Hazardous to health
Drawing on her extensive work looking into the wellbeing of nurses and social workers, Gail Kinman (University of Bedfordshire) spoke in the first keynote address of the British Psychological Society’s Annual Conference about a key concern of Occupational Health Psychologists – the implications of delivering compassionate care for the mental health of health and social care professionals.
Some of the recent high-profile cases of failures of care, such as those documented in the Francis Report, Professor Kinman said, pointed to a need for a more compassionate culture of care. There has, she added, been some progress made towards such a culture, thanks to values-based recruitment techniques. But having a caring workforce is not enough – there also needs to be a focus on staff wellbeing and health.
Compassion, care and empathy are the cornerstone of health and social care and employees often have an intrinsic drive to be involved in this sort of work. Kinman pointed out that many people go into caring work because they want to make a difference, and they have often had a notable experience in their early years.
Compassion not only benefits service users, who see compassionate clinical staff as more competent and are more likely to comply with their advice, but professionals themselves. Showing compassion can lead to personal growth, and feelings of fulfilment from the job can help to prevent burnout.
But what of the current state of wellbeing in health and social care? A recent Labour Force Survey published by the Health and Safety Executive found that 46 per cent of employees in the health and social care sectors had experienced work-related stress, depression and anxiety over the previous year. Although comparatively high levels of absenteeism are also found in these sectors, presenteeism (where people show up for work when not physically or mentally well enough to do so) is a greater concern for the long term health and effectiveness of the workforce.
Kinman said these professionals also experience emotional labour – or having to ‘display’ positive emotions to their patients or service users and mask their real feelings. This is a risk factor for burnout. She presented some recent figures from a study of burnout in social workers suggesting that 73 per cent experience high levels of emotional exhaustion (a key element of burnout), but over nine out of every ten respondents reported felt that they were making a difference to people’s lives. The long-term implications of burnout are serious in terms of to ill health, absenteeism and retention problems; Kinman outlined shocking figures which show the average working life of a social worker is only eight years – with three years in training and one in assessed practice. Similarly two in every 10 nurses will have left the profession by their third year of practice.
What can protect people in caring professions against burnout? Kinman said self care and compassion were key protective factors along with psychological capital – which comprises several elements such as hope, optimism, self efficacy and resilience. In her own work Kinman recruited several samples of social workers and nurses and found that emotional literacy, emotional self-efficacy, ‘bounded’ empathy, reflective ability, self-care and compassion were just some of the facets of resilience.
In another ongoing study, Kinman’s team is following a cohort of nurses through their 36 months of training. Some of the protective factors for nurses’ mental and physical health were having previous experience in a caring role, a moderate amount of intrinsic motivation, psychological capital (especially optimism and hope), reflective ability, emotional support, psychological flexibility and a sense of belongingness gained from positive placement experiences.
Kinman and her collaborator, Louise Grant, have carried out intervention work with social workers along key points of their career paths. This included using an ‘emotional log’ to reflect upon emotional responses to interactions with service users (both positive and negative), leading to benefits for the trainees’ emotional literacy, empathy and wellbeing. The social workers were also given an eight-week mindfulness intervention, and the researchers saw an increase in emotional self-efficacy, self compassion, and compassion satisfaction.
Kinman said that while individually-focused interventions were useful in building emotional resilience and protecting wellbeing, they risked pathologising people who are unable to cope. Burnout may very well be a logical response to the intense emotional demands of caring work, particularly as many areas have seen intense cutbacks in resources. Kinman added that work should not be hazardous to wellbeing, and that sources of stress are often on an organisational level rather than an intrinsic aspect of the job. It is therefore vital to carefully diagnose organisational hazards and monitor change over time.
- More reports from the Society's Annual Conference will appear online over the next fortnight, and then a selection in the July edition. Next year's event is to be held in Brighton from 3-5 May.
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