Dying to Care: Work, Stress and Burnout in HIV AIDS Professionals (Social Aspects of Aids)

300 Pages·1999·2.02 MB·English

by  David Miller

Dying to Care?
Based on major multi-centre research in the UK, Dying to Care? aims to identify
why work stress is such a problem in healthcare generally, and in HIV healthcare
in particular. The similarities and differences between work stress experienced in
general healthcare settings and in HIV/AIDS are explored in a state-of-the-art
review of international research and experience in the field to date.
Practical in focus, Dying to Care? explores ways in which the unique stresses
of patient advocacy in HIV/AIDS can be addressed, identifying the best
approaches for management. Based on extensive research and clinical experience
of the author and the experiences of health workers of all disciplines working in
HIV/AIDS and oncology, the book examines the general historical confusion
between work stress and burnout, and presents concrete suggestions for burnout
prevention. The studies conducted include ‘context initiatives’ such as:
• ensuring staff vary workloads, enabling expression of work successes
• encouragement for planning non-work periods
• normalising the experience and expression of work stress
• recognising the impact of loss
• incorporating the use of ritual in saying goodbye to dying patients.
This will be a key handbook for managers, physicians, nurses, social workers,
health advisers and counsellors working in or alongside healthcare. It will also
have practical relevance to similar groups working in the context of other life-
threatening diseases.
David Miller is Head of the Department of Psychology and Psychotherapy for
HIV/STD at Mortimer Market Centre, London (Camden and Islington NHS
Trust), and Honorary Senior Lecturer at Royal Free and University College
Medical School, University College London. He is presently the Psychosocial
Adviser to UNAIDS, Geneva.
Social Aspects of AIDS
Series editor: Peter Aggleton
Institute of Education, University of London
AIDS is not simply a concern for scientists, doctors and medical researchers, it
has important social dimensions as well. These include individual, cultural and
media responses to the epidemic, stigmatization and discrimination, counselling,
care and health promotion. This series of books brings together work from many
disciplines including psychology, sociology, cultural and media studies,
anthropology, education and history. The titles will be of interest to the general
reader, those involved in education and social research, and scientific researchers
who want to examine the social aspects of AIDS.
Recent titles include:
Power and ommunity AIDS as a Gender Issue
Organizational and cultural responses Edited by Lorraine Sherr, Catherine Hankins
to AIDS and Lydia, Bennett
DennisAltman
Drug Injecting and HIV Infection
Moral Threats and Dangerous Desires Global dimensions and local responses
AIDS in the news media Edited by Gerry Stimson, Don C.Des Jarlais
Deborah Lupton and Andrew Ball
Last Served? Sexual Behaviour and HIV/Aids in
Gendering the HIV pandemic Europe
Cindy Patton Comparisons of national surveys
Edited by Michel Hubert, Nathalie Bajos
Crossing Borders
and Theo Sandfort
Migration, ethnicity and AIDS
Edited by Mary Haour-Knipe Men Who Sell Sex
International perspectives on male
Bisexualities and AIDS
prostitution and AIDS
International perspectives
Edited by Peter Aggleton
Edited by Peter Aggleton
The Dutch Response to HIV
Sexual Interations and HIV Risk
Pragmatism and consensus
New conceptual perspectives in European
Edited by Theo Sandfort
research
Edited by Luc Van Campenhoudt, Mitchell Families and Communities Responding
Cohen, Gustavo Guizzardi and Dominique to AIDS
Hausser Edited by Peter Aggleton, Graham Hart
and Peter Davies
iii
AIDS
Activism and alliances Mental Health and HIV Infection
Edited by Peter Aggleton, Peter Davies and Edited by José Catalán
Graham Hart
Dying to Care?
Work, stress and burnout in HIV/
AIDS
David Miller
London and New York
First published 2000
by Routledge
11 New Fetter Lane, London EC4P 4EE
Simultaneously published in the USA and Canada
by Routledge
29 West 35th Street, New York, NY 10001
Routledge is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection
of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
© 2000 David Miller
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
British Library Cataloguing in Publication Data,
A catalogue record for this book is available
from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book has been requested
ISBN 0-203-98268-1 Master e-book ISBN
ISBN 1-85728-820-3 (hbk)
ISBN 1-85728-821-1 (pbk)
Social Aspects of AIDS
Series editor: Peter Aggleton
Editorial Advisory Board
Dominic Abrams, University of Kent at Canterbury, UK
Dennis Altman, La Trobe University, Australia
Maxine Ankrah, Makerere University, Uganda
Mildred Blaxter, University of East Anglia, UK
Manuel Carballo, Nyon, Switzerland
Judith Cohen, University of California, San Francisco, USA
Anthony Coxon, University of Essex, UK
Peter Davies, University of Portsmouth, UK
Gary Dowsett, La Trobe University, Australia
Jan Grover, Oakland, California, USA
Graham Hart, MRC Medical Sociology Unit, Glasgow, UK
Mukesh Kapila, Department of International Development, UK
Hans Moerkerk, Ministry of Foreign Affairs, The Hague, The Netherlands
Cindy Patton, Temple University, USA
Diane Richardson, University of Sheffield, UK
Werasit Sittitrai, UNAIDS, Geneva, Switzerland
Ron Stall, University of California, San Francisco, USA
Robert Tielman, Utrecht, The Netherlands
Simon Watney, London, UK
Jeffrey Weeks, South Bank University, UK
This book is dedicated to absent friends and to a new
one, Ada P (16.10.98).
Contents
List of tables and figures xi
Series editor’s preface xii
Foreword xiii
Preface xiv
PART I Development of the awareness of work stress and burnout 1
1 Introduction 2
Imagine… 2
The costs of ill health at work 5
Main aims of this book 7
Who this book is intended for 9
Outline of the book chapters 10
2 Occupational stress: the background to the 12
development of burnout
Stress models—the springboard for recognition of 12
occupational stress
What is occupational stress? 13
What causes stress at work? 15
3 Burnout before HIV/AIDS 28
What is burnout? 29
How does burnout happen? 32
Process models of burnout 34
Distinguishing burnout from stress, and from occupational 45
stress
4 Symptoms and correlates of burnout 51
Symptoms of burnout 51
Physical symptoms of burnout 52
Emotional symptoms 53
Behavioural symptoms 55
ix
Symptoms associated with interpersonal relations 56
The social support buffering hypothesis 60
Other issues affecting the experience of burnout 61
Burnout and personality 66
Conclusions 67
PART II Burnout in the context of HIV/AIDS 69
5 Burnout in HIV/AIDS 70
Staff fears 71
Issues of association 74
Professional and role issues 77
Stigma, discrimination and ethical issues 85
Mediators of HIV/AIDS burnout 87
The context of caring 89
Context matters—the pressures of HIV/AIDS counselling 91
Some concluding thoughts 92
6 Methodological limitations and issues raised in 95
burnout research to date
Limitations of questionnaire-only studies 95
Limitations of cross-sectional studies 97
Potential bias of burnout research volunteers 98
Problems with interpreting burnout measures 99
The necessity for clear characterisations and appropriate 101
measures
Recognising that HIV/AIDS is new 104
Relationships and communication 107
Demographic and other information 107
Conclusions 108
7 The UK Multi-centre Occupational Morbidity Study 109
(MOMS): experiences and independent predictors of
workplace stress and burnout
Aims and objectives 109
Methods 110
Results 115
Discussion 135
8 The UK studies on staff preferences for support, and 153
burnout management and prevention
MOMS: stress management and support preferences 153