Maslach Burnout Inventory Manual

A growing body of empirical evidence shows that occupational health is now more relevant than ever due to the COVID-19 pandemic. This review focuses on burnout, an occupational phenomenon that results from chronic stress in the workplace. After analyzing how burnout occurs and its different dimensions, the following aspects are discussed: (1) Description of the factors that can trigger burnout and the individual factors that have been proposed to modulate it, (2) identification of the effects that burnout generates at both individual and organizational levels, (3) presentation of the main actions that can be used to prevent and/or reduce burnout, and (4) recapitulation of the main tools that have been developed so far to measure burnout, both from a generic perspective or applied to specific occupations. Furthermore, this review summarizes the main contributions of the papers that comprise the Special Issue on “Occupational Stress and Health: Psychological Burden and Burnout”, which represent an advance in the theoretical and practical understanding of burnout.

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Burnout: A Review of Theory and Measurement

In Brief The COVID-19 pandemic has exposed and amplified the longstanding occupational circumstances of nurses. In this article, the authors provide updates to their 2020 institutional recommendations and craft a national plan to tackle burnout and moral suffering. 

An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic

In 2020, members of our team developed an institutional-level blueprint to minimize nursing burnout and moral distress, published in this journal as “A Blueprint for Leadership During COVID-19: Minimizing Burnout and Moral Distress Among the Nursing Workforce.”1 To sustain the nursing workforce, it’s imperative to decipher between “unavoidable occupational suffering (inherent to the [nurse’s] role) and avoidable occupational suffering (systems failures that can be prevented).”2 Although resilience capacity building is key to addressing the unavoidable suffering of clinical practice, avoidable suffering must be prevented and resolved at the organizational level. Here, we provide an expanded blueprint, with updates to our previous institutional recommendations accompanied by a national plan to address nurses’ burnout and moral suffering.1

An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic.

Aim To explore how healthcare providers in acute care mental health settings navigate ethically challenging situations, enact moral agency, practice in congruence with ethical standards and mitigate moral distress (MD). Design Grounded theory, a qualitative methodology. Methods Over 18 months between 2015 and 2017, we reviewed documents, conducted observations and interviewed multidisciplinary participants (N = 27) from inpatient and emergency departments. Participants either provided direct care (N = 14) or were in leadership positions (N = 13). Data were analysed iteratively using constant comparison, coding, memoing and theorizing, which continued until saturation was reached in July 2016. Findings The basic social process of how healthcare professionals enacted moral agency, Risking Vulnerability, occurred in the context of Systemic Inhumanity, a constant source of MD. Participants Risked Vulnerability, balancing professional obligations, clinical expertise and organizational processes with their own vulnerability in the system as they strove to practice ethically. Risking Vulnerability was composed of Pushing Back, Working Through Team Relationships and Struggling with Inhumanity. Conclusion Healthcare professionals' moral agency occurred at the nexus of structure (organizational constraints) and agency (persons). Given this, interventions for MD should be directed at all levels of healthcare to support moral agency, promote ethical practice and improve care. Impact Sociopolitical elements such as austerity measures undermined ethical practice at the level of direct care. Enactment of moral agency is dynamic, influencing experiences of MD: participants supported by leadership or colleagues to enact moral agency noted that they were not stuck in MD. Interventions supporting moral agency throughout the healthcare system are necessary to mitigate experiences of MD. Findings enhance our understanding of the role of action in the experience of MD.

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Risking vulnerability: Enacting moral agency in the is/ought gap in mental health care.

Burnout incurs significant costs to health care organizations and professionals. Mattering, moral distress, and secondary traumatic stress are personal experiences linked to burnout and are byproducts of the organizations in which we work. This article conceptualizes health care organizations as moral communities-groups of people united by a common moral purpose to promote the well-being of others. We argue that health care organizations have a fundamental obligation to mitigate and prevent the costs of caring (eg, moral distress, secondary traumatic stress) and to foster a sense of mattering. Well-functioning moral communities have strong support systems, inclusivity, fairness, open communication, and collaboration and are able to protect their members. In this article, we address mattering, moral distress, and secondary traumatic stress as they relate to burnout. We conclude that leaders of moral communities are responsible for implementing systemic changes that foster mattering among its members and attend to the problems that cause moral distress and burnout.

David Zhao

Papers

Moral Distress, Mattering, and Secondary Traumatic Stress in Provider Burnout: A Call for Moral Community