Bakker AB, Demerouti E. The job demand–resources model: state of the art.

Journal of
Managerial Psychology 2007;22:309–28

Bakker AB, Geurts SAE. Toward a dual-process model of work–family interference.

Journal of Work and Occupations 2004;31:345–66

Role is a descriptive term for relatively predictable behavioural patterns. En el caso de las
enfermeras (Gandi JC, Beben WW, Gyarazama Y. Nurses' roles and the mediating effects of stress
on job performance in low developing economies. Psychology 2011;2(4):323–30) su rol se resume:
caring for the sick and the aged. an emotional view of the nurse role as ‘mother: gentle, kind,
always available, nurturing life by natural means, wise but not learned’ Nursing is synonymous with
caring which encompasses empathy for and connection with people. Despite the expanded roles
(practitioner, clinician, clinical specialist and others), the professional nurse is at times in situations
that pose ethical and or moral conflict.Nursing is a caring profession, and the caring encompasses
empathy for and connection with people. Caring is best demonstrated by a nurse's ability to embody
the five core values of professional nursing:21human dignity (worthy of honour or respect’),
integrity (one's actions on an internally consistent framework of principles), autonomy (right to self-
government), altruism (selfless concern for the welfare of others) and social justice.

INTERVENCIÓN
Bringing about personal growth and renewal involve optimizing a sense of meaning at work and in
personal life.
increased workload, increased governmental oversight, decreased insurance reimbursement,
decreased autonomy, and the complex demands of office management

Continuo burnout , work engagement (Demerouti,

E., Mostert, K., & Bakker, A. B. (2010). Burnout and
work engagement: a thorough investigation of the independency of both constructs. Journal
of occupational health psychology, 15(3), 209.)

Bragard, I., Dupuis, G., & Fleet, R. (2015). Quality of work life, burnout, and stress in emergency
department physicians: a qualitative review. European journal of emergency medicine : official
journal of the European Society for Emergency Medicine, 22 4, 227-34.
D physicians showed moderate to high levels of burnout with difficult work conditions including
significant psychological demands, lack of resources, and poor support.

Pines, A.M. (2002). The changing psychological contract at work and employee burnout. Journal of
health and human services administration, 25 1, 11-32.
The article describes burnout, differentiates it from stress,. management are used to point in the
recommended for preventing employee burnout, despite the new psychological contract, namely--a
democratic, egalitarian management style.

Boehm, J.K., Lyubomirsky, S., & Walsh, L.C. (2018). Does Happiness Promote Career Success?
Revisiting the Evidence. Journal of Career Assessment, 1-21
We conclude that the evidence continues to per-
suasively suggest that happiness is correlated with and often precedes career success
and that
experimentally enhancing positive emotions leads to improved outcomes in the workplace.
Martínez-Zaragoza, F. (2018). Personality and interpersonal behaviour may impact on burnout in
nurses. Evidence-based nursing, 21 1, 24.
onal exhaustion and depersonalisation decreased when interpersonal behaviour was friendly
submissive or friendly.
Emotional exhaustion and depersonalisation increased when
interpersonal behaviour was more directed towards dominance.

Kanthak, M.K., Kirschbaum, C., Ludwig, V.M., Miller, R., Penz, M., & Stalder, T. (2018). Hair
cortisol as a biological marker for burnout symptomatology. Psychoneuroendocrinology, 87, 218-
221.
Burnout is a syndrome with negative impact on cognitive performance and mood as a consequence
of long-term stress at work. It is further associated with increased risk for mental and physical
diseases. One potential pathway to mediate chronic work-stress and adverse health conditions in
burnout is through alterations in long-term glucocorticoid secretion.
The present findings indicate specific hypercortisolism in participants who suffer from burnout.

Anuk, D., Guveli, H., Guveli, M.E., Oflaz, S.B., Ozkan, M., Ozkan, S., & Yildirim, N.K. (2015).
Oncology staff: burnout, job satisfaction and coping with stress. Psycho-oncology, 24 8, 926-31.

Angus, L.D., Boutin, A., Dupiton, L., & Munnangi, S. (2018). Burnout, Perceived Stress, and Job
Satisfaction Among Trauma Nurses at a Level I Safety-Net Trauma Center. Journal of trauma
nursing : the official journal of the Society of Trauma Nurses, 25 1, 4-13.

Eddy, P., Hale, M., Wertheim, E.H., & Wright, B.J. (2018). A Systematic Review and Meta-
analysis of the Effort-Reward Imbalance Model of Workplace Stress and Hypothalamic-Pituitary-
Adrenal Axis Measures of Stress. Psychosomatic medicine, 80 1, 103-113.

effort-reward imbalance and overcommitment were similarly related with hypothalamic-pituitary-

adrenal axis responsivity. However, because OC moderated the relationship between ERI and HPA
axis markers, the importance of OC should not be overlooked. Because OC is likely more malleable
than ERI to intervention, this may be a promising avenue for future research.

Lynch, W.D., Perlman, A., Smith, B., Shatté, A.J., & Siers, M. (2018). Improvements in Resilience,
Stress, and Somatic Symptoms Following Online Resilience Training. Journal of occupational and
environmental medicine.

online resilience training program had a positive effect on resilience, stress, and symptoms

Kandelman, N., Levy, A., & Mazars, T. (2018). Risk factors for burnout among caregivers working
in nursing homes. Journal of clinical nursing, 27 1-2, e147-e153.

Caregiver burnout rate was 40% The only significant risk factor in the multivariate analysis was the
antecedent of bullying by a resident
In high-risk populations of healthcare professionals, screening and management of risk factors is
crucial for preventing burnout.

Colville, G.A. (2018). Paediatric intensive care nurses report higher empathy but also higher
burnout than other health professionals. Evidence-based nursing, 21 1, 25.
A recent increase in the number of publications on the high prevalence of burnout and moral
distress in health professionals in general, and in critical care staff in particular, has led to a call for
more research into the mechanisms by which burnout arises and into interventions to increase
resilience in the workplace. associations between exposure to pain, empathy and work-related
distress

Aldana, S., Desmarais, N., Dollinger, R., Grossman, S.D., & Harscher, H.V. (2018). The impact of
empathy on burnout in medical students: new findings. Psychology, health & medicine, 23 3, 295-
303.

students with high levels of empatic concern had statistically lower scores of burnout over time
while students with high levels of personal distress empathy showed statistically higher scores of
burnout over three years. Implications for these findings are discussed.

Cross, W.I., Guo, Y., Luo, Y., Lam, L., Plummer, V., & Zhang, J. (2018). Burnout and its
association with resilience in nurses: A cross-sectional study. Journal of clinical nursing, 27 1-2,
441-449.

negative relationship between burnout symptoms and resilience

Drake, D.A., Pasupathy, K.S., & Steege, L.M. (2018). A work systems analysis approach to
understanding fatigue in hospital nurses. Ergonomics, 61 1, 148-161.
he relationship between a task variable of 'excessive work' and acute fatigue varied based on an
organisation variable related to 'time to communicate with managers/supervisors'.

Coronado, J.I., Chandola, T., & Steptoe, A. (2018). Allostatic Load and Effort-Reward Imbalance:
Associations over the Working-Career. International journal of environmental research and public
health, 15 2.
work stress towards the end of the working career predicts allostatic load, a measure of chronic
stress related physiological processes
The accumulation of work related stressors could have adverse effects on chronic stress biological
processes.

Luthans, F. (2018). The need for and meaning of positive organizational behavior.

Bizhanova, Z., Curtis, B.R., Condle, J.P., Coppler, P.J., Flickinger, K.L., Higgins, J.S., Kroemer,
A.J., Lang, E.S., Matthews, M.E., Martin-Gill, C., Patterson, P.D., Runyon, M.S., Renn, M.L.,
Sequeira, D.J., Teasley, E.M., Weaver, M.D., Weiss, P.M., & Xun, X. (2018). Shorter Versus
Longer Shift Durations to Mitigate Fatigue and Fatigue-Related Risks in Emergency Medical
Services Personnel and Related Shift Workers: A Systematic Review. Prehospital emergency care :
official journal of the National Association of EMS Physicians and the National Association of
State EMS Directors, 1-9.

shifts <24 hours in duration are more favorable than shifts ≥24 hours

Keeling, A.N., McManus, I.C., & Paice, E. (2004). Stress, burnout and doctors' attitudes to work are
determined by personality and learning style: A twelve year longitudinal study of UK medical
graduates. BMC Medicine, 2, 29 - 29.
Stress, burnout and satisfaction also correlate with trait measures of personality taken five years
earlier.
Alić, A.Š., Brekalo-Lazarević, S., Pranjić, N., Pašić, Z., Ramić, E., & Selmanović, S. (2011). Stress
at work and burnout syndrome in hospital doctors. Medicinski arhiv, 65 4, 221-4.
Continuous exposure to stressors at the workplace, such as work at shifts, excessive workload, poor
communication with superiors, and lack of continuous education of hospital physicians can lead to
mental and physical exhaustion, professional burnout.

Leiter, M., Maslach, C., & Schaufeli, W.B. (2001). Job burnout. Annual review of psychology, 52,
397-422.
Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is
defined by the three dimensions of exhaustion, cynicism, and inefficacy. The past 25 years of
research has established the complexity of the construct, and places the individual stress experience
within a larger organizational context of people's relation to their work. Recently, the work on
burnout has expanded internationally and has led to new conceptual models. The focus on
engagement, the positive antithesis of burnout, promises to yield new perspectives on interventions
to alleviate burnout. The social focus of burnout, the solid research basis concerning the syndrome,
and its specific ties to the work domain make a distinct and valuable contribution to people's health
and well-being.
Jennings, B.M. (2008). Chapter 26. Work Stress and Burnout Among Nurses: Role of the Work
Environment and Working Conditions.
Boone, S.L., Dyrbye, L.N., Oreskovich, M.R., Shanafelt, T.D., Sotile, W.M., Satele, D.V., Sloan, J.,
Tan, L.L., & West, C.P. (2012). Burnout and satisfaction with work-life balance among US
physicians relative to the general US population. Archives of internal medicine, 172 18, 1377-85.
Substantial differences in burnout were observed by specialty, with the highest rates among
physicians at the front line of care access (family medicine, general internal medicine, and
emergency medicine). more dissatisfied with work-life balance, aquellos con postgrado presenaron
menor riesgo de burnout. Burnout is more common among physicians than among other US
workers. Physicians in specialties at the front line of care access seem to be at greatest risk.

Johnson-Leong, C., & Rada, R.E. (2004). Stress, burnout, anxiety and depression among dentists.
Journal of the American Dental Association, 135 6, 788-94.
Although contextual variables were strong prospective predictors and personality traits weak
predictors of burnout, the results suggested the importance of the interaction between personality
and contextual variables in predicting burnout.
Personality traits proved to be significant but weak prospective predictors of burnout and as a group
predicted only reduced professional efficacy (R(2)=0.10), with agreeableness being a single
negative predictor. Organizational stress was positive, affective-normative commitment negative
predictor, while continuance commitment was not related to any dimension of burnout. We found
interactions between neuroticism as well as conscientiousness and organizational stress, measured
as role conflict and work overload, on reduced professional efficacy (βNRCWO=-0.30; βcRCWO=-
0.26). We also found interactions between neuroticism and affective normative commitment
(β=0.24) and between openness and continuance commitment on reduced professional efficacy (β=-
0.23), as well as interactions between conscientiousness and continuance commitment on
exhaustion.

Fountoulakis, K.N., Iacovides, A., Kaprinis, S.G., & Kaprinis, G.S. (2003). The relationship
between job stress, burnout and clinical depression. Journal of affective disorders, 75 3, 209-21.
Work is an indispensable way to make a decent and meaningful way of living, but can also be a
source of stress for a variety of reasons. Feelings of inadequate control over one's work, frustrated
hopes and expectations and the feeling of losing of life's meaning, seem to be independent causes of
burnout, a term that describes a condition of professional exhaustion. It is not synonymous with 'job
stress', 'fatigue', 'alienation' or 'depression'. Burnout is more common than generally believed and
may affect every aspect of the individual's functioning, have a deleterious effect on interpersonal
and family relationships and lead to a negative attitude towards life in general. Empirical research
suggests that burnout and depression are separate entities, although they may share several
'qualitative' characteristics, especially in the more severe forms of burnout, and in vulnerable
individuals, low levels of satisfaction derived from their everyday work.

Bianchi, R., & Schonfeld, I.S. (2016). Burnout and Depression: Two Entities or One? Journal of
clinical psychology, 72 1, 22-37.
Treated dimensionally, burnout and depressive symptoms were strongly correlated (.77;
disattenuated correlation, .84). Burnout and depressive symptoms were similarly correlated with
each of 3 stress-related factors, stressful life events, job adversity, and workplace support. In
categorical analyses, 86% of the teachers identified as burned out met criteria for a provisional
diagnosis of depression. Exploratory analyses revealed a link between burnout and anxiety.
this study provides evidence that past research has underestimated burnout-depression overlap. The
state of burnout is likely to be a form of depression. Given the magnitude of burnout-depression
overlap, treatments for depression may help workers identified as "burned out."

Smith, A. M., Ortiguera, S. A., Laskowski, E. R., Hartman, A. D., Mullenbach, D. M., Gaines, K. A.,
... & Fisher, W. (2001). A preliminary analysis of psychophysiological variables and nursing
performance in situations of increasing criticality. In Mayo Clinic Proceedings, 76(3), 275-284.

Those nurses who are high state anxious, high trait anxious, and worried and who had a faster heart
rate performed less well than their more relaxed peers. Nurses with high state anxiety may be at risk
for attrition, burnout, medical errors, and poor performance in other ICU nursing tasks.

Interventions for Burnout

Once burnout has set in, one has to look at therapeutic strategies. There is a shortage of well-
designed studies on interventions for established burnout among doctors. There are anecdotal
reports of a wide range of strategies being effective against burnout once it has set in. Such
strategies include participation in panel and group discussions, conferences, and retreats without
having to take time off; providing a list of resources to doctors including books, websites, and
contact information for experts and workshop leaders who are trained in combating burnout; having
professional body policy acknowledging the specific occupational stressors faced by physicians and
encouraging physician self-care through proper rest and exercise, spending time with family and
having a personal physician to assess well-being objectively; setting limits on hours and choosing a
certain type of medical practice, being positive and maintaining a balance in life (Gundersen L.
Physician burnout. Ann. Intern. Med. 2001;135:145–148).

Stress management programmes are often recommended for managing burnout. A systematic
review (Van Wyk B.E., Pillay-Van Wyk V. Preventive staff-support interventions for health
workers. Cochrane Database Syst. Rev. 2010) found no evidence of effectiveness of brief stress
management training interventions in reducing job stress for health workers. While this systematic
review did not look at specific interventions for doctors, it did find low-quality evidence to support
the effectiveness of stress management training of moderate intensity (defined as more than six
hours contact over one month) in short-term reduction of job stress levels, but the beneficial effects
diminished without booster sessions. The review found strong levels of evidence to support the
effectiveness of intensive, long-term stress management training programmes in reducing
workplace stress and risk of burnout among a wide range of health workers. This systematic review
specifically examined the effectiveness of different strategies on reducing workplace stress. It is
worth keeping in mind that workplace stress does not necessarily equate to burnout. Chronic
exposure to workplace stress leads to burnout in some individuals, but not everyone exposed to
chronic stress develops burnout. Therefore, simply reducing stress levels may not necessarily lead
to reducing the risk of burnout. Factors such as personality traits and personal circumstances may
determine whom among those exposed to chronic stress may experience burnout. Strategies found
effective in reducing work-place stress may not necessarily and automatically reduce burnout unless
these personal factors are evaluated and intervention strategies individualised to the person
experiencing burnout.

Findings from a systematic review (Marine A., Ruotsalainen J., Serra C., Verbeek J. Preventing
occupational stress in health care workers. Cochrane Database of Syst. Rev. 2006) may shed some
light on the effectiveness of individualised intervention strategies against burnout. This systematic
review (Marine A., Ruotsalainen J., Serra C., Verbeek J. Preventing occupational stress in health
care workers. Cochrane Database of Syst. Rev. 2006) grouped intervention strategies against
burnout into Person-directed (cognitive behavioural therapy, relaxation, music making, massage,
and multi-component programmes) and Work-directed (attitude change and communication,
support from colleagues, participatory problem solving and decision making, and changes in work
organisation). The authors found limited evidence to support the efficacy of either Person- or Work-
directed intervention strategies in reducing burnout in healthcare workers, and highlighted the need
for good-quality intervention studies for burnout. Participation in “wellness programmes” was
suggested to be related to lower incidence of burnout among doctors (Amoafo E., Hanbali N., Patel
A., Singh P. What are the significant factors associated with burnout in doctors? Occup. Med.
2015;65:117–121.) although another systematic review that cautioned no causal relationship
between participation in wellness programmes with lower incidence of burnout in doctors could be
established.

There is some evidence to suggest participation in a mindful communication programme may be

associated with short-term and sustained improvements in burnout among doctors. teaching in
mindfulness, communication, and self-awareness found improvements in mindfulness to be
associated with significant improvements in all three dimensions of burnout (emotional exhaustion,
depersonalisation, and personal accomplishment (Krasner E. Mindfulness training being helpful in
reducing burnout scores. JAMA. 2009;302:1284–1293. doi: 10.1001/jama.2009.1384.)

Based on the evidence reviewed, one could speculate an intense stress management programme
with booster sessions delivered over a longer period may yield longer-lasting results among those
experiencing burnout. Alternatively, mindfulness-based strategies may be promising. Intervention
studies comparing the efficacy of long- and short-term programmes of varying intensities against
burnout among doctors are needed.

Fture

Burnout among doctors is a global phenomenon. By virtue of their profession, doctors are a
vulnerable group for experiencing burnout. Burnout among doctors can lead to poor quality of care
delivered to patients, increased medical errors and poor retention, in addition to poorer health
outcome. Enhancing resilience and work engagement at an individual doctor level while also
creating a positive work environment that helps doctors achieve work−life balance and enjoy job
security, and provides a family-friendly work environment may help prevent burnout among
doctors. Once burnout has set in, there is limited evidence to support the usefulness of modalities
such as cognitive behavioural therapy, relaxation, music, or creating a positive work environment.
Prevention appears to be, once again, far more beneficial than treatment when it comes to burnout.

Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work Related Stress, Burnout, Job
Satisfaction and General Health of Nurses. International Journal of Environmental Research and
Public Health, 12(1), 652–666.
Described as a state of physical and emotional depletion, burnout is a result of prolonged exposure
to stressful working environments [1]. As such, burnout among nurses in particular has been
reported to be higher than other health professionals owing to the nature of their work [2]. Nursing
requires the delivery of humane, empathetic, culturally sensitive, proficient and moral care, in
working environments with limited resources and increasing responsibilities. Such imbalance
between providing high quality care and coping with stressful working environments can lead to
burnout [3].

Work related stress is associated with burnout, job satisfaction and physical as well as mental health
outcomes [3,4,5]. Stressors contributing to the experience of work related stress, including poor
supervision, conflict with peers and patients, high job demands [6,7] and overtime [8] are all
associated with one or more dimensions of burnout. The Maslach Burnout Model [9,10] postulates
that prolonged exposure to environmental and situational stressors resulting in work related stress,
contributes to emotional exhaustion, depersonalization and a lack of personal accomplishment.
Similarly, work related stress resulting from stressors, such as higher workloads, as well as staff
issues, including lack of resources, has been found to be associated with poor job satisfaction
[11,12]. Spector attributes this to a mismatch between job expectations and actual working
environments, which contributes to higher levels of work related stress and lower levels of job
satisfaction [13]. Research confirms higher levels of job satisfaction within less stressful working
environments [5]. Stressors such as poor patient outcomes, conflict with peers, high workload and
job demands as well as poor supervision and lack of support are all associated with poor physical
and mental health outcomes [14,15,16]. Cannon’s stress theory [17,18] explains this response as an
imbalance in homeostasis, whereby prolonged exposure to stressors results in a breakdown of the
biological system. This breakdown prevents compensatory and anticipatory changes that aid in
coping, thereby resulting in poor health outcomes such as headaches, insomnia, social dysfunction
and depression [4,19,20].

With grave impact on work productivity, patient care, staff attrition and turnover rates [24], a better
understanding of existing relationships between work related stress, burnout, job satisfaction and
general health of nurses is required.

Gray-Stanley, J. A., & Muramatsu, N. (2011). Work Stress, Burnout, and Social and Personal
Resources among Direct Care Workers. Research in Developmental Disabilities, 32(3), 1065–1074.
Work stress is endemic among direct care workers (DCWs) who serve people with intellectual and
developmental disabilities. Social resources, such as work social support, and personal resources,
such as an internal locus of control, may help DCWs perceive work overload and other work-related
stressors as less threatening and galvanize them to cope more effectively to prevent burnout.
However, little is known about what resources are effective for coping with what types of work
stress.
Work stress, specifically work overload, limited participation decision-making, and client disability
care was positively associated with burnout. Whether work social support and locus of control make
a difference depends on the kinds and the levels of work stressors.

work overload, client disability, and low decision-making participation had statistically significant
Role ambiguity associations with burnout.
Resources: work
social support, the subdimensions of supervisor and coworker support, and locus of
control
Burnout was significantly associated with work stress, specifically the work stress subdimensions of
work overload, low participation in decision-making,

As the perceived workload increases, other types of supports may be more effective than locus of
control. locus of control lessened burnout when workload was low also suggests limits to internal
control resources (Gray-Stanley, J. A., & Muramatsu, N. (2011)
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