Feeling burnout? You're not alone

As daily cases increase across the globe due to ease of transmission and lack of population immunity; COVID is taking its toll and furthermore exposing structural vulnerabilities within our health care infrastructures (Horesh & Brown, 2020).

COVID-19 exacerbates stress levels, anxiety, and burnout rates due to a higher risk of infection and worries about the family’s health (Lou et al., 2021). Dobson et al. (2021) examined psychological distress in health care workers (HCWs) during April-May 2020 and reported that up to 80% HCWs experience higher rates of anxiety and depression when compared to the general population. 29.5% of the participant (n= 416) screened positively for burnout.

Previous research such as Poghosyan 2010 proved that as burnout increases, the quality of care decreases along with a loss of clinical empathy. Clinical empathy is an essential skill for HCWs as it not only improves rapport, it can also improve a patient’s adherence to treatment and most importantly reduce errors. With the pressures of increased workload and the high occurrence of occupational violence, the need for additional vigilance has many HCWs feel they lack control over their jobs which challenges their sense of professional efficacy (Anzaldua &Halpern 2021).

Burnout can be “contagious” as often people who experience burnout can have a negative impact on their colleagues, from cynicism, disrupting other’s job tasks to interpersonal aggression. Therefore, burnout should be considered a characteristic of the work group, not of an individual syndrome (Maslach & Leiter 2016). In Figure 1 highlight the signs and symptoms of burnout cascade (modified from Weber & Jaekel-Reinhard 2000).

Since the pandemic will be around for a while, it is important to find ways to adapt by learning how to recognize burnout, avoid it, and recover.

In the book Burnout: The secret to unlocking the stress cycles, Nagoski reveals evidence-based techniques to avoid burnout. Here are the techniques to unlocking the stress cycles:

1. Exercise, breathing, and creative expression

The body’s naturally reaction to any “threat” is to provide a fight or flight response, altering the various autonomic nervous system. Closing the stress cycle means restoring the body and mind to a safe environment. Exercise is the number one recommended tool in tackling stress; as moderate physical activity (20-60mins) will often result in the muscles of the body to relax, change breathing patterns, and therefore, provide emotional release.

An alternative to physical activity is creative expression, such as painting or sculpting or creating music. These ‘relaxing’ activities also complete a cycle by signaling to the body the feeling of being SAFE.

2. Manage frustration through positive reappraisal and planful problem-solving
To tackle stress, one must develop a strong understanding of the difference between stress and stressors. From this, one can differentiate which stressors are controllable and apply mitigation techniques. Controllable stressors can be managed through planful problem-solving. For situations that are not controllable, the most effective strategy is to apply positive reappraisal which must not be confused with “always looking on the bright side”.

3. Remember the game is rigged and fight unrealistic expectations with facts
It is important to acknowledge that we are living through a pandemic, and an unbalanced society where patriarchy still exists and perfection within the health and beauty industry places further undue pressure. Recognizing these factors, we can defeat the patriarch by practicing self-compassion and gratitude to be our best selves and live with more joy.

4. Build your resilience to stress by aligning yourself with something larger

One of the most effective ways of persisting through stressful days is to know what you want and to have your life aligned with something bigger than yourself. This can be spiritual or the mission of leaving a meaningful legacy behind. “Let no one ever come to you without coming away better and happier” Mother Teresa.

5. Needing people is not a sign of weakness

In our modern society it is expected that a ‘healthy adult’ is someone who can feel whole with or without other people. The reality is we need to be connected to others and feeling autonomous at the same time. The length of interaction can vary per the individual, it’s the quality of our interactions that is the key. Whether it is interactions with your loved ones or as simple as a pleasant exchange of compliments with your barista. “Just that much tells your body the world is a safe place” E. Nagoski says.

6. Rest and sleep

The pillars of good health are sleep, movement, and nutrition. Multiple research has proved the importance of sleep in allowing the body to undergo all kinds of repairs and memory consolidation.

Modern society is obsessed with productivity, squeezing every ounce of energy until you are empty. We forget that active rest is also an effective tool for problem solving. “It takes courage to say yes to rest and play. In a culture where exhaustion is seen as a status symbol” Brene Brown.

Horesh & Brown (2020) impart that in a crisis with the magnitude of COVID-19, we must remember that trauma-related mental health aid should be integrated with other forms of care. We will need to respond by creating training programs for those in non-mental health care to extend support to those experiencing mental health issues. This will reduce stigma around mental health issues and may reduce barrier to care.

If you are unsure whether you are at risk or experiencing burnout, the link below is a tool that can help you check yourself for burnout.        

Checking Yourself for Burnout - Burnout Self-Test - Stress Management from MindTools.com

Need to find digital mental resources from trusted service providers - Welcome to Head to Health | Head to Health

References:

Anzaldua A, Halpern J (2021) ‘Can Clinical Empathy Survive? Distress, Burnout, and Malignant Duty in the Age of Covid-19’, Pub Med, 51(1):22-27, doi: 10.1002/hast.1216 Dobson H, Malpas C. B, Burrell A. J, Gurvich C, Chen L, Kulkarni J, & Winton-Brown T (2021) ‘Burnout and psychological distress amongst Australian healthcare workers during the COVID-19 pandemic’, Australasian Psychiatry, 29(1), 26–30. https://doi.org/10.1177/1039856220965045

Horesh D, & Brown A. D (2020) ‘Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities’, Psychological Trauma: Theory, Research, Practice, and Policy, 12(4), 331-335, http://dx.doi.org.ezproxy.library.sydney.edu.au/10.1037/tra0000592

Lou NM, Montreuil T, Feldman LS, Fried GM, Lavoie-Tremblay M, Bhanji F, Kennedy H, Kaneva P & Harley JM (2021) ‘Nurses' and Physicians' Distress, Burnout, and Coping Strategies During COVID-19: Stress and Impact on Perceived Performance and Intentions to Quit’, Journal of Continuing Education in the Health Professions, doi: 10.1097/CEH.0000000000000365.

Maslach C, & Leiter M. P (2016) ‘Understanding the burnout experience: recent research and its implications for psychiatry’, World psychiatry: official journal of the World Psychiatric Association (WPA), 15(2), 103–111, https://doi.org/10.1002/wps.20311

Nagoski E & Nagoski A (2020) ‘Burnout the secret to unlocking the stress cycle’, Kindle end, Penguin Random House UK.

Poghosyan L, Clarke S.P, Finlayson M, & Aiken L.H (2010) ‘Nurse burnout and quality of care: Cross-national investigation in six countries’ Res Nurs Health, 33: 288-298, https://doi.org/10.1002/nur.20383

Written by Maggie Ku

Alfred Hospital