Burnout Syndrome. Burnout syndrome: prevention and treatment Emotional burnout of medical workers

overwork health emotional burnout

Burnout Syndrome in Medical Workers

The place of practice is a private dental clinic. The area of ​​interest of the organization is medicine. The team of the organization consists of 7 people (three men and four women), including the leader.

For practical work, the topic "Burnout Syndrome" was chosen.

Burnout syndrome is a reaction of the body that occurs as a result of prolonged exposure to professional stress of medium intensity. The main reason is considered to be psychological, mental overwork. When demands (internal and external) and stresses prevail over resources (internal and external) for a long time, a state of balance is disturbed in a person, which inevitably leads to emotional burnout.

The main factors contributing to burnout include: high workload; lack or lack of social support from colleagues and management; a high degree of uncertainty in the assessment of the work performed; inability to influence decision-making; ambiguous, ambiguous job requirements; constant risk of penalties; monotonous, monotonous and unpromising activity; the need to outwardly show emotions that do not correspond to reality; lack of days off, vacations and interests outside of work. Occupational risk factors include altruistic professions (doctors, nurses, teachers, social workers, psychologists, priests).

There are 5 key groups of symptoms characteristic of the syndrome:

physical symptoms (fatigue, physical fatigue, exhaustion, insomnia, dizziness, increased blood pressure);

emotional symptoms (pessimism, cynicism and callousness in work and personal life, indifference, fatigue, aggressiveness, irritability, anxiety, feeling of loneliness);

Behavioral symptoms (working time more than 45 hours a week; fatigue and a desire to rest appear during work; indifference to food; little physical activity; justification for the use of tobacco, alcohol, drugs; accidents - falls, injuries);

intellectual state (loss of interest in new theories and ideas in work, in alternative approaches to solving problems; boredom, melancholy, apathy, formal performance of work);

social symptoms (low social activity; loss of interest in leisure, hobbies; social contacts are limited to work).

Since this team belongs to the "risk group" for the occurrence of burnout syndrome according to the professional criterion for hard work without days off, it is advisable to diagnose the emotional sphere of the team.

To identify the level of emotional burnout in this team from psychodiagnostic methods, the method of diagnosing the level of emotional burnout was used (V.V. Boyko)

Methodology for diagnosing the level of emotional burnout (V.V. Boyko)

Instruction. Read the judgments and, in case of agreement, answer "Yes", "+", and in case of disagreement - "No", "-".

Questionnaire text

1. Organizational shortcomings at work constantly make you nervous, worried, tense.
2. Today I am satisfied with my profession no less than at the beginning of my career.
3. I made a mistake in choosing a profession or profile of activity (I take the wrong place).
4. I am worried that I began to work worse (less productively, qualitatively, more slowly).
5. The warmth of interaction with partners is very dependent on my mood - good or bad.
6. The well-being of a partner does not depend on me as a professional.
7. When I come home from work, for some time (2-3 hours) I want to be alone so that no one communicates with me.
8. When I feel tired or tense, I try to quickly resolve the partner's problems (curtail the interaction).
9. It seems to me that emotionally I cannot give partners what professional duty requires.
10. My work dulls emotions.
11. I'm frankly tired of the human problems that I have to deal with at work.
12. It happens that I fall asleep (sleep) badly because of the experiences associated with work.
13. Interaction with partners requires a lot of stress from me.
14. Working with people brings me less and less satisfaction.
15. I would change jobs if given the opportunity.
16. I am often frustrated that I cannot properly provide professional support, service, help to my partner.
17. I always manage to prevent the influence of a bad mood on business contacts.
18. It makes me very sad if something goes wrong in a relationship with a business partner.
19. I get so tired at work that at home I try to communicate as little as possible.
20. Due to lack of time, fatigue or tension, I often pay less attention to my partner than I should.
21. Sometimes the most ordinary situations of communication at work cause irritation.
22. I calmly perceive the justified claims of partners.
23. Communication with partners prompted me to avoid people.
24. When I remember some work colleagues or partners, my mood deteriorates.
25. Conflicts or disagreements with colleagues take a lot of energy and emotions.
26. I find it increasingly difficult to establish or maintain contacts with business partners.
27. The situation at work seems to me very difficult, difficult.
28. I often have anxious expectations related to work: something must happen, how not to make a mistake, will I be able to do everything right, will I be laid off, etc.
29. If a partner is unpleasant to me, I try to limit the time of communication with him or pay less attention to him.
30. In communication not at work, I adhere to the principle: "do not do good to people, you will not get evil."
31. I willingly tell my family about my work.
32. There are days when my emotional state has a bad effect on the results of my work (I do less, quality decreases, conflicts happen).
33. Sometimes I feel that I need to show emotional responsiveness to my partner, but I can’t.
34. I am very worried about my work.
35. You give attention and care to your work partners more than you receive gratitude from them.
36. When I think about work, I usually feel uneasy, I start to prick in the heart area, my blood pressure rises, and a headache appears.
37. I have a good (quite satisfactory) relationship with my immediate supervisor.
38. I often rejoice seeing that my work benefits people.
39. Lately (or always) I have been haunted by failures at work.
40. Some aspects (facts) of my work cause deep disappointment, plunge into despondency.
41. There are days when contacts with partners are worse than usual.
42. I divide business partners (subjects of activity) into pleasant and unpleasant.
43. Tiredness from work leads to the fact that I try to reduce communication with friends and acquaintances.
44. I usually show interest in the personality of the partner besides what) concerns the case.
45. I usually come to work rested, refreshed, in a good mood.
46. ​​I sometimes find myself working with partners automatically, without a soul.
47. At work, you meet such unpleasant people that you involuntarily wish them something bad.
48. After communicating with unpleasant partners, I have a deterioration in mental and physical well-being.
49. At work, I experience constant physical and mental overload.
50. Success at work inspires me.
51. The situation at work in which I found myself seems hopeless.
52. I lost my peace because of work.
53. During the last year there were complaints (there was a complaint) addressed to me by partners.
54. I manage to save my nerves due to the fact that I don’t take a lot of what happens with my partners to heart.
55. I often bring home negative emotions from work.
56. I often work through force.
57. Before, I was more responsive and attentive to partners than now.
58. In working with people, I am guided by the principle: do not waste your nerves, take care of your health.
59. Sometimes I go to work with a heavy feeling: I’m tired of everything, I wouldn’t see or hear anyone.
60. After a busy day at work, I feel unwell.
61. The contingent of partners I work with is very difficult.
62. Sometimes it seems to me that the results of my work are not worth the effort that I spend.
63. If I had luck with my job, I would be happier.
64. I am desperate because I have serious problems at work.
65. Sometimes I treat my partners the way I would not like to be treated.
66. I condemn partners who count on special indulgence, attention.
67. Most often, after a working day, I don’t have the strength to do household chores.
68. I usually rush time: I wish the working day would end soon.
69. Conditions, requests, needs of partners usually concern me sincerely.
70. When working with people, I usually put up a screen that protects me from other people's suffering and negative emotions.
71. Working with people (partners) disappointed me a lot.
72. To restore my strength, I often take medicine.
73. As a rule, my working day is calm and easy.
74. My requirements for the work performed are higher than what I achieve due to circumstances.
75. My career has been successful.
76. I am very nervous about everything related to work.
77. Some of my regular partners I would not like to see and hear.
78. I approve of colleagues who devote themselves entirely to people (partners), forgetting about their own interests.
79. My fatigue at work usually has little effect (no effect) in communication with family and friends.
80. If an opportunity is given, I pay less attention to my partner, but in such a way that he does not notice it.
81. I often get on my nerves when dealing with people at work.
82. To everything (almost everything) that happens at work, I have lost interest, a lively feeling.
83. Working with people had a bad effect on me as a professional - it made me angry, made me nervous, dulled my emotions.
84. Working with people is clearly undermining my health.

In accordance with the key, the following calculations are carried out:

Tension: experiencing psychotraumatic circumstances: +1(2), +13(3), +25(2), -37(3), +49(10), +61,(5), -73(5); dissatisfaction with oneself: -2(3), +14(2), +26(2), -38(10), -50(5), +62(5), +74(3); "Caged": +3(10), +15(5), +27(2), +39(2), +51(5), +63(1), -75(5); anxiety and depression: +4(2), +16(3), +28(5), +40(5), +52(10), +64(2), +76(3).

Resistance: inadequate selective emotional response: +5(5), -17(3), +29(10), +41(2), +53(2), +65(3), +77(5); emotional and moral disorientation: +6(10), -18(3), +30(3), +42(5), +54(2), +66(2), -78(5); expansion of the sphere of saving emotions: +7(2), +19(10), -31(2), +43(5), +55(3), +67(3), -79(5); reduction of professional duties: +8(5), +20(5), +32(2), -44(2), +56(3), +68(3), +80(10).

Exhaustion: emotional deficit: +9(3), +21(2), +33(5), -45(5), +57(3), -69(10), +81(2); emotional detachment: +10(2), +22(3), -34(2), +46(3), +58(5), +70(5), +82(10); personal detachment (depersonalization): +11(2),+23(3),+35(3),+47(5),+59(5),+72(2),+83(10); psychosomatic and psychovegetative disorders: +12(3), +24(2), +36(5), +48(3), +60(2), +72(10), +84(5).

By quantitative indicators, it is legitimate to judge only how much each phase has formed, which phase has formed to a greater or lesser extent: 36 points or less - the phase has not formed; 37-60 points - phase in the formation stage; 61 or more points - the formed phase.

Group results.

	Subject data	voltage	resistance	exhaustion
	V.A., 45 years old, husband.
	L.T., 38 years old, husband. Hand - l
	T.P., aged 32, female
	L.F., 38 years old, female
	A.I., 31 years old, female.
	G.M., 30 years old, husband.
	V.G., 26 years old, female

In general for the group: Tension - 46; Resistance - 38.4; Exhaustion - 46.3.

From the results obtained, it can be seen that the condition of the majority of the subjects is unfavorable. In all subjects, all phases of emotional burnout are in the formation stage; in one subject, a formed stage of stress is observed. You can also note the high tension and exhaustion of the team leader.

The conducted mini-diagnostics testifies to the importance of clarifying and explaining such a concept as burnout syndrome, as well as the stress factors that lead to it. After all, the manifestations of this syndrome negatively affect communication with a large number of people, emotive abilities and emotional stability. Moreover, the burnout syndrome progresses with each moment of stress or failure and threatens with a general violation of health and working capacity.

The work was approved for defense at the GEK

deputy Director for Academic Affairs, DBMK

E.N. Tarasenko

Order No. ___ "__" _____________ 20_

Donetsk 20___

Introduction (from 3-4)

Chapter 1. Social and psychological essence of the professional burnout syndrome (p.5-12)

1.1 The concept of professional burnout (p.5-7)

1.2 Causes, factors, symptoms of professional burnout (p.7-11)

Chapter 2

2.1 The influence of the specifics of medical activity on the formation of symptoms of professional burnout syndrome (p.12-17)

Chapter 3. Organization of measures for the prevention of the syndrome

professional burnout of a medical worker (p.18-24)

3.1 Measures to prevent professional burnout syndrome (p.18-21)

3.2 Methods of self-regulation (p.21-24)

Conclusion (p.25-26)

Literature (p.27-28)

Applications

Introduction

Relevance of the research topic:

At the present stage of development of society in conditions of socio-economic instability, competition in the labor market, social stress, the requirements for the professionalism of the individual are growing. However, not everyone can adapt, effectively carry out their professional activities and social role, and therefore the likelihood of developing adverse mental conditions increases.

One of the priority tasks of developmental psychology, medical psychology, and labor psychology is the study of specific socio-psychological phenomena, which include “professional burnout” among specialists in various fields of work, and the development of programs for their prevention and correction.

Professional burnout occurs as a result of the internal accumulation of negative emotions without the appropriate "discharge" or "liberation" from them, leads to the depletion of a person's emotional-energetic and personal resources. From the point of view of the concept of stress, first formulated in 1936 by the Canadian physiologist G. Selye, professional burnout is distress, or the third stage of the general adaptation syndrome - the stage of exhaustion. In 1981, E. Moppoy (A. Morrow) proposed a vivid emotional image that, in his opinion, reflects the internal state of an employee experiencing professional burnout distress: “The smell of burning psychological wiring.”

Doctors and nurses are highly susceptible to this syndrome. The basis for such a conclusion is both the general causes inherent in the emergence of professional burnout in all categories of workers, and the specific features associated with the nature of their activities.

However, the dedication of doctors, their dedication, "burning out" does not mean complete devastation, impotence, self-forgetfulness, emotional fatigue, leading to professional burnout. Medical workers who have fallen under the influence of the syndrome of professional burnout, its symptoms are clearly expressed. They lose mental energy, quickly get tired. Psychosomatic problems appear, such as fluctuations in blood pressure, headaches, diseases of the digestive system, insomnia, irritability, etc. As a result, a negative attitude towards patients appears, a decrease in motivation for work, aggressiveness and increased conflict when communicating with colleagues.

This problem is relevant at the present time and requires a detailed study of the features of the manifestation of burnout, clarification of the symptoms and factors that determine its formation in the professional activities of physicians, timely detection, development of evidence-based health programs focused on the prevention of professional deformities and diseases, as well as the restoration of psychoenergetic potential. workers.

The purpose of the thesis:

The study of the phenomenon of professional burnout, as well as the prevention and correction of this syndrome in medical workers, since the presence of burnout negatively affects not only the psychophysical well-being of individual workers, but also the activities of the medical institution as a whole.

Work tasks:

Give a definition of the concept of professional burnout syndrome;

Investigate the causes, factors, symptoms of professional burnout;

To study the features of the manifestation of the syndrome of professional burnout in medical workers;

To analyze the influence of the specifics of medical activity on the formation of symptoms of professional burnout syndrome;

To characterize measures to prevent the syndrome of professional burnout of a medical worker.

The object of the study is:

Occupational burnout syndrome as a special condition of a person resulting from occupational stress. The subject of the study is the prevention and correction of negative phenomena associated with the burnout syndrome.

Chapter 1. Socio-psychological essence of the syndrome of professional burnout

1.1 The concept of professional burnout

Professional burnout is a syndrome that develops against the background of chronic stress and leads to the depletion of the emotional, energetic and personal resources of a working person. Professional burnout occurs as a result of the internal accumulation of negative emotions without a corresponding "discharge" or "liberation" from them. The danger of burnout lies in the fact that this is not a short-term transient episode, but a long-term process of "burning to the ground." A burnout person begins to experience a feeling of self-doubt and dissatisfaction with his personal life. Not finding sufficient grounds for self-esteem and strengthening positive self-esteem, developing a positive attitude towards his own future and thus losing the meaning of life, he tries to find it through self-realization in the professional sphere. Daily work, sometimes without breaks and days off, with constant physical, psychological stress, complicated by intense emotional contacts, leads to a life in a state of constant stress, accumulation of its consequences, depletion of a person’s vital energy and, as a result, to serious physical diseases. Therefore, workaholics who are ready to give all the best for 24 hours a day, give themselves to work without a trace, without breaks, entrances and holidays, are the first candidates for complete psychological burnout, resulting in early death.

Since the appearance of the concept of burnout, the study of this phenomenon has been difficult due to its content ambiguity and multicomponent nature. On the one hand, the term itself was not carefully defined, so the measurement of burnout could not be reliable, on the other hand, due to the lack of appropriate measuring tools, this phenomenon could not be described empirically in detail.

American specialists paid attention to the problem of mental burnout in connection with the creation of social services. People working in the field of psychological and social assistance, who are obliged by duty to show sympathy and empathy, contact visitors for a long time. The duty of the workers of these services is to provide psychological support: they must listen and support people who have asked for help. However, despite the special training and selection of personnel for social services according to certain criteria necessary for this type of activity, service managers after some time often encountered facts of unsatisfactory work of employees, primarily with complaints from visitors about inattention, indifference, callousness, and sometimes coarseness. The conducted research led to the discovery of a kind of professional "communication stress", which was called the "mental burnout" syndrome. This syndrome began to be considered as a stress reaction to prolonged stresses in interpersonal relationships. Thus, the “burnout” syndrome has turned from a “payment for sympathy” into a “disease” of workers in “communicative” professions, that is, professions that place high demands on psychological stability in situations of business communication.

For the first time, the term burnout (burnout, combustion) was introduced by the American psychiatrist H. Fredenberg. Burnout meant a state of exhaustion combined with a sense of one's own uselessness, uselessness. However, the term has become widely used in scientific literature and psychotherapeutic practice after numerous publications by K. Maslach (Maslakh). In 1982, her book Burnout is the price of sympathy was published, in which she presented the results of her extensive research on this sad phenomenon. Her new view on the problems of stress was immediately accepted by many scientists and practicing psychologists in all countries.

Later K. Kondo [S. Condo, 1991] defines burnout as "a state of maladjustment to the workplace due to excessive workload and inadequate interpersonal relationships". T. V. Formanyuk (1994) considers burnout syndrome to be “a specific type of occupational disease of persons working with people.”R. Kociunas (1999) defines burnout syndrome as "a complex psychophysiological phenomenon accompanied by emotional, mental and physical exhaustion due to prolonged emotional stress." According to V.V. Boyko (1999), emotional burnout is “a psychological defense mechanism developed by a person in the form of a complete or partial exclusion of emotions (lowering their energy) in response to their chosen psychotraumatic effects.” L.A. Kitaev-Smyk (2007) points out that "burnout of emotions is only one component of the burnout syndrome, the main result of which is not a deterioration in performance, but a deformation of the personality of a professional" and supplements the terminology with the expressions: "burnout of the personality", "burnout of the soul".

What is "burnout" of the soul? The answer to this question is brought closer by the judgment of the outstanding thinker of the second half of the 20th century V.V. I. Volodkovich: “A person lives in a world of illusions and cannot live without them. They are at the heart of faith, hope, love. Burning out the soul, a person loses the illusion of having faith, hope, love. First, faith melts, and a person is filled with a sense of his unaccountable unhappiness. Then hope flies away. A person has a disregard for everything. Love is the last thing that leaves a person, and with it he loses the meaning of life. Only by moving to a new life area, radically different from the previous one, can a burned-out person be saved by new illusions.

1.2 Causes, factors, symptoms of professional burnout

The literature on burnout syndrome indicates a significant expansion of areas of activity subject to such a danger. These include: teachers, psychologists, educators, educators, doctors, social workers, law enforcement officers and representatives of other professions. All these are employees of "communicative" professions, the specificity of which lies in a large number of emotionally rich and cognitively complex interpersonal contacts, which requires a significant personal contribution from a specialist in daily professional affairs. As K. Maslach writes: “The activities of these professionals are very different, but all of them are united by close contact with people, which, from an emotional point of view, is often difficult to maintain for a long time.”

In addition, in professions focused on working with people, it is of great importance to receive feedback from them (for example, gratitude, recognition, showing respect, information about changes in well-being or about new plans for further business interaction, etc.), there is also high responsibility for the result of communication; a certain dependence on communication partners; the need to understand their individual characteristics, claims and expectations, private claims to informal relations in solving their problems; conflict or tense situations of communication, caused by distrust, disagreement and manifested in various forms of refusal to further interaction (communication).

T.I. Ronginskaya rightly notes that the basis of research on the psychological phenomenon - professional burnout syndrome - can be based on a metaphor: "Nothing is such a strong burden for a person and such a strong test as another person."

Thus, occupational risk factors for burnout include:

Emotionally rich business communication;

High requirements for continuous self-development and improvement of professional competence;

High responsibility for business and for other people;

The need to quickly adapt to new people and rapidly changing professional situations;

High demands on self-control and interpersonal sensitivity.

Along with these potential risk factors for burnout, there may be existential factors:

Unfulfilled life and professional expectations;

Dissatisfaction with self-actualization;

Dissatisfaction with the results achieved;

Disappointment in other people or in the chosen business;

Devaluation or loss of meaning of their efforts;

Experiencing loneliness;

Feeling the meaninglessness of vigorous activity and life.

As for the relationship between gender and burnout, there are opposing points of view on who is more prone to the process of burnout - men or women. It has been established that men have higher scores on depersonalization, and women are more prone to emotional exhaustion, which is due to the fact that men are dominated by instrumental values, while women are more emotionally responsive and have less sense of alienation from their clients.

Scheme 1. Severity of the burnout syndrome in the examined doctors depending on gender

Among organizational factors, the main emphasis in the study was placed mainly on the time parameters of activities and the amount of work. Almost all studies give a similar picture, indicating that an increase in the load in activities, overtime work stimulate the development of burnout.

The content of the work includes quantitative and qualitative aspects of working with clients: the number of clients, the frequency of their service, the degree of depth of contact with them. So, direct contact with clients, the severity of their problems usually contribute to the occurrence of burnout. The influence of these factors is most clearly shown in those types of professional activity where the acuteness of clients' problems is combined with the minimization of success in the effectiveness of their solution. This is work with chronic patients or people suffering from incurable diseases (AIDS, cancer and some others). At the same time, it is noted that any critical situation with a client, regardless of its specifics, is a heavy burden for the employee, negatively affecting him and eventually leading to burnout.

Considerable attention is paid to the relationship between burnout and motivation. Thus, researchers note a decrease in work motivation characteristic of “burnt out”, which manifests itself in the desire to reduce work to a minimum, manifestations of apathy and chronic negativism in relation to functional duties, although the difference between burnout and unsatisfactory profession is emphasized.

The syndrome of professional burnout is closely related to personal endurance - a quality that can affect a person's predisposition to stress. It is defined by foreign psychologists as the ability of a person to be highly active every day, to exercise control over life situations and to respond flexibly to various kinds of changes. People with a high degree of this characteristic have low values ​​of emotional exhaustion and depersonalization and high values ​​on the scale of professional achievements.

Psychologists distinguish 3 stages of burnout syndrome.

First stage - at the level of performing functions, arbitrary behavior: forgetting some moments, speaking in everyday language, lapses in memory (for example, the necessary entry was made or not in the documentation, whether the planned question was asked, what answer was received), failures in the performance of any motor actions etc. Usually, few people pay attention to these initial symptoms, jokingly calling it “girl's memory” or “sclerosis”. Depending on the nature of the activity, the magnitude of the neuropsychic stress and the personal characteristics of the specialist, the first stage can be formed within three to five years.

On the second stage there is a decrease in interest in work, the need for communication (including at home, with friends): “I don’t want to see” those with whom the specialist communicates by occupation (schoolchildren, patients, clients), “on Thursday it feels like it’s already Friday ”,“ the week lasts endlessly ”, an increase in apathy by the end of the week, the appearance of persistent somatic symptoms (no strength, energy, especially towards the end of the week, headaches in the evenings;“ dead sleep, no dreams ”, an increase in the number of colds); increased irritability, a person “turns on”, as they say, from a half turn, although he had not noticed this before. The time of formation of this stage is on average from five to fifteen years.

Third stage - personal burnout. Characterized by a complete loss of interest in work and life in general, emotional indifference, dullness, a feeling of constant lack of strength. Man seeks solitude. At this stage, it is much more pleasant for him to communicate with animals and nature than with people. The stage can be formed from ten to twenty years.

Thus, professional burnout syndrome is one of the phenomena of personal deformation and is a multidimensional constructive set of negative psychological experiences associated with prolonged and intense interpersonal interactions characterized by high emotional saturation or cognitive complexity; professional burnout syndrome is a response to prolonged stresses of interpersonal communications.

Scheme 2. The prevalence and severity of the syndrome of "emotional burnout"

Chapter 2

2.1 The influence of the specifics of medical activity on the formation of symptoms of professional burnout syndrome

The profession of a medical worker refers to complex types of work that require the subject to have a versatile education, the continuity of the process of professionalization, as well as the possession of personal and professional qualities.

A medical worker is endowed with the trust of society, therefore the attention and humanism of a medical worker, his respect for the patient should not be determined by the feigned courtesy and sugary sweetness of his words, good but false manners. He must have a sense of duty, responsibility, fierce patience, observation, intuition, determination, optimism, etc.

The work of medical workers is responsible, requires endurance, involves a high and constant psycho-emotional load, as well as the need to make decisions in extreme situations. The very professional activity of medical workers involves emotional richness and a high percentage of factors that cause stress. Emotions are usually ambivalent: satisfaction with a successful operation or treatment, a sense of self-worth, belonging to other people, approval and respect from colleagues; but also regret, oppression due to misdiagnosis or mistreatment, envy of successful colleagues, disappointment in the profession, etc.

The duties of medical workers include providing medical assistance to citizens, and often such assistance should be urgent, provided in a situation of severe stress experienced by a patient who is in serious condition. In the course of their activities, medical workers keep records of the patient's health status, prescribe him the necessary medical supplies, thereby taking responsibility for his future condition. A medical worker has a great responsibility for the life and health of the population in the area entrusted to him, which undoubtedly causes this category of employees to be exposed to daily stressful situations and can affect their mental health.

The communicative side of the activities of medical workers is of no small importance, because. in the course of it, a healthcare employee must provide assistance to the patient, and often such assistance is not so much medical as psychological. A medical worker is obliged to support a person who finds himself in a difficult situation, to show care, attention, empathy. Faced with negative emotions, a medical worker involuntarily and involuntarily becomes involved in them, as a result of which he himself begins to experience increased emotional stress.

The work of most medical workers is carried out in such conditions that they are affected by a complex of adverse production factors of various nature, neuro-emotional overstrain, and high responsibility.

The doctor at the level of emotional experience is constantly dealing with death. She can act for him in three forms:

1) real (uselessness of resuscitation, death on the surgeon's table);

2) potential (health, and, possibly, life of a person depends on the results of the doctor’s activity, on his professionalism);

3) phantom (in the form of it, complaints about the state of health of a suspicious person, fear and anxiety of a chronic patient, relationships with relatives of seriously ill patients, and even the idea of ​​​​death in the public mind) can act.

In each of these cases, there is a problem for the doctor of not including his feelings in the situation. This is far from always possible, because with all these formations (real, potential and phantom death) he simply needs to build relationships. Naturally, only an emotionally mature, holistic person is able to solve these problems and cope with such difficulties.

Among the psychological stress factors that affect the medical staff are:

A large number of contacts with sick people and their relatives, constant contact with other people's problems and other people's pain, with negative emotions that carry negative energy;

Increased requirements for the professional competence of a doctor and for service to others, dedication;

Responsibility for the life and health of other people;

Work environment with new social risk factors such as crime, drug addiction, homelessness, etc.

As a result of observations of specific studies of the syndrome of mental burnout, it shows that among the causes of burnout in physicians, general and specific ones can be distinguished.

Common reasons include:

Intensive communication with different people, including negative ones;

· work in changing conditions, collision with unpredictable circumstances;

Features of life in megacities, in conditions of imposed communication and interaction with a large number of strangers in public places, lack of time and money for special actions to improve one's own health.

Specific reasons include:

problems of a professional nature (career growth) and working conditions (insufficient salary level, condition of jobs, lack of necessary equipment for high-quality and successful performance of one's work);

inability to provide assistance to the patient in some cases;

higher mortality than in most other departments;

The impact of patients and their relatives seeking to solve their psychological problems through communication with a doctor;

· recent trend - the threat of appeals from relatives of patients in case of death with legal claims, lawsuits, complaints.

Often, employees exposed to long-term professional stress experience internal cognitive dissonance: the harder a person works, the more actively he avoids thoughts and feelings associated with internal “burnout”. The development of this condition is facilitated by certain personal characteristics of medical workers - a high level of emotional lability (neuroticism), high self-control, especially when expressing negative emotions with the desire to suppress them, rationalization of the motives of one's behavior, a tendency to increased anxiety and depressive reactions associated with the unattainability of "internal standard” and blocking negative experiences in oneself, a rigid personality structure. The paradox is that the ability of medical professionals to deny their negative emotions may indicate strength, but often this becomes their weakness.

Scheme 3. Constituent elements of the professional burnout syndrome

Let us consider in more detail the features of professional activity and the individual characteristics of professionals working in ambulance teams.

“Burned out” ambulance workers indicate the long hours of work, a large number of calls, lack of equipment and medicines, unclear work planning (unstable work schedule). Ambulance workers have increased responsibility for their functions and operations. Doctors and paramedics work "for wear and tear" - after all, responsibility and self-control are very high. As a result, anxiety, depression, emotional rigidity, emotional devastation may appear. Ambulance personnel constantly deal with psychologically difficult contingents (heavy and dying patients). Sometimes there are conflict cases in the “head-subordinate” system, more often in the “colleague-colleague” system, when the doctor and paramedic working in the team are people with completely different views and positions on certain things.

All of the above refers to external factors (features of professional activity) that cause the syndrome of "emotional burnout".

Internal factors (individual characteristics of the professionals themselves) include: a tendency to emotional rigidity; intensive internalization of the circumstances of professional activity.

About 20% of young ambulance professionals leave in the first five years of their employment. They either change the profile of work, or even change their profession. After 5-7 years, doctors and paramedics acquire energy-saving strategies for performing professional activities. The reason is the depletion of emotional and energy resources and, in connection with this, the search for ways to restore and save them. Indeed, it sometimes happens that periods of intense interiorization and psychological defense alternate in work; weak motivation of emotional return in professional activity, moral defects and disorientation of the personality are possible.

The main symptoms of "emotional burnout" of emergency medical workers include (according to the conducted clinical and psychological interviews):

Fatigue, fatigue, exhaustion (after vigorous professional activity);

psychosomatic problems (fluctuations in blood pressure, headaches, diseases of the digestive and cardiovascular systems, neurological disorders);

insomnia;

negative attitude towards patients (after positive relationships that have taken place);

Negative attitude to the activity performed (instead of the previously present “this is a matter for life”);

stereotyping of personal attitudes, standardization of communication, activities, acceptance of ready-made forms of knowledge, narrowing of the repertoire of work actions,

Rigidity of mental operations;

aggressive tendencies (anger and irritability towards colleagues and patients);

functional, negative attitude towards oneself;

anxiety states;

· pessimistic mood, depression, sense of meaninglessness of current events.

One of the first places on the risk of burnout is the profession of a nurse. Her working day is the closest communication with people, mainly with the sick, who require vigilant care and attention.

By the nature of their activities, nurses are required to clearly know and apply the theoretical knowledge they have gained in practice, to carry out sanitary and educational work on the site, including the promotion of medical knowledge, hygiene education and training of the population in a healthy lifestyle, to organize an outpatient doctor's appointment (preparation of the workplace, instruments , tools, preparation of individual outpatient cards, forms, prescriptions, conducting a preliminary history taking, preliminary examination of the patient), perform preventive, therapeutic, diagnostic measures prescribed by the doctor in the clinic and in the hospital, assist the doctor during outpatient operations and complex manipulations, etc. d.

Various categories of medical workers are subject to the formation of the syndrome of professional burnout. The risk of disease is high among professionals working in the field of psychiatry and psychotherapy. For example, psychiatrists are more likely than other physicians to report burnout, depression, or other psychiatric disorders. It is noticeable that, first of all, novice specialists are prone to health disorders caused by stress. 76% of junior residents show symptoms of professional burnout, such as emotional exhaustion or demotivation. The fact is that they often have idealized ideas about their profession and therefore the beginning of their work activity is often associated with disappointments for them.

Employees of "heavy" departments, primarily those who care for seriously ill patients with cancer, HIV / AIDS, in burn and resuscitation departments constantly experience a state of chronic stress due to negative mental experiences, intense interpersonal interactions, tension and complexity of work and etc. As a result of the gradually emerging burnout syndrome, mental and physical fatigue, indifference to work arise, the quality of medical care decreases, and a negative and even cynical attitude towards patients is generated.

Thus, the specificity of the professional activity of medical workers is a prerequisite for the development of SEB.

Burnout syndrome is a complex complex that many of us have experienced at least once. It looks like complete physical, psycho-emotional and mental exhaustion. Weekends and days off do not give a visible improvement, by the end of the vacation the person feels better, but after returning to working days the situation worsens again. It is precisely because this problem is very large-scale and significant that psychologists and doctors are seriously working on it today.

After all, the loss of a good staff can mean a lot not only for an individual company, but also for society as a whole. Here it must be said separately that the syndrome of emotional burnout is not a disease, but an alarming symptom. If you do not pay attention to it for a long time and do not seek professional help, then it may well go into a chronic phase. It was then that psychosomatics flourished in a stormy color, the body began to put forward the last arguments so that a person would stop attending work that kills him. These are hypertension, asthma, gastritis and ulcers, obesity and diabetes.

What an employer should pay attention to

A newcomer comes to his position. He burns with zeal, ready to stay late in the evening, eagerly catching the advice of more experienced colleagues. He has all the prerequisites to become the best employee and grow up the career ladder. But, it doesn't always happen that way. They didn’t notice his outstanding contributions to the company’s business (a newcomer should work more than others for a minimal fee), they loaded him with routine work (he doesn’t refuse when venerable employees ask to finish something for them), and also a suspicious person, who is very worried about everything inside, but not giving a view. Add emotional load from the very activity that the person performs. Without the necessary adaptation, he will, like a sponge, absorb all the troubles of the world (especially for “helping” professions).

And then, as if by magic, the employee changes. In the morning he gets up broken, without any desire to go to work. Performance is reduced, performance suffers. If the working day is loaded to the limit, then there is a feeling of running on a wheel, a trap from which there is no way out. A person feels hopelessness, resentment, loses interest in what is happening around. All this diversity is called the term "burnout syndrome".

How burnout is formed

This process does not take one day. Depending on the personality characteristics of a person, the terms can vary greatly: for some, a few months will be enough, while for others, a dozen years. The intensity of the burnout process will be affected by the degree of emotional saturation of the work, the level of stress, the adequacy of the "return". According to Greenberg's theory, there are five stages that an employee goes through before complete burnout.

• Satisfaction of a person with his activity, understanding that he is doing important work. But at the same time, repetitive stress reduces physical energy.
• Fatigue accumulates, sleep patterns are disturbed, interest in the work performed is reduced.
• If the work goes in rhythm without vacations with one day off or without them at all, then the experience increases and the risk of diseases increases.
• Dissatisfaction with oneself, the activities carried out, the company is increasing. Chronic diseases develop.
• The state of health is critically deteriorating.

General signs of CMEA

In order to notice burnout in time and prevent personal deformation of employees, an effective psychological service should be established in each company whose activities lie in the “person-to-person” sphere. First of all, this concerns medical and educational institutions, law enforcement agencies. Burnout syndrome has several striking signs that a professional can easily notice. It is exhaustion, personal detachment, a sense of loss of self-efficacy.

Burnout syndrome, symptoms

First of all, we ourselves should know this in order to track signals in time and take measures without leading to a nervous breakdown. Emotional burnout syndrome is especially common among teachers. First of all, frequent headaches, general fatigue, a desire to retire, sit with your eyes closed in silence, physical exhaustion, but at the same time nocturnal insomnia should alert you.

Every day, the lack of a night's rest increases the tension, and the stresses experienced during the day do not allow you to fall asleep soundly the next night. As a result, the processes of memory and attention are disturbed. There are problems with the cardiovascular system. And the last thing that is already impossible not to pay attention to is self-doubt, dissatisfaction with others (colleagues, employer, patients), tantrums and periods of depression, indifference to relatives and the feeling that life is only negative.

Emotional symptoms are one of the main components of the syndrome. They can be directed inward, and then we observe excessive restraint of emotions, withdrawal into ourselves, pessimism, a feeling of loneliness. The other extreme is irritability and aggressiveness, tantrums. But common to both cases is the feeling that the work is impossible and useless.

Thus, we see changes in feelings. Loss of sense of humor, feeling of failure or guilt, powerlessness, irritability over trifles. And the first thing a person seeks to do is to take coffee, alcohol, smoke more cigarettes, but will not turn to a specialist or try his hand at creativity. Changes are also taking place in thinking. Do not leave the thought of quitting work. As a result of this self-pressure, a person feels like a squeezed lemon. Attention is not concentrated, memory deteriorates, suspicion and a cynical attitude towards others increase. Finally, behavior changes. A person tries very hard to come to work on time, but over and over again he is late. This is how internal resistance manifests itself. It must be remembered that the syndrome of emotional burnout in teachers proceeds with irreversible personality changes, so it is important to carry out prevention.

What are the reasons why CMEA develops

There may be several such reasons. Most of all it depends on the work itself. If a person is overloaded physically and emotionally, but at the same time does not feel sufficient appreciation of his work, he simply “burns out” at his workplace, forgetting about his personal life and needs. Even after work, he does not feel the strength and desire to do what he loves. That is, it becomes a kind of "zombie", which mechanically performs the work, but does not have time to remove this protective shell even after work.

The syndrome of emotional burnout is especially difficult for medical workers and psychologists. Constantly communicating with patients, they take over all complaints, sorrows, aggression and irritation. A low level of payment, often a lack of gratitude from clients, taking responsibility for the fate of people and a sense of guilt towards those who could not be helped - all this provides fertile ground for burnout. Of course, the character of a person, the level of training, the ability to abstract, build a psychological “wall” that protects the inner world from other people's problems play a role here. Demanding to oneself is also important, as well as personal commitment. If these indicators are high, the employee tends to take on an exorbitant range of duties, wanting to keep everything under control. If, at the same time, the schedule implies the absence of a vacation, and scandals await at home due to the constant presence at work, then deterioration is inevitable.

Health care workers on guard

But at the same time, they often forget about themselves. Indeed, the burnout syndrome among health workers is a serious problem. It takes about 9 years to learn a good doctor, plus specialization. And a young specialist has yet to undergo an internship and become a real specialist, the loss of which is quite difficult to make up for. As a rule, young doctors are most prone to burnout. They lack practical and life experience, this can provoke a medical error, which, in turn, will lead to self-destruction of the individual. And to a greater extent - these are doctors with a capital letter, who are extremely responsible for their work, have exorbitant demands on themselves. They blur the line between work and personal life.

Most often, men are at risk. Medical worker burnout is associated with women. But it is their natural emotionality that makes it possible to discharge and preserve the integrity of their personality. And impassive and imperturbable men quietly go into alcoholism, depression, psychosomatic illnesses and insanity.

Burnout Syndrome Factors

We have already mentioned them, now we will only generalize to make it easier to perceive. So, the first is a personal factor, that is, the tendency to burnout will depend on our individual characteristics. At the same time, neither age, nor marital status, nor even length of service (according to research) affect these processes in any way. The more a person is humane, empathetic, gentle and idealizing (of himself, work process, society), the more he is prone to burnout.

The syndrome of professional emotional burnout depends on another factor - role. That is, the better the roles of each employee, his personal field of activity and the boundaries of responsibility are described, the less burnout processes are observed. Conversely, if synergy is not coordinated, there is competition where the result depends on coherent action, burnout will be very high, even with a small workload.

Finally, the third factor is organizational. This is the planning of work and the daily routine, bureaucratic issues, the content of the work, the presence and absence of conflicts in the system itself. One more factor can be added to these three - the presence of a psychologically difficult contingent with which a professional has to deal.

Diagnosis of burnout syndrome

In order to be able to track the development of this problem in time, there are special techniques. Burnout syndrome can be avoided by paying attention to personality changes in the early stages and seeking help. Another thing is that in our country this usually happens only when the employee stops going to work or goes on a drinking binge. In the arsenal of psychologists there is a personal questionnaire that allows you to effectively diagnose the syndrome of emotional burnout. Boyko V. V. proposed to explore it as a psychological defense mechanism, that is, it is an extreme measure of the psyche, which is designed to protect itself from traumatic reality and allows you to economically spend energy resources. The methodology consists of 84 statements that can be answered "yes" or "no". As a result, 3 stages of stress development can be distinguished: “tension”, “resistance”, “exhaustion”.

Prevention and treatment

If you are faced with such a problem as professional burnout syndrome, then you need to urgently take action. First of all, you need to try to eliminate the cause. Review your work instructions. Are you doing too much? If yes, feel free to refuse. No need to follow the lead of colleagues, learn to say “no” and protect your rights. Nothing soothes as a clearly defined scope of tasks. "I do it and then I go home." If the reasons are deep in the structure of the personality: hyper-responsibility, suspiciousness, guilt before the whole world, then you need to go to psychotherapy. This will allow you to throw off a lot of excess cargo. This is especially important for doctors and teachers. Remember that you are not responsible for the fate of people, but only do your job.

And finally, sleep and rest. Finish work according to the work schedule. If there are so many tasks that you cannot physically fit in, raise the question of the need for an additional unit. Be sure to take a walk along the promenade or go to the gym, and also go to bed on time. Prevention of the syndrome of emotional burnout of teachers includes the same points. A healthy lifestyle, alternation of work and rest, good sleep, friendly relations with colleagues and a clear knowledge of their functional tasks, as well as compliance with the work schedule - this is the key to a long and happy work.

Summing up

In order to learn how to withstand the stresses that fall on you every day, master any means of managing emotions and auto-training techniques. Every situation and person that appeared in our lives came for a reason, but to teach something. So, instead of getting offended, arguing, or accumulating anger, see what this situation has to teach you. As soon as you learn the lesson, you will stop reacting to such things, and workdays will become easier. And auto-training or a little meditation in the morning and evening will give you the opportunity to get the right mood, work out unnecessary emotions, recharge your batteries or, conversely, relax.

The problem of human stress resistance in various professions has long attracted the attention of psychologists in various fields. In the classical studies of G. Selye, and later A. Lazarus, it was shown that prolonged exposure to stress leads to a decrease in the overall mental stability of the body, a feeling of dissatisfaction with the results of one's activities, a tendency to refuse to complete tasks in situations of increased demands, failures and defeats. An analysis of the factors that cause similar symptoms in various activities has shown that there are a number of professions in which a person begins to experience a feeling of inner emotional emptiness due to the need for constant contact with other people. “Nothing is such a strong burden and such a strong test for a person as another person” - this metaphor can be used as the basis for research on a psychological phenomenon - professional burnout syndrome. In the early 70s. of the last century, the American psychologist X. Freudenberger first used the phrase "mental burnout". Initially, the author described this phenomenon as a deterioration in mental and physical well-being among representatives of social professions. Later, this phenomenon was defined, and it is now generally accepted that this is the Burnout Syndrome.

It is known that medical professions, like no other, are associated with interpersonal interaction, therefore, for doctors and nurses, timely diagnosis and correction of such disorders is very relevant. The professional activity of a doctor involves emotional saturation, psychophysical stress and a high percentage of factors that cause stress. Carrying the "burden of communication", the doctor is forced to constantly be in the oppressive atmosphere of other people's negative emotions - to serve either as a consolation for the patient, or as a target for irritation and aggression. Based on this, medical workers are forced to erect a kind of barrier of psychological protection from the patient, to become less empathic in order to avoid emotional burnout.

Emotional burnout syndrome (EBS) is a fairly new concept for domestic psychology and psychiatry. Its relevance to the country's medical community has been demonstrated in several studies. In particular,. It has been shown that the prevalence of SEB among psychiatrists, narcologists, psychotherapists is almost 80%. Signs of the syndrome of emotional burnout of varying severity were observed in 58% of specialists, and in 16% these disorders had an extended character with manifestations of all stages of BS. The clinical picture of BS is multifaceted and consists of a number of psychopathological manifestations, psychosomatic disorders and signs of social dysfunction. Psychopathological manifestations include chronic fatigue, loss of energy, impaired memory and attention (lack of accuracy, disorganization), lack of motivation, as well as personality changes (decreased interest, cynicism, aggressiveness). Perhaps the development of anxiety and depressive disorders, which can contribute to suicide. In addition, there is a connection between SES and the development of addictions to psychoactive substances. Common somatic symptoms are headache, gastrointestinal disorders (symptom of an irritable stomach, diarrhea), cardiovascular disorders (tachycardia, arrhythmia, arterial hypertension). There are frequent colds, exacerbation of chronic diseases is possible: bronchial asthma, dermatitis, psoriasis, etc. Signs of social dysfunction include social isolation, problems in the family, at the workplace. Most psychologists identify three key signs of CMEA:

1. ultimate exhaustion;
2. feeling of personal detachment from patients and from work.
3. feeling of inefficiency and insufficiency of their achievements.

The development of CMEA is preceded by a period of increased activity, when a person is completely absorbed in work, refuses needs that are not related to it, forgets about his own needs. But then exhaustion sets in. Personal withdrawal is the interpersonal aspect of burnout and can be characterized as a negative, callous, or overly distant response to various aspects of the job. The surveyed people experiencing burnout themselves describe detachment as an attempt to cope with emotional stressors at work by changing their compassion for the patient. As a peculiar way of protection from emotional irritants that interfere with the effective performance of work. In extreme manifestations of BS, a person is almost not worried about anything from professional activity, does not cause an emotional response - neither positive nor negative circumstances. Lost interest in a person - the subject of professional activity, He is perceived as an inanimate object, the very presence of which is sometimes unpleasant.

The feeling of loss of achievements, or the feeling of incompetence in the process of development of the CMEA becomes the dominant motive in the assessment of a specialist of his work. People do not see prospects for professional activity, job satisfaction decreases, and faith in their professional capabilities is lost. CMEA also has a negative impact on people's personal lives. After an emotionally intense day spent with patients, a person feels the need to move away from all people for a while, and this desire for loneliness is usually realized at the expense of family and friends. The signs of mental dysfunction observed in CM include the following: loss of clarity of thinking; difficulty concentrating, deterioration of short-term memory; constant lateness despite great efforts to be on time; an increase in errors and reservations; an increase in misunderstandings at work and at home, accidents and situations close to them. It should be noted that people experiencing burnout have a negative impact on their co-workers as they contribute to more interpersonal conflicts and also disrupt work assignments. Thus, burnout can be "contagious" and spread through informal interactions at work. There are five key groups of symptoms characteristic of BS:

1. Physical symptoms (fatigue, physical exhaustion, exhaustion, sleep disturbances and specific somatic problems).
2. Emotional symptoms (irritability, anxiety, depression, guilt, hopelessness).
3. Behavioral symptoms (aggressiveness, callousness, pessimism, cynicism, addiction to psychoactive substances).
4. Work-related symptoms (absenteeism, poor quality of work, tardiness, abuse of work breaks).
5. Symptoms in interpersonal relationships (formality of relationships, detachment from patients, colleagues.

Factors Contributing to the Development of Burnout Syndrome

A key component in the development of SEB is the discrepancy between the personality, its ability to withstand stress and the demands of the environment. Therefore, all factors contributing to the development of this syndrome are divided into organizational and personal. At the same time, it should be noted that organizational factors have a greater influence on the development of the CMEA. Organizational factors include: high workload, lack of time to complete work. lack or lack of social support from colleagues and superiors. insufficient remuneration for work, both moral and material. the inability to control the working situation, the inability to influence the adoption of important decisions. ambiguous, ambiguous job requirements. constant risk of penalties (reprimand, dismissal, prosecution). monotonous activity. irrational organization of labor and workplace (extreme temperatures, noise, passive smoking, sleep deprivation, etc.). the need to outwardly show emotions that do not correspond to real ones, the absence of days off, vacations and interests outside of work.

Among the personal characteristics, the most important are the following:

Increased personal anxiety

• Low self-esteem, a tendency to feel guilty.
• Severe emotional lability.
• External locus of control (in life they rely on chance, luck, achievements and the opinions of other people).
• Passive, avoiding exit strategies from difficult situations.

Diagnosis of burnout syndrome

Due to the fact that most symptoms of SES are nonspecific, the diagnosis of such disorders often requires an integrative, interdisciplinary approach and good cooperation between the patient, general practitioner, psychiatrist, psychologist, etc. To identify SES and determine the stage of its development, it is necessary to take into account: the presence symptoms of burnout, sleep disturbances, somatic complaints, their sequence and temporal relationship with significant life changes, conflict situations in the family and at work; previous and existing diseases \ chronic somatic, infectious \, which may be accompanied by an asthenic symptom complex or complicate the patient's condition; social and professional history (presence of potential stress factors, consideration of possible negative impacts on personal and professional life); smoking, drinking alcohol and drugs (antidepressants, tranquilizers, etc.); physical examination data; mental status, the presence of mental disorders; the results of psychometric testing (the use of questionnaires to identify burnout syndrome); results of laboratory tests (general blood count, tests for liver function, kidney function, electrolyte levels in the blood); "stress biomonitoring" - if necessary and possible to perform (cortisol level, special immunological and endocrinological tests).

Prevention and treatment of burnout syndrome

Preventive and therapeutic measures for SES are largely similar, since what protects against the development of this syndrome can also be used in the treatment of already developed emotional burnout. Studies show that if you do not actively intervene in the development of burnout syndrome among staff, then spontaneous improvement does not occur! Primary prevention: debriefing (discussion) after a critical event, exercise, adequate sleep, regular rest, etc.); training in relaxation techniques (relaxation) - progressive muscle relaxation, autogenic training, self-hypnosis, meditation; the ability to share responsibility for the result with the patient, the ability to say “no”; hobbies (sports, culture, nature); maintaining stable partnerships, social relations; frustration prophylaxis (reduction of false expectations). If expectations are realistic, the situation is more predictable and better manageable.

Strategies to prevent external circumstances that cause burnout (combination of primary and secondary prevention),

Measures aimed primarily at the work environment are: creating, maintaining a "healthy work environment" (ie interim management, communicative leadership styles); recognition of the results of work (praise, appreciation, payment); training of leaders. The manager must ensure that employees have the opportunity to participate in making important decisions for them. Support from management is sometimes even more important than peer support. You can influence almost all the factors that contribute to the development of burnout syndrome.

Person-oriented strategies.

Performing “aptitude tests” before training for a profession; conducting special programs among risk groups (for example, Balint groups for teachers and doctors); regular professional medical, psychological monitoring. When treating an already developed burnout syndrome, the following approaches can be used: pharmacological treatment according to the symptoms: antidepressants, tranquilizers, adrenoblockers, hypnotics. Pharmacological drugs are prescribed in average therapeutic doses. Tranquilizers or blockers are used for short-term relief of the condition, as they can be dangerous with long-term use due to the risk of developing dependence on tranquilizers and cardiac conduction disorders from blockers. They don't get to the root of the problem. Antidepressants are prescribed in the presence of depression in the structure of the syndrome and it is better to combine their appointment with psychotherapy. Psychotherapy (cognitive-behavioral, relaxation techniques, integrative psychotherapy); reorganization of the working environment; a combination of changes in the working environment with rehabilitation and retraining First of all, it is necessary to recognize the problem and take responsibility for one's work, one's professional result. A mental restructuring is needed: a reassessment of goals, an awareness of one's limitations, a positive outlook on life. Unfortunately, in some cases, the development of the syndrome of emotional burnout goes very far. There is a persistent negative attitude towards work, towards patients, colleagues. In such situations, it becomes necessary to change the place of work, the transition to an administrative type of activity, work that is not related to people. improving stress management skills.

Therapeutic and preventive measures are in many ways similar, but in the prevention of SES, it is still possible to do without medical correction of the condition. So what preventive measures are needed? First of all, training in methods of muscular and mental relaxation. The former include: periodic "revision" of the muscular corset, elimination of "clamps" that can become chronic. They are the bodily manifestation of emotional blocks! And the ability to relax prevents the occurrence of muscle clamps, helps to increase stress resistance. One of the exercises:

• Take a comfortable position sitting or lying down. Determine for yourself the inconvenience or stress that you want to eliminate. This emotion must have its localization in the body! For example, you are annoyed by the behavior of a colleague or patient. Try to identify this area where irritation is based. It can be anywhere - in the legs, in the torso, in any part of the body. Try to describe the shape and size of this area, its color, hardness or softness, any other qualities. After a detailed description (for yourself), start mentally sending energy to the problem area of ​​the body. You should imagine this clot of energy in the form of, say, a golden ball, the glow and heat of which “evaporates”, dissolves, destroys (as it is more convenient for anyone) the problem in this area of ​​the body. Watch how things change in your body that prevent you from living. The shape, color, size, location and other characteristics may change. Gradually you will eliminate this negative energy and problem. And you will feel great relief!

• Another exercise - "raising the sky" - is often used in various oriental practices, including martial arts: Stand up straight. Relax all muscles. Legs together. Lower your hands down. Turn your palms inward so that they are facing the ground and at right angles to your forearms. The fingers are pointing towards each other. Raise your hands forward and up. The palms are directed to the sky. As you move, inhale slowly through your nose. Raise your head up and look at your palms. Reach up, but keep your heels off the ground. Hold your breath for a few seconds and feel the energy flow from your palms down along your body. Then, through the sides, lower your hands down, gently exhaling through your mouth. Lowering your hands, look ahead. Do this exercise ten times every morning (or during the day, whenever you feel like it). Regular performance of only this exercise for two to three months will give very tangible results! And then you will understand how much "raising the sky" is one of the best exercises!

Now about mental relaxation. These are different meditations. There are many of them and there is no need to list them here. For believers, the best meditation is prayer! Well, for the rest, I suggest the following simple, but effective tricks:

1. Sit comfortably. Close your eyes. Take a few deep breaths - exhalations. Now breathe as usual (“automatic breathing”). And just watch the air enter your lungs through your nose and out through your mouth. After a while, you will feel that tension and annoying disturbing thoughts have disappeared! This method, as you already understood, is very simple and effective! (Of course, you can do this exercise while lying down).
2. Sit comfortably. Choose on the wall opposite you, at the level of your eyes, two objects at a distance of 1.5 - 2 meters from each other. It can be wallpaper patterns, various spots. It is better, of course, to cut out circles or squares from paper or cardboard and paint them in different colors. And attach at the specified distance. Fix your gaze for a few seconds, first on one object, then for a few seconds on another. And so continue for several minutes. The result - the head will be "empty". All negative thoughts will disappear!

Proper organization of the workplace is also a preventive measure. This is the correct lighting, furniture arrangement, color design - wallpaper in "relaxing" tones. Of course, the office should not be overloaded. When the staff room is “full” of doctors, this is bad. Ideally, there should be a room for psychological relief. Not in vain, in many medical and nursing offices, “compartments” are organized where you can eat or simply “isolate yourself” for a short time from the problems of the department, sit in a chair or lie down. Quite often you can see aquariums in the classrooms. The contemplation of water, algae and fish relieves stress well! Many people know that physical exercises perfectly relieve internal tension, relieve negative emotions and give a positive attitude. But physical education and sports are outside working hours, this is understandable. How to solve the problem of relaxing physical activity during working hours? Of course, it's good if somewhere there is a tennis table, an exercise bike

_________

Why do I describe this fun in such detail, you ask? Yes, because from the standpoint of bioenergetics, this exercise is very useful. Firstly, it is a certain muscle load. Second, you can do it anywhere. And most importantly - this is a wonderful relaxing exercise. In the partner lying on his back, the spine and the whole body takes the form of an arc. The load is removed from the spine and relaxation occurs. If, at the same time, you also shake the lying person a little, then the relaxing effect will only intensify. Speaking about the relaxing effect of physical activity, do not forget about the relaxing effect of music. Coming to consultations in some departments of the Central Regional Hospital, I observe how some doctors, mostly young, of course, relax while listening to music through headphones. It is very good. Music therapy is a wonderful thing in itself. And the headphones give the effect of detachment from the outside world, completely immersing the listener in the world of sounds, especially if you close your eyes. We talked about bodily oriented "protection" measures. But the medical staff works, as they say, in the midst of the sick. And they are all very different. Among them are many "viscous", detailed, requiring increased attention to one's own person. They are ready to "drown" you in their own complaints, the search for sympathy. And very often, all this turns into manipulation of the doctor. If you don’t know how to say “no”, delicately get out of an imposed conversation, cut yourself off from problems you don’t need, then you are the first candidate for “burnout”. Empathy is good up to certain limits. There should be a clearly defined personal boundary, a separation of "I" and "You". Merging with the personality and, accordingly, with the problems of the patient, will de-energize you! If you, when communicating with a patient, feel discomfort, slight dizziness, or you have other unpleasant sensations, then you should know that this is a person with low energy! And he, more often subconsciously, is fueled by your energy. If you are well distanced from the patient, then it is easy to leave the communication. There are many reasons to interrupt the conversation (operation, detour, call to the authorities, consultation in another department, etc.). And you can always resort to the help of colleagues who can help you "create a reason" to get out of a protracted communication. Let's do a fun experiment.. Try a threesome conversation. Let one of you be the patient asking questions of his "doctor". The third person who joins must ask counter questions to the “patient” in the context of the “conversation”. The result is that the conversation will stall rather quickly - the patient's attention is scattered, and he will lose the initiative. The result will be even more noticeable if you invade the patient's personal space, be behind or to the side. Some might think that this is not entirely ethical. But you do not commit violence against a person. It's just a psychological trick to make things easier for you. Burnout candidates are often those who cannot solve their personal or family problems. And “protects” from them by working hard. If there is a feeling of guilt before someone in the family, then a person can subconsciously "punish" himself with unrestrained activity ... This can also be a sublimation of unclaimed sexuality, which is sometimes observed in single women! Of course, every health worker should constantly improve their professional level! This will give self-confidence, raise the status in their own eyes, among colleagues and patients.

Burnout syndrome can not be called a disease in the truest sense of the word. This is not a disease, but a change in the personal and psychological characteristics of a person under the influence of professional stress. The change manifests itself under the influence of the need for constant communication with people and the expenditure of emotional energy associated with this communication. The syndrome affects the development of emotional coldness, indifference and subsequent dehumanization.

History of the term

The term “professional burnout syndrome” (the equivalent term is burnout syndrome) entered medicine in 1974 thanks to a study by the American psychiatrist Freidenberg. His concept of "burnout" is translated as "emotional combustion", and it is directly related to the professional environment.

The syndrome is formed in people who, by virtue of their profession, are constantly forced to contact other people, listen to their requests, complaints, and demands. Therefore, the circle of professions subject to the development of emotional burnout is quite clearly established:

• health workers,
• doctors,
• teachers,
• psychologists and psychotherapists,
• social workers,
• service workers,
• law enforcement officers.

The conclusion is simple: the more a person is forced to communicate, the more he is forced to respond to the emotional mood of his interlocutors. Such a response, being a regular event, can cause psychological trauma. A natural defense against constant traumatic events is to dull and block emotions. The consequences are manifested in a general state of impotence, indifference to others, awareness of one's professional failure and personal uselessness. The final stage is the feeling of the aimlessness of one's existence.

American psychologists Kristina Maslak and Susan Jackson studied the burnout syndrome after Freudenberg. On the territory of the former Soviet Union, V.V. Boyko and E.P. Ilyin.

Factors affecting the formation of the syndrome

Emotional burnout can be affected not only by the above professions, but among them the percentage of carriers of the syndrome is much higher. Emotional deformation is influenced by a number of other factors. They are usually divided into three groups:

1. personal factor;
2. role factor;
3. organizational factor.

The personal factor is an indicator of a person's tendency to acute emotional reactions and experiences, and as a result, to the formation of detachment from experiences, to coldness. The researchers note that the portrait of such a person consists of the following characteristics:

• Emotional openness, softness, at the same time - vulnerability.
• The capacity for acute empathy.
• Easy excitability, that is, a tendency to react violently to other people's ideas, to get carried away by them to the point of fanaticism. Lack of self-sufficiency and independence of the individual.
• Strong feelings about their professional failures and troubles at work.

The role factor is a factor that is formed by the distribution of roles and systems of responsibility at work.

• Scientists have found that those employees who are directly responsible for their actions and deeds are more susceptible to emotional burnout. This responsibility weighs heavily on the individual and does not give peace of mind.
• The role factor also includes insufficient coherence of official duties and functions. The system of competition also does not contribute to emotional stability.

Organizational factor - refers to the system of organization of work in the team.

• If there is an unhealthy environment in the team, and the administration not only does not regulate the relationship between colleagues, but also imposes its own principles that constrain free behavior at work, emotional burnout of employees will not take long.
• This can also include a large employment, which is incommensurable with the amount of payment. The employee loses motivation in the expediency of his work.
• Professional burnout is facilitated by regular work with the “difficult” population: scandalous parents, uncontrollable children, seriously ill patients, criminal elements, etc.

CMEA among medical workers

Emotional burnout of medical workers is a natural phenomenon. The formation of the syndrome in this professional environment is only a matter of time. Why? Work in medicine involves close communication with a contingent that requires increased attention and care. This is especially true for specific categories of patients: cancer patients, AIDS carriers, the disabled, patients in burn and trauma centers, mentally ill people. Medical professions where the burnout rate is quite high:

• nurses;
• doctors;
• psychiatrists and psychotherapists;
• employees of "heavy" departments.

The need to delve into the situation of each patient leads to the fact that after a year and a half of work experience, a nurse or a novice doctor feels the first symptoms of burnout. After 3 years, signs of burnout are evident. Among them, the most common manifestations of the syndrome are:

1. Overwork due to irregular working hours and stressful environment.
2. The appearance of concomitant diseases: headaches, psychosis, sleep disorders, disorders in the work of the heart and digestive tract.
3. Indifferent attitude towards patients, which gradually develops into frankly negative and cynical.
4. Disappointment in their profession and dissatisfaction with their own professional achievements. Feeling of pointlessness of activity.
5. Aggression, anger, irritability towards oneself and others.

Scientists have found that women are the most prone to burnout among healthcare workers. Their emotional openness becomes their weak spot. Men behave more aloofly, because among them the percentage of carriers of the syndrome is approximately two times lower than among women. Nurses are the most favorable contingent for the development of emotional burnout. This is connected with the specifics of their work and professional employment, and with personal qualities. It has been established that nurses of three personality types fall into the risk category:

1. Pedants. They are characterized by exceptional accuracy, conscientiousness, striving for absolute order.
2. Demonstrators. Nurses with a mindset to stay at the center of the action, in front of everyone, to be constantly in sight.
3. Sensitive. Women with open emotions, empathizing, taking everything that happens to heart. Such sensitivity soon leads to self-destruction.

It is typical for carriers of the syndrome to transfer all the negative aspects of their professional activities to their personal lives. Statistics show that this trend leads to either loneliness or divorce. Families where both husband and wife work in medicine are especially affected.

Pedagogical activity and emotional burnout

The syndrome of emotional burnout among teachers is as common as among medical workers. The situation in which he develops is somewhat different, although it is born of the same need for constant tension in professional activities.

The teacher, again - by virtue of his profession - must set himself certain tasks and goals:

• he is a model worthy of imitation;
• an educator, a teacher must raise a mentally and morally healthy generation;
• maintain your "ideal image" among students and colleagues.

Initially overstated requirements, a high degree of responsibility at work and the discrepancy between expected and reality often lead to emotional burnout of teachers. This is clearly facilitated by the level of material remuneration that does not correspond to the load, the management's not always clear and rational attitudes, and sometimes the relations between colleagues and the administration that are very far from friendly.

When studying the level of susceptibility to the syndrome among teachers, it was found that the absence of emotional burnout is typical only for young teachers with little work experience. Further work in this profession is almost always associated with the formation of the syndrome. It manifests itself in different stages, which is often associated with the personal characteristics of a person, and with trouble in private life, and with age.

1 stage. The tension of the psychological defenses of the individual. It is expressed in a slight disappointment with work, lack of sharpness of emotions, dulling of the emotional reaction.

2 stage. Resistance, resistance of psychological defenses. Students and the environment begin to frankly annoy, fatigue from constantly recurring, routine events appears. A desire to emotionally withdraw from what is happening is formed, reaching a persistent need for silence and loneliness. The teacher often continues to experience work stress at home: he wants no one to touch him, leave him alone.

3 stage. Exhaustion. There are no forces and psychological resources for sympathy and empathy. The environment does not cause any emotions, except for negative ones. All this is accompanied by a whole train of diseases of the cardiovascular and digestive systems.

Emotional burnout of teachers is becoming a real threat to the entire education system. Naturally, over time, a system of detection, prevention and training was developed to combat the syndrome.

Methods of dealing with burnout syndrome

The study of the syndrome of professional burnout aims not only to identify a certain kind of malfunction in the emotional system of a person, but also to search for a solution to such a problem. At the first stage - testing, which will show you whether you suffer from the syndrome or not. If the answer is yes, testing will reveal at what stage of emotional burnout the person is. The first step towards overcoming the syndrome is its recognition.

Further, you can try to get rid of it yourself, or contact a psychologist who will help you. If the first option is chosen, and it is decided to fight the syndrome on your own, then the main thing that should be taken into account is the measure in everything.

1. Maintaining a balance between your "I" and other people's experiences. Do not give up compassion, but always be aware that it is outside your inner space. Keeping your distance is the key to your mental health.
2. Don't forget about physical health. Going in for sports or morning exercises will not only allow you to keep fit, but also distract you from “soul-searching”. A good mood as a result will provide a very useful service in overcoming your problems.
3. Focus on the best, optimism, confidence in yourself and your abilities should also be cultivated through training and sports.
4. Rationalism. Act, guided in your actions not by emotions, but by logic. Try to analyze the consequences of your actions and correct them accordingly.

Emotional burnout is not mental burnout. A person is not only emotions and feelings, it is a powerful mind. Not forgetting, and even reminding yourself of this, you can come into balance with yourself, preserve your health and the ability to enjoy life.

A good prevention of emotional burnout is a vacation, the opportunity to relax and make time for activities that you like: walking, reading, music. Managing personal time and space is an important step towards emotional health.