Outline
In this article, I use the phenomenon of Alzheimer’s neurodegenerative disease to study the syndrome of professional burnout in nurses who provide care to such patients. This is a comprehensive project that consists of two key sections, namely the study of Alzheimer’s disease and the study of nursing burnout practices. The focus of the entire article was on leadership skills in health care administrators, whether they be clinic directors or nurse managers, aimed at maintaining nurse functioning. Neurodegenerative Alzheimer’s disease is a severe threat to the health of elderly patients, as there are problems with socialization and effective communication due to temporary memory lapses and diminished intellectual capacity. As a result, these patients are unable to communicate adequately with nursing staff and follow doctor’s orders, which means that the quality of therapy deteriorates. In turn, this affects the mental state of the nursing staff, who are forced to constantly perform routine activities and explain the same instructions to patients with Alzheimer’s several times. The problem is incredibly complicated during the pandemic when the unpreparedness of the health care system for such a severe threat has disrupted the efficiency and speed of clinical facilities. Thus, the problem of professional burnout in them is not uncommon, and thus there is a need for administrative management of their work practices.
Using the literature review as the primary research tool, both Alzheimer’s disease separately and the phenomenon of professional burnout in nurses were studied. Based on the results of the literature review, I can state with great confidence that burnout is an important and urgent problem among medical workers. At the same time, this problem becomes even more urgent for professionals in the field of caring for elderly patients with Alzheimer’s syndrome due to the unique features of the course of this disease. As a result, nurses experience severe emotional stress and impaired mental well-being, sleep, and appetite problems, which is reflected not only in their health but also in their relationships with loved ones.
This work is valuable and relevant material, valuable to the entire student community and those interested in exploring the problem described. In this paper, I not only acknowledge — through a literature review — the significance of the problem of professional burnout but also offer several practices and recommendations for how to minimize this threat effectively. Thus, the overall structure of this paper contains the following components:
Introduction
Leadership issues in clinical organizations require special attention for the reason that quality, safe and inspiring management directly determines the outcome of care. For any healthcare organization, regardless of its focus, location, or funding, the key priority is to fulfill its professional goals, namely, to treat patients. In an effort to realize this goal, clinic staff performs high-quality activities, improving performance and earning valuable experience. A large number of visitors allows the company to become more recognizable in the industry and attract more patients. Eventually, this not only means better commercial and professional metrics for the clinical organization but also an improved health care agenda for the company. However, an overabundance of visitors has a downside: It contributes to career burnout for individual employees. Conveyors work with patients associated with routine tasks even though each patient is treated individually, which can ultimately lead to problems of concentration, emotional satisfaction, and productivity. It is easy to conclude that in the case of professional burnout of the majority of workers, the overall productivity of the whole clinical company decreases as well. Consequently, a surplus of visitors for a healthcare organization has ambiguous effects and can be useful only in case of adequate personnel management.
However, the situation remains similar in the case of inpatient visitors who do not leave the hospital room for treatment. It can be said that the need for round-the-clock observation of patients, associated with increased responsibility and emotional attachment to specific individuals, whose interaction with whom constantly occurs, rather than for a few sessions, are more severe predictors of professional burnout. In this sense, nurses, as the principal attendants of sick people, find themselves in the most vulnerable position. In addition, if patients are represented by people suffering from severe neurodegenerative diseases, such as Alzheimer’s disease, in this case, the professional burden on nurses increases. It should be understood that Alzheimer’s disease is an acute problem for effective communication between the patient and the caregiver. Whereas other illnesses do not generally deprive the individual of the ability to communicate with the nurse, receive advice actively, and have the ability to follow doctor’s orders, patients with this diagnosis are prone to memory loss and decreased intelligence (Bursack, 2020). In other words, nurses in these units are required to do more work, not only to perform basic clinical tasks but also to monitor the Alzheimer’s patient’s adherence to the treatment plan.
The purpose of this essay is to conduct an academic analysis from available sources and to critically evaluate the findings in an effort to examine the issue of professional burnout in nurses caring for patients with Alzheimer’s disease. The stated characterization of inpatients in the title implies a narrowing of the topic to those nurses who care for patients in clinics. Moreover, not all patients with this neurodegenerative disease are prescribed to be in a clinical setting, and thus the scope of this essay may include nursing homes, boarding homes, and social centers, where patients with this diagnosis may also live temporarily or permanently.
Literary Review
Alzheimer’s Disease
Some of the most severe and dangerous diseases of the human body are those that affect the nerve centers, thus causing cognitive damage. Alzheimer’s disease is one such condition that is characterized by its progressiveness and duration (Melinosky, 2021). As a result of the effects of this pathology on the nerve cells of the brain, there is atrophy, accompanied by signs that are at first often perceived as natural aging of the body. In particular, this refers to a general decline in intellectual capabilities along with a decline in memory. This connection with age determines the fact that the majority of the patient category is represented by the elderly (Melinosky, 2021). The progressive nature of the pathology determines the weakness and low visibility of symptoms at the beginning of the course and the aggravation of the condition as it progresses. As a result, the patient has more severe memory impairment, inability to remember and reproduce information, impaired thinking, dementia, and decreased social and behavioral attributes (Bursack, 2020). An individual with severe forms of Alzheimer’s disease is unable to act independently and take responsibility for his or her actions.
It is noteworthy that the pathogenesis of this diagnosis is poorly understood, and in-depth studies are still being conducted. The plurality of views and differences in approaches lead to the existence of four competing hypotheses, each of which (or even combinations of them) may be true. On the one hand, decreased biosynthesis of acetylcholine, which has a critical neurotransmitter function, may be responsible for the initiation of a neurodegenerative state (Fan et al., 2020). On the other hand, beta-amyloid accumulation, which is suspected to be involved in the infectious defense of the body, is one of the predictors of the development of Alzheimer-type dementia. A third hypothesis is infectious, in which the patient’s brain is affected by Porphyromonas gingivalis. Finally, the academic community also tends to believe that an abnormal tau protein triggers a cascade of biochemical processes that leads to neuronal death. Each of these hypotheses has the right to exist, but none of them can fully explain the complexity and complexity of such nerve fiber degradation.
Epidemiologically speaking, Alzheimer’s disease is extremely common in the adult population. More than 50 million people worldwide are thought to have Alzheimer’s (ADI, 2020). It is estimated that about 6.2 million Americans age 65 and older will have Alzheimer’s disease by 2021, with the number doubling by 2060 (Wiley, 2021). Regarding Canada, it is fair to say that every 16.4 people in 100,000 die of Alzheimer’s disease in 2019 (Elflein, 2021). This number is slightly lower than in previous years, which means that one can talk about a generally stable mortality rate from the disease. Notably, Canadian authorities are finding a link between Alzheimer’s disease progression in elderly patients and vulnerability to COVID-19. More specifically, among Canadian patients who died of COVID-19, about 42% of women and 33% of men were diagnosed with Alzheimer’s disease (ST, 2020). All of this should lead to the conclusion not only of the danger of this disease in combination with the immune system attacking infections but also of its high prevalence.
Nursing Burnout
As a result of the high prevalence of this diagnosis, large numbers of older people around the world, and in Canada included, find themselves unable to be capable and effectively manage their lives. Essential life skills such as cooking and cleaning the house become overwhelming for these patients (Bursack, 2020). Young relatives of such people are not always able to provide adequate care for sick elders, and the only solution is to transfer them to inpatient clinics, nursing homes, and social care centers. It is noteworthy that the U.S. national Medicare program allows families to cover some or all of the costs of care for elderly patients, which is an additional benefit for relatives in the decision to send adult family members to inpatient clinics. Finally, it should not be ignored the fact that the world’s population is rapidly aging. Because of increased medical options and accessibility, the number of potential Alzheimer’s patients is also increasing.
In turn, this solution does not have strictly positive effects. On the one hand, the more patients end up in clinical settings, the more likely they are to receive high-quality medical care. It is generally evident that relatives cannot care for an ill family member with the degree of responsibility, competence, and care that nurses do (Bursack, 2020). Thus, providing clinical care to patients with Alzheimer’s disease is the right solution in terms of realizing national health care goals. On the other hand, however, the health care system at the local levels may not be ready for such a high demand for services. Because of the large number of clients, clinics and other social centers are overcrowded and therefore unable to provide the services they offer. In addition, because of the difficulties encountered, current nurses — due to a situation where the manager cannot expand the staff — are forced to work more and harder than usual. This over-performance may have short-term benefits for improving the company’s performance, but overall, it leads to serious productivity problems, of which professional burnout is the most important.
It should be particularly emphasized that nursing work and professional duty are always related to the provision of services to others. The direct proximity to other individuals and the tasks on which their quality of life depends place a high degree of responsibility on the nurse. However, it is always important to remember that a nurse is a person who should never sacrifice her health in order to help others: the public value of such an approach would be minimal. On the contrary, the real agenda clearly shows the heroic performance of work tasks by nurses. In an attempt to take care of a patient’s health at risk, nurses often go beyond prescribed obligations to sacrifice their own time and health. This was especially evident during the COVID-19 pandemic when imperfections in the health care machine forced workers to work to their limits (Matsuo et al., 2020). Indeed, such acts deserve public recognition and encouragement, but from a nursing perspective, such acts are not beneficial. Excessive concentration, overtime, and lack of healthy sleep make nurses’ personal lives broken and inadequate. All of this becomes a significant problem that goes by the name of professional burnout.
In reality, burnout is not a contrived or abstract problem but instead is a serious danger. The widespread prevalence of this phenomenon, combined with recognized threats to its effects, has made occupational burnout one of the six dimensions of stress (Molina-Hernández et al., 2021). According to 2017 statistics, 63% of American nurses stated that their work resulted in burnout (Larson, 2017). However, as such, there is still no standard definition for the term, so the definition of the critical causes of this condition also varies. The most universal answer is given by WHO, which postulates that burnout should be understood as a syndrome caused by the experience of chronic stress in the workplace (WHO, 2019). Moss (2019) also suggests emphasizing the conditions of the workplace, rather than the character and endurance of people, by making firm managers responsible for employee burnout. In addition, there is also evidence to support a link between burnout and depression (Melinosky, 2021; Bianchi et al., 2017). In turn, this can only indicate the seriousness and danger of such a problem. The lack of adequate leadership to prevent the threats of burnout has dangerous effects both on the health of the employee individually and on the productivity and reputation of the clinical company as a whole.
The connection between nurse burnout and patients with Alzheimer’s disease is apparent. Working with these patients requires a nurse, caregiver, or babysitter to provide special attention and care to an elderly patient who consistently demonstrates a progression of dementia. Diminished intellectual capacity and inability to communicate adequately, combined with memory lapses, make the nurses’ job much more difficult. Appropriate care typically includes pain management, nutrition, and personal care, help with falls, and dealing with complex issues. In addition, the behavior of these patients is rarely predictable; their moods, motives, and actions can change quite frequently. Consequently, an experienced nurse must constantly adjust her plans and live, in fact, in a situational, non-systematic manner. It is known that about 39% of health care providers feel uncomfortable when forced to work with this syndrome (AA, 2020). At the same time, according to the same author, about a quarter of all health care providers do not have separate training in specializing in working with patients with dementia. Summarizing these data, one can conclude that nurses in clinics helping patients with Alzheimer’s are forced to work harder, more complicated, and harder, which is an essential predictor of professional burnout (Berg, 2020). This is fully supported by research showing that nurses working in nursing homes have an increased risk of professional burnout due to the nature of working with patients with dementia (Rachel & Francesco, 2018). Emotional attachment, visual perception of neuropathological changes, and grief are serious predictors linking the professional activity of such nurses with a high risk of burnout.
As a result, burnout nurses become apathetic and cynical and do not show their former motivation and inspiration. The overwork in their lives affects problems in their personal lives and relationships, which further aggravates the situation. The need to be involved in the clinic and to genuinely care for patients, combined with problems with a partner or children, create a particular stressor for the employee. This, in turn, can translate into decreased appetite, sleep disturbances, skin and concentration problems, and even depression (Melinosky, 2021). Thus, it is evident that no one is interested in such outcomes for their employees, which means that experienced managers should invest in learning a methodology to combat burnout.
Measures to Combat Burnout
By now, there is no longer any doubt that professional burnout is a significant threat. Accordingly, finding effective and optimal tools to curb this condition is a priority for managers of clinical organizations. Analysis of the relevant literature showed that the methodology for combating burnout could be roughly divided into general recommendations, suitable for any nurse regardless of the direction of work, and tips and practices that are most effective for helping with clinical staff working with older adults with Alzheimer’s disease.
On the first side are general tips that can generally be effective for any nurse. For example, the most effective of these is to take a break. Burnout is a long-term process with cumulative effects, so any break in this consistent system has the potential to zero in on the effects of burnout. It could be a vacation, a day off, or a temporary layoff aimed at trying to return to the original mental and physical state. Some authors report on creative therapy, where a diversion from work to a hobby has a positive effect on well-being. Such hobbies typically include music, painting, dancing, traveling, or any other activity (Kometiani, 2017). The same applies to support when a “burnout” employee can try to find help in other people: in particular, it can be loved ones or other colleagues (Bursack, 2020). In this context, it is essential to emphasize that the people concerned may not always provide the support that is truly necessary and, just as importantly, helpful. A nurse’s loving spouse or spouse is definitely interested in their partner’s well-being, but their help may be focused on keeping the family together in the first place. The same is true for coworkers, who may have no idea of the extent of the nurse’s family problems. In such a case, as Janeway (2020) shows, the best option for emotional support for the staff member is mentors or psychologists whose interests are focused only on their client’s well-being.
On the other hand, there are some guidelines that are particularly effective for nurses working with patients with dementia and Alzheimer’s disease. This is not to say that the previously mentioned strategies, whether support seeking or creativity, do not work. On the contrary, in addition to the coping measures already noted, the ones below should be considered. For example, a unique feature of Alzheimer’s disease is its progressive nature, as a consequence of which the complexity and number of tasks a nurse needs to perform are expected to increase (Melinosky, 2021). Moreover, nurses tend to place the interests of dementia patients above their own. As a solution to this problem, such workers are encouraged to use emotional state self-assessment tools to determine the severity of burnout (Bursack, 2020). At the same time, working with frail people is associated with a constant sense of responsibility for them. As a result, a nurse may experience guilt over not caring for a particular patient on weekends or during vacations. Overcoming this guilt through self-awareness and through the psychological processing of trauma are useful tools for the clinical organization. In addition, it is widely known that the number of specialized centers for working with patients with dementia is increasing significantly around the world. Consequently, if such a patient is in a multidisciplinary inpatient clinic, the nurse can suggest that the patient’s relatives send the patient to a specialized facility for better care. This is a kind of delegation, which is also effective with regard to burnout.
At a higher level, clinic management can take care of reviewing patient follow-up plans. It is known that a nurse cannot make critical decisions about a patient’s therapy alone and understanding this inability can also become a cause of burnout. Organizational leaders can examine the history of treatment programs and restructure them in ways that make the nurses’ jobs easier. This can include both hiring more staff and changing work schedules. Ultimately, quite a few different strategies have been reviewed and used around the world.
Practice Summary
The results of the literature review clearly demonstrated several key findings. First, professional burnout is a pressing and serious problem among nurses. Second, among nurses caring for patients with dementia and Alzheimer’s disease, burnout is the most pressing problem because of the unique characteristics of the neuropathological disease. Third, by now, there are a number of valuable practices that will reduce perceived stress levels. In fact, any of the above recommendations can be practical for nurses in a particular clinic, but there must be integrity and consistency in their implementation. Situations, when a company manager either does not take any actions to prevent burnout or does not give them any orderliness must be excluded.
Accordingly, the first step in the fight against burnout in a particular inpatient clinic should start with the recognition of this problem on the management level. The leader must be genuinely interested in solving the problem and motivate other employees to take care of their well-being. Naturally, this caring will require extra work from nurses since any practice is primarily a time-consuming endeavor. However, convincing subordinate employees that such an investment is of critical benefit is a priority. After the necessity of burnout management is no longer in doubt, a manager together with the H.R. department can start implementing practical steps.
Further phases directly depend on what exactly is supposed to be implemented for the clinic. If questionnaire self-assessment tools are implemented as a method of combating burnout, this will require the creation of printed or online materials for employees to fill out. If creative therapy is proposed as a solution, it will require providing employees with a separate room in which to spend time on hobbies. This may include hiring coaches and mentors to help employees discover their creativity. If psychological counseling is proposed as a measure, then management should take care to hire responsible and reliable psychologists and mentors who will conduct systematic work with nurses. Thus, any of the proposed solutions are individualized and involve a different number of stakeholders, in addition to nurses, patients, and management.
Measuring Change
It seems evident that systematic and systematic burnout management cannot be achieved without regular control of the responsible persons. Any of the measures taken can be ineffective overall if the manager initiates them but does not ensure proper monitoring of their implementation. Thus, several optimal monitoring strategies are suggested for any clinic working with patients with Alzheimer’s disease. First, it is recommended that a system of surveys be established on a regular basis to monitor the dynamics of burnout management. Such surveys include the measurement of work satisfaction, personal emotional states, and problems. In addition, a predictive method can be used, clarifying from nurses their wishes and visions for the future (Narme, 2018). Second, third-party audits can be conducted to work with nurses’ mental states and preventively manage burnout. The key figures in such an audit can be third-party mentors and psychologists who interact with nurses on a regular basis. An important parameter to monitor is the financing of changes because any investment requires money. To make sure that funds are spent wisely and correctly, it is necessary to analyze the budget and study deviations from the plan.
Conclusion
To summarize, career burnout in nurses, nannies, and caregivers serving patients with Alzheimer’s disease is an urgent problem. The unique traits of this diagnosis complicate a nurse’s routine work, provoking emotional stress, dissatisfaction and burnout. The result of this outcome is the undermining of the nurse’s own health and a decline in the clinical firm’s productivity. An experienced manager should take care of this problem and offer preventive solutions to manage burnout. For example, such solutions can be psychological support, creative therapy, vacations, or any other kind of mental relaxation.
References
AA. (2020). Primary care physicians on the front lines of diagnosing and providing Alzheimer’s and dementia care: Half say medical profession not prepared to meet expected increase in demands. Alzheimer’s Association.
ADI. (2020). Numbers of people with dementia worldwide. Alzheimer’s Disease International.
Bianchi, R., Schonfeld, I. S., & Laurent, E. (2017). Physician burnout is better conceptualised as depression. The Lancet, 389(10077), 1397-1398.
Berg, S. (2020). 5 strategies for dealing with nurse anxiety. IH.
Bursack, C. B. (2020). How to cope with Alzheimer’s caregiver burnout. Aging Care.
Elflein, J. (2021). Death rate for Alzheimer’s disease in Canada 2000-2019. Statista.
Fan, L., Mao, C., Hu, X., Zhang, S., Yang, Z., Hu, Z.,… & Xu, Y. (2020). New insights into the pathogenesis of Alzheimer’s disease. Frontiers in Neurology, 10, 1312-1320.
Janeway, D. (2020). The role of psychiatry in treating burnout among nurses during the COVID-19 pandemic. Journal of Radiology Nursing, 39(3),176-178.
Kometiani, M. K. (2017). Creating a vital healing community: A pilot study of an art therapy employee support group at a pediatric hospital. The Arts in Psychotherapy, 54, 122-127.
Larson, J. (2017). New survey finds high rate of nurse fatigue. American Mobile.
Matsuo, T., Kobayashi, D., Taki, F., Sakamoto, F., Uehara, Y., Mori, N., & Fukui, T. (2020). Prevalence of health care worker burnout during the coronavirus disease 2019 (COVID-19) pandemic in Japan. JAMA Network Open, 3(8), 1-17. Web.
Melinosky, C. (2021). Understanding Alzheimer’s disease: the basics. WebMD.
Molina-Hernández, J., Fernández-Estevan, L., Montero, J., & González-García, L. (2021). Work environment, job satisfaction and burnout among Spanish dentists: a cross-sectional study. BMC Oral Health, 21(1), 1-10.
Moss, J. (2019). Burnout is about your workplace, not your people. Harvard Business Review, 11, 1-6.
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.
Rachel, H., & Francesco, S. (2018). Factors associated with and impact of burnout in nursing and residential home care workers for the elderly. Acta Bio Medica: Atenei Parmensis, 89(Suppl 7), 60-69.
ST. (2020). Study: Contributing causes, conditions and complications involved in COVID-19 deaths in Canada [PDF document].
WHO. (2019). Burn-out an “occupational phenomenon”: International Classification of Diseases. World Health Organisation.
Wiley, J. (2021). 2021 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 17(3), 327- 406.