IJERPH | Free Full-Text | Using Concepts of Photovoice to Engage in Discussions Related to Burnout and Wellbeing

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IJERPH | Free Full-Text | Using Concepts of Photovoice to Engage in Discussions Related to Burnout and Wellbeing


Thematic analysis was used to identify patterns across data derived from two open-ended items during interviews with community professionals and one open-ended question on how the Photovoice event impacted students. The process of coding took place in six phases: (1) became familiar with the data; (2) generated grid and initial codes; (3) searched for themes among the codes; (4) reviewed and defined themes; (5) named themes; and (6) reported final themes to other coders. Recognizing researcher subjectivity and researcher generational perspectives was important within the analysis, and valid interpretations were managed throughout by checking across members of the research team.

3.1. Interviews with Community Professionals

Ten community professionals participated in the study. There were two professionals from nursing, and one each from physical therapy, public health, healthcare administration, social work, dietetics, athletic training, speech language pathology, and dental hygiene. The majority of the community professionals were female (80%) and Caucasian (90%). Three professionals were between the ages of 30 and 39 years old, four were between 40 49 years old, two were between 50 and 59 years old, and one was between 60 and 69 years old.

The themes that emerged from the data regarding factors that contribute to burnout in health services and professions were (1) Workload demands, (2) Unrealistic expectations, (3) Amount of time dedicated to care, and (4) Lack of work–life balance. See Table 1.

There were two most commonly identified factors contributing to burnout. The first was workload demands (n = 9). Lack of adequate staffing, administrative pressure to see large numbers of cases/patients, and increased number of required tasks in a workday were reported as contributors to burnout.

One participant quote echoed this theme: “Being overwhelmed with how several tasks there are to complete makes it very difficult to spend the time that you need to with patients”.

Another quote echoed this theme: “That’s definitely just the volume that gets pushed by a lot of employers in health care and I think that is due to what we see of just lower reimbursement rates to healthcare providers. I will say that is mostly driven by insurance companies”.

The other most commonly identified factor was unrealistic expectations (n = 9). Professionals expressed that unrealistic expectations from administration, patients, and self-imposed expectations all contribute to burnout.

One professional expressed this with the quote “I think perfectionism is a big driver for burnout because we strive to make sure all the i’s are dotted and t’s crossed. Then, when it doesn’t go the way you want, you are just pushing yourself to be perfect”.

Another quote also supported this theme along with several others: “It’s about the demands related to time and caseloads and client numbers and expectations. Also, it’s being present with people in some of the darkest or hardest moments of their lives”.

Another frequently mentioned factor contributing to burnout was the amount of time dedicated to care (n = 8). Participants indicated that the need to provide patient care even after the workday ends as well as being accessible all the time were drivers of burnout in health services professions.

One quote capturing this factor was “Ultimately, we stop when we are done with proper patient care and taking care of all the urgent and necessary requirements that the patient has or questions. So, not having a dedicated start and end time is primary reason for burnout across the board in healthcare because you can’t leave at the end of the day”.

Another quote supporting this theme: “I might probably say one of the biggest factors is now my normal day is I get here at 6:00 am and I am not going to leave until 7:30 tonight”.

Lack of work–life balance (n = 8) was also frequently mentioned in the interviews. The need to unplug and get away from work were listed as contributors to burnout, as well as the need to help everyone that asks. Several participants highlighted that often individuals that go into health services professions are “helpers”, so they consistently give of themselves even at their own detriment.

One quote captured this: “We’re in a position of service. So, I feel like every person we interact with, we give a little piece of ourselves to them. We are trying to help that person whether they understand that we are or not”.

Another quote also spoke to this theme: “We go into this because we like helping people. And there is such strong need for help, we become exhausted. But there’s always one more person that we want to help. Helpers aren’t always good at separating”.

The themes that emerged from the data regarding factors that promote well-being in health services professions were 1. Connecting with peers, 2. Physical activity, 3. Self- care, and 4. Identifying a mentor. See Table 2.

Again, there were two most commonly identified factors promoting well-being. The first factor was developing a strong peer group (n = 8). Most participants indicated the need to connect with peers in the same profession. This peer relationship allows for opportunities to empathize with one another and decompress without the need to explain all of the facets of the situation since both individuals have shared work experiences.

One professional said “I think it’s important to have somebody that you feel like is a really close friend that is in the same situation as you if at all possible, like a best friend at work. That relationship can offload so much of the stress by just being able to vent and get out some of the feelings that you’re having so that you’re just not internalizing them constantly”.

Another quote that supported this theme: “Talking with other people that are in the same boat as you and collaborating. I guess unloading your emotions. So, let me tell you about the day I had, especially if a patient dies or something, you really need an outlet to talk to somebody”.

The other most commonly identified factor was physical activity (n = 8). Outdoor activities, taking exercise classes, swimming, and lifting weights were all given as ways to promote well-being.

One participant captured the impact of physical activity by saying: “I started exercising and that has had a huge impact on my mental health. I was amazed after the first session. That I went in the car and turned the radio on and somebody said something funny on the radio and I laughed out loud and I was like, I haven’t heard myself laugh out loud in a long time. This exercise, there’s something to it. So, exercise is big for me”.

Another quote supporting this theme: “Also, I cannot overestimate the importance of exercise. As nurses, I feel like a lot of the time we don’t, we don’t focus on our own needs. Continuing to exercise and get out and do things that are good for you”.

Another frequently mentioned factor promoting well-being was self-care (n = 8). Methods of self-care listed were reading books, spending time with loved ones, pets, and meditating.

One professional expressed their thoughts on the importance of self-care on well-being by stating “We spend a lot of time teaching strategies to clients and vulnerable populations, but we don’t always employ those things with ourselves. And so, I think those are my most valuable things. One of those books I read once a year, just to remind myself of the strategies of how to protect myself, to shield myself, and to care for myself”.

Another quote supporting self-care: “I like to spend some time alone just reflecting on what it is that I like, like hobbies and pets and family. Just having something outside of work that helps you switch off and lets you come back after refreshing your mind”.

Identifying and connecting with a mentor (n = 5) was also frequently mentioned in the interviews. Having someone to assist with decision making, support you during difficult times, and share their past experiences with was identified as a protective factor with regard to burnout.

The role of a mentor was expressed by one participant by saying: “It’s really important to establish a mentor. In the field, someone that you trust and someone that you can feel good about talking to when you face situations where you may not feel confident in how you should move forward”.

Another quote regarding the importance of mentorship: “I had some great mentors in my late twenties who just really poured into me and helped me to start to understand what my purpose was and what my passion was. I just found fulfillment in that. I was able to lead in such a way that I truly understood my servant’s role”.

3.2. Results from Engagement Event

A total of 83 individuals completed the survey following the engagement event. Most participants identified as female (78%), White (75%), and non-Hispanic (86%). The majority of the participants were students (94%); other participants included community professionals (5%) and faculty (1%). Of the student participants, most were undergraduate students (88%) with the largest group comprised of college seniors (29%). Over half (59%) of the student participants were affiliated with programs related to health and human services. See Table 3.
Again, thematic analysis was used to identify patterns across data derived from the one open-ended question on how the Photovoice event impacted participants. The themes that emerged from these data are 1. Learning self-care practices, 2. Gaining insight into the need for self-care, 3. A sense of connection, and 4. Exposure to different healthcare careers. See Table 4.

The most prominent theme students identified was learning different self-care practices when working in healthcare (n = 24). Specifically, students indicated they learned that stress reduction and maintaining work–life balance was critical to avoiding burnout in their prospective fields of work. Students identified specific techniques to utilize when experiencing stress and to avoid burnout. Among these techniques were investing time in hobbies and interests, exercising, listen to music, and prioritizing mental health.

One student quote exemplified this theme: “This event taught me how important it is to leave your work at work and focus on yourself to be healthy and happy”.

Another quote that emphasized this theme: “I learned how to separate work and life by using stress reduction techniques”.

The second most prominent theme was gaining insight into the need for self-care (n = 21). This theme was evident by students sharing their newly found insight that burnout is a serious health concern. The student comments that fell in this theme highlighted the realization that working in healthcare is overwhelming and the need for self-care is necessary to avoid inevitable burnout. For some students, the event caused them to look at their own stress and the need to take action.

One quote that emphasized this theme: ”This event helped me realize that I have to prioritize mental health and stress relief. After reading the posters, I now understand that I have to take part in self-care habits”.

Another quote that underscores this theme: “This event showed me the reality how working in healthcare is extremely draining and causes burnout but that there are ways to remedy this”.

The third theme that emerged from the student reflections on the impact of the Photovoice study was feeling connected (n = 17). Student perceptions indicated they felt a sense of connection when talking with professionals in the field of healthcare, especially if the professional was in their prospective field of study. Learning about their career of interest from actual professionals in the field was impactful. There was also another connection that students indicated, and this was feeling a sense of belonging. Students felt they were not alone in their own struggles with stress management. For these students, this connection gave them hope and confirmation that they are on the right path in their career pursuits.

One quote that emphasizes this theme: “Personally connecting with professionals and seeing that stress impacts them too impacted me the most”.

Another quote that underscores the theme of connection: “I got to talk to people in my career of interest that really knew what they were doing and loved it. It assured me that I am on the right path”.

The final theme that emerged from student reflections was learning about the different fields in healthcare (n = 15). Students shared their appreciation of being exposed to the various careers that are in healthcare which in turn, helped them consider more options than they previously had prior to the event. Student perceptions also indicated a newfound respect for the high levels of stress that is involved in healthcare careers. For some students, their impact also references the second theme regarding realization of the need for self-care.

One quote that emphasizes this theme: “I learned about different professions and how it effects them”.

Another quote that underscores this theme: “It allowed me to explore other areas of healthcare and learn more from experienced professionals”.


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