Caregiver Stress and Burnout

In their article, Gray and Muramatsu seek to exemplify how work stress and resources investment on the side of the caregiver contributes towards their intentions to quit their jobs. According to the authors, various types of work stress are connected to increased intentions by caregivers to quit their jobs. They assert that work stress has led to “low job satisfaction, high intentions to quit and high turnover rates…” among caregivers. Further, Gray and Muramatsu links increased intention to quit to decreased participation in organizational decision making process which by extension makes the job less appealing for the caregiver. Equally, role ambiguity also has an indirect impact on turnover rate among caregivers as is with the case of being undervalued or disrespected. The authors claim that “work social support can help foster…satisfaction and retention and guard against… intentions to quit”. This implies that caregivers are less likely to suffer from workload related stress or contemplate on quitting their jobs if they receive the right support from their supervisor, family members and colleagues. Similarly, under a supportive environment, caregivers can be able to develop their identities and roles within the organization.
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Whilst Gray and Muramatsu points towards support as a means of reducing intentions to quit among caregivers, it is important to note that different types of support may yield more results than others. Take the case of supervisory support for example. As compared with support from a coworker, supervisory support is arguably a reflection of the general organizational support. A caregiver receiving support from his or her supervisor is more likely to stick with the organization much longer with the hope that the supervisor can have an influence on promotion process. Compared to coworkers, supervisors can offer advice and guidance on different work processes which by extension motivates and increases the commitment of the caregiver. This does not however imply that support from coworkers, family members and friends are not important to caregivers. In essence, stress can either result from internal or external factors. Consider a caregiver who is in the middle of a divorce process. The output of such a caregiver will definitely be affected by the divorce. As a health care professional, one cannot ignore an individual’s locus of control as a contributory factor in his or her intentions to quit his job. Locus of control in this context can be defined as the perceptions of one’s control in the context of his operating environment. An internal locus orientation represents greater control and mastery within the operating environment. Workers with an internal orientation use self-advocacy to nurture a more manageable environment. On the other hand, workers with an external orientation fosters the belief that they have little or no control over their job environment and related decisions and by extensions sees quitting as a viable alternative. Closely related to the concept of locus of control is the level of involvement in the decision making process. Gray and Muramatsu believes that caregivers who are more involved in this process tend to have an internal control orientation and are less likely to quit their jobs as compared with those who are not involved in decision making process. Consider a caregiver charged with the role of taking care for people with disabilities. If such a caregiver feels that he has been sidelined in the decision making process, he may divest from the organization emotionally. He may end up becoming frustrated or feel devalued by the organization viewing the work environment as unsupportive. On the other hand, if such a caregiver has internal control orientation, he may successfully devise strategies to manage the situation. Such workers are less interested in immediate gratification and tend to take their time developing sustainable solutions. Gray and Muramatsu are keen to observe the role played by sociodemographic factors in determining the level stress a caregiver is exposed to and his or her intentions to quit. Sociodemographic factors have often been ignored in discussing caregivers’ stress and burnout as well as their intentions to or not to quit their job.  As an aspiring healthcare professional, I once had a chance to work as a volunteer in an elderly home, offering support to the much more experienced caregivers. Looking back at the time, young caregivers were more active as compared with the more experienced caregivers we found in the facility. Still, the same group of young caregivers would complain the more over issues otherwise considered trivial by the older generation of caregivers. Reflecting back on this group’s composure, it is evident they were less more stressed by their job not because they did not find it daunting but because of their level of maturity. Being older, it is possible that these caregivers were less flexible in terms of changing jobs or quitting owing to their economic or family responsibilities. The experience they had gained over the years while playing their roles as caregivers could also have been a contributing factor towards their approach in addressing challenges related to their jobs. The number of years that a caregiver has worked and the level of experience coupled with personal aspirations also contributes to their level of stress and intentions to quit job. Despite the fact that caregivers have some positive experiences, they are also prone to poor health status, anxiety and depression and modified if not neglected aspects of social life. While it is still unclear how coping strategies and how caregivers’ psychological wellbeing are related, it is possible to assume that under stressful situations, strategies focusing on the problem are more effective as compared with those that focus on emotion. Disheartening is the fact that despite the various needs that caregivers experience, they may be reluctant to seek support due to different factors. For example, a caregiver may feel that he or she has enough experience to take care of him/herself but this may not always be the case. According to Gray and Muramatsu, believing in oneself, establishing priorities and engaging in other issues are just but some of the coping strategies commonly used by caregivers to deal with stress. There is no doubt that caregivers are trained to be determined and proactive in discharging their duties and they tend to extend these characteristics even in their own personal lives. This however poses the risk of underestimating one’s expertise and by extension shunning away interventions even when such interventions are highly required. Consider a woman who has been taking care of her paralyzed husband for several years following a road accident. Arguably, the weariness caused years of hard work and constantly assisting his husband to perform major activities for will have a toll on her life by for example making her look older than she actually is. As a caregiver, being able to spend time on oneself is crucial for maintaining a healthy life. Perhaps this calls for the need to enlist the help of a secondary caregiver, an issue that Gray and Muramatsu failed to address in their article. A secondary caregiver in this regard may be seen as a family member, a neighbor or friend who offers support to the primary caregiver. A secondary caregiver does not have principal responsibility for the care receiver but rather only plays a supportive role to enable the primary caregiver attend to other issues albeit for a short period of time. Arguably, Gray and Muramatsu study on how caregivers cope with stress and burnout and how they make decision as to whether to quit or not to quit their jobs offers a powerful insight into the field of healthcare providers. In recognizing that there are different stressors, both internal and external, caregivers can be more prepared to develop strategies for dealing with challenging situations in their work environment. Evidently, adopting problem focused strategies may prove to be more beneficial as compared with emotion-focused strategies. Strategies that are focused on the problem are cognitive in nature and allow one to directly address the problem and find suitable solutions as opposed to dealing with the consequences associated with that problem. Still, different stressors may not always be addressed using one strategy and it is the responsibility of the caregiver to enlist the required support in tackling their work related challenges. Organizational, supervisory, and peer support is needed if caregivers are to be successful in coping with stressful situations. Organizations should ensure that caregivers are involved in decision making process in an effort to reduce turnover rate and level of commitment among the staff. Devaluing caregivers’ efforts and excluding them from the decision making process only acts to increase their intentions to quit their job. Whilst healthcare organizations have a responsibility to create a conducive environment, caregivers also have a personal responsibility over their lives. Believing in oneself may be good but not good enough as one may lack the necessary expertise or experience to address a particular situation hence the need for interaction between primary and secondary caregivers.