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Coping styles and empathy in professional burnout: A study of physical therapists

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The profession of a physical therapist is among so-called social professions, which are particularly exposed to high risks of burnout. Our paper analyzes the relationships between professional burnout in physical therapists and their perceived levels of stress, the strategies they use to cope with stress, as well as their levels of empathy and professional satisfaction. The following questionnaires were used in the study: the Burnout Scale Inventory (Okła & Steuden, 1998); the multidimensional coping inventory COPE (Carver, Scheier, & Weintraub, 1989); and the Questionnaire Measure of Emotional Empathy (Mehrabian & Ep-stein, 1972). Varying levels of professional burnout were observed in a sample of 76 physical therapists, who demonstrated no significant relationships between burnout and empathy levels. Higher burnout levels were found in participants working in public compared to privately-owned health centers, while those scoring higher on job satisfaction also had lower burnout results. Further, participants with higher professional burnout also reported higher levels of stress at the workplace and at home, as well as using avoidance coping strategies. The results of our study call for further investigation into the determinants of burnout in physical therapists and for implementing preventive measures.
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53
Polish Journal of Applied Psychology
2015, vol. 13 (3), 53–72
DOI: 10.1515/pjap-2015-0037
Anna Juszkiewicz, Urszula Dębska1
University of Wrocław
Coping styles and empathy in professional burnout:
A study of physical therapists
Abstract:
The profession of a physical therapist is among so-called social professions, which are particularly exposed
to high risks of burnout. Our paper analyzes the relationships between professional burnout in physical
therapists and their perceived levels of stress, the strategies they use to cope with stress, as well as their
levels of empathy and professional satisfaction. The following questionnaires were used in the study: the
Burnout Scale Inventory (Okła & Steuden, 1998); the multidimensional coping inventory COPE (Carver,
Scheier, & Weintraub, 1989); and the Questionnaire Measure of Emotional Empathy (Mehrabian & Ep-
stein, 1972). Varying levels of professional burnout were observed in a sample of 76 physical therapists,
who demonstrated no signicant relationships between burnout and empathy levels. Higher burnout levels
were found in participants working in public compared to privately-owned health centers, while those scor-
ing higher on job satisfaction also had lower burnout results. Further, participants with higher professional
burnout also reported higher levels of stress at the workplace and at home, as well as using avoidance cop-
ing strategies. The results of our study call for further investigation into the determinants of burnout
in physical therapists and for implementing preventive measures.
Keywords:
burnout, stress, coping, empathy, physical therapist
Streszczenie:
Zawód zjoterapeuty należy go grupy tzw. zawodów społecznych, w których obserwuje się zagroże-
nie procesem wypalenia. Artykuł analizuje związki wypalenia zawodowego u zjoterapeutów z od-
czuwanym stresem, stosowanymi strategiami radzenia sobie z nim, empatią oraz satysfakcją zawodo-
wą. Zastosowano kwestionariusze: Skalę Wypalenia Zawodowego SWS (Okła i Steuden, 1998),
Wielowymiarowy Inwentarz do Pomiaru Radzenia Sobie ze Stresem COPE (Carver, Scheier i Wein-
traub, 1989), Skalę Empatii Mehrabiana i Epsteina (1972). U 76 badanych zaobserwowano zróżnico-
wany poziom wypalenia zawodowego. Nie stwierdzono istotnych związków wypalenia z poziomem
empatii w grupie badanych. Osoby pracujące w ośrodkach publicznych cechowały się wyższym po-
ziomem wypalenia niż pracujące w ośrodkach prywatnych. Bardziej usatysfakcjonowani z pracy uzy-
skali niższe wyniki wypalenia. Wyższy poziom stresu w pracy i w miejscu zamieszkania oraz stoso-
1 Anna Juszkiewicz, Urszula Dębska, Institute of Psychology, Faculty of Pedagogical an Historical Sciences,
University of Wrocław, ul. Dawida 1, 50‒527 Wrocław, Poland: anna.juszkiewicz@uwr.edu.pl; urszula.
debska@uwr.edu.pl
54
Anna Juszkiewicz, Urszula Dębska
wanie unikowych strategii radzenia sobie ze stresem występowało u osób z wyższym poziomem
wypalenia. Wyniki badania sugerują konieczność prowadzenia dalszych badań nad uwarunkowania-
mi zjawiska u zjoterapeutów oraz wdrażanie działań prolaktycznych.
Słowa kluczowe:
wypalenie zawodowe, stres, radzenie sobie, empatia, zjoterapeuta
Introduction
Social professions, also called helping professions, impose considerable demands on those
who serve them, as direct contact and interpersonal involvement account for a substantial
part of their work. While offering specialist help, such professions also focus on qualitative
contact, bringing rehabilitation and health benets to the patients, as well as mobilizing
and activating them (Diebelt, 2009; Dibbelt, Schnaidhammer, Fleischer, & Greitemann,
2009; Kelly-Irving et al., 2009). However, if such work delivers much satisfaction to the
professional who chooses it intentionally, with a view to helping people in need, it also
poses an increased risk of professional burnout.2
Social professions feature physical therapy, in which interpersonal contact with the pa-
tient is coupled with a host of therapeutic activities, including passive and active exercises.
Indeed, a majority of physical therapists (Janaszczyk & Leoniuk, 2009) are aware that they
participat in and share co-responsibility for social, rather than merely physical, patient reha-
bilitation. They recognize their active involvement in the structure of social support (Janaszc-
zyk & Leoniuk, 2009). The more comprehensive the approach to rehabilitation that therapists
use, the stronger the effects of their work. However, there is also a ip side to this greater
responsibility for the patients and active involvement in their rehabilitation, as they also ex-
pose the therapist to an increased stress load.3
According to Sęk, the burnout risk in social professions invariably rises in times of fast
civilizational changes, with its progressive dehumanization of professions and increases
alienation at the workplace (Sęk, 2000). Exploring burnout among physical therapists is sub-
2 The problem of professional burnout has been the subject of extensive psychological exploration since the
1970s. Professional burnout results from the accumulation of several factors, including prolonged emotional
exhaustion, dehumanizing the people one has professional relations with, lack of job satisfaction, decreased
involvement in one’s work, and chronic physical fatigue (Bielecki, 2008; Fengler, 2000; Freudenberger, 1974;
Sęk, 2000). Several theoretical approaches to the burnout phenomenon have been developed so far (Maslach
& Jackson, 1981; Maslach, 2008; Sęk, 2000, 2007; Okła, 1994; Okła & Steuden, 1998, 1999).
3 Under the cognitive-transactional model, stress is dened as “a relationship with the environment that the
person appraises as signicant for his or her well being and in which the demands tax or exceed available
coping resources” (Lazarus & Folkman, 1984, p. 19). Hobfoll (1989) considers stress to be a reaction
to the environment in which there is a loss of resources, a threat of a loss of resources, or a threat of a re-
source gain (Sęk, 2002, p. 17).
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Coping styles and empathy in professional burnout: A study of physical therapists
stantiated by the sheer volume of changes taking place in their closer and further environ-
ment, which lead to growing workload levels under those changing working and living con-
ditions. The numbers of people requiring rehabilitation – the elderly, the disabled and the
chronically-ill patients – are on the increase; meanwhile, welfare benets continue to be un-
dernanced. As a result, physical therapists’ working and nancial conditions, not unlike
those serving other helping professions, leave much to be desired. Furthermore, greater social
awareness and care for one’s health and tness leave a growing number of patients seeking
private physical therapy services.
For the sake of the patients, who require maintained interpersonal contact with the
therapists, it is essential to monitor the therapists resources so as to prevent burnout. In this
profession, the effect of any action are rarely observed in the short-time perspective, mak-
ing these professionals prone to a generalized feeling of having achieved little or no suc-
cess. This, in turn, strengthens their conviction about being unable to cope with stress
at work, reduces positive work experience and reinforces the belief that they do not meet
their work goals, all of which lead to a high risk of professional burnout (Sęk, 2000, 2007).
Requiring therapeutic help themselves, burned-out physical therapists lose their helping
potential, becoming in effect a “hindrance” to the patients’ rehabilitation process. This may
likely generate particularly high social costs.
There are multiple factors affecting burnout (Heszen & Sęk, 2007; Maslach, 1998,
2003; Sęk, 2000, 2007; Okła & Steuden, 1998, 1999; Tucholska, 2009), including subjec-
tive as well as environmental ones. Among the former, a key role is attributed to effective
coping (Okła & Steuden, 1998, 1999; Sęk, 2000, 2007),4 as the ability to use adequate cop-
ing strategies may prevent the onset of burnout. The strategies focusing on problem-solv-
ing and involving a task-oriented approach are reported to be particularly effective mea-
sures against burnout (Sęk, 2007; Bielecki, 2008), as is the use of feedback at work,
recognizing self-efcacy, exercising control over events, focusing on positive experiences,
and receiving social support (Sęk, 2007).
The extensive model by Okła and Stueden examines burnout with regard to both the
giver and the receiver of support (Okła, 1994, 1998, 1999), and attributes a signicant role
to the workplace, including the stress level at the workplace as a dominant factor leading
to professional burnout. The external factors include group belonging as well as organiza-
tional and institutional variables, such as job expectations, work effectiveness and work or-
4 Coping processes are triggered upon the evaluation of an event as a stressful one. These processes in-
clude all cognitive and behavioral attempts made at overcoming the challenges that threaten or exceed
the resources of the individual (Heszen-Niejodek, 2000; Sęk, 2007). Carver, Schaier & Weintraub (1989)
put together Lazarus’s relational theory of stress and the model of behavioral self-regulation, which led
them to distinguish between coping styles and coping strategies. The ability to cope with stress effec-
tively is also reported to be conducive to higher life satisfaction (Juczyński, 2006; Juczyński & Ogińska-
Bulik, 2006; Zalewska et al., 2003).
56
Anna Juszkiewicz, Urszula Dębska
ganization. A signicant role in the burnout process is also attributed to the subjective features
of the working individual (Okła, 1994; Okła & Steuden, 1998, 1999). In turn, the relevant
internal factors include the individual’s emotional maturity, level of empathy,5 and ability
to cope with stress (Okła & Steuden, 1999).
Impacting on the motivation for undertaking prosocial activities, a high level of empa-
thy is particularly desired in people working in the helping professions (Hoffman, 2006, after
Wilczek-Rużyczka, 2008; Dibbelt et al., 2009), as it places the support and care in a moral
context, making the therapist more sensitive to the patient’s suffering (Wilczek-Rużyczka,
2002, 2008). Both the patient and the helping personnel greatly benet from enriching their
relationship with empathy-based affective contact, whereas the opposite is true when this
relationship is limited to providing impersonal service and merely transmitting information
in an uninvolved manner (Dibbelt et al., 2009; Qien, Steihaug, Iversen, & Råheim, 2010).
Hope-Stones and Mills (2001) showed low empathy levels in nurses working with cancer
patients to be accompanied by higher levels of experienced stress (after Wilczek-Rużyczka,
2008). Marcysiak (2008) conrmed a relationship between empathy and two burnout com-
ponents: sense of personal achievement correlates positively, while a tendency to depersonal-
ize patients correlates negatively with empathy (Kliś & Kossewska, 1998; Marcysiak, 2008).
A study carried out among American nurses showed that high levels of burnout have a delete-
rious impact on empathic behavior (Bradham, 2009).
Aims and hypotheses
Taking into account the multifactorial burnout determinants, our study was conducted
among physical therapists working in times of fast civilizational changes. It was carried out
with a view to analyzing the relationships between therapists’ professional burnout and
their empathic levels, perceived stress, the strategies they used to cope with stress, and
selected organizational variables, namely, length of service and type of workplace. Pro-
longed exposure to work-related stress resulting from work overload, inadequate work
organization, time pressure, and personnel and equipment shortages have all become part
and parcel of a physical therapist’s work (Mikołajewska, 2014; Pastułka-Piwnik et al.,
2014). For this reason, the means used for coping with stress may prove to be critically
important in the development of burnout. Research on the burnout syndrome among med-
5 There are three psychological approaches to empathy. Emotional empathy is understood as the ability
to “feel into” the emotional states of others. Cognitive empathy involves entering into others’ roles – un-
derstanding their motives and thoughts, and predicting their behavior. In turn, cognitive-emotional em-
pathy is dened as the ability to recognize and understand the emotional states of others, and to perceive
the world from their perspective (Knowska, 1986). Mehrabian and Epstein dene empathy as “a vicari-
ous emotional response to the perceived emotional experiences of others” (Mehrabian & Epstein, 1972,
p. 525).
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Coping styles and empathy in professional burnout: A study of physical therapists
ical personnel has emphasized a positive role for active strategies in coping (Sęk, 2007),
allowing for the hypothesis that, in the sample under examination, burnout should show
a negative relationship with problem-solving strategies, and a positive relationship with
strategies based on avoidance behavior. Existing research provides grounds to the predic-
tion that empathy should play a buffer role against professional burnout among medical
personnel (e.g. Wilczek-Rużyczka, 2008). A paucity of research on burnout in physical
therapists indicates that the organizational and personal determinants that are specic
to this particular professional group should be looked for more actively. In addition, demo-
graphic changes related to an aging society and the growing demand for physical therapy
services reinforce the need for more thorough exploration of this issue.
Participants
Participation in our study, which involved a sample of randomly-chosen physical thera-
pists working in Poland, was voluntary and anonymous. The sample consisted of 76
persons, 59 females and 17 males, with 48 therapists working in public medical centers
and 28 in privately-owned centers. Participants’ age ranged from 23 to 67 years (M =
34.71; SD = 9.65); the mean age was 34.22 years for females (SD = 9.17) and 36.41
years for males (SD = 11.25). The mean length of service for the whole sample was
10.91 years (SD = 9.12), with considerable discrepancy in service periods between the
shortest (0.5 year) and the longest (42 years).
Variables and methods
The following variables were measured to verify the proposed hypothesis: ve profes-
sional burnout dimensions, empathic level, and types of strategies used to cope with
stress. Moreover, sociodemographic variables were measured using an original survey,
which included the levels of stress at the workplace and at home, job satisfaction, and
perceived efcacy at work.
The Burnout Scale Inventory (BSI) by Steuden and Okła (1998). The scale com-a.
prises 66 statements presented in a table, with a 5-point response scale ranging from
“yes” to “no”. The statements concern respondents’ work-related experiences, their
involvement, and fatigue. The following ve factors were distinguished based on em-
pirical research: 1. Deterioration in emotional control (DEC; 22 statements); 2. Loss
of personal involvement (LPI; 15 statements); 3. Reduced personal efcacy (RPE;
12 statements); 4. Narrowing of social contacts (NSC; 10 statements); and Physical
fatigue (PF; 7 statements). The DEC and LPI factors concern losing emotional abil-
58
Anna Juszkiewicz, Urszula Dębska
ity to cope with stress and the losing subjectivity in one’s actions, respectively, and
correspond to two of the three aspects concerning burnout dened by Maslach and
Jackson (1981): emotional exhaustion and depersonalization. The remaining three
BSI factors (RPE, NSC and PF) concern the loss of ability to cope with ones tasks
efciently, the reduced belief in one’s capabilities, and physical fatigue. The BSI al-
lows for obtaining a general burnout index (GBI) and a conguration of burnout fac-
tors in particular individuals and groups.
The multidimensional coping inventory COPE (Carver et al., 1989) in the Polish b.
adaptation by Juczyński and Ogińska-Bulik (2009). The inventory comprises 60
statements describing people’s reactions to demanding and stressful life situations,
with a 4-point response scale describing how often a person behaves in a particular
way (almost never to almost always). The method consists of 15 scales describing
15 theoretically distinguished coping strategies (4 items per scale):6 Active coping
– taking action to eliminate a given stressor or to reduce its consequences; Plan-
ning thinking about how to handle the problem; Seeking social support for in-
strumental reasons – seeking support, advice and information; Seeking social sup-
port for emotional reasons – seeking moral support, sympathy and understanding;
Suppression of competing activities – putting aside other activities in order to con-
centrate on the problem; Turning to religion turning to religion for emotional
support and guidance toward positive reinterpretation and growth; Positive reinter-
pretation and growthlooking for an opportunity to grow in what is happening
and trying to see it in a more positive light; Restraint copingrestraining oneself
from acting too quickly and waiting for a better moment to act; Acceptance – ac-
cepting that what has happened is irreversible and getting used to it; Focus on and
venting of emotionsgetting upset by emotions and tending to let them out; De-
nial refusing to believe what has happened and pretending it has not; Mental
disengagement – avoiding to think about the consequences of what has happened
and turning to other activities to think about it less, such as sleeping and watching
TV; Behavioral disengagement – feeling helpless and putting no effort into reach-
ing one’s goals; Alcohol-drug disengagement using alcohol and drugs to sup-
press unpleasant emotions; Sense of humor using humor to reduce unpleasant
emotions. These scales can also be grouped into three factors (coping styles) en-
compassing problem-focused coping strategies, emotion-focused strategies and
seeking support, and avoidance behavior.
6 The inventory is used for measuring both dispositional coping styles as well as situational coping responses.
For the purposes of the present study, the tool was used for measuring dispositional coping, that is, typical
responses toward demanding situations. This was motivated by the tool’s multidimensional character and
satisfactory reliability, with Cronbach’s alphas ranging from 0.48 to 0.94 for particular scales.
59
Coping styles and empathy in professional burnout: A study of physical therapists
The Questionnaire Measure of Emotional Empathy (QMEE; Mehrabian & Ep-c.
stein, 1972) in the Polish adaptation by Rembowski (1989). This instrument is used
for measuring the level of empathy, understood as the ability to assume the other
person’s perspective while also being able to recognize, understand and experience
their own emotional reactions (Wilczek-Rużyczka, 2008). The statements included
in the questionnaire are related to the cognitive-emotional aspects of empathy, al-
though the tool’s authors attribute greater signicance to the emotional component.
The scale consists of 33 items describing behavior and a 9-point response scale
ranging from 1 fully agree to 9 fully disagree. Following the theoretical as-
sumptions of result interpretation, the level of empathy is interpreted as a numeri-
cal indicator that summarizes all the responses.
An original survey. Developed by the Author of our study, this survey comprises two d.
parts. Part 1 includes a form for collecting basic sociodemographic data, namely, sex,
age, type of workplace, and length of service. Part 2 is problem-based, asking par-
ticipants to estimate their stress level experienced at work, sense of efcacy at work,
and job satisfaction on a 5-point scale ranging from 1 – low to 5 – high.
Results
1. Analysis of professional burnout in the sample
Professional burnout scores were calculated by obtaining the BGI and separately for the
ve dimensions of Deterioration in emotional control, Loss of personal involvement, Re-
duced personal efcacy, Narrowing of social contacts, and Physical fatigue. The mean BGI
among physical therapists was M = 115.84, with a considerable discrepancy between the
lowest and the highest results (66 and 256 points, respectively; SD = 41.59).
Table 1. BSI: mean burnout values for the entire sample
Burnout Scale Inventory (BSI) MSD Minimum Maximum Scale range
General burnout index (GBI) 115.84 41.59 66 256 66‒330
Deterioration in emotional control (DEC) 35.34 15.92 22 110 22‒110
Loss of personal involvement (LPI) 27.05 10.23 15 57 15‒75
Reduced personal efcacy (RPE) 20.11 7.86 12 41 12‒60
Narrowing of social contacts (NSC) 16.25 5.96 10 41 10‒50
Physical fatigue (PF) 17.12 6.95 734 7‒35
The Mann-Whitney U test results for burnout levels showed differences with respect
to the type of workplace. The GBI was signicantly higher in therapists employed at pub-
lic centers (M = 124.40; SD = 45.30) than in those working in privately-owned ones (M
60
Anna Juszkiewicz, Urszula Dębska
= 101.18; SD = 29.66). Signicant differences were also found regarding the three di-
mensions of Loss of personal involvement, Narrowing of social contacts,
and Physic al f atigue . The therapists working in public medical centers demonstrated
higher burnout levels on these dimensions that did those who worked in privately-owned
centers (see Table 2).
Table 2. BSI: burnout levels and type of workplace
Public centers (n=48) Privately-owned centers (n=38) Mann-Whitney U statistic
MSD MSD U p
GBI 124.40 45.30 101.18 29.66 462.50 0.02*
DEC 37.75 17.50 31.21 11.95 519.00 0.10
LPI 28.71 10.71 24.21 8.81 504.50 0.07***
RPE 21.50 8.72 17.71 5.47 519.50 0.10
NSC 17.85 6.68 13.50 2.92 352.50 0.00**
PF 18.58 7.38 14.61 5.38 476.50 0.03*
*p < 0.05; **p < 0.01; ***trend, p < 0.08
Analysis of Spearman rank correlation coefcients showed no signicant correlations
between burnout and participants’ age and length of service.
2. Professional burnout and coping styles and coping strategies
Analysis of Spearman rank correlation coefcients was performed to verify the hypoth-
esis about the relationship between professional burnout and coping strategies. The re-
sults are shown in Table 3.
Table 3. Spearman rank correlation coefcients between professional burnout (BSI)
and coping styles (COPE)
GBI DEC LPI RPE NSC PF
Problem-
focused
coping
r = −0.03 r = −0.02 r = 0.01 r = −0.12 r = 0.01 r = −0.06
p = 0.82 p = 0.84 p = 0.93 p = 0.31 p = 0.92 p = 0.61
Avoidance
behavior
r = 0.38*** r = 0.30** r =0.36** r = 0.33** r = 0.35** r = 0.26*
p = 0.0007 p = 0.008 p =0.001 p = 0.002 p = 0.001 p = 0.02
Emotion-
focused
strategies
and seeking
support
r = 0.19 r = 0.14 r =0.21 r = 0.21 r = 0.22 r = 0.13
p = 0.72 p = 0.59 p =0.91 p = 0.89 p = 0.95 p = 0.62
*p < 0.05; **p < 0.01; ***p < 0.001
61
Coping styles and empathy in professional burnout: A study of physical therapists
Correlation analysis showed that avoidance behavior signicantly and positively correlat-
ed with both the GBI as well as particular burnout factors. Correlation coefcients between
burnout and the remaining coping styles proved to be statistically non-signicant.
The results showing the relationship between burnout and coping strategies are
given in Table 4. A moderate positive correlation was observed between burnout and the
strategy of Focus on and venting of emotions. Participants declaring more frequent use
of the coping strategies focused on emotions scored higher on both the GBI and particu-
lar burnout factors. Moreover, a weak positive relationship was also found between the
strategy of Seeking social support for instrumental reasons and both the GBI and the
Loss of personal involvement factor.
Table 4. Spearman rank correlation coefcients between professional burnout (BSI)
and coping strategies (COPE)
GBI DEC LPI RPE NSC PF
AC 0.03 0.04 0.06 −0.02 0.01 0.03
P−0.14 −0.11 −0.09 −0.19 −0.13 −0.11
SSIR 0.25* 0.21 0.28* 0.21 0.22 0.19
SSER 0.04 0.04 0.06 0.07 0.04 0.09
SCA 0.07 0.12 0.11 −0.05 0.10 0.01
TR −0.02 −0.05 0.00 0.03 0.09 −0.12
PRG −0.23 −0.17 −0.19 −0.30** −0.14 −0.22
RC 0.20 0.17 0.19 0.14 0.19 0.15
A 0.03 0.00 −0.03 −0.05 0.11 0.04
FVE 0.35** 0.33** 0.31** 0.32** 0.38*** 0.32**
D 0.37*** 0.28* 0.37*** 0.40*** 0.38*** 0.22
MD 0.25* 0.20 0.26* 0.22 0.20 0.15
BD 0.30** 0.25* 0.24* 0.37* 0.36* 0.22
ADD 0.37** 0.30** 0.39*** 0.27** 0.19 0.37**
SH 0.15 0.16 0.23 0.13 0.05 0.03
*p < 0.05; **p < 0.01; ***p < 0.001
Correlation analysis revealed a signicant positive relationship between burnout and the
four strategies making up the avoidant behavior style: Denial, Mental disengagement,
Behavioral disengagement, and Alcohol-drug disengagement. Thus, the hypothesis was
conrmed that a higher frequency of using these coping strategies should be accompa-
nied by higher scores on the GBI and particular burnout factors (see Table 4).
62
Anna Juszkiewicz, Urszula Dębska
3. Professional burnout and empathy
Participants’ emotional empathy levels were measured as the overall score on the QMEE,
with possible scores ranging from 1 to 297 points. Mean empathy level for the entire
sample was M = 211.79 (SD = 21.57), while a substantial discrepancy was also observed
between the lowest and the highest scores: 171 and 246 points, respectively. Analysis
of Spearman rank correlation coefcients was performed to test the hypothesis about the
relationship between empathy levels and professional burnout. The results for the entire
sample showed no signicant relationship between empathy levels and burnout scores
on both the GBI and particular burnout factors.
4. Analysis of professional burnout in the context of other independent variables
Table 6 shows relationships between burnout scores on both the GBI and particular burn-
out factors, and selected independent variables. Analysis of Spearman rank correlation
coefcients showed a signicant negative relationship between job satisfaction and
burnout on both the GBI and particular burnout factors. Moreover, the GBI and the RPE
and NSC factors were correlated with a lower job satisfaction level, while participants
with high scores on particular burnout factors also reported higher levels of stress at the
workplace and at home.
Table 5. Spearman rank correlation coefcients between burnout (BSI)
and selected independent variables
GBI DEC LPI RPE NSC PF
Stress at workplace 0.33** 0.31** 0.34** 0.20 0.14 0.39**
Stress at home 0.50*** 0.45*** 0.50*** 0.39*** 0.46*** 0.42***
Job satisfaction −0.48*** −0.40*** −0.47*** −0.36*** −0.32** −0.53***
Sense of efcacy at work −0.23* −0.22 −0.19 −0.27* −0.25* −0.13
*p < 0.05; **p < 0.01; ***p < 0.001
5. Analysis of physical therapists’ burnout prole
Regression analysis was dispensed with since there were no initial predictions about the
relationships between burnout and the two empathic and length of service variables. Given
the substantial discrepancy in burnout levels observed for the entire sample, two homoge-
neous groups were distinguished with a view to performing a more detailed analysis
of burnout and its particular factors. To that end, k-means clustering analysis was con-
ducted, which allows for classifying participants into homogeneous groups based on mul-
tiple characteristics. It combines several factors, rather than a single isolated variable, that
leads to the development of the burnout syndrome (Okła & Steuden, 1999). The results
of classifying participants into two groups are shown in Table 7 and Figure 1.
63
Coping styles and empathy in professional burnout: A study of physical therapists
Table 6. Results of variance analysis for the groups classi ed by k-means clustering
Group 1 (n = 52) Group 2 (n = 24)
MSD MSD Between-group SS Within-group SS F p
DEC 1.24 0.24 2.41 0.78 22.38 16.88 98.14 0.00***
LPI 1.52 0.45 2.42 0.70 13.19 21.68 45.01 0.00***
RPE 1.35 0.35 2.39 0.60 17.68 14.51 90.19 0.00***
NSC 1.37 0.28 2.18 0.72 10.77 15.87 50.23 0.00***
PF 1.91 0.56 3.61 0.68 47.33 26.54 131.97 0.00***
Mean scores for each factor are expressed as a weighted mean (sum of points divided by the number of state-
ments) to enable a direct comparison of means for particular factors;
***p< 0.001
Group 1 (n = 52) comprised participants with a burnout pro le characterized by signi -
cantly lower scores on all burnout factors and Group 2 (n = 24) comprised participants
with higher scores on all burnout factors. The most considerable differences between
means for the two groups were found for Physical fatigue (F = 131.97; p < 0.001), sug-
gesting this factor made for the main criterion for belonging to the cluster.
Figure 1. Mean burnout pro les for the two groups classi ed by k-means clustering
DEC – Deterioration in emotional control; LPI – Loss of personal involvement; RPE Reduced personal
ef cacy; NSC – Narrowing of social contacts; PF – Physical fatigue
Next, the groups were analyzed with respect to variables that were considered as contrib-
uting to burnout (see Table 8).
64
Anna Juszkiewicz, Urszula Dębska
Table 7. Comparison of the groups classied by k-means clustering
Group 1 (n = 52) Group 2 (n = 24)
MSD MSD U p
Age 33.98 9.82 36.29 9.25 531.00 0.30
Length of service 10.10 9.21 12.69 8.85 500.00 0.17
Empathy 207.88 23.18 202.04 22.00 522.00 0.26
Problem-focused strategies 2.79 0.33 2.78 0.38 602.50 0.81
Avoidance behavior 1.77 0.35 1.96 0.43 448.50 0.05*
Emotion-focused strategies
and seeking support 2.69 0.52 2.74 0.44 597.00 0.77
Stress at workplace 2.51 1.05 3.22 1.00 371.00 0.01*
Stress at home 1.84 0.86 2.74 0.96 290.50 0.00**
Job satisfaction 4.06 0.68 2.74 1.18 280.50 0.00**
Sense of efcacy at work 1.84 2.74 3.87 0.87 513.50 0.40
*p < 0.05; **p < 0.001
This analysis revealed a signicantly higher frequency of using avoidance coping strate-
gies by the participants with the high-burnout prole than by their low-burnout prole
counterparts. Furthermore, as well as scoring higher on perceived stress at the workplace
(U = 371.0; p = 0.01) and at home (U = 290.50; p < 0.001), the physical therapists in the
high-burnout group also declared signicantly lower levels of job satisfaction (U =
280.50; p < 0.001). No statistically signicant differences were found between the two
groups with respect to service length and empathy levels.
Discussion and conclusions
Characterized by considerable physical strain and emotional involvement in the healing
process of another human being, the physical therapy profession is exposed to high stress
and burnout risk. Our results showed a substantial diversication in the burnout levels
and its particular factors among participants, showing the exploration of this phenome-
non to be a worthwhile endeavor.
Higher levels of burnout were found in therapists working in public compared
to privately-owned health centers, an observation that is consistent with research nd-
ings conducted abroad. A study carried out in Cyprus (Pavlakis, Raftopoulos, & The-
odorou, 2010) revealed that almost 46% of physical therapists regarded their work as
stressful, with those working in public centers reporting relatively higher stress levels.
This gives grounds to the observation that, in our contemporary reality, working in the
public health care sector is associated with a greater number of responsibilities, lower
nancial satisfaction and a need for taking up additional work. These, in turn, lead
65
Coping styles and empathy in professional burnout: A study of physical therapists
to a reduction in the time available for one’s family life, social interaction and rest, which
are vital factors in preventing professional burnout (Śliwiński et al., 2014). Higher burn-
out levels in therapists employed at public medical centers point to the direction of fur-
ther research. Such research ought to be designed to analyze the specic work character
in public medical facilities that occasion additional stress.
The present study showed no relationship to exist between burnout levels and length
of service. Although some ndings indicate that longer service in home rehabilitation
and the medical professions is associated with higher professional burnout levels (Pav-
lakis et al. 2010; Mikalauskas et al., 2012), no unambiguous relationship between burn-
out and the physical therapists’ length of service has so far been found. On the one hand,
lengthy service is accompanied by prolonged exposure to stress at work, likely leading
to overexertion and fatigue; whereas on the other, longer work experience is often ac-
companied by higher levels of knowledge and competence, which may translate into
better results at work and higher job satisfaction. A large body of research shows that
younger, less experienced workers are by far more exposed to professional burnout
(Maslach & Schaufeli, 2001; Oyefeso, Clancy, & Farmer, 2008). In a previous study
conducted on a Polish sample, physical therapists with 15+ years of service declared
higher life satisfaction than did their less-experienced counterparts (Śliwiński et al.,
2014). At the same time, the study showed the level of professional burnout to decrease
with growing life satisfaction. The ambiguity of ndings in this area suggests that length
of service may be an important factor in choosing a strategy for preventing stress and
professional burnout (Mikołajewska, 2014).
Our ndings conrm the positive inuence of empathy on the quality of medical
care and patient satisfaction (See also Omdahl & O’Donnell, 1999; Seaberg, Godwin, &
Perry, 2000; Hojat et al., 2004; Mercer et al., 2005; Eide et al., 2004), which in turn im-
pact on physical therapists’ job satisfaction. Extant research has also demonstrated the
protective function of empathy against developing professional burnout in other profes-
sions as well (e.g. Astrom et al., 1990; Bradham, 2009; Kuremyr et al.,1994; Lee et al.,
2003; Larson, 2005; Marcysiak, 2008). Our study did not reveal a signicant relation-
ship between empathy and burnout. Under its theoretical assumptions, the QMEE is pri-
marily used for measuring the emotional component of empathy – which is understood
as the ability to “feel into” the emotional states of others, focusing on the cognitive and
behavioral components to a much lesser extent. As Maslach (1998) observes, an unreal-
istic model of an ideal caregiver-caretaker relationship prevails in the helping profes-
sions, which calls for a paradox: medical personnel are required to show care for and feel
compassion toward, the patient on the one hand, and maintain emotional distance on the
other. A lack of balance between emotional distance and emotional involvement with the
66
Anna Juszkiewicz, Urszula Dębska
patient may lead to excessive mental stress. In such a therapeutic context, the role
of compassion may perhaps be surpassed by that of the cognitive component of empa-
thy, one related to the medical personnel’s capacity to appreciate the perspective of oth-
ers and objectivize their feelings. A promising avenue of research would be to explore
the relationships between physical therapists’ burnout and empathy levels by using meth-
ods for assessing all the components of empathy at the same time.
On account of the considerable diversity in the participants’ burnout levels, our
sample was divided into two homogeneous groups with high and low burnout proles,
with Physical fatigue subsequently turning out to be the key differentiating factor be-
tween the two groups. Physical strain related to therapists’ responsibilities such as
performing massages, kinesitherapy, and lifting and carrying the patients as well as
exposure to physical factors, including radiation and various temperatures, all contribute
to excessive overload of the skeletal and muscular systems (Mikołajewska, 2014). Re-
search has shown many physical therapists to experience chronic pain associated with
work-related strain (Krause, Regland, Fisher, & Syme, 1998), while an additional source
of pain may also be sought in stress at the workplace. A key issue is the low wages that
make the medical personnel take on extra work in privately-owned centers. Our ndings
show physical fatigue to be a major problem in this profession, one that demands certain
organizational solutions for preventing work-related exhaustion and overload.
A leading factor contributing to professional burnout (e.g. Potter, 2006), stress
is unavoidable in the social professions. Participants with the high burnout prole re-
ported higher levels of stress at the workplace and at home. Family life satisfaction, good
relationships with family and friends, and support of the people around them could play
a crucial role in preventing stress at work (see also Mikołajewska, 2014; Śliwiński et al.,
2014). Moreover, our study demonstrated that the type of mechanisms used to cope with
stress is another important factor contributing to the burnout level. By showing that in-
dividuals who use avoidance-focused strategies are at greatest risk of professional burn-
out, our study provides a premise for planning and implementing preventive action in the
future. It demonstrates the necessity to educate physical therapists on stress and burnout
prevention as well as to help them develop effective abilities to cope with stress.
Under the model by Potocka and Waszkowska (2013), job satisfaction depends
on job demands, job resources, and individual resources of the worker. Allowing the
worker access to job resources (e.g. sense of control at work, support of the superiors,
communication, and opportunities to develop) and individual resources is conducive
to lowering the number of stressors and increasing job satisfaction. Apart from family
life, job satisfaction is ranked among the determining factors in preventing professional
burnout (Mikołajewska, 2014). Low job satisfaction observed in physical therapists with
67
Coping styles and empathy in professional burnout: A study of physical therapists
high burnout levels suggests a possibility of bidirectional action in the future, targeted
at both developing competencies (individual resources) and identifying adverse working
conditions. Such an approach is in keeping with the postulate given by Sęk et al. (1997),
claiming that burnout prevention can be realized using both positive and negative strate-
gies. Whereas the positive approach is focused on strengthening social skills, communi-
cation competencies, coping strategies, and similar other abilities, the negative approach
is directed at reducing the risk factors contributing to the development of burnout, in-
cluding low wages and organizational shortcomings (in this case: identifying and im-
proving the adverse working conditions in public medical centers).
A signicant limitation of our study is the small sample size. However, similarly
to previous research, these ndings also conrmed that physical therapists do indeed expe-
rience professional burnout. They constitute the third largest group of health care profes-
sionals (Mikołajewska, 2014). Given the aging of societies and the growing demand for
physical therapy services, the burnout problem affecting this profession is becoming
a global issue that needs to be carefully addressed. Burnout is becoming ever more preva-
lent in the contemporary world, having pronounced effects at both the individual level –
including symptoms of depression (Li Calzi et al., 2006) and cardiovascular diseases
(Blackmore et al., 2007; Clays et al., 2007), and the organizational level for example,
increased absence from work and staff turnover, decreased productivity of workers and
their frequent giving up work (Śliwiński et al., 2014). It is a situation that demands further
research on burnout phenomenon determinants and urgently calls for implementing ap-
propriate preventive programs.
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... Zmęczenie może również pełnić funkcję modyfikującą wobec stosowanych strategii radzenia sobie ze stresem, jednak zależność ta nie jest jednoznaczna. Wyższy poziom wyczerpania związany z odczuwanym silnym stresem w pracy i w środowisku rodzinnym wiąże się ze stosowaniem unikowych strategii radzenia sobie ze stresem [16]. Być może stosowanie aktywnego radzenia sobie w sytuacji obciążającej może zostać ograniczone celem zachowania energii jednostki. ...
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Background. Home mechanical ventilation is a form of long-term nursing intervention over people with chronic respiratory failure. The aim of this research was to determine the connections between daily life fatigue and coping strategies in caregivers of people supported by home mechanical ventilation, considering the role of objective medical factors of the ill (ventilation method and time). Material and methods. The study included 61 caregivers aged 29-74. The variables were measured with Daily Life Fatigue Questionnaire, Inventory to Measure Coping Strategies with Stress Mini-COPE and survey Results. Higher level of: General, physical, psychological and social fatigue contributes to increased avoidance behaviour and manifestation of helplessness among the caregivers of home mechanically-ventilated individuals. The method and time of mechanical ventilation application significantly differentiate the relation between daily life fatigue and coping strategies. Conclusions. The results acquired showed that the caregivers were significantly differentiate in measured variables. Diagnosing the fatigue and coping strategies is very important matter in creation of psychological support programmes for caregivers of home mechanically-ventilated individuals.
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Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy. The past 25 years of research has established the complexity of the construct, and places the individual stress experience within a larger organizational context of people's relation to their work. Recently, the work on burnout has expanded internationally and has led to new conceptual models. The focus on engagement, the positive antithesis of burnout, promises to yield new perspectives on interventions to alleviate burnout. The social focus of burnout, the solid research basis concerning the syndrome, and its specific ties to the work domain make a distinct and valuable contribution to people's health and well-being.
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Job burnout is a prolonged response to chronic emotional and interpersonal stressors on the job and is defined here by the three dimensions of exhaustion, cynicism, and sense of inefficacy. Its presence as a social problem in many human services professions was the impetus for the research that is now taking place in many countries. That research has established the complexity of the problem and has examined the individual stress experience within a larger social and organizational context of people's response to their work. The framework, which focuses attention on the interpersonal dynamics between the worker and other people in the workplace, has yielded new insights into the sources of stress, but effective interventions have yet to be developed and evaluated.
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Aims This paper reports a critical review of the literature examining burnout among nurses and physicians working in emergency departments. The objective was to draw together a diverse collection of literature to undertake an in-depth analyse of the issues raised by the review question. Background Burnout among nurses and physicians working in emergency departments has only been brought to the attention of researchers recently. It is thought that the highly stressful environment and unpredictable nature of the work puts nurses and physicians at risk of burnout. Method A literature review was undertaken using the electronic databases CINAHL and MEDLINE, Royal College of Nursing and British Medical Journal websites. The papers retrieved used quantitative and qualitative approaches and were scrutinised for relevance. Twelve articles met the inclusion criteria and corresponded to the aim of this review. Conclusion The findings of the review reinforce concerns about the adverse effects of burnout among nurses and physicians working in emergency departments. Future research in this field is recommended, particularly around the naturalistic paradigm, to gain a deeper insight into the lived experiences of emergency department nurses and physicians.