Stress of conscience and burnout among healthcare personnel in elderly care

Project description

In two organisations for elderly care, personnel’s perceptions of conscience, degree of stress of conscience, burnout scores, social support and person-centred climate are investigated over time. An intervention is implemented aiming to find ways to constructively deal with stress of conscience. We investigate if / how this intervention affects personnel, residents and their close relatives.

Burnout among personnel in health care is a problem. The project builds on previous research from the project “Stress of Conscience Study” at Umeå University, published in five dissertations (Glasberg 2007, Dahlqvist 2008, Ericson-Lidman, 2008, Juthberg 2008, Gustafsson 2009). Our results have shown that healthcare personnel’s perception of conscience and stress of conscience (stress related to troubled conscience) are associated with signs of burnout.

To perceive conscience as a warning-signal not to harm others and simultaneously experience that one can not follow one’s conscience in work, feel that one is unable to live up to expectations from the surrounding, having to reduce the aspirations to give good care and having to deaden one’s conscience in order to keep working in health care seems to be a heavy burden to bear for healthcare personnel. Results also showed that one third of the personnel in municipal elderly care in Sweden perceived that their conscience is far too strict and every fifth reported they needed to deaden their conscience in order to keep working in healthcare. The results indicate that it is important to learn to live with one’s conscience in a constructive way.

The project includes two parts: 1. In two healthcare organisations for elderly care describe healthcare personnel’s perceptions of conscience, degree of stress of conscience, burnout scores, assessment of social support and person-centred climate, analyse the relationship between these variables, highlight any differences over time and compare within and between the healthcare organisations. Healthcare organisation A (Christian values, multicultural healthcare personnel, private mode of operation, and urban) and healthcare organisation B (secular values, culturally homogeneous personnel, municipal mode of operation, and small town). Reasonably stress of conscience is linked to fundamental values and cultural backgrounds and the mode of operation has been discussed. 2. Intervention in homes for elderly in health care organisations A and B aiming to, in cooperation with healthcare personnel, find ways to constructively deal with stress of conscience. The project is anchored and implemented in cooperation with political leaders, managers and healthcare personnel. Pilot studies started in autumn 2009.

The intervention design is based on participatory action research. The intervention means that researchers, for one year, will regularly meet healthcare personnel and managers at the intervention-units. Situations in which personnel feel troubled conscience is identified, if needed, scientific knowledge as well as best practices is acquired and possible areas of change is discussed. Finally, actions considered possible and meaningful are implemented.

As stress of conscience is correlated to risk of burnout and symptoms of burnout affect personnel’s wellbeing, quality of care (many care providers at work despite symptoms of burnout) and as burnout leads to costs for society research that illuminates the problem are valuable. Measures to prevent and treat burnout must be founded in understanding of the problems and their origins. We neither need personnel without a conscience nor personnel that are burnout due to stress of conscience. This project can produce knowledge that can be used to prevent burnout among personnel and provide knowledge that can enhance the quality of care.


Keywords: Stress of conscience, burnout, elderly care, intervention, participatory action research.