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Combating employee burnout in long-term care




Ferrara, Katherine, author
Morgan, George, advisor
Buchan, Vicky, advisor
Quijano, Louise, committee member
Kaiser, Leann, committee member

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Employee burnout in long-term care is a growing concern due to the changing demographics of individuals admitted to nursing homes in the United States. There is an increase in the number of admissions to nursing homes that include residents with dementia or some form of major mental illness. In addition to having some form of mental disorder, over half of these individuals also have some type of challenging behavior such as verbal or physical aggression. In spite of these changing demographics, there is a lack of adequate training for staff in these settings to care for this population. Lack of training and poor stress management coping skills can contribute to burnout. Burnout can have detrimental effects on the organization, the individual and the residents served in nursing homes. An eight session skills based intervention derived from the Cognitive-Behavioral therapeutic foundation was designed to educate employees on stress management skills and skills to effectively manage challenging resident behaviors. The skills based intervention was implemented in eight sessions to three different nursing homes that had a minimum of a 40% resident population with some form of mental disorder as a diagnosis. This study used a pretest/posttest comparison group design. Change scores on the data collection instruments were analyzed to determine the effect of the intervention on employee level of burnout as well as level of knowledge of behavior management techniques, for the intervention group only. Results indicated no statistically significant difference between the experimental and comparison group on change scores pertaining to level of burnout. There was, however, a significant gain in knowledge of behavior management techniques from pre to post intervention. Other constructs measured that are considered characteristics of burnout included tardiness and absenteeism. There was significant decrease in frequency of absenteeism comparing pre to post intervention in the experimental group. There was no significant change from pre to post intervention in the area of tardiness. A participant evaluation was administered to experimental group participants. Results of a participant evaluation indicated participants had a positive experience with the intervention. Participants felt an increase in level of support from co-workers and increase of knowledge on how to effectively care for residents with challenging behaviors. The length of time of the intervention may have been too short to achieve the desired results of a significant decrease of level of burnout from pre to post intervention. Evaluations revealed the majority of participants would have liked more time for the intervention. Also, vicarious trauma was not a consideration for the development of the intervention or as a contributing factor to burnout in the participants of this study. The majority of participants in the experimental group were classified as non-direct care staff, included members of the activities, social services and business office. It is recommended to include vicarious trauma as a contributing factor of burnout and to include interventions to combat vicarious trauma in future studies. It is further recommended for future studies to have the length of time of the intervention increased to greater than eight sessions. A final recommendation would be to limit participants to both the experimental and comparison groups to those who are classified as direct care staff.


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cognitive-behavioral therapy
mental illness
nursing homes


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