الفهرس 
Stress at workOnly 14 pages are availabe for public view
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Abstract
The burnout syndrome has been discussed well with the methods of prevention and management by Vachon since 1982. The individual in the more advanced stages of burnout may well be most resistant to help. Such a person may need to take a break from the work situation and to spend time examining what is happening. Such an examination might include looking at the dreams that brought the person into his job and what has happened to these dreams. What part can the individual see himself playing and what part does the organization play? What has happened to his relationships with other people as he began to burnout, and what has happened to him? (Vachon, 1982).
In the early stages of burnout, it may be possible to suggest some lifestyle changes. These might include taking at least an hour a day for oneself to do something interesting and pleasurable such as exercise or developing a hobby -something which the individual once enjoyed or has always wanted to try. (Vachon, 1982).
When burnout is in progress or has fully developed, the solutions are much more difficult to accomplish. The burned-out person usually does not want to hear that he is burned out. Frequently he tends to deny all feelings and is annoyed with others who point out that he seems to be changing. The person will frequently present to the family physician with physical symptoms, from which he may want immediate relief. Careful history taking may well begin to develop the links between stimulus and response in the person’s mind and he or she can often become actively involved in attempting to see what changes can be made in the situation (Vachon, 1982).
This is not the time to change jobs, as the person cannot bring his burned-out self into the next job until he develops insight into what caused his current situation, he will continue to burnout (Vachon, 1982).
Having developed some personal insights, the individual could be encouraged to keep a diary for a one or two week period in which he/she records particularly stressful situations which exacerbated the symptoms of burnout. Having done this, the person might be encouraged to share such situations with colleagues, who may well be experiencing similar difficulties and feeling equally isolated. Group meetings or stress workshops might then be suggested in which colleagues can get together to brainstorm about problems and potential solutions-which they can then put into practice. This allows the group to redefine the problem as being external rather than internal and to develop more effective techniques for decreasing both individual and organizational burnout (Vachon, 1982).
If burnout occurs when demands exceed resources, it follows ultimately that either demands need to be modified or resources enhanced. Individuals can tolerate exposure to high levels of stress without increased risk of mental and physical illness if they receive adequate support this is reinforced by the growing body of evidence demonstrating a strong relationship between effective social support and improved mental and physical health, which may well be mediated by the formation of secure attachments (Quick et al., 1996).
Prevention begins with recognition and understanding. The first step in managing burnout is to take responsibility for the individual own experience of stress and then make a commitment to change (Firth-Cozens, 1994). The important thing is to take up the challenge and gradually consider what is needed and how to adapt ’stress-busting’ strategies to the particular situation (Roberts, 1997).
A physician or nurse experiencing significant distress may need to seek individual supervision, training, or psychiatric help. Medical staff often resist seeking help because of denial (by themselves, family members, and colleagues), reluctance to assume the sick role, a preference to diagnose and to treat themselves, worries about stigma, shame about weakness, and constraints of time and money (Schneck, 1998).
To decrease stress and function better, a nurse or physician may need to seek individual supervision, training, or psychiatric help. Resistance to obtaining individual help is a common problem and is aggravated by fear of being stigmatized, by shame about weakness, and by constraints imposed by time and finances. (Mikkael et al., 2003).
It is difficult for physicians to receive medical treatment; physicians often try to diagnose and treat themselves and have difficulty assuming the patient role. When they do go for treatment, they often are treated like very important persons and, as a consequence, do not receive the care they need or receive too much care in the form of aggressive diagnostic evaluations. These difficulties often are fuelled by denial—not only by the physician-patient, but also by his or her family, colleagues, and other caregivers. This also may be true for nurses (Mikkael et al., 2003).
The cost of burnout can be high. Recovery is not without its price. It is important to realize that burnout begins slowly. This is good news and bad news. The good news is that you have plenty of time to take preventive steps. The bad news is that it can creep up so slowly you won’t recognize it. It is an insidious disease. It does not strike like a bolt of lightning out of the sky – it creeps up on you like a snake in the grass. If the problem does develop quickly, say over a few days, it is more likely to be an endogenous depression than burnout (Hart, 2007).
Cognitive-behavioral training