Week 4: 9-13 May
The experience of studying occupational therapy is, to me, much like juggling a dozen balls at one time, as we try hold all our theory in our minds at once, apply it practically, and still lead some semblance of a functional life outside the course content. This week, I had the sense that all those little balls finally succumbed to gravity and dropped in a clatter to the ground.
Sports was definitely out given the state of my body, so I'm now behind on my karate training, with grading coming up in just a few weeks.
Family commitments were the next to drop, as all my time at home during the week began to be dedicated to solitary work on my laptop or sleep, with me only emerging at mealtimes and, even then, thinking about something I had due the next day.
My involvement in student organisations was pushed to the back of my mind, leaving a pile of admin to follow up on to ensure projects go according to plan.
And my OT skills lie scattered all over my brain, leaving holes in my intervention programmes, and making me doubt my competence as a healthcare professional. The pile of theory books I've had on my desk for months (and accounted an atrocious number of library fines on) still remain largely unread, only paged through when I am looking for a particular piece of information
So now, with all the little balls lying haphazardly on the ground, I am free to take a step back and survey the situation. Why have things begun to unravel, and how can I knit them all back together tighter than before?
The dreaded 'B' word is one that has cropped up more frequently than ever this year. We have seen therapists, caregivers, clients and colleagues go through it, and seen first hand what happens when people just stop caring. Before this year, it was difficult to understand why a mother would be unwilling to carry over a home programme that would benefit her child, or why a therapist would go through years of training only to sit in air-conditioned offices and play Candy Crush for most of the working day. Perhaps these people are just immoral and heartless fiends, but a more compelling reason that has become increasingly publicised, is that these people may have started off with the best intentions, but have fallen victim to Burnout.
According to Smith, Segal and Segal (2016),
"Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands. As the stress continues, you begin to lose the interest or motivation that led you to take on a certain role in the first place."
I have seen this in the mothers of children I have worked with, who have no motivation to provide the stimulation their child needs, and who are unwilling to meet us halfway in the therapeutic process. Living in a society where minimal or no support is provided to the caregivers of children with illnesses or disability, the constant stress of having to deal with the challenges of raising these children places these women at high risk of burnout (Uren, 2013). For us, working with these caregivers can be immensely frustrating. Being met with resistance to what we perceive as sincerely-intended help is often demotivating, and can lead to our own experiences of burnout as we put in significant effort and yield minimal results. For this reason, understanding the concept of burnout, and how to deal with it, as well as reviewing the socio-cultural dynamic of these caregivers is of critical importance in working with these individuals.
Gerry (2013) describes ten signs of burnout, including exhaustion, lack of motivation, frustration, cognitive problems such as decreased attention or memory, deteriorating occupational performance, interpersonal problems, being preoccupied with work, decreased satisfaction, and health problems.
I know these signs well. Not only have I seen them in my colleagues and in my clients, but I have noticed them increasingly in myself. A study conducted by Painter, Akroyd, Eliott and Adams (2009) showed that occupational therapists have a high rate of emotional exhaustion, particularly when working with chronic care clients. To be efficient healthcare workers, even now at an undergraduate level, it is important that we tackle the issue of burnout so that we can function effectively, and provide the best care possible.
Gerry (2013) describes some steps to deal with burnout:
- Schedule relaxation time, dedicated towards rejuvenating the mind and body.
Over the past few months, I have noticed that I find it difficult to completely relax, even in activities that I had previously found calming, something that other students have also expressed. There is always the nagging sensation in the back of my mind that something needs to be done, preventing me from being able to relax fully. However, one way I have recently found to combat this is to write down all the things running through my mind beforehand (hand it over to the paper) so that I can achieve a better state of relaxation.
For many of the clients we work with who experience burnout, relaxation time is not easy to achieve, especially if they have a child and home that need constant attention. Hence, achieving this would involve an in-depth analysis of the resources and opportunities available, to determine where and how best to incorporate relaxation into a busy schedule in an under-resourced context.
- Get enough sleep
This one I have down:) Sleep is a non-negotiable.
For many people we work with, however, sleep is not necessarily a given. Sometimes waking in the early hours of the morning to begin the household or childcare tasks, caregivers, particularly those who care for multiple individuals, may not be getting sufficient, or quality, sleep.
- Unplug: do not allow work stress into personal or family time
Unfortunately, as a student, our home environments are also our work environment. Coming home after a day of working in the community, I still have to switch on my laptop and start typing up session plans, blogs, essays or letters for projects, while following the work-related discussions on all the 23 active WhatsApp groups on my phone. Setting aside dedicated no-work hours may assist with this, as the lines between personal time and work time are often blurred.
For primary caregivers, the home environment is the environment in which their primary care function occurs. They are 'on-duty' for 24 hours daily, leaving no escape from the burden of care, unless they are lucky enough to have the support of someone else to provide assistance with care while they engage in other pursuits. Hence, providing some form of community support, allowing them a break in the care routine, is an important part of intervention.
- Cultivate a balanced, rich lifestyle beyond work
Balance has become the new buzz word in health. Incorporating physical recreation, social interaction, community participation and family time into my lifestyle have always been important for me, and I still maintain all these roles. However, these aspects are the first to be reduced when OT course demands intensify. This causes internal role conflict, as these non-work roles are of immense value to me, yet must be deprioritised.
For many people within the community, caregivers in particular, balance is not easy to maintain, given the heavy burden of care many of them face, as well as the lack of opportunities for meaningful recreation within the community. This may result in a routinized, monotonous and unfulfilling lifestyle, which can exacerbate feelings of dissatisfaction and burnout.
Solving the issue of burnout is not an easy task. As with any health issue, prevention is better than trying to treat the symptoms, or to trace back the symptoms to a cause which may have become more complex over time. Some of the simplistic ideas provided by articles on coping with burnout do not take into consideration the socio-cultural context of many of the people we work with, and the impact that the lack of physical, financial, social and cultural resources has on the ability of these individuals to make effective lifestyle changes. It is important for us as healthcare providers to recognise the symptoms of burnout both in our clients and in ourselves, so that we can create the support and lifestyle changes necessary for productive and meaningful function, and quality of life.
Smith, M., Segal, J., Segal, R. (2016).Preventing Burnout: Signs, Symptoms, Causes, and Coping Strategies. Retrieved from http://www.helpguide.org/articles/stress/preventing-burnout.htm on 13 May 2016.
Gerry, L.M. (2013). 10 Signs You're Burning Out -- And What To Do About It. Retrieved from http://www.forbes.com/sites/learnvest/2013/04/01/10-signs-youre-burning-out-and-what-to-do-about-it/#2eba7fa15e01 on 13 May 2016
Painter, J., Akroyd, D., Elliot, S., Adams, R.D. (2003). Burnout Among Occupational Therapists. Occupational Therapy In Health Care. 17(1). 63-78
Uren, S (2009). An Investigation into the Emotional Experience of Caregiving. University of the Witwatersrand: Johannesburg
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