Coping, mindfulness, stress and burnout among forensic health care professionals

Transcription

1 Coping, mindfulness, stress and burnout among forensic health care professionals Dr Sarah Angela Kriakous, Clinical Psychologist Dr Katie Ann Elliott, Consultant Clinical Psychologist Dr Robin Owen, Clinical Psychologist Division of Forensic Psychology Annual Conference 14 th June 2017

2 Aims Why look at this area of study Focus of the present study What did we do? Measures used What did we find and why is this important? The importance of formal mindfulness practice Study strengths and limitations Final thoughts.

3 Why look at this area of study? Increased levels of stress and burnout (Goodman & Schorling, 2012) Burnout associated with mental health and physical health problems (Peterson et al., 2008) Increased staff sickness and turnover (Wright, 2005) Reduced job satisfaction (Happell, Martin & Pinikahana, 2003) Poor quality of service user care (Coffey, 1999) Existing research into burnout and stress have methodological limitations Limited research within inpatient forensic settings. Mindfulness may be a possible intervention to help reduce stress and prevent burnout.

4 Focus of the present study 1) FHCPs will report elevated levels of stress and burnout compared with other groups of HCPs 2) FHCPs that report higher levels of dispositional mindfulness will report lower levels of maladaptive coping, stress and burnout. 3) The psychological predictors, namely coping strategies and facets of dispositional mindfulness, will be predictive of stress and burnout, whilst taking into account demographic variables and other aspects of working environment.

5 What did we do? Postal questionnaire design 151 FHCPs recruited from five secure hospitals in Wales Completed a background information questionnaire and four questionnaires measuring: 1)Burnout 2)Stress 3)Coping 4)Dispositional or trait mindfulness.

6 Measures used The Maslach Burnout Inventory Human Services Survey (MBI) (Maslach, Jackson & Leiter, 1996). 22 item questionnaire measuring three dimensions of burnout: 1) emotional exhaustion (EE); 2) depersonalisation (DP) and 3) personal accomplishment (PA). The Staff Stressor Questionnaire (SSQ) (Hatton et al, 1999) 35 item questionnaire that assesses work stressors amongst HCPs. The SSQ has seven subscales: 1) service user challenging behaviour; 2) service user poor skills; 3) lack of staff support; 4) lack of resources; 5) low jobstatus; 6) bureaucracy and 7) work-home conflict.

7 Maslach Burnout Inventory (MBI) Normative Scores Table 1. Normative MBI Scores for Mental Health Workers (n=730) MBI subscales Low Burnout Moderate Burnout Personal Accomplishment Emotional Exhaustion Depersonalisation High Burnout Reproduced from Maslach, C., Jackson. S.E., & Leiter, M.P. (1996). (p. 6). Maslach Burnout Inventory Manual. Third Edition. California, USA: CPP Inc.

8 Measures used The Brief Cope Inventory (BCI) (Carver, 1997) 28 item questionnaire that assesses a broad range of coping strategies. Includes 14 coping strategies with two subscales (Hastings & Brown, 2002): 1) adaptive coping; and 2) maladaptive coping. The Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF) (Bohlmeijer, ten Klooster, Fledderus, Veehof & Baer, 2011) 24 item questionnaire designed to measure dispositional or trait mindfulness. Includes five subscales: 1) observe; 2) describe; 3) acting with awareness; 4) non-judging of inner experiences; and 5) non-reactivity to inner experiences.

9 What did we find? Stress Most associated with service user challenging behaviour and least associated with lack of staff support and home-work conflict Significantly higher levels of stress compared with other HCPs. Burnout Personal accomplishment fell in the low burnout range, emotional exhaustion and depersonalisation fell within the moderate burnout range Despite moderate levels of burnout, a positive sense of personal accomplishment was retained However, significantly lower levels of personal accomplishment compared with other MHCPs.

10 ther FHCPs Study findings Table 2. Comparison of Stress and Burnout Levels with other HCPs p.05* Assessment Measures and Subscales Present study Other HCPS (Literature Findings) SSQ Mean (SD) Mean t p (SD) value value Service User (7.17) * Challenging Behaviour Poor Service User Skills 4.76 (4.67) * Lack of Staff Support 3.39 (2.85) * Lack of Resources 5.68 (2.64) * Low-Job Status 5.70 (4.21) * Bureaucracy 4.05 (2.55) * Home-Work Conflict 3.51 (2.95) * MBI Personal Accomplishment Emotional Exhaustion Depersonalisation (7.15) (10.58) 4.93 (4.33) 35.6 (9.8) 17.4(12.2) 4.5 (4.9) * Reference and Occupational Group Robertson et al., (2005) Intellectual disability residential staff (n = 92) SD not available Happell et al., (2003) Mainstream mental health nurses (n = 78)

11 Why is this important? High levels of stress and burnout Greater organisational awareness Particular occupational factors were found to be stressful Individual and occupational factors need to be addressed Lack of significant differences in burnout levels was surprising Aggression is expected and tolerated (Dickinson & Wright, 2008).

12 What else did we find? Higher mindfulness was significantly associated with: Lower maladaptive coping Lower stress Lower emotional exhaustion and depersonalisation Higher personal accomplishment Supports previous research (Palmer & Rodger, 2009) Attentional aspects of mindfulness may play a process in the cognitive appraisal of stress (Salmon et al., 2004) Cognitive appraisal theory of coping and stress (Lazarus & Folkman, 1984) Further support for mindfulness based interventions in reducing stress (Irving, Dobkin & Park., 2009).

13 What else did we find? Higher stress significantly predicted higher emotional exhaustion and depersonalisation Higher maladaptive coping significantly predicted higher stress and emotional exhaustion and lower personal accomplishment Higher acting with awareness significantly predicted lower emotional exhaustion and depersonalisation Dispositional mindfulness predicted self regulated behaviour (Brown & Ryan, 2003). Changes in self-regulation could help lower the automatic stress reaction and thus prevent burnout.

14 Formal mindfulness practice How similar is acting with awareness to other facets of mindfulness? Attention regulation and body awareness skills also required for other facets of mindfulness Self-regulation is enhanced via four mechanisms that occur during mindfulness meditation: 1) attention regulation; 2) body awareness; 3) emotion regulation; and 4) change in perspective in the self (Holzel et al., 2011). Reduced automatic stress reaction and enhanced self-regulation (Kadziolka, Di Pierdomenico & Miller, 2016). Importance of formal mindfulness practices. Formal and informal mindfulness practices may help prevent burnout in FHCPs.

15 Study strengths and limitations Included a variety of FHCPs in the sample Postal questionnaire design Added helpful information to the literature regarding underlying mechanisms Low response rate, approx. 24%, could limit generalisability Absence of information regarding those who did not participate Self-selected sample Use normative rather than secondary data.

16 Final thoughts Greater organisational awareness Individual and organisational factors may need to be addressed for longer term changes Mindfulness based interventions (MBIs) could prove to be a viable intervention Higher levels of the mindfulness facet acting with awareness associated with lower levels of stress and burnout (Yang, Meredith & Khan, 2016) Findings need to be replicated in other forensic services Role of different facets of mindfulness in the effectiveness of MBIs Inform future planning of interventions for FHCPs.

17 Thank you for listening!

18 References Bohlmeijer, E., ten Klooster, P.M., Fledderus, M., Veehof, M., & Baer, R. (2011). Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment, 18 (3), Brown, K.W., & Ryan. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84 (4), Carver, C. S. (1997). You want to measure coping but your protocol s too long: consider the Brief COPE. International Journal of Behavioural Medicine, 4, Coffey, M. (1999). Stress and burnout in forensic community mental health nurses: an investigation of its causes and effects. Journal of Psychiatric and Mental Health Nursing, 6, Dickinson, T., & Wright, K.M. (2008). Stress and burnout in forensic mental health nursing: a literature review. British Journal of Nursing, 17 (2),

19 References Happell, B., Martin, T., & Pinikahana, J. (2003). Burnout and job satisfaction: a comparative study pf psychiatric nurses from forensic and a mainstream mental health service. International Journal of Mental Health Nursing, 12, Hastings, R.P. & Brown, T. (2002). Coping strategies and the impact of challenging behaviors on special educators burnout. Mental Retardation, 40 (2), Hatton, C., Rivers, M., Mason, H., Kiernan, C., Emerson, E., Alborz, A., & Reeves, D. (1999). Staff stressors and staff outcomes in services for adults with intellectual disabilities: The staff stressor questionnaire. Research in Developmental Disabilities, 20 (4), Holzel, B.K., Lazar, S.W., Gard, T., Schuman-Olivier, Z., Vago, D.R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6,

20 References Goodman, M.J., & Schorling J.B. (2012). A mindfulness course decreases burnout and improves well-being among health care providers. International Journal of Psychiatry in Medicine, 43 (2), Irving, J.A., Dobkin, P. L., & Park, J. (2009). Cultivating mindfulness in healthcare professionals: A review of empirical studies of mindfulnessbased stress reduction (MBSR). Complementary Therapies in Clinical Practice, 15, Kadziolka, M.J., Di Pierdomenico, E. & Miller, C.J. (2016). Trait-like mindfulness promotes healthy self-regulation of stress. Mindfulness, 7 (1), Lazarus, R.S., & Folkman, S. (1984). Stress, Appraisal and Coping. New York, NY: Springer. Palmer. A., & Rodger, S. (2009). Mindfulness, stress and coping among university students. Canadian Journal of Counselling, 43 (3), Peterson, U., Demerouti, E., Bergstrom, G., Samuelsson, M., Asberg, M., & Nygren, A. (2008). Burnout and physical and mental health among Swedish healthcare workers. Journal of Advanced Nursing, 62 (1),

21 References Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach Burnout Inventory Manual (3rd Ed.). Palo Alto: Consulting Psychologists Press, Inc. Robertson, J., Hatton, C., Felce, D., Meek, A., Carr, D., Knapp, M., Hallam, A., Pinkney, L., Caesar, E., & Lowe, K. (2005). Staff stress and morale in community-based settings for people with intellectual disabilities and challenging behaviour: a brief report. Journal of Applied Research in Intellectual Disabilities, 18, Salmon, P., Sephton, S., Weissbecker, I., Hoover, K., Ulmer, C., & Studts, J.L. (2004). Mindfulness meditation in clinical practice. Cognitive and Behavioral Practice, 11, Wright, S. (2005). Burnout. A spiritual crisis. Nursing Standard, 19 (46): Yang, S., Meredith, P., Khan. (2016). Is mindfulness associated with stress and burnout among mental health professionals in Singapore? Psychology, Health & Medicine, 19: 1-7.