Thesis (M.A. (Industrial Psychology))--North-West University, Vaal Triangle Campus, 2004.

Étude de limpact dinterventions psychologiques préventives sur le burnout des médecins Le burnout est défini comme un syndrome psychologique susceptible dapparaître chez des individus qui travaillent avec dautres individus, en réponse à des stresseurs émotionnels et interpersonnels présents depuis un certain temps sur le lieu de travail. Différents facteurs individuels (ex. manque dexpérience), communicationnels (ex. manque de formation à la communication, stress de communiquer, faible sentiment defficacité personnelle en consultation), et professionnels (ex. exigences de travail élevées) peuvent contribuer au développement du burnout chez les médecins. Les études ayant testés lefficacité dinterventions psychologiques (ex. gestion du stress, formation à la communication) sur le burnout de médecins sont peu concluantes. Ce travail de thèse visait donc à répondre à deux questions: (1) Une formation à la communication permet-elle de réduire le burnout de médecins? (2) Quest-ce qui explique le changement ou le non-changement dans le burnout de ces médecins parmi des facteurs prédicteurs individuels, communicationnels et professionnels? Une première étude contrôlée et randomisée portant sur 62 médecins spécialistes travaillant avec des patients cancéreux a montré quune formation à la communication (35 heures) ne permet pas de réduire leur burnout. Deux hypothèses ont été avancées pour expliquer ce non-changement : (1) laltération de certaines croyances des médecins, construites par des années de pratique sur la façon de communiquer avec les patients, aurait empêché leffet positif de la formation, (2) linfluence de la charge clinique sur le burnout naurait pas été suffisamment prise en compte dans la formation. Une seconde étude a profité des leçons tirées de la première : organiser ces formations au cours des études de médecine, ajouter un module de gestion du stress et tester lefficacité des formations sur des mesures proximales (stress de communiquer, sentiment defficacité personnelle). La seconde étude contrôlée et randomisée portant sur 75 médecins assistants a montré quune formation à la communication (30 heures) combinée à une formation à la gestion du stress (10 heures) permet de réduire le stress de communiquer en consultation, daméliorer le sentiment defficacité personnelle à communiquer et à gérer le stress en consultation mais pas de réduire le burnout. Deux hypothèses ont été avancées pour expliquer ce non-changement : (1) un niveau danxiété élevée aurait empêché leffet positif de la formation, et (2) linfluence de la mauvaise qualité de vie au travail sur le burnout naurait pas été suffisamment prise en compte dans la formation. Les résultats positifs concernant le sentiment defficacité personnelle et le stress sont encourageants. Que manque t-il aux formations pour réussir au niveau du burnout ? Plusieurs pistes peuvent être proposées : réaliser des interventions centrées à la fois sur la personne, sur la communication et sur le travail ; les intégrer dans les études de médecine ; les implanter sur le lieu de travail ; organiser des supervisions individuelles ; former lensemble du service. La relation médecin-patient est souvent gratifiante mais, elle est aussi source de risque émotionnel sévère. Lengagement professionnel du médecin a un coût et le médecin doit sen rendre compte avant darriver à des conséquences négatives pour les médecins et les patients.

Introduction   Client violence toward social workers has become recognized as a common problem, and major concern has been raised with regard to its impacts on the workers’ practice, and physical and psychological health. More than half a century has passed since the social work profession was established in Iran, and yet client violence and the associated health-related consequences remain unexplored. This thesis aims to address this gap in knowledge. Methods   A national survey was conducted involving 390 social workers from the Centres for Socially Injured People (CSIP), affiliated to the Social Affairs Department of the State Welfare Organization, Iran. The survey included self-administered questionnaires, namely, the Workplace Violence in the Health Sector questionnaire, the General Health Questionnaire-28 (GHQ-28), the Ways of Coping questionnaire, the Burnout Measure, and the Rosenberg Self-esteem Scale. Results   A high proportion of CSIP social workers (67%) have experienced violence. Psychological violence was about three times more common than physical violence. A high tendency of not reporting psychological violence to managers/supervisors was found. Psychological violence was associated with poorer mental health. Social workers with experience of psychological violence were found to be more worried about occurrences of violent events. Worrying about violence was significantly correlated with poorer mental health. Active coping had a direct effect on health, suggesting a poorer health status with more frequent use of active coping. Burnout was experienced by 10.9% of social workers, and 17.4% were found to be at risk of developing burnout symptoms. Low self-esteem and experience of violence were associated with burnout. Conclusion   The results suggest the importance of not neglecting cases of client violence and of putting the health and safety of social workers on top of the agenda. A victimized social worker with limited resources at work needs to note that coping skills may reduce the impact of stressors, not only by changing the stressors themselves, but also by changing how the social worker responds to them.

This thesis focuses on the role of different psychosocial factors in the course of pain over time in a general population sample of women in Sweden. The main aim was to identify and quantify such factors as predictors of pain, pain-related disability and quality of life within a biopsychosocial framework for the understanding of the pain experience over time.  The studies were based on baseline (BL) and follow-up (FU) measures with 12 months apart among 2,300 women living in Sweden, and included physical and psychological health and socio-economic status. Study I investigated associations between socio-economic status (SES) at baseline and pain and pain-related disability at follow-up, and additionally a possible mediating role of depressive symptoms in such associations. The results indicated that educational level, financial strain and occupational level were associated with pain over time. Symptoms of depression were related to all pain-and SES factors, and might be understood as a mediating factor within this context. The results of Study II showed a link between symptoms of burnout at baseline and several pain-locations. Additionally, among women with pain, the characteristics of the pain experience and pain-related disability were associated with level of burnout over time. Study III focused on the sub sample of women reporting pain at follow-up, and examined possible predictors of their perceptions of quality of life (QOL). Several psychosocial factors were associated with QOL, and seemed to be more important predictors than the characteristics of pain in terms of intensity and frequency. These factors were burnout, emotional distress, and social support. Study IV was an attempt to sum up the results of the previous studies by analysing predictors of the course of pain, i.e. by comparing women that developed pain from BL to FU with those that remained pain-free and to compare women with sustained pain with those who recovered from pain during the assessment period. These analyses showed symptoms of posttraumatic stress (PTSD) to be associated with reporting emerging pain, while pain variables, educational level and social support were related to sustained pain. The results of the four studies in this thesis indicate that psychosocial factors and their interplay with the characteristics of pain can be identified and described in a female sample, with a broad definition of pain, and that these factors play a central role in the experience of pain and its impact on the everyday life of these women. There may be several possible paths leading to the development of persistent pain among women and the identification of risk factors is complicated by never-ending interactions between biological, psychological and social processes. At an early stage, prior to pain development, several risk factors may cluster together (e.g. SES, depression), and work as indicators of, e.g. dysfunctional coping in relation to pain. In the first contact with health care and among primary care personnel the identification of such indicators is crucial so as to find women at risk for prolonged pain conditions. General indicators might then be more easily distinguishable than certain individual behaviour characteristics widely accepted as risk factors for pain and disability (e.g. fear-avoidance). To spread the knowledge of general factors in the first line of health care is therefore of great importance in preventive work. Finally, the results demonstrated that many women report pain with characteristics that to a great extent affect their lives and through interactions with psychological and social health might have grave consequences for perceptions of quality of life.

Sjukskrivningarna för utmattningssyndrom har de senaste åren ökat dramatiskt i Sverige. Detta har lett till allt mer komplexa och långvariga rehabiliteringar. Syf-tet med denna studie var att beskriva och analysera hur ett antal individer upplev-de sin rehabilitering efter sjukskrivning för utmattning. Delsyften var att öka kun-skapen om hur rehabiliteringen efter utmattning kunde förbättras samt belysa kvinnors och mäns skilda förutsättningar till rehabilitering beroende på kulturell kontext. Tio personer som kommit åter till arbete efter sjukskrivning djupintervju-ades om rehabiliteringen. Resultaten från studien antydde att det var viktigt att vidga perspektiven på rehabilitering genom att använda ett kontextberoende syn-sätt. Studien resulterade i tre teman; Lärande, Styrning och Organisering. I samtli-ga teman var timing betydelsefullt. Lärandet och strategier att hitta nya insikter var viktigt både för individ och organisation för att en lyckad rehabilitering skulle ske, där strategierna blev olika för kvinnor och män. När det gällde rehabilitering-ens styrning visade det sig hur viktig balansen mellan att få stöd och att själv få agera var. Rehabiliteringens organisering visade sig i denna studie vara grund-läggande och central för rehabiliteringen, där möjligheten att kunna återskapa goda sociala möten var avgörande.

In recent years because of the multiplex duty border plan & the globalization competition environment competition, developed ¡§the Atypical Employment Relationship¡¨ gradually the manpower dispatch pattern¡CThe globalization increased enterprise's competitive power, in order to be survived under the entire competition, the most enterprises tend to adopt a flexible HRM system to reduce the cost, the production diversification as well as promote the product quality, except will move to the manpower cost inexpensive area, will also use the Non-traditional Employment Relationship in the non-core business execution, will create the biggest superiority. But in domestic, the Executive Yuan economic construction could announce ¡§service industry development guiding principle & the course of action¡¨ in Apr. 2004, the manpower dispatch is included one of 12 prioritize industries, in this plan to the manpower dispatch service entrepreneur hoped could achieve 1000~2000 market capacities, but to dispatched the laborer to hope could achieve 300,000 people ¡CThis plan, attracts the entrepreneur who favors this market sesame seed cake to take place of the fallen invests this industry. Is engaged in the manpower dispatch industry personnel therefore increasing, & provide their profession & customize service to these needs enterprise. Although the manpower dispatch in domestic is already in fashion for many years, at present in domestic is engaged in the dispatch industry personnel also closely 80,000 people(According to the Council of Labor Affairs Executive Yuan in 2003 estimates, but it estimates the scope also to contain includes the service to contract the jobholders),however, a job dem& the manpower dispatch is often decided by these needs enterprise, confronting positions to dispatched worker, therefor these staff in Employee Dispatching Industry will blend with each othere. The goal of the thesis is to provide a dispatching industry study and analysis of: 1) The job characteristic of the employee dispatching industry. 2) The relations between the job characteristic of the employee dispatching industry and turnover. 3) The effect of the job characteristic and job satisfaction on distpatching industry turnover, and 4) The effect of the job characteristic and job burnout on distpacthing industry turnover. During this study, there are 400copies of the questionnaire were sent out to those staff in employee dispatching industry, 102 were returned. The return rate was 25.5%. From this research, we can conclude that: 1.These staff in Employee Dispatching Industry mostly are university degree, female, single & within 3 years experience in this industry. We think that because female characteristics compare job characteristics. 2.The job characteristics category, resigning intention can be restrained by increasing working autonomy . Skill variety has outst&ingly direct effect on turnover. 3.The job characteristics category, internal satisfaction can be improved by increasing skill variety, task significance & working feedback, but external satisfaction can by improved by increasing working autonomy. 4.Job burnout has mediating effect between the job characteristics & turnover.

The overall purpose of this thesis is to investigate whether there is an association between “stress of conscience” — that is, stress related to a troubled conscience — and burnout, and to obtain an enhanced understanding of factors related to stress of conscience and burnout in healthcare. Of the four “studies” included, one uses qualitative research methods and the others use quantitative research methods. The data are based on cross-sectional questionnaire studies (I, II, and IV) and open-ended interviews (III). We could find no existing suitable instrument for measuring troubled conscience in healthcare, and so we constructed and tested the “Stress of Conscience Questionnaire” (SCQ) (I), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. We included 164 participants in the pilot studies, an additional 444 in the main analysis, and 55 in the test-retest verification. Participants had various occupational backgrounds and were recruited from different parts of Sweden. Our findings suggest that the SCQ is a valid and reliable measurement for use in various healthcare contexts. Cronbach’s α for the overall scale was 0.83, ensuring internal consistency. Explorative factor analysis identified and labelled two factors: “internal demands” and “external demands and restrictions”. To investigate factors related to stress of conscience and burnout (II, IV) we used a sample of 423 healthcare personnel from various specialities and with various occupations, from a district in northern Sweden. Multiple regression analysis showed that the factors related to stress of conscience (II) were: perceiving that conscience warns us against hurting others while at the same time not being able to follow one’s conscience at work, and having to deaden one’s conscience in order to keep working in healthcare; and also moral sensitivity items belonging to the factor “sense of moral burden”. In addition, deficient social support from superiors, low levels of resilience, and working in internal medicine wards were all associated with stress of conscience. The model explained 40% of the total variance. Interviews were conducted with 30 healthcare managers, to illuminate their explanatory models of the sources contributing to burnout in healthcare settings (III). The data were analysed using qualitative content analysis. The findings indicate that continuous reorganisation and downsizing of health care has reduced resources, while at the same time demands and responsibilities have increased. These problems are compounded by high ideals and expectations, making staff question their own abilities and worth. All in all this throws healthcare employees into a spiralling sense of inadequacy and an emerging sense of pessimism and powerlessness. Multiple regression analysis showed that having to deaden one’s conscience, stress of conscience from lacking the time to provide the necessary care, the work being so demanding that it influences one’s home life, not being able to live up to others’ expectations, low social support from co-workers, and low levels of resilience were all related to emotional exhaustion. Other factors that had an impact were being female, being a physician or being other healthcare professional and working in geriatric care or a primary healthcare centre. The full model explained 59% of the variance. Factors contributing to depersonalisation were: having to deaden one’s conscience, stress of conscience from not being able to live up to others’ expectations and from having to lower one’s aspirations to provide good care, deficient social support from co-workers, and being a physician; however, the percentage of variation explained was smaller (30%) (IV). The findings indicate that burnout is related to being unable to live up to one’s moral convictions; thus, it is a consequence of healthcare employees’ feeling that they are not acting on their values and for the wellbeing of the patients.

Syftet med mitt arbete är att få en fördjupad insikt i en lärares arbete, och få kunskap om hur stress och utbrändhet kan påverka arbetet som lärare. För att få denna förståelse har jag intervjuat en manlig lärare, Ove. Han har arbetat som lärare i fyrtio år. Genom att använda mig utav livsberättelsemetoden har jag fått tagit del av hans erfarenheter. I hans berättelse framkommer det att stress var inledningsvis något som var positivt för hans arbete. Han berättar att det är lätt att brinna för sitt arbete och lägga ner all sin tid och energi för det man tycker är roligt och intressant. Genom berättelsen får man ta del av hur den positiva stressen vänder, och Ove blir sjukskriven. Genom berättelsen framkommer Oves frustration över hur lärarrollen har förändrats genom åren. Det framkommer att det finns många faktorer som är avgörande hur en lärare ska fördela sin tid. Exempel på sådana faktorer är hur samhället och hur lärarrollen har förändrats genom åren. / The purpose with my work is to get a deeper insight into a teacher's job, and gain insight into how stress and burnout can affect the work as a teacher. To obtain this understanding, I interviewed a male teacher, Ove. He has worked as a teacher for forty years. The method I have used is a personal life story around this person. In his story it becomes clear that stress was initially something that was positive for his work. He says that it is easy to burn for their work and spend all their time and energy for what we think is fun and interesting. Through the story may take some of the positive stress turns, and Ove become sick. Through the story emerges Oves frustration with how the teacher's role has changed over the years. It is found that there are many factors that determine how a teacher should allocate their time. Examples of these factors is how society and how the teacher's role has changed over the years.

The multidimensional construct of perfectionism is well studied as it relates to coping with stress and burnout (Flett & Hewitt, 2002). Bontempo and Napier (2011) identify the personality trait of conscientiousness, which includes perfectionistic traits, as beneficial to an interpreter’s job performance. In contrast, several studies suggest that constructs related to maladaptive perfectionistic traits play a role in the development of burnout among interpreters, although perfectionism has not been explicitly identified or used as a research variable (Qin, Marshall, Mozrall, & Marschark, 2008). These studies identify key components of both adaptive and maladaptive perfectionism in the assessment of stress-related outcomes, thereby laying the groundwork for a more focused study on the particular role of perfectionism among interpreters who experience burnout. The multidimensional construct of perfectionism is well studied as it relates to coping with stress and burnout (Flett & Hewitt, 2002). Bontempo and Napier (2011) identify the personality trait of conscientiousness, which includes perfectionistic traits, as beneficial to an interpreter’s job performance. In contrast, several studies suggest that constructs related to maladaptive perfectionistic traits play a role in the development of burnout among interpreters, although perfectionism has not been explicitly identified or used as a research variable (Qin, Marshall, Mozrall, & Marschark, 2008). These studies identify key components of both adaptive and maladaptive perfectionism in the assessment of stress-related outcomes, thereby laying the groundwork for a more focused study on the particular role of perfectionism among interpreters who experience burnout. The current study evaluated the relationship between perfectionism, stress, coping resources and burnout in a sample of sign language interpreters. The results provided support for the mediating role of stress in the association of maladaptive perfectionism and burnout within a sign language interpreting sample. Coping resources did not serve as a moderator between perfectionism variables and burnout or a moderated mediator between perfectionism variables and perceived stress. The implications of these findings for sign language interpreters are discussed. The current study evaluated the relationship between perfectionism, stress, coping resources and burnout in a sample of sign language interpreters. The results provided support for the mediating role of stress in the association of maladaptive perfectionism and burnout within a sign language interpreting sample. Coping resources did not serve as a moderator between perfectionism variables and burnout or a moderated mediator between perfectionism variables and perceived stress. The implications of these findings for sign language interpreters are discussed.

Abstract Working with child and youth welfare is one of the most difficult challenges a social worker might face in the field of social work. Those who work with child and youth welfare are more exposed to stress and burnout than other comparable human service occupations. Research links the prevalence of stress and burnout to several key variables, such as demographics, working conditions and personality factors. In contrast, even though social workers in this field face many negative work-related problems they report a high job satisfaction. The aim of this study is to examine how uplifting and straining experiences affect social workers, who work with child and youth welfare, through the use of The Critical Incident Technique and interviews. There were many factors that contributed to the social workers experiences of stress, but many ultimately reported a high satisfaction and engagement towards their work. Success with clients and positive client feedback generated engagement, even to the extent that it gave the social workers a sense of affirmation to their career choice. This means that the social workers sense of engagement is closely tied to their clients. They provide a large and important source of engagement, albeit an unstable one. Since positive client results and client feedback cannot be guaranteed nor manipulated, it is not a stable or usable source of engagement. It is therefore imperative to not rely on clients for engagement, but instead search for other alternative that might generate engagement in social workers.