Psychological exhaustion among caregivers

Repeated patient deaths in the department, the death of young patients, dramatic family situations, tension and patient family reproach are all stress factors for caregivers who do not always have the opportunity to express their distress.

The fact that caregivers keep all of these traumatisms inside, their fear of expressing them, the absence of rites and of dialogue or the simple weight of successive bereavements end up by exhausting caregivers’ psychological resources.

The ‘burnout’ syndrome takes the form of a relatively typical depressive state:

• Sadness and crying,
  
• Irritation at the slightest criticism,
  
• Doubts on one’s efficiency and fear of hurting,
  
• Devaluation of one’s ideal, demotivation
  
• Aggressiveness towards colleagues, or even towards patients or their families
  
• Sleep loss,
  
• Various digestive disorders,
  
• Need to take a break
  
• Repeated absence from work due to illness.

The syndrome can develop prematurely and more profoundly when associated with personal or familial difficulties or in the case of excessive fatigue (difficult working hours, absence of holidays, etc.)

It also occurs more frequently when patients have been treated repeatedly or over a long period in the same department, in particular if their care has involved periods of therapeutic hope. It tends to be less frequent in units exclusively dedicated to palliative care.

The burnout syndrome requires serious discussion with the caregiver’s superior and on the eventuality of a temporary job change.

The syndrome can also affect physicians confronted with difficult situations and who do not maintain the necessary distance from patient care.

The existence of multidisciplinary concertation groups, or better still, physicians’ acceptance to participate in support groups, enable the care team to increase their awareness of burnout among physicians, which can often be hidden behind a more or less aggressive attitude towards other caregivers.

Medical burnout can lead to suicide attempts or to alcoholism, a form of suicide from the physician’s medical mission.

Support groups are a way of fighting against the burnout syndrome. They should be organised over and above staff or handover meetings which deal with concrete objectives and do not necessarily give caregivers the opportunity to analyse their reaction to successive bereavement.