Oliver Ommen

Burnout in nurses – the relationship between social capital in hospitals and emotional exhaustion

AIMS The aim of this study is to examine the relationship between a hospitals social capital, individual decision latitude, workload and emotional exhaustion in nurses, controlling for age, sex, years of professional experience and job tenure. BACKGROUND In western countries between 15-45% of nurses working in hospitals suffer from burnout, characterised by emotional exhaustion, depersonalisation and decreased personal performance. The prevention of burnout constitutes a great challenge to those responsible for the health care system, not least because burnout may cause increasing turnover rates in nurses and lead to medical mistakes. DESIGN Survey. METHOD A questionnaire was mailed to 1325 nurses working at four hospitals in east and west Germany in 2002. Nine hundred and fifty nine nurses responded (response rate: 72.4%). RESULTS Logistic regression identified three significant predictors of emotional exhaustion in nurses: workload (OR: 4.523, CI: 3.230-6.333) was positively associated with emotional exhaustion. Decision latitude (OR: 0.376, CI: 0.254-0.557) and social capital in the hospitals (OR: 0.549, CI: 0.403-0.746) were negatively associated with emotional exhaustion. Emotional exhaustion was not affected by age, sex, years of professional experience and job tenure. Nagelkerkes Pseudo R(2) was 0.225. CONCLUSIONS The findings underline the importance of social capital and organisational development in hospital management. RELEVANCE TO CLINICAL PRACTICE Efforts to create a good working atmosphere with readiness to provide mutual support and the pursuit of joint values in a hospital, the reduction of workload and increased decision latitude may prevent the development of emotional exhaustion in nurses.

Determinants and implications of cancer patients' psychosocial needs.

Goals of workCancer patients often experience distress. However, the majority of newly diagnosed patients gradually adapt to the crisis. When symptoms of distress and anxiety persist over months, patients require psychosocial support. The aim of the present study was to determine the proportion of cancer patients who indicate the need for psychosocial support and to identify sociodemographic, psychological and illness-related factors predicting the need for psychosocial support in a German sample.Materials and methodsThe cross-sectional retrospective study was administered to 710 cancer patients who had been inpatients at the University Hospital of Cologne. The response rate was 49.5%. Patients suffering from bronchial, oesophageal, colorectal, breast, prostate and skin cancer participated in the study. The severity of depressive symptoms was assessed using the German version of the Major Depression Inventory. The level of anxiety was assessed with the state subscale of the German version of the State-Trait Anxiety Inventory. To measure the functional aspects of health-related quality of life, the scales “physical functioning”, “role functioning”, “emotional functioning”, “cognitive functioning” and “role functioning” of the European Organisation for Research and Treatment of Cancer QLQ-C30 Questionnaire (EORTC QLQ-C30) were used.Main resultsOf the cancer patients, 18.9% indicate an unmet need for psychosocial support and 9.5% are actually using psychosocial services. In a multiple logistic regression, significant indicators of the need for psychosocial support are gender [p = 0.014; standardised effect coefficient (sc) = 1.615] and emotional functioning (p < 0.001; sc = 1.533). The estimated model has a specificity of 92.2% and a sensitivity of 54.0%.ConclusionAlmost a third of the cancer patient population indicates an unmet need for psychosocial support or is actually using psychosocial services. Emotional functioning is a central predictor of the requirement for psychosocial support. Women are emotionally more affected than men and need more psychosocial support. The prognostic validity of the severity of depression and anxiety is limited.

The Relationship between Social Capital in Hospitals and Physician Job Satisfaction

BackgroundJob satisfaction in the hospital is an important predictor for many significant management ratios. Acceptance in professional life or high workload are known as important predictors for job satisfaction. The influence of social capital in hospitals on job satisfaction within the health care system, however, remains to be determined. Thus, this article aimed at analysing the relationship between overall job satisfaction of physicians and social capital in hospitals.MethodsThe results of this study are based upon questionnaires sent by mail to 454 physicians working in the field of patient care in 4 different German hospitals in 2002. 277 clinicians responded to the poll, for a response rate of 61%. Analysis was performed using three linear regression models with physician overall job satisfaction as the dependent variable and age, gender, professional experience, workload, and social capital as independent variables.ResultsThe first regression model explained nearly 9% of the variance of job satisfaction. Whereas job satisfaction increased slightly with age, gender and professional experience were not identified as significant factors to explain the variance. Setting up a second model with the addition of subjectively-perceived workload to the analysis, the explained variance increased to 18% and job satisfaction decreased significantly with increasing workload. The third model including social capital in hospital explained 36% of the variance with social capital, professional experience and workload as significant factors.ConclusionThis analysis demonstrated that the social capital of an organisation, in addition to professional experience and workload, represents a significant predictor of overall job satisfaction of physicians working in the field of patient care. Trust, mutual understanding, shared aims, and ethical values are qualities of social capital that unify members of social networks and communities and enable them to act cooperatively.

Associations between emotional exhaustion, social capital, workload, and latitude in decision-making among professionals working with people with disabilities.

BACKGROUND Many people working in human services in Western countries suffer from burnout, characterized by emotional exhaustion, depersonalization, and decreased personal performance. Prevention of emotional exhaustion (the first phase of burnout) constitutes a great challenge because emotional exhaustion may cause increasing turnover rates in staff and lead to a lesser quality of care. Prevention of emotional exhaustion requires knowledge of its predictors. The aim of this study was to investigate the associations between emotional exhaustion, social capital, workload, and latitude in decision-making among German professionals working in the care of persons with intellectual and physical disabilities. MATERIALS AND METHODS The study was based on a survey in a sheltered workshop and 5 homes for disabled persons with 175 professionals. Burnout was measured with the German version of the Maslach Burnout Inventory-General Survey (MBI-GS). A multivariate logistic regression analysis was computed. RESULTS Logistic regression identified the following three significant predictors of emotional exhaustion in the sample: workload (OR, 4.192; CI, 2.136-8.227), latitude in decision-making (OR, 0.306; CI, 0.115-0.811), and male gender (OR, 4.123; CI, 1.796-9.462). Nagelkerkes Pseudo-R(2) was 0.344. CONCLUSIONS The results of this study demonstrate that specific factors in work organization are associated with emotional exhaustion. Taking into account sociodemographic changes and the upcoming challenges for human services professionals, the results underline the importance of considering aspects of organization at the workplace to prevent burnout. Specific circumstances of male employees must be considered.

Identifying and predicting subgroups of information needs among cancer patients: an initial study using latent class analysis

PurposeUnderstanding how the information needs of cancer patients (CaPts) vary is important because met information needs affect health outcomes and CaPts’ satisfaction. The goals of the study were to identify subgroups of CaPts based on self-reported cancer- and treatment-related information needs and to determine whether subgroups could be predicted on the basis of selected sociodemographic, clinical and clinician–patient relationship variables.MethodsThree hundred twenty-three CaPts participated in a survey using the “Cancer Patients Information Needs” scale, which is a new tool for measuring cancer-related information needs. The number of information need subgroups and need profiles within each subgroup was identified using latent class analysis (LCA). Multinomial logistic regression was applied to predict class membership.ResultsLCA identified a model of five subgroups exhibiting differences in type and extent of CaPts’ unmet information needs: a subgroup with “no unmet needs” (31.4% of the sample), two subgroups with “high level of psychosocial unmet information needs” (27.0% and 12.0%), a subgroup with “high level of purely medical unmet information needs” (16.0%) and a subgroup with “high level of medical and psychosocial unmet information needs” (13.6%). An assessment of sociodemographic and clinical characteristics revealed that younger CaPts and CaPts’ requiring psychological support seem to belong to subgroups with a higher level of unmet information needs. However, the most significant predictor for the subgroups with unmet information needs is a good clinician–patient relationship, i.e. subjective perception of high level of trust in and caring attention from nurses together with high degree of physician empathy seems to be predictive for inclusion in the subgroup with no unmet information needs.ConclusionsThe results of our study can be used by oncology nurses and physicians to increase their awareness of the complexity and heterogeneity of information needs among CaPts and of clinically significant subgroups of CaPts. Moreover, regression analyses indicate the following association: Nurses and physicians seem to be able to reduce CaPts’ unmet information needs by establishing a relationship with the patient, which is trusting, caring and empathic.

Barriers to using psycho-oncology services: a qualitative research into the perspectives of users, their relatives, non-users, physicians, and nurses

PurposeThe present explorative study was designed as a qualitative evaluation of the psycho-oncology services (POS) available at a psycho-oncology institution (POI) in Germany. The study focused on barriers to using these services.MethodsSeven focus groups and five complementary individual interviews were conducted with POS users, their relatives, and POS non-users from a German POI, as well as with oncology physicians and nurses from an affiliated hospital. The focus groups and individual interviews were audiotaped and fully transcribed. Data were analyzed using the documentary method.ResultsFour utilization barriers were identified: (1) patients’ and physicians’ information deficits about POI and POS, (2) patients’ and physicians’ subjective norms regarding POS, (3) lack of organizational and therapeutic integration of POI and POS into routine oncology care on the ward, and (4) specific characteristics of cancer patients. The most important finding was that lack of organizational and therapeutic integration of POS in routine oncology care on the ward might have a lasting, negative effect on patients’ and physicians’ information deficits and subjective norms. Furthermore, the identified utilization barriers seem to be a multi-causal problem with complex interdependencies.ConclusionBased on these results, the organizational and therapeutic integration of POS in routine oncology care on the POI ward appears to be a useful tool in offering widely accessible therapies and providing patients with concise, straightforward information via different channels, such as personnel, brochures, and the Internet. Nevertheless, the results should be interpreted tentatively, due to the explorative character of this study.

How to improve satisfaction with hospital stay of severely injured patients

BackgroundIn the context of medical quality assurance, patient satisfaction with medical and organisational aspects of health care service is considered to be a relevant outcome of patient surveys after a stay in hospital. Within quality research, it is assumed that assessments of patient satisfaction represent a direct measure of the quality of health care received. Furthermore, there is evidence that satisfied patients demonstrate higher levels of compliance for the course of their treatment and that the probability of successful treatment completion thus considerably increases. The present analysis aims to identify determinants of satisfaction of seriously injured patients with regard to their acute hospitalisation.Materials and methodsOne hundred twenty-one seriously injured survivors of work-related or traffic-related accidents treated in two hospitals in Cologne during the years 1996 to 2001 were sent a survey questionnaire. In addition to socio-demographic details, the survey covered the subjective evaluation of organisational and structural aspects of the acute hospitalisation and the psychosocial care provided by the medical staff.ResultsEmploying the “tailored design method”, a response rate of 74.4% (n = 90) was obtained. Three highly significant factors influencing the satisfaction of seriously injured patients were identified by means of logistic regression: (1) patients’ perception of being involved in treatment, (2) patients’ feeling of being neglected by physicians and (3) patients’ perception of trust in physicians.ConclusionsIn the present study, the perceived quality of psychosocial care proved to have a significant effect on patients’ satisfaction with their hospital stay. Results of the current analysis thus indicate that psychosocial aspects of physician–patient interaction are of considerable importance in the medical care of seriously injured patients. Although this study is mainly based on subjective patient reported outcome, there is evidence that the subjective view of a patient is relevant in many aspects of medical treatment and outcome. These results already gave the motivation to develop a prospective interventional study with a training programme of communication skills to improve subjective and objective outcome parameters of severely injured patients.

Der Einfluss von sozialer Ungleichheit auf die medizinische und gesundheitsbezogene Versorgung in Deutschland

Der vorliegende Beitrag untersucht anhand einer systematischen Literaturrecherche den Einfluss der sozialen Ungleichheit auf die medizinische und gesundheitsbezogene Versorgung in Deutschland. Das Thema „Soziale Ungleichheit, medizinische und gesundheitsbezogene Versorgung in Deutschland“ ist auserst komplex, da im allgemeinen verschiedenste Komponenten der sozialen Ungleichheit in der Versorgung darunter verstanden werden. So konnen unter sozialer Ungleichheit horizontale Ungleichheiten wie Alter und Geschlecht wie auch vertikale Ungleichheiten wie Beruf, Bildung und Einkommen, also der soziale Status bzw. die soziale Schicht, untersucht werden. Der vorliegende Beitrag konzentriert sich auf diese - auch soziookonomischen Merkmale genannten - Aspekte der sozialen Ungleichheit, d.h. auf die Unterschiede in Bildung, Beruf und Einkommen (Jockel 1998, Mielck 2000). Zur Analyse der horizontalen Ungleichheit sei an dieser Stelle exemplarisch auf jungste umfassende Arbeiten zu diesem Thema bzw. Beitrage im vorliegenden Band verwiesen (Babitsch 2005, Knesebeck 2005, Richter 2005, siehe auch die Beitrage der Autoren in diesem Band).

The relationship between social capital in hospitals and emotional exhaustion in clinicians: a study in four German hospitals.

Background: About 30% of doctors working in inpatient and outpatient departments suffer from burnout, characterized, for example, by emotional exhaustion. The prevention of burnout constitutes a great challenge for those responsible for the healthcare system. Aims: Research into the relationship between social capital in hospitals and the occurrence of emotional exhaustion in clinicians is still at an early stage. The aim of the current study is to examine the effects of social capital in the workplace on the emotional exhaustion of clinicians. Method: A questionnaire was posted to 2,644 employees working in four German hospitals, and 1,645 responded. Responses from the 277 clinicians (61%) are analyzed here. The questionnaire looked at symptoms of emotional exhaustion and levels of organizational social capital. Results: Logistic regression identified two significant predictors of emotional exhaustion in clinicians: low self-efficacy and subjectively perceived lower levels of social capital in the hospitals where they worked. The model accounted for 26 % of Nagelkerke’s R2. Conclusion: Efforts to create a good working atmosphere, with the readiness to provide mutual support and the pursuit of joint values and objectives within a hospital, may reduce the development of, or even prevent, emotional exhaustion in clinicians.

Psychometric properties of the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M)

BackgroundFrom a management perspective, it is necessary to examine how a hospitals top management assess the patient safety culture in their organisation. This study examines whether the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M) has the same psychometric properties as the HSOPS for hospital employees does.MethodsIn 2008, a questionnaire survey including the HSOPS_M was conducted with 1,224 medical directors from German hospitals. When assessing the psychometric properties, we performed a confirmatory factor analysis (CFA). Additionally, we proved construct validity and internal consistency.ResultsA total of 551 medical directors returned the questionnaire. The results of the CFA suggested a satisfactory global data fit. The indices of local fit indicated a good, but not satisfactory convergent validity. Analyses of construct validity indicated that not all safety culture dimensions were readily distinguishable. However, Cronbachs alpha indicated that the dimensions had an acceptable level of reliability.ConclusionThe analyses of the psychometric properties of the HSOPS_M resulted in reasonably good levels of property values. Although the set of dimensions within the HSOPS_M needs further scale refinement, the questionnaire covers a broad range of sub-dimensions and supplies important information on safety culture. The HSOPS_M, therefore, is eligible to measure safety culture from the hospital managements points of view and could be used in nationwide hospital surveys to make inter-organisational comparisons.