of each employer to take care of their personnel since research shows that anxious healthcare workers do not perform as well as their more relaxed and self-compassionate colleagues . In addition, healthcare workers that participate in constant meditation find it easier to deal with the strenuous events at the workplace as compared to non-participants . In essence, by encouraging active participation in hobbies, meditation, and personal reflection; the healthcare workers can then operate with realistic expectations at the workplace.
The authors report no conflicts of interest in this work.
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