mercè balcells olivero* & daniel vega...

Mercè Balcells Olivero* & Daniel Vega Moreno***Centre de Salut Mental les Corts. Barcelona (Spain). ** Mental Health an

Addictions Service. Igualada Hospital. Igualada( Spain)

MI in Spain

1999 Translation and publishing of the MI book in Spanish1999 creation of GETEM (Grupo Español de Trabajo en Entrevista Motivacional)1999 first TNT (Training New Trainers) meeting in Tarragona, Spain

Began to be used in the mid 1970’s (Freudenberger, 1974) to refer to the process of: deterioration in the care and professional attention given to users of human service organizations(public service, volunteer, medical, human social service, educational organizations)

“What started out as important, meaningful and challenging work becomes unpleasant,

unfulfilling and meaningless. Energy turns into exhaustion, involvement turns into cynicism,

and efficacy turns into ineffectiveness”

Maslach C. et al (2001). Job burnout. Ann Rev Psychol. 52: 397-422

Developed in 1980 Validation during last 20 years22 items evaluate 3 domains of burnoutRespondents rate frequency on 7 point Lickert’s scale3 sub-scales:

Emotional Exhaustion Depersonalization (Cynicism)Personal Accomplishment (professional efficacy): scored in reverse

“I feel emotionally drained from my work.”

“I feel like I’m at the end of my rope.”

“ I’ve become more callous toward people since I took this job”

“I worry that this job is hardening me emotionally”

“I deal calmly with emotional problems at work.”

“I feel I’m positively influencing other people’s lives through my work.”

Syndrome of depersonalization, emotional exhaustion, and low personal accomplishmentleading to decrease effectiveness at work

McManus IC. et al (2002).The Casual Links between stress and burnout in a longitudinal study of UK doctors. The Lancet 359:2089-2090

In a 3 years study:

PREPARING PEOPLE FOR PREPARING PEOPLE FOR CHANGECHANGE

Addictions and substances useEnhancing compliance in adults with schizophreniaTreatment of eating disordersPromoting treatment adherence in physical health care settings like hypertension, asthma or diabetes.Promote healthy life-styles in a number of settings from stopping smoking , improving dietary adherence in adolescents ...

Can MI help health care professionals to feel less

burnout ?

Authors:Vega D, Trepat R, Torres M, De Flores T & Balcells M (2007)

Mental Health an Addiction Service. Igualada HospitalGrupo Español de Trabajo en Entrevista Motivacional

Aim of the studyto establish whether learning and implementing motivational interviewing can help health professionals to feel less burnout

Subjects:Subjects:A group of 18 healthcare professionals from a County General Hospital who completed voluntary an introductory course on theory and practice in MI.

Female: 61% , Male: 39%Age: 41 ± 8 years

Course of 25 hours long divided in two parts:

Part 1:

•Bases of MIPart 2:

•Supervision andproblem solving

3 months

Assessed :•burnout levels (MBI)

Assessed :•burnout levels (MBI)•Utilization of learned skills•Perception of improves in relation withpatients•Perception of improves in job stress•Intention of continuing MI

VAS

Visual Analog Scales (VAS) that assesses: the utilization of learned skills

the perception of improvement in the relation with patients

I have applied the MI skills1 2 3 4 5 6 7 8 9 10

Never Allways

The application of the skills has improved my relation with some patients

1 2 3 4 5 6 7 8 9 10Never Allways

the perception of improves in job stress

Intention of continuing MI training in future.

The application of the skills has reduced my level of stress in the work

1 2 3 4 5 6 7 8 9 10Never Always

I will continue my training in M.I.1 2 3 4 5 6 7 8 9 10

Totally of disagreement

Totally in agreement

DataData analysis:analysis:

Test re-test design was used. The results were analyzed with a Wilcoxonnon-parametric test to compare means for paired samples.

Grau A, et al (2005) Desgaste profesional en el personal sanitario y su relación con los factores personales y ambientales. Gaceta Sanitaria, 19 (6): 463-70

BURNOUT LEVELS (MBI)

0

5

10

15

20

25

30

35

40

45

50

Mea

n/S.

D.

Pre-trainig 32,28 9,67 36,11

Grau A, et al (2005) * 22,5 6,2 36,3

EE DP PA

* 1095 catalonian health workers

Mean and Standard Deviation (SD) scores in Emotional Exhaustion (EE), Depersonalization (DP) and Personal Accomplishment (PA) of MBI pre-training – MBI post-training

* p=0.023

MB I 

0

10

20

30

40

50Med

ia / DE.

P re‐tra inig 32,28 9,67 36,11

Pos t‐tra ining 26,61 9,38 38,05

E E DP   PA

*

BURNOUTBURNOUT PREPRE--TRAININGTRAINING vs. BURNOUT POSTvs. BURNOUT POST--TRAININGTRAINING

VISUAL ANALOG SCALES

(VAS)

Continuing MIStress reduction

P-D RelationshipUtilization MI

Mea

n/S

.D./R

ange

12

10

8

6

4

2

VISUAL ANALOG SCALES (VAS)VISUAL ANALOG SCALES (VAS)

Utilization of the MI skills in daily practice :

5.70 + 2.14

Improvement in the patient doctor relationship:

7 + 2.29 Reduction of stress

levels in clinical practice:

6.29 + 2.33

Intention of continuing the MI training in future:

8.41 + 2.39

Our sample has very high level of burnout

The level of emotional exhaustion decreased 3 months after the MI training

The results of our study suggest that motivational interviewing may be an effective tool in coping with burnout, at least by decreasing emotional exhaustionemotional exhaustion that provider often experience.

1. Associated with the presence of physical diseases

2. Might generate distortions in the way of perceiving threats and damages, fact that would facilitate the presence of dysfunctional strategies of protection like the emotional distancing in the relation with the patients

3. More absenteeism to work

Whereas the participants valued moderately the utilization of the MI skills in their clinical practice.Nevertheless, this seems to have a clear influence in the level of perceived stress and the improvement of the relation with patients

High values in the intention of continuing MI training in future, would support MI skills as a element of subjective well-being and of active coping

MI might constitute a preventive tool and a treatment option for burnout in the healthcare professionals.

No change of the organization is needed = easy and low cost

Perhaps …

MI TRAINING:

•INCREASING COMPETENCE AND COPING STRATEGIES (?)•INCREASING SENSATION OF EFFICACY (?)

GO TO ACTION!

AKNOWLEDGMENTS

Daniel Vega (Hospital d’Igualada)Rita Trepat (Hospital d’Igualada)Meritxell Torres (EAIA Lleida Nord)Marga Sánchez (Hospital d’Igualada)Carolina Yahne (University of New Mexico, Albuquerque, USA)All members of GETEM (Grupo Español de Trabajo en Entrevista Motivacional)