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Recovery From Burnout During a One-Year Rehabilitation Intervention With Six-Month Follow-Up: Associations With Coping Strategies

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This study explored burnout and coping longitudinally by applying a person-oriented approach to employees (n = 85) referred for burnout rehabilitation. We investigated burnout (measured by Maslach Burnout Inventory – General Survey) symptom trajectories and their associations with coping (measured by Coping Inventory with Stressful Situations) during a 1-year rehabilitation intervention with 6-month follow-up. The study included two rehabilitation interventions (each lasting 5 + 12 days) with four measurements. The results indicated four trajectories for exhaustion and three each for cynicism and reduced professional efficacy. The trajectories comprised employees who either recovered from burnout or whose symptoms showed some decrease across time. Additionally, a subgroup of employees was identified whose symptoms increased across time, but also a subgroup reporting no burnout symptoms across time. Burnout recovery was evident only in exhaustion and was associated with decreased emotion-oriented coping. This coping strategy was the most susceptible to rehabilitation, that is, it decreased linearly during the intervention. Nonrecovery, that is, stable or increased serious burnout, was related to increased use of avoidance-oriented coping. Additionally, among those with stable mild or stable no symptoms of burnout, two coping strategies often changed across time. This may indicate that these employees have more resources and resilience to vary or regulate their coping strategies in response to the stressful situation. In this study, working with negative emotional responses (i.e., emotion-focus coping) was associated with alleviation of burnout, which thus appears to be an important rehabilitation activity. However, more precise targeting and tailoring of burnout rehabilitation is clearly needed.
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... Consequently, burnout interventions have focused on these same categories of causes (Schaufeli & Enzmann, 1998). While rehabilitation interventions have been found to exert a positive effect on burnout reduction (Norlund et al., 2011;Stenlund, Birgander, Lindahl, Nilsson, & Ahlgren, 2009;Stenlund, Nordin, & Järvholm, 2012), particularly in the components of exhaustion (Hätinen et al., 2009;Hätinen, Kinnunen, Pekkonen, & Kalimo, 2007;Hätinen, Mäkikangas, Kinnunen, & Pekkonen, 2013) and cynicism (;Hätinen et al., 2007), the focus tended to be on investigating correlations between variables rather than individual developmental trajectories of burnout and recovery (Mäkikangas & Kinnunen, 2016). ...
... As the reinforcement of agency is an important goal in rehabilitation and its significance has been demonstrated in previous studies (Järvikoski et al., 2013;Salminen et al., 2015), a further aim was to explore the role of the three modes of agency (personal, proxy and collective) in more depth along with their impact on recovery within this sample. Narrative inquiry was chosen as the primary method of investigation, as recovery paths are typically individual and heterogeneous (; Hätinen et al., 2013). ...
... Additionally, all the participants were female and thus further studies with mixed samples are needed to validate the results across gender. However, the study participants were representative of the population typically attending such courses (Hätinen et al., 2009(Hätinen et al., , 2007(Hätinen et al., , 2013. The results cannot be generalized beyond the study participants owing to the size of the sample and the fact that participant selection was based on a decrease in burnout symptoms. ...
Conference Paper
Statement of the problem: The present study aims to provide knowledge about the recovery process during rehabilitation and two years later. It explores the manifestation of agency in its three forms – personal, proxy, and collective – in the accounts of four participants in a national rehabilitation course. As recovery paths are individual and heterogeneous, the study employs a narrative approach, which preserves the individual’s voice and enables the emergence of a unique set of meanings ascribed to the narrative. Procedures: The study participants were selected from national rehabilitation courses funded by the Finnish social insurance institution. Rehabilitation adopts holistic and multidisciplinary approaches. It includes a comprehensive evaluation of an employee’s physical, psychological, and social conditions by various rehabilitation professionals. Intervention is conducted in groups of 4-10 persons, lasts 15 days, and is divided into an initial 10-day period and a 5-day follow-up period within at most 7 months after the first period. Four participants, whose burnout levels had decreased between the two periods of the course, were interviewed via extensive semi-structured interviews on two occasions: at the end of the course in 2012 (T1) and two years after the course, in the autumn of 2014 (T3). They also answered an electronic questionnaire 1.5 years post rehabilitation (T2), which contained a measurement instrument BBI -15 (Bergen Burnout Indicator) and questions on participants’ well-being, its maintenance and possible changes during the follow-up period. Two of the four participants had changed jobs and two had stayed in the same job between the first and second data collection points. Two of them continued on the path of recovery and two reported an increase in burnout symptoms. Analyses: Data were analyzed by using thematic narrative analysis and interpreted through the lenses of agency, which served as the theoretical framework for the study. Furthermore, four different spheres of meaning were discerned in the narrative: 1) emotional (whether the tone in the narrative is happy or tragic); 2) explanatory (what are the causes and consequences of events); 3) moral (who bears responsibility for events); and 4) ethical (what is good/bad, right/wrong in life). Finally, common themes in the narratives were identified and examined more closely. Results: The analysis revealed highly individual and heterogeneous paths of recovery. The first parts of the narratives demonstrated a high degree of proxy (through rehabilitation professionals) and collective agency (through the rehabilitation group). As recovery advanced, personal agency was strengthened. Enhanced personal agency was discernible in all follow-up narratives, but it was more pronounced in the narratives of continued recovery. Proxy agency in the face of occupational health professionals was exercised two years post rehabilitation in order to maintain recovery. Spheres of meaning participants attached to their stories also varied, with the rehabilitation course and the professionals involved being viewed as positive and morally good. Three major common themes were identified: 1) The benefits of the rehabilitation course; 2) Supervisor support; and 3) Personal factors. The rehabilitation course was regarded by all as highly beneficial, awareness-raising and crucial for the commencement of recovery. Through exercising of proxy and collective agency, participants’ personal agency was re-activated and strengthened. Supervisor support was of immense importance for the recovery. A supportive supervisor could alleviate the symptoms of exhaustion and facilitate the re-adaptation to work, whereas an unsupportive or disregarding supervisor led to an increase of burnout symptoms and the experience of injustice. Finally, personal factors such as divorce, the sickness of a close family member or of oneself had a substantial impact both on the onset of burnout as well as on subsequent recovery. Practical Implications: Rehabilitation courses exert a long-lasting positive impact on recovery, and can be made more effective by training managers to handle better employees’ re-adaptation to work after burnout. Furthermore, knowledge of burnout symptoms has the potential to increase individual and organizational awareness and prevent full-scale development of burnout. Conclusions: The four narratives demonstrated that the process and the degree of recovery from burnout may very as a multitude of factors - change of workplace, participation in rehabilitation, supervisor support, and individual effort shape the path each individual takes. On the other hand, strong personal agency combined with supervisor support, stability in the workplace, and good physical health appeared to be conducive to a steady path of recovery. Following the development of recovery over time by using qualitative methods offers a unique opportunity to uncover individual paths and sense-making processes.
... For example, abusive leadership, a form of ineffective leadership, is associated with diminished job satisfaction, employee distress, and burnout (Kelloway & Barling, 2010). Burnout, most commonly affecting both individuals and organization, is characterized as consisting of three symptoms: exhaustion, cynicism, and reduced selfefficacy (Hätinen, Mäkikangas, Kinnunen, & Pekkonen, 2013). ...
... Shin et al., 2014;Van de Ven, van den Tooren, & Vlerick, 2013). Recovery (e.g., a decrease in symptom level) through coping and interventional change from burnout occurred only in the exhaustion stage; cynicism and efficacy did not change during the intervention or revealed additional deterioration in the symptoms, which had already been evaluated as dangerous at baseline (Hätinen et al., 2013). It was reported that all employees experienced exhaustion from occupational stress, at least to some extent (65% serious and 35% mild exhaustion) (Hätinen et al., 2013), and that exhaustion has been shown to affect both individual and the organization outcomes. ...
... Recovery (e.g., a decrease in symptom level) through coping and interventional change from burnout occurred only in the exhaustion stage; cynicism and efficacy did not change during the intervention or revealed additional deterioration in the symptoms, which had already been evaluated as dangerous at baseline (Hätinen et al., 2013). It was reported that all employees experienced exhaustion from occupational stress, at least to some extent (65% serious and 35% mild exhaustion) (Hätinen et al., 2013), and that exhaustion has been shown to affect both individual and the organization outcomes. ...
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... Longitudinal studies have uncovered that the development of burnout displays a variety of patterns. Individual differences in onset and recovery of burnout seem to exist [39][40][41][42]. Such differences indicate the existence of a complex system that drives the behavior of the variables underlying burnout. ...
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The phenomenon of burnout is a complex issue, which despite major efforts from researchers and organizations remains hard to prevent. The current literature highlights an increasing global prevalence of employees that are dealing with burnout. What has been largely missing is a more systemic, dynamic, and personal perspective on the interactions of the key determinants of burnout. Burnout can be seen as the outcome of a complex system involving feedback loops between individual mental models, individual behavior, and external social influences. Understanding the feedback loops involved may enable employees and organizations to intervene in burnout trajectories early and effectively. System dynamics (SD) modeling is a methodology that can describe the structure and behavior of a complex system. The current paper describes the development of an SD model of burnout. First, an expert- and literature-informed causal loop diagram (CLD) of burnout is developed. Then, a novel approach is developed to collect personal retrospective scenario data. Finally, the CLD and data are translated into a quantitative SD model. The potential of the SD model is illustrated by simulating the behavior of three realistic personas during the onset of and recovery from burnout. The process of development of an SD model of burnout is presented and the strengths and limitations of the approach are discussed.
... Likewise, not all coping strategies work in the same way in all situations and/or for all people, such that the risk of physical and psychological pathologies increases with the use of maladaptive coping strategies, including burnout [31][32][33][34][35][36]. Whilst problem-focused coping behaviours are not associated with fatigue in nurses, avoidance coping such as drinking alcohol, avoiding situations, or blocking emotions appear to predict fatigue [37]. ...
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Nurses experience significant stress and emotional exhaustion, leading to burnout and fatigue. This study assessed how the nurses' mood and fatigue evolves during their shifts, and the temporal factors that influence these phenomena. Performing a two-level design with repeated measures with moments nested into a person level, a random sample of 96 nurses was recruited. The ecological momentary assessment of demand, control, effort, reward, coping, and nursing tasks were measured in order to predict mood and fatigue, studying their current, lagged, and accumulated effects. The results show that: (1) Mood appeared to be explained by effort, by the negative lagged effect of reward, and by the accumulated effort, each following a quadratic trend, and it was influenced by previously executing a direct care task. By contrast, fatigue was explained by the current and lagged effect of effort, by the lagged effect of reward, and by the accumulated effort, again following quadratic trends. (2) Mood was also explained by problem-focused and emotion-focused coping strategies, indicative of negative mood, and by support-seeking and refusal coping strategies. (3) Fatigue was also associated with direct care and the prior effect of documentation and communication tasks. We can conclude that mood and fatigue do not depend on a single factor, such as workload, but rather on the evolution and distribution of the nursing tasks, as well as on the stress during a shift and how it is handled. The evening and night shifts seem to provoke more fatigue than the other work shifts when approaching the last third of the shift. These data show the need to plan the tasks within a shift to avoid unfinished or delayed care during the shift, and to minimize accumulated negative effects.
... Likewise, not all coping strategies work in the same way in all situations and/or for all people, such that the risk of physical and psychological pathologies, increases with the use of maladaptive coping strategies, including burnout (Chang, Bidewell, Huntingto n, Daly, & Johnson, 2007;Hä tinen, Mä kikangas, Kinnunen, & Pekkonen, 2013;Lazarus & Folkman, 1984;Nayomi, 2016;Rothbaum, Weisz, & Snyder, 1982;Yoshizawa et al., 2016). Whilst problem-focused coping behaviours are not associated with fatigue in nurses, avoidance coping like drinking alcohol, avoiding situations or blocking emotions appear to predict fatigue (Samaha, Lal, Samaha and Wyndham, 2007). ...
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Nurses experience significant stress and emotional exhaustion, leading to burnout and fatigue. This study assessed how the nurses’ mood and fatigue evolves during their shifts, and the lagged and accumulated factors that influence these phenomena. A two-level design with repeated measures was applied to a sample of 113 nurses, performing an ecological momentary assessment of different parameters and multilevel longitudinal two-level modelling of the data. Accordingly, mood appeared to be explained by effort, by the negative lagged effect of reward and by accumulated effort, each following a quadratic trend, and it was influenced by previously executing a direct care task. By contrast, fatigue was explained by the current and lagged effect of effort, by the lagged effect of reward and by accumulated effort, again following quadratic trends. Fatigue was also associated with direct care, and the prior effect of documentation and communication tasks. Mood was also explained by problem-focused and emotion-focused coping strategies, indicative of negative mood, and by support-seeking and refusal coping strategies. Hence, mood and fatigue do not depend on a single factor like workload but rather, on the evolution and distribution of tasks, as well as on the stress during a shift and how it is handled.
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It has been almost twenty years since the term "burnout" first appeared in the psychological literature. The phenomenon that was portrayed in those early articles had not been entirely unknown, but had been rarely acknowledged or even openly discussed. In some occupations, it was almost a taboo topic, because it was considered tantamount to admitting that at times professionals can (and do) act "unprofessionally." The reaction of many people was to deny that such a phenomenon existed, or, if it did exist, to attribute it to a very small (but clearly mentally disturbed) minority. This response made it difficult, at first, for any work on burnout to be taken seriously. However, after the initial articles were published, there was a major shift in opinion. Professionals in the human services gave substantial support to both the validity of the phenomenon and its significance as an occupational hazard. Once burnout was acknowledged as a legitimate issue, it began to attract the attention of various researchers. Our knowledge and understanding of burnout have grown dramatically since that shaky beginning. Burnout is now recognized as an important social problem. There has been much discussion and debate about the phenomenon, its causes and consequences. As these ideas about burnout have proliferated, so have the number of empirical research studies to test these ideas. We can now begin to speak of a "body of work" about burnout, much of which is reviewed and cited within the current volume. This work is now viewed as a legitimate and worthy enterprise that has the potential to yield both scholarly gains and practical solutions. What I would like to do in this chapter is give a personal perspective on the concept of burnout. Having been one of the early "pioneers" in this field, I have the advantage of a long-term viewpoint that covers the twenty years from the birth of burnout to its present proliferation. Furthermore, because my research was among the earliest, it has had an impact on the development of the field. In particular, my definition of burnout, and my measure to assess it (Maslach Burnout Inventory; MBI) have been adopted by many researchers and have thus influenced subsequent theorizing and research. My work has also been the point of departure for various critiques. Thus, for better or for worse, my perspective on burnout has played a part in framing the field, and so it seemed appropriate to articulate that viewpoint within this volume. In presenting this perspective, however, I do not intend to simply give a summary statement of ideas that I have discussed elsewhere. Rather, I want to provide a retrospective review and analysis of why those ideas developed in the ways that they did. Looking back on my work, with the hindsight of twenty years, I can see more clearly how my research path was shaped by both choice and chance. The shape of that path has had some impact on what questions have been asked about burnout (and what have not), as well as on the manner in which 2 answers have been sought. A better understanding of the characteristics of that path will, I think, provide some insights into our current state of knowledge and debate about burnout. In some sense, this retrospective review marks a return to my research roots. The reexamination of my initial thinking about burnout, and an analysis of how that has developed and changed over the years, has led me to renew my focus on the core concept of social relationships. I find it appropriately symbolic that this return to my research roots occurred within the context of a return to my ancestral roots. The 1990 burnout conference that inspired this rethinking took place in southern Poland, from which each of my paternal grandparents, Michael Maslach and Anna Pszczolkowska, emigrated to the United States in the early 1900s. Thus, my travel to Krakow had great significance for me, at both personal and professional levels.
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