Social work and burnout in psychiatric care settings

¶ … Social Work and Burnout

Providing psychiatric and other forms of social work has been the chosen field of many generations of social workers and a major source of services in mental health facilities. Since psychiatric services are a subset of a larger career field of the health care profession, when the definition of social worker was expanded to health care professionals, it can be understood that the issue of burnout in the health care fields is of increasing importance. The health care professional is responsible for the well-being of others, and when the health care worker spends their time and energy giving to the well being of others without monitoring, or attending to their own needs, not only is the health care worker affected, but so is the entire health care profession, and client base. This research is designed to investigate, and determine some of the factors which contribute to burn out in the social work field.

Literature Review

Burnout among professionals in the health care, and social work field has been of considerable interest. Increasing amounts of research have been accomplished on the phenomena of job satisfaction and burnout in the social work profession (Farber, 1983a; Harrison, 1980). The health care worker is responsible for the emotional and social well being of his or her clients, and the well being of the client can affect virtually every area of the client's life, and relationships which are important to the client. Therefore the health care professional not only affects the well being of the individual client, but can be understood to have a causal effect on every widening numbers of people through their influence on their client's life. Therefore the direct contact with clients in clinical practice and the continual responsibilities of meeting their emotional offer both intrinsic satisfaction and stresses for the service providers (Maslach & Jackson, 1982; Pines & Kafry, 1978).

The emotional condition of the individual social worker can be understood as being directly related to the professional's job satisfaction. Job satisfaction is no longer understood as the results of a monetary successful practice, or other extrinsic factors which affect the social worker. Job satisfaction is defined as a positive emotional state resulting from the self appraisal of one's job situation as it is linked with the characteristics and demands of one's work (Arches, 1991; Butler, 1990). Job satisfaction is understood increasingly as the emotional connection the professional receives and makes to his chosen career. Job satisfaction is a measure of the level to which the person's individual goals and desired for their own match up with the rewards and benefits which the professional receives form their chosen career. Therefore the work-related satisfaction of helping people, achieving change and improvement, and promoting their growth has important implications for social workers' behaviors at work, their desire to continue in their work, and their involvement in the job and with their clients (Beemsterboer & Baum, 1984).

Burnout, on the other hand, is defined as a negative psychological experience that is a reaction of workers to job-related stress (Daley, 1979). Burnout refers to a cluster of physical, emotional, and interactional symptoms, including but not limited to emotional exhaustion, a sense of lacking personal accomplishment. This condition often results in the professional depersonalizing clients their clients, and detaching from the lists of emotional and psycho-social needs which clients bring into their office each day (Maslach & Jackson, 1982). Burnout symptoms also can include physical symptoms, emotional exhaustion, depression, or other serious emotional dysfunction. Recurrent bouts of flu, headaches, fatigue, poor self-esteem, difficulty in interpersonal relationships, substance abuse, inability to concentrate, rigidity, and tendency to blame clients for their problems can appear singularly, or in combination as evidence of burnout (Cherniss, 1980; Pines & Maslach, 1978).

In a profession that is client centered and requires emotional involvement that puts stress on service providers, it is not uncommon for the professional to deplete their own emotional and physical resources in the process of applying their job skills. Pressures of their positions can create an emotionally drained and chronically frustrated worker (Beemsterboer & Baum, 1984; Maslach, 1982). While in this state, these workers are likely to be unable to deal with the inevitable and everyday stresses of their job. This failure to cope can result in a number of negative consequences, including impaired performance, low morale, absenteeism, and high turnover (Beemsterboer & Baum, 1984; Daley, 1979). If left unchecked, the burnout cycle and continued impaired performance can become a self feeding, and devolving condition for the social worker.

The nature of human services occupations often attracts people who are empathetic and sensitive and who tend to be people oriented but who are also anxious, introverted, and overenthusiastic (Freudenberger & Richelson, 1980) Often the self-perceived need to help others is exaggerated as the social worker seeks to comprehend the needs of their clients. Their clients needs can be based on their workers own low self-esteem, and therefore when the social worker seeks to make progress, he or she sets unrealistic goals, which are also factors associated with the burnout phenomenon (Farber, 1983a).

Koeske and Kirk (1995) found that the issue of perceived locus of control was also associated with tendency toward burnout. According to their research, an internal locus of control was associated with less burnout and higher job satisfaction. Those social workers who had developed an internal locus of control were the workers who most often were able to avoid the burnout cycle, and maintain a personal balance to their lives.

Locus of control (Rotter, 1966) refers to one's belief in his or her abilities to control their own life's events. The term locus of control is often used interchangeably with self-efficacy, and a feeling so positive self-esteem, but the terms are not equivalent. While self-efficacy focuses on an individual's perception of ability to act competently and effectively, locus of control focuses on the individual's perception of their control over their circumstances and over the outcome of their efforts (Bandura, 1977a). An individual with an internal locus of control believes that outcomes are related to his or her behavior or personal investment. An individual with an external locus of control believes that outcomes are not related to his or her behavior but to external forces beyond his or her control. Individuals with an external locus of control may perceive life events to be controlled by luck, chance, fate, or powerful others, including their perception of religious beliefs. Stated differently, individuals with an internal locus of control are more likely to change their behavior in order to attain new and different goals following reinforcement to an individual action. Individuals with an external locus of control are likely to continue behaviors regardless of reinforcement, believing that they are limited by the actions of others, or 'victims' who are 'locked into' a certain situation because of the power others have over the situation.

Locus of control has also been implicated in a wide variety of career and vocational behaviors. Spector (1988) developed the Work Locus of Control Scale as a measure of generalized control in work settings which has been used to suggest that the work locus of control may act as a strong mediating variable in job stress and strain (Spector & O'Connell, 1994). Locus of control has also been related to attitude toward work and client participation in vocational rehabilitation (Duvdevany & Rimmerman, 1996).

The nature of the work setting, as well as the person's perception of the work setting can also be understood to be factors which can create work-related stresses that can lead to workers' burnout (Poulin & Walter, 1993). The nature of the work setting affects the personal sense of their locus of control. The nature of the work setting can offer significant amounts of psycho-social support, or minimal amounts of the same and each have a corresponding effect on the presence of, and the appearance of burn out. Organizational factors that have been found to contribute to, and affect the presence of burnout positively and negatively include:

Lack of autonomy (Arches, 1991)

Role conflict (Harrison, 1980),

Inadequacy of organizational resources (Poulin & Walter, 1993),

Lack of social support (Pines & Maslach, 1978).

On the other hand, job satisfaction can be defined as the degree of the person's connection to, and the amount of positive affect the person perceives he or she can contribute toward the overall job or its components (Weisman, Alexander, & Chase, 1980). Job satisfaction literature is extensive, and its relevance to health care settings and professions is well worth examining, especially literature on organizational commitment and the three constructs which affect the levels of organizational commitment which will appear in the professional lives of the staff. Because staffing costs in health care settings are high, and a considerable proportion of management's time can devoted to personnel issues, making sure that the professional builds a balances career path that does not lead to burnout is a valuable goal for professional health care organizations. Organizations which have a low occurrence of burnout can dedicate more of their time and resources to patient care, whereas the organization which has a high occurrence of burn out will have to divert resources which are intended for patient care to the management and improvement of their own organization. Workers who are vulnerable to burnout create a demised organizational potential "with all its ramifications from personal trauma to deterioration in quality of services" (Ullmann, Goos, Davis, & Mushinski, 1971).

Research methods.

This study will be a two part cross over study, and will select a cross section of professionals from social work professions to interview regarding their personal experiences with burn out. The research will break the surveyed population into groups by age and gender demographics, and attempt to identity common experiences, factors and perceptions which affect the appearance of burn out in the professional's career path.

Part One

Likert scale-based survey of 20 questions will be created that focus on the participant's personal beliefs regarding locus of control, personal efficacy, and burn out. The questions will be ranked on an appreciating scale from 1-7, and the participants will be asked to rank the degree to which they either agree with, or disagree with the factors and situations which have been suggested in literature as having influence over the presence of burnout in the social worker.

Part Two

The second part of the survey will be composed of 6 questions that focus on the professional's personal experiences with burnout. This part of the study will seek to identify the prevalence of burnout in the different career stages of the social worker. This section will seek to identify the social workers perception of the factors which led to the inset of burnout, and their perceptions of the factors in their own life which helped them overcome the occurrence. In the case of participants who have not experiences burnout, the survey will ask questions regarding the individual's actions which prevented burnout from becoming a part of their own career experiences.

By using the cross over approach of qualitative and quantitative research, this study will be able to measure the presence of factors which lead to burnout, and the perceptions of the workers regarding these factors, and their influence.

Sampling Plan

The population sample of this research will be a cross section of social workers who work in both private and public practice. The target population will be a group of 150 workers in the public sector and 150 workers in the private sector. The target population will also be composed of 1/3 who are in their first 3 years of practice, 1/3 who are have been practicing from 3-15 years, and 1/3 who have been practicing social work for over 15 years. The population will also be composed equally of men and women. This diverse selection of research population members should create comprehensive research as to the presence, prevalence, and impact of burnout in the field.