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      Examining the relationship between burnout and empathy in healthcare professionals: A systematic review

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          Highlights

          • As with previous research findings relating to the direction of the relationship between burnout and empathy were not unanimous.

          • Only one of the ten studies included in the review supported a positive correlation between burnout and empathy.

          • Eight studies reported a negative relationship between burnout and empathy.

          • Studies included in this review satisfied all of the quality assessment criteria.

          • Burnout is supported as a cross cultural construct.

          Abstract

          Objective

          Empathy and burnout are two related yet distinct constructs that are relevant to clinical healthcare staff. The nature of their relationship is uncertain and this review aimed to complete a rigorous, systematic exploration of the literature investigating the relationship between burnout and empathy in healthcare staff.

          Design

          A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.

          Data sources

          Search terms (Burnout OR Burn-out OR “Burn out”) AND (Empathy OR Empath*) enabled identification of studies investigating burnout and empathy in healthcare staff, using five electronic data bases (MEDLINE, PsycINFO, CINAHL Plus, PubMed, and SCOPUS). Manual searching amongst reference lists of eligible articles was also completed.

          Review methods

          Databases were searched for studies published in the English language, from inception to February 2017. Key inclusion criteria were: 1) participants who were nurses or medical professionals, 2) full written manuscript in English, 3) use of the Maslach Burnout Inventory to assess burnout and a standardized outcome measure for empathy, 4) quantitative methodology exclusively.

          Results

          Ten eligible studies were reviewed. Of those, seven were conducted in countries where English was not the first language. Eight of the studies provided empirical support for a negative relationship between empathy and burnout. One study provided support for a positive relationship between burnout and empathy. One study reported contradictory evidence with positive and negative correlations between different subscales of the empathy and burnout measures. In general, the quality of the studies was assessed to be good. However, some of the studies failed to provide information pertaining to sample size, with the reporting of data less than adequate from one study.

          Conclusions

          There was consistent evidence for a negative association between burnout and empathy. This review avoided a common English-speaking country bias of some areas of the literature. Given that all of the studies reviewed were cross sectional, further research is necessary to establish causality.

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          Most cited references51

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          The functional architecture of human empathy.

          Empathy accounts for the naturally occurring subjective experience of similarity between the feelings expressed by self and others without loosing sight of whose feelings belong to whom. Empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. In light of multiple levels of analysis ranging from developmental psychology, social psychology, cognitive neuroscience, and clinical neuropsychology, this article proposes a model of empathy that involves parallel and distributed processing in a number of dissociable computational mechanisms. Shared neural representations, self-awareness, mental flexibility, and emotion regulation constitute the basic macrocomponents of empathy, which are underpinned by specific neural systems. This functional model may be used to make specific predictions about the various empathy deficits that can be encountered in different forms of social and neurological disorders.
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            The hazards of scoring the quality of clinical trials for meta-analysis.

            Although it is widely recommended that clinical trials undergo some type of quality review, the number and variety of quality assessment scales that exist make it unclear how to achieve the best assessment. To determine whether the type of quality assessment scale used affects the conclusions of meta-analytic studies. Meta-analysis of 17 trials comparing low-molecular-weight heparin (LMWH) with standard heparin for prevention of postoperative thrombosis using 25 different scales to identify high-quality trials. The association between treatment effect and summary scores and the association with 3 key domains (concealment of treatment allocation, blinding of outcome assessment, and handling of withdrawals) were examined in regression models. Pooled relative risks of deep vein thrombosis with LMWH vs standard heparin in high-quality vs low-quality trials as determined by 25 quality scales. Pooled relative risks from high-quality trials ranged from 0.63 (95% confidence interval [CI], 0.44-0.90) to 0.90 (95% CI, 0.67-1.21) vs 0.52 (95% CI, 0.24-1.09) to 1.13 (95% CI, 0.70-1.82) for low-quality trials. For 6 scales, relative risks of high-quality trials were close to unity, indicating that LMWH was not significantly superior to standard heparin, whereas low-quality trials showed better protection with LMWH (P<.05). Seven scales showed the opposite: high quality trials showed an effect whereas low quality trials did not. For the remaining 12 scales, effect estimates were similar in the 2 quality strata. In regression analysis, summary quality scores were not significantly associated with treatment effects. There was no significant association of treatment effects with allocation concealment and handling of withdrawals. Open outcome assessment, however, influenced effect size with the effect of LMWH, on average, being exaggerated by 35% (95% CI, 1%-57%; P= .046). Our data indicate that the use of summary scores to identify trials of high quality is problematic. Relevant methodological aspects should be assessed individually and their influence on effect sizes explored.
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              • Article: not found

              Compassion fatigue: psychotherapists' chronic lack of self care.

              Psychotherapists who work with the chronic illness tend to disregard their own self-care needs when focusing on the needs of clients. The article discusses the concept of compassion fatigue, a form of caregiver burnout among psychotherapists and contrasts it with simple burnout and countertransference. It includes a multi-factor model of compassion fatigue that emphasizes the costs of caring, empathy, and emotional investment in helping the suffering. The model suggests that psychotherapists that limiting compassion stress, dealing with traumatic memories, and more effectively managing case loads are effective ways of avoiding compassion fatigue. The model also suggests that, to limit compassion stress, psychotherapists with chronic illness need to development methods for both enhancing satisfaction and learning to separate from the work emotionally and physically in order to feel renewed. A case study illustrates how to help someone with compassion fatigue. Copyright 2002 Wiley Periodicals, Inc.
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                Author and article information

                Contributors
                Journal
                Burn Res
                Burn Res
                Burnout Research
                Elsevier GmbH
                2213-0586
                1 September 2017
                September 2017
                : 6
                : 18-29
                Affiliations
                [a ]Institute of Psychology, Health and Society, University of Liverpool, Liverpool, L69 3GB, UK
                [b ]Broset Forensic Department, St. Olav’s University Hospital, Trondheim, 7440, Norway
                [c ]Department of Mental Health, Norges Teknisk- Naturvitenskapelige Universitet (NTNU), Trondheim, 7491, Norway
                [d ]Mersey Care NHS Foundation Trust, Liverpool, L34 1PJ, UK
                Author notes
                [* ]Corresponding author at: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, L69 3GB, UK. whitting@ 123456liverpool.ac.uk
                [1]

                Present address: Thames Valley Forensic Mental Health Service, Oxford Health NHS Foundation Trust, Manzil Way, Oxford, OX4 1XE, UK.

                Article
                S2213-0586(17)30002-5
                10.1016/j.burn.2017.06.003
                5534210
                28868237
                4ae5aba3-e721-4de2-a50d-fd1523484246
                © 2017 The Authors. Published by Elsevier GmbH.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 January 2017
                : 31 May 2017
                : 15 June 2017
                Categories
                Article

                burnout,empathy,healthcare staff,systematic review
                burnout, empathy, healthcare staff, systematic review

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