International Association for Hospice & Palliative Care

International Association for Hospice & Palliative Care

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Promoting Hospice & Palliative Care Worldwide


2006; Volume 7, No 5, May



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Article of the Month

Carla Ripamonti, MD

Reducing the risk of burnout in end-of-life care settings:
The role of daily spiritual experiences and training.

Author(s): Holland JM and Neimeyer RA

Journal: Palliative and Supportive Care 2005; 3: 173-181

Individuals in the caring professions, in particular those working in end-of-life care, undergo various kinds of stress: physical, emotional, cognitive, organisational, increased workload, administrative difficulties, and lack of resources, they are therefore more prone to burnout.

Dealing with death and dying is considered to be one of the most important stressors among oncologists and internal medicine physicians. Recognizing these risks and taking the necessary precautions to prevent them is of great importance for health professionals.

Data in the literature show that health professionals cope more proficiently with stressors like illness and death when they apply their own personal experiences in a positive, spiritual and religious context. It has also been noted that health care professionals who attend seminars or other end-of-life care training feel more comfortable with the care of dying patients.

Holland and Neimeyer carried out this study to examine the relationship between daily spiritual experiences, training and workplace burnout in end-of-life care practitioners.

Eighty health care professionals (mean age 44 years; 19% men) working with traumatic loss, terminal illness (37.5%) or bereavement (45.5%) were enrolled. Most of the participants were nurses (51.3%), and only 2.6% were physicians. Hospital chaplains (19.2%), psychotherapists (7.7%), social workers (6.4%), and volunteers (5.1%) were also represented.

The participants completed the end-of-life questionnaire that included the Daily Spiritual Experience Scale (DSES), Shirom-Melamed Burnout Measure (SMBM), and questions about their level of education, number of hours of training specific to death and loss, questions about age, gender, ethnicity and work organization.

The SMBM is a 16-item self-report questionnaire that assesses physical fatigue (6 items), emotional exhaustion (4 items), and cognitive weariness at work (6 items). The DSES is a 16-item self-report measure of the daily ordinary experience of spirituality. The amount of end-of-life training was assessed by the number of hours ranging from 0 to 40 hours.

The authors found that DSES was inversely correlated with all 3 subscales of the SMBM: physical, cognitive and emotional forms of burnout in the work place (p≤ 0.002). This suggests that people with a greater frequency of daily spiritual experiences reported less physical, cognitive and emotional burnout. Moreover participants with more end-of-life care training reported less physical fatigue and cognitive weariness (r = -0.29, p= 0.01; r= -0.30, p= 0.006, respectively) but not less emotional exhaustion. The level of end-of-life training was inversely correlated with the SMBM overall (r = -0.27, p = 0.02).


Why I chose this article

Prevention or a reduction in the symptoms of burnout is important for all health workers who are regularly exposed to suffering and death.

These data support and reinforce previous data in the literature that enhanced training and daily personal spiritual experiences are two separate factors that reduce the stress of working with terminally ill patients.

It is therefore important to encourage and support continuous training and spiritual expression among the employees.


Carla Ripamonti, MD
Member of the Board of Directors, IAHPC

Please visit the following link to read past Articles Of The Month:


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