This paper is about a nurse who was sexually and physically assaulted while in charge of a dementia-specific ward. The Nurse was assaulted by a patient who was in his early 60s, with early-onset dementia, schizophrenia and used to be a boxer. Dementia is the loss of cognitive, remembering and behavioural function. Behavioural issues include physical/verbal aggression, anxiety, and irritability (Gale et al., 2018). For families and health care professionals, dementia care can lead to higher levels of anxiety, depression, use of psychotropics, and chronic fatigue (Narme,2018). All of which can be symptoms of burnout. A meta-analytic estimation of burnout done on mental health nurses found that they had higher levels of emotional exhaustion and are more likely to exhibit depersonalisation behaviours (López-López et al., 2019). The study also found that variables such as workload, work-related stress and aggressions tend to contribute to the burnout.
Burnout is described as a syndrome that results from workplace stress that has not been managed. Burnout can manifest in three ways, these are; energy depletion, increased mental distance and reduced professional efficacy. Burnout can affect professional and personal life (Information et al., 2020). Especially in cases where nurses who care for dementia residents, will also care for loved ones with dementia at home. Professionals that are burnt out are very negative, cannot concentrate properly, and lack creativity (Rudman et al., 2020). Studies show that there is a link between burnout and increased likelihood of infections among patients. Other studies show that burnout was a significant predictor for type two diabetes, coronary heart disease, hospitalisation and other cardiovascular disorders among nurses (Garcia et al., 2019).
Health care professionals deal with death, the dying process and people with complex health conditions. They not only have to care for the individual with the illness, but also provide emotional support to the family of the patient. It is very easy in these circumstances to depersonalise from work and life as a coping mechanism. Burnt-out nurses are very aggressive, unempathetic and generally impatient. At an organisational level, nurses who are burnt out tend to be physically and emotionally exhausted and frequently miss work. This can contribute to high staff turnover, which inevitably affects patient care (Garcia et al., 2019).
The diathesis model of psychology is a framework for understanding the development of psychological disorders. According to the general model, everyone possesses some degree of inherent vulnerability for a given disorder, all the person needs is a trigger. This is usually a combination of environmental and genetic factors (Broerman, 2017). Stress is part of nursing, and there is no way of avoiding it, some areas of nursing are more stressful than others. The question then is not why some nurses suffer psychological issues due to stress. But rather what prevents 100% of the nurses working in the same field from suffering psychological issues. The interaction between stress and diathesis could explain why some individuals develop psychological issues while others do not (Broerman, 2017).
The self-care model appropriate to this nurse is the ‘ART’ model. The ‘ART model’ involves acknowledging a feeling or wound that needs healing, recognise choices and act or turn outwards towards self and others. The ART model posits that how one feels cannot be removed from the workplace, and the individual and collective feelings count in the efforts to provide care (Enhancing Professional Quality of Life, 2019). The misconception in professional life of not showing emotions in a tragedy is not only damaging to the professional’s mental health, but it also makes the nursing profession mechanical and ungenuine. This is because pain and anguish are part of life and are impossible to avoid; suppressed emotions will always manifest themselves in other ways. Either through anger or other high-risk behaviours like drugs and alcohol. Acknowledging how one feels and realising there is a problem is the first step in finding better protective strategies.
Broerman, R. (2017). Diathesis-Stress Model. In V. Zeigler-Hill & T. K. Shackelford (Eds.), Encyclopedia of Personality and Individual Differences (pp. 1–3). Springer International Publishing. https://doi.org/10.1007/978-3-319-28099-8_891-1
FT, V. T.-F., PhD, RN. (2019). Compassion Fatigue and Burnout in Nursing, Second Edition: Enhancing Professional Quality of Life. Springer Publishing Company.
Gale, S. A., Acar, D., & Daffner, K. R. (2018). Dementia. The American Journal of Medicine, 131(10), 1161–1169. https://doi.org/10.1016/j.amjmed.2018.01.022
Garcia, C. de L., de Abreu, L. C., Ramos, J. L. S., de Castro, C. F. D., Smiderle, F. R. N., dos Santos, J. A., & Bezerra, I. M. P. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina, 55(9). https://doi.org/10.3390/medicina55090553
Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2020). Depression: What is burnout? In InformedHealth.org [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK279286/
Narme, P. (2018). Burnout in nursing staff caring for patients with dementia: Role of empathy and impact of empathy-based training program. Geriatrie Et Psychologie Neuropsychiatrie Du Vieillissement, 16(2), 215–222. https://doi.org/10.1684/pnv.2018.0735
Rudman, A., Arborelius, L., Dahlgren, A., Finnes, A., & Gustavsson, P. (2020). Consequences of early career nurse burnout: A prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia. EClinicalMedicine, 27. https://doi.org/10.1016/j.eclinm.2020.100565