New Perspectives: Towards an Integration of the concept "burnout" and its explanatory models

Nuevas perspectivas: Hacia una integración del concepto de burnout y sus modelos explicativos

Guadalupe Manzano-García and Juan-Carlos Ayala-Calvo

Universidad de La Rioja

Correspondence

ABSTRACT

During the last 30 years, as the concept "burnout" has evolved, multiple definitions and models of the concept "burnout" have appeared and been used to account for the phenomenon of the burn out syndrome. However, none of these has tackled the phenomenon from an integrating perspective. Based on the historical evolution of the the concept "burnout" and on the study of the different models that try to account for it, we propose a more global definition of the term together with a more parsimoniuos explanatory model of the burn out syndrome. From our point of view, in a definition of "burnout" we need to highlight the subject's expectations, his/her concept of equity, and the quality of his/her interpersonal relations. We belive that the burn out syndrome is the result of unfulfilled expectations which leads to demotivation and robot-like behaviour. When explaining the syndrome, we need to consider that the individual owns a set of inputs that simultaneously undergo a series of personal and working stress factors that interact resulting in an output that will lead to the appearance of burnout.

Key words: Burnout; theoretical study; explanatory models.

RESUMEN

Durante los últimos 30 años, a medida que el concepto del burnout ha ido evolucionando, han aparecido múltiples definiciones y modelos que han sido utilizados para explicar el fenómeno del síndrome de quemarse en el trabajo. Sin embargo, ninguno de ellos ha abordado el fenómeno desde una perspectiva integradora.
Partiendo de la evolución histórica del concepto burnout y el estudio de los diferentes modelos que han tratado de explicarlo, proponemos una definición más holística del término y un modelo teórico explicativo más parsimonioso del síndrome de quemarse por el trabajo.
Desde nuestro punto de vista, en la definición del burnout han de destacarse siempre las expectativas del sujeto, su concepto de equidad y la calidad de las relaciones interpersonales. Consideramos el burnout como el resultado de unas expectativas no cumplidas que generan desmotivación llevando al sujeto a comportarse como un robot.
En la explicación del síndrome debe tenerse en consideración que el individuo posee un conjunto de inputs que se ven sometidos simultáneamente a una serie de estresores personales y laborales que interactúan dando como resultado los outputs que llevarán finalmente a la aparición del burnout.

Palabras clave: Concepto burnout; estudio teórico; modelos explicativos.

Introduction

We have been talking about burnout syndrome for barely 30 years and already it has become a kind of "epidemic" with repercussions both at the individual, organizational and social level. The information that has accumulated regarding this syndrome over the years has been growing exponentially.

The term burnout has never been defined unanimously by all researchers. Terms such as "burned out syndrome", "burnout due to work pressure", "professional wearing out syndrome", "professional exhaustion syndrome" or "psychological fatigue" among others have all been used to describe this same concept.

Initially professionals focused particularly on the practical aspect, pushing the conceptualization of the term to one side (Maslach and Schaufeli, 1993; Moreno-Jiménez, 1998), and this has made it difficult to establish a more precise definition of the term burnout.

One of the most commonly used definitions is that of Maslach and Jackson (1981a) "a three-dimensional syndrome characterised by emotional exhaustion, depersonalization, and reduced personal accomplishment", although in 1982 Perlman and Hartman had already found nearly fifty different definitions of the term burnout. This fact shows the dimension, dispersion and difficulty of limiting the concept that overlaps with other concepts such as stress, depression, etc. in which the same predisposing factors, triggers and risk, are present.

Often the boundaries between some terms (depression, boredom, work-related stress, etc.) and others are not clear, resulting in much terminological confusion that prevents one from discerning what is and what is not work-related burnout syndrome.

As stated by Maicon and Garces de Los Fayos (2010) the term burnout is "... a "hotchpotch". While for his part, Gil-Monte (2005) considers burnout as a work-related medical syndrome brought on by a lack of adaptation to the work environment. This situation results in a poor quality of service provided together with a low level of self-efficacy which can lead to a possible abandonment of the profession. Burnout has become an "anything goes" without a precise definition of what it is.

Although there are many definitions, none of them provides a comprehensive view of the phenomenon in question. Work-related burnout is analysed as a state/process but without qualifying it as a whole. In this article we will tackle the ambiguity of the burnout concept and propose a definition consistent with the evolution that the term has undergone over time.

As regards the explanatory models of burnout, these only provide part of the explanation without giving an overall view that is so necessary for a proper understanding of the concept. In this article we propose a model that brings them all together so that none of the different theoretical perspectives regarding the syndrome are lost.

Historical evolution of the burnout concept

The concept of burnout can be traced back to the year 1974 when Freudenberger described it as a "feelings of failure and being worn or wrung out, resulting from an overload of claims on energy, on personal resources, or on the spiritual strength of the worker".

Freudenberger and Richelson (1980, p. 13) define burnout as "A state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that failed to produce the expected reward and that ultimately leads to a reduction in commitment and effectiveness at work". Burnout comes from a gap between what the subject considers as an ideal and the reality of the working environment.

Freudenberger (1974) refers to an individual immersed in his emotions with negative and cynical attitudes. Burnout develops when people have an idealized image of themselves as dynamic and charismatic individuals (Fernández et al., 2006).

There is currently a consensus that the work environment is the source of the syndrome (Maslach and Leiter, 1997; Escriba-Agüir, Artazcoz and Pérez-Hoyos, 2008). And although it is true that the gap between professional expectations and the everyday reality of employment are always a source of burnout, the expectations and the reality are not the same as those of the past. For example, the work and values of the 1970s are not the same as those of today. Professional success is no longer the subject of the same representations. The search for social status, money, the simple need to find a job and keep it, has become today's priorities. McNeese-Smith and Crook (2003) found that a group of nurses with little professional experience gave greater value to the economic aspect than those who had been in the profession for longer. Likewise, new doctors valued their private lives more than more veteran practitioners.

Pines and Kafry (1978) define burnout as a "general experience of physical, emotional and attitude exhaustion".

Dale (1979) perceived burnout as a consequence of work-related stress with intensity and variable duration.

Pines and Aronson (1988) claim it is not restricted to those working in helping professions. They believe that this state of mental, physical and emotional exhaustion is due to excessive chronic involvement accentuated in over-demanding emotional situations. For their part, Pines, Aronson and Kafry (1981) claim that this syndrome is not limited just to the professional field.

Pines (1993) defends the idea that burnout is an inability to make sense of the work carried out (Gomero, Palomino, Ruiz and Llapyesán, 2005). Pines (1993) states that for the subject to become "burnt out" they first have to have been very committed and involved in the workplace. According to this author, the last root of burnout lies is in the need we humans have to think that our life and the things we do are important. Each profession attracts certain subjects, the 'helping professions' respond to a common denominator: doing something for others. In this case the cause of burnout is the perception that no matter how hard the subject tries they will not achieve their expectations (González, La-casta and Ordoñez, 2008).

Cherniss (1980) emphasized the importance of work, as a background to the development of burnout, defining it as "negative personal changes which in helping professionals working in demanding or frustrating jobs". For Cherniss (1980, p.18), burnout is "a process in which a professional initially committed to their work disengages due to stress and strain experienced in their work setting".

As stated by Freudenberger (1974), who saw burnout as "the fighter's illness", the individual characteristics have their explanatory part in the emergence of the phenomenon. Certain subjects have expectations and professional inclinations that create greater work overload, making such subjects more likely to suffer burnout.

Edelwich and Brodsky (1980), defined it as "a progressive loss of idealism, energy and purpose experiences by people in the helping professions as a result their conditions of work".

A year later, Maslach and Jackson (1981a) defined the concept from a three-dimensional perspective: emotional exhaustion, depersonalization, and reduced personal accomplishment. The emotional exhaustion refers to feelings of physical and psychological stress that occur as a result of the continuous interactions between the workers themselves and with their clients. Depersonalization is manifested in negative attitudes in relation to users/clients. There is an increase in irritability and loss of motivation. Talking in a way such as "the breakage of room 24's internal ligament "; "the student in the blue shirt... " are examples of such attitudes. Depersonalization can eventually result in stigmatization and abuse. The term depersonalization may lead to confusion as it refers to a psychological state in which the expression of feeling strange in oneself dominates. The term robotisation seems more suitable and could have been chosen as more appropriate to the subject that concerns us (Manzano, 1998).

Reduced personal accomplishment can lead to loss of confidence in personal achievement and the presence of a negative self-concept as a result of unsatisfactory situations.

Cristina Maslach and Susana Jackson (1981a, 1986) claim that burnout is more common in the health professions and in people who deal with patients, clients, etc. on a daily basis. (Gil-Monte, Carretero, Roldán and Núñez, 2005; Gil-Monte, 2008; Soler, Yaman and Esteva, 2008; Grau and Suñer, 2008; Ruiz, 2009). In contrast with Freudenberger (1974), who emphasised personal factors, Maslach and Jackson considered the main causes of burnout were to be found in the workplace.

In relating the results of her early research, Maslach (1976) speaks of the "dynamics of burnout" and frequently uses the term "collapse". She noted that this "collapse" was accompanied by a loss of efficiency in the health and social services.

Emener, Luck and Gohs (1982) indicated that all definitions that had been set out up to that point had described the condition as the "syndrome of the burnt out ", the name they had used to refer to individuals who suffered this problem. This originated in today's expression "to be burnt out".

Perlman and Hartman (1982) define burnout as a response to chronic emotional stress with three dimensions: emotional and/or physical exhaustion; lowered job productivity and over-depersonalisation.

Sturgess and Poulsen (1983) define the syndrome as a progressive loss of idealism, energy and purpose, experienced by individuals in the helping professions as a result of their work.

Johnson and Stone (1987) talk about a state of exhaustion resulting from involvement with people in emotionally demanding situations.

Etzion (1987) states that burnout comes from continuous rarely recognizable maladjustments, usually mixed among individual characteristics and those relating to the environment. These maladjustments are the source of a process of slow and hidden psychological erosion. And this process of erosion can continue over a long period without being detected.

Shirom (1989, p.33) considers "burnout as a combination of emotional exhaustion, physical fatigue, cognitive weariness".

Leiter (1991), states that subjects who suffer from burnout have no fixed schedule, receive low pay, have high demands put upon them and work in an unfavourable environment.

Maslach and Schaufeli (1993) note that early papers on the subject are characterised by the fact that the meaning of the term could differ from one author to another. The term includes a whole range of "crises" that an individual could suffer from, with the risk of encapsulating everything and not providing a specific definition.

For Hallsten (1993) "burning out occurs when the enactment of an active, self-defining role is threatened or disrupted with no alternative role at hand".

Leiter and Schaufeli (1996, p. 240) consider that "burnout pertains to any occupation in which people are psychologically engaged in the job". This opinion is based on the idea that burnout is a crisis in the relationship between the subject and their work rather than labour relations.

A conclusion that can be drawn from the historical review of the burnout concept is that the definitions of burnout are complementary rather than conflicting with one another; and that they can be regrouped depending on whether the phenomenon is considered as a state or as a process. Therefore, the definitions in terms of state and process help the understanding of the phenomenon. For Schaufeli and Enzmann (1998), these definitions vary according to their extension, accuracy and dimension.

The best-known definition of burnout as a state ("a three-dimensional syndrome characterised by emotional exhaustion, depersonalization, and reduced personal accomplishment") is that of the aforementioned Maslach and Jackson (1981a). The definitions by Cherniss (1980) or Etzion (1987) clearly conceive burnout as a process. For Schaufeli and Enzmann (1998), the definitions in terms of process claim that burnout begins with tension resulting from the gap between the expectations, intentions, efforts, the ideals of the individual and the demands of harsh daily reality.

According to Farber (2000a), Guerrero, (2003), Latorre and Saez, (2009), individuals no longer suffer burnout in the conventional way, but rather through the utopian search for socially significant goals, fighting against the resistance of a working environment that overrides their professional expectations; and instead, according to Farber (2000a), the burnout that prevails today, is marked by the fact that individuals have a myriad of obligations, increasing external pressures and greater demands from others, limited possibilities of commitment and wages that only partially compensate for the effort made.

Farber (2000b) refers to three types of burnout."Exhaustion" burnout, in which the individual either leaves or only partially does their job because finds themselves up against too much stress and very few rewards. "Classic" or "frantic", burnout, in which the individual works ever harder until exhaustion, in the pursuit of rewards in order to offset the stress suffered. The third type contrasts with the previous two. It occurs not as a result of excessive tension but due to a monotonous and unstimulating job.

Burnout is a type of chronic stress people suffer in the working environment due to negative relationships that go beyond a person's capacity to adapt. The individual has no personal resources for dealing with it and suffer from all kinds of symptoms.

The initial pattern consists of very subtle symptoms together with the particular behaviour and attitudes of each subject. The process of the syndrome incorporates physical and mental exhaustion, negative self-concept and attitudes, hopelessness regarding their life and work and a depersonalized and cold treatment towards people and tasks to be undertaken.

It is a mistake to limit burnout to a single form of presentation. As stated by Maslach and Leiter (1997, p. 415) "burnout directly affects the values and the hopes of people, causing vocational and existential questioning". The individual, in addition to having to deal with stress at work, is facing the stress of daily life, the product of the challenges and problems in the dynamics of their family and social life, requiring a continuous effort of adaptation.

The study of the evolution of the term burnout shows that it is the result of an internal conflict that opposes or hinders the implementation of personal values in the project of the company, family, etc.

From our point of view, and taking into consideration the historical evolution of the term, in the definition of burnout, emphasis has always been placed on the expectations of the subject, their concept of fairness and the quality of interpersonal relationships. We consider burnout to be the result of unfulfilled expectations that generate demotivation, leading the subject to behave like a robot.

Unfulfilled expectations will lead the subject to a lack of commitment, opting instead for certain robotic behaviour that will damage their self-efficacy and sense of fairness, both at work and in their daily lives.

The growing pressures that the subject has to cope with both in their personal and professional life, lead them to carry out their daily chores perceiving them as unrewarding, resulting in a clear lack of motivation. In addition, their interpersonal relationships will be affected and they will even seek to avoid them so that they do not have to give explanations concerning how they behave with others. They will make the decision to do what is asked of them but they will not be willing to go any further.

Different theoretical models of the burnout syndrome

The need to understand the burnout syndrome has led researchers to propose various theoretical models that try to explain the phenomenon. Most of them are based on the idea that the syndrome is sequential and understand burnout as a response to chronic work stress. The main underlying theories in such models come from social psychology and the psychology of organizations. Thus, some of the theories on which the models of burnout are based are: the cognitive-social theory of self (Harrison, 1983), the social exchange theory (Buunk and Schaufeli, 1993), the conservation of resources theory (Hobfoll, 1989, 2001), the organisational theory (Winnubst, 1993), the structural model (Gil-Monte, Peiro and Valcarcel, 1995) and the model of guilt (Gil-Monte, 2005).

Each of the models highlights certain variables that will serve as a basis for the development of their respective theories.

Each theory provides that "plus" in order to achieve a better understanding of the phenomenon under study.

As an element common to all the theories we should point out people faced with work. The person-work binomial will be perceived with different variables (competition, perceived effectiveness, motivation, depersonalization, perceived self-efficacy, self-awareness, emotion, skills, resources, guilt..etc.) and their respective sequences in the theoretical model provided.

Another aspect common to all theories is that they conceive the syndrome of being burnt out by work as the result of chronic work stress that will perpetuate over time and lead to undesirable consequences.

For Harrison (1983), the main factors that explain the burnout syndrome are competition and perceived effectiveness. According to this model, originally the motivation will predetermine the effectiveness of the subject in achieving work objectives, thus the greater the motivation, the greater the work efficiency.

Pines (1993) has developed a similar model although it incorporates the idea that only the subjects who try to give an existential meaning to work will end up getting burnt. Thus burnout will develop in subjects who are highly motivated by their work and highly identified with their work when they fail to achieve their objectives, their expectations are frustrated and they feel that it is not possible to make a significant contribution to life.

The model of Golembiewski, Munzenrider and Carter (1983) perceives burnout based on three dimensions: depersonalization, low personal fulfilment at work and emotional exhaustion. Work-related stress is basically generated by an overload of work and role poverty. In these cases, the subject feels a loss of autonomy and control, a deteriorated self-image and feelings of irritability and fatigue.

For its part, Cherniss's (1993) model bases itself on that of Hall (1976) to explain the relationships between the execution of work, subjective feelings of success or failure experienced by the subject after carrying out the work and the consequences arising for self-esteem, motivation, satisfaction and job involvement. According to Cherniss (1980), it is possible to establish a causal relationship from the inability of the subject to develop feelings of personal success and the syndrome of being burnt out. To this end it includes the notion of "perceived self-efficacy" of Bandura (1989), understood as the beliefs that people have about their abilities to exercise control over situations that affect them.

The model of Thompson, Page and Cooper (1993) is based on the model of self-control of Carver, Scheier y Weintraub (1989) to explain stress. On the basis of this model they limited the etiology of the syndrome to four variables: level of self-awareness, discrepancies between the demands of the tasks and resources of the subject, expectations of success and feelings of self-confidence.

The self-awareness variable is conceptualized as the ability to self-regulate stress levels encountered while executing a task. The perceived discrepancies variable can intensify the level of self-awareness negatively affecting the subject's mood which will result in a lack of perceived confidence for resolving those discrepancies and low feelings of personal achievement at work. Thompson, Page and Cooper (1993) point out that high levels of self-awareness increase disillusionment, frustration or loss, and the predisposition of optimistic expectations of success can boost the confidence of the subjects.

The social exchange model of Buunk and Schaufeli (1993) explains the origin of burnout for nursing professionals from a double etiology: emotional and aptitudinal. In the processes of social exchange with patients, three stressor variables are identified: uncertainty, the perception of fairness and lack of control. For these authors nursing is a job that generates considerable uncertainty and the expectations of reward and fairness are usually frustrated (Cummings, Hayduk and Estabrooks, 2005; Segura et al, 2006). According to these authors, nurses in stressful situations do not seek social support from their peers for fear of being criticised. They also point out that the process of social affiliation would lead to situations of the syndrome spreading. Buunk and Schaufeli (1993) indicate that the relationship between background variables and feelings of burnout due to work is shaped by feelings of self-esteem, levels of reactivity and by orientation in the exchange.

Hobfoll and Freedy (1993) consider that the stress arises when the subjects perceive that the thing that motivates them is threatened or frustrated. Occupational stressors threaten the resources of the subjects, leading to insecurity regarding their skills. They emphasise the importance of relationships with others and their consequences as a source of stress in the perception of situations of loss or gain (Peinado and Garces, 1998).

The model of Cox, Kuk and Leiter (1993) considers burnout as a particular episode within occupational stress, occurring specifically in human service professionals and in situations when coping strategies are not effective. For these authors, emotionally exhaustion is related to "feeling worn out". Depersonalization is seen as a coping strategy in the face of emotional exhaustion, while feelings of low personal achievement are connected to the cognitive evaluation of the subject regarding their experience of stress.

The structural model (Gil-Monte, Peiro and Valcarcel, 1995) in relation to the etiology and the process of the syndrome considers the personal, interpersonal and organizational level as a background. This model has analysed three areas of research. The first emphasizes the personal variables as the etiology of the syndrome and highlights variables such as feelings of competence, existential meaning that the work provides and the levels of awareness of the subject. The second emphasizes the processes of social exchange and their consequences for professionals. It emphasizes the perception of equitable relationships without these posing any kind of threat or loss. The third area of research gives importance to the variables of the work environment that play a part in the dysfunction of the role, the problems linked to the type of organisational structure and the organisational climate.

For its part, the model of Price and Murphy (1984) highlights the importance of emotional deterioration due to emotional exhaustion and the emergence of feelings of guilt (Gil-Monte and Peiro, 1999; Gil-Monte, 2005).

According to Gil-Monte (2005), the sense of guilt in the burnout process enables one to identify two profiles in the evolution of the syndrome. One characterises workers who do not develop intense feelings of guilt, and who despite suffering burnout are not prevented from carrying out their work even if it is of a lower standard. For others, guilt will result in greater work involvement to try to reduce their feelings of remorse. As the working conditions do not change, low personal fulfilment at work and emotional exhaustion will increase and depersonalization is displayed again. This vicious circle takes one back to the development of feelings of guilt or the intensification of existing ones, causing a loop that reinforces burnout syndrome (Gil-Monte, 2005; Gil-Monte and Moreno, 2007). All this will contribute to a deterioration of the worker's health and of the standard of the service offered.

Proposal of integration

As can be seen from the above, the models proposed so far have addressed specific aspects of burnout syndrome, but none of them has provided a more inclusive vision.

In our opinion, to provide a clear explanation of the syndrome we must bear in mind that the individual has a set of inputs (internal personal characteristics and particular conditions experienced by each subject) which are simultaneously subjected to a series of personal and occupational stressors that interact resulting in the outputs (behaviour, attitudes, feelings, strategies used or experienced by each subject) that will finally lead to the occurrence of burnout. Thus we propose an explanatory model that is more cohesive and comprehensive than previous ones, which seeks to unite equally work and personal aspects that lead, most of the time, to burnout (see Figure 1).

High expectations are due to poor anticipatory socialisation, which prevents the subject from making the adjustment between what one expects and what one receives. The excess of involvement leaves the subject worn out in their daily work, leading them to distort the reality of the interactions with clients; the subject has no real criteria to assess what they must really give. It is the eternal mistaken process of confusing desire with reality. The value given to the work performed is out of proportion, leading the subject to believe that there is a lack of equity between what they give and what they believe they should receive. The individual makes an unrealistic assessment of what the institution expects of them. Higher or equal interpersonal relationships are affected by a distorted analysis of reality.(Brummelhuis, Hoeven, Bakker and Peper, 2011).

As regards self-efficacy, this refers to beliefs about the subjects own capabilities that allow them to organize and execute the courses of action required to achieve certain types of performance (Bandura, 1997; 1999). According to Bandura, success in managing and coping with the environment that affects our life does not consist only in possessing certain potential resources, or having prior knowledge of the most appropriate way of performing in each situation or possessing the appropriate behavioural skills in our behavioural repertoire, rather it implies a generative social-cognitive capacity in which cognitive, social and behavioural skills are integrated in order to achieve a purpose. Cherniss (1993) states that feelings of competition act as motivators in people, and when such feelings are frustrated, one experiences symptoms such as emotional fatigue, characteristic of burnout.

Personal and multi-role stressors, negative personal experiences and scarce social relationships equally interact with work stressors such as conflict and role ambiguity, work overload, few opportunities of promotion and the lack of appreciation for a job well done (Gil-Monte, 2005, 2008).

The interrelation of the stressors with the subject's inputs lead to outputs such as unfulfilled expectations, the robotisation of behaviour (despersonalization-cynisim), lack of operability in management, demotivation and lack of attention to the people receiving the services. This multi-causal aspect inevitably leads to burnout with all the consequences that arise in terms of the standard of the services provided and the well-being of the subjects involved in the work.

The robotisation of behaviour refers to acts that the subject performs both at work and in their personal life. Carrying out their "jobs" within acceptable limits even though they are aware they could do better; the subject is not willing to provide the "plus" that leads to the quality of a job well done. They behave like a robot without concerning themselves about much else. They do the work entrusted to them in order not to draw attention, but without any extra input. This concept that we call "robotisation" may resemble the concept of depersonalization or cynicism used by other authors (Maslach and Schaufeli, 1993). We feel the term "robotisation" is more appropriate as it gives a more accurate image of the way the subject affected by burnout syndrome behaves (Manzano, 1998).

The extent and depth of the interactions that can occur between the different factors will depend on the personal and professional experiences of the individual. (Schaufeli, Maassen, Bakker and Sixma, 2011).

We must not forget that small or significant daily annoyances can become as important as major life events. These everyday sources of discomfort are related to work, family and social aspects. If these problems are frequent and repetitive they may eventually have a major impact on the well-being of the subject as they do have a cumulative effect. All chronic and persistent, situations whether occupational or personal, will impact on the well-being of the human being.

Discussion

These new conditions or rules of the game, coupled with an excessively rapid mutation, will undoubtedly generate new stressors (Tuesca, Iguarán, Suárez, Vargas y Vergara, 2006) both in the world of work and in one's personal life that will require a new redefinition of burnout syndrome. With this outlook, it is necessary that the person has an optimal degree of maturity and is able to differentiate between the effective reality of projects and mere desires. They must be able to accept limitations, a fact that will give the individual a sense of serenity and security. (Galit, Shirom and Melamed, 2012).

This allows one to act in a coherent, serene manner and ultimately with freedom. We must learn from mistakes without sinking, knowing we are able to overcome potential frustrations and failures inherent in the human condition.

We have started out on the idea that future research will require these distinctions mentioned above and will add other forms of burnout.

As can be seen in the historical review of the concept, the term burnout is easier to observe and describe than to define. One of the challenges posed by this phenomenon is managing to identify the states and processes that contribute to the different forms of burnout (Dunford, Shipp, Boss, Angermeirer and Boss, 2012).

Early research was initially based on empirical studies. Too many publications focused on the search for factors related to the health of individuals. However, by extending the catalogue we do not obtain more knowledge about the mechanisms that trigger burnout. If we look at the prevention and treatment of burnout based solely on the trigger factors, we can imagine the perplexity of the person in charge of a company or of the affected person faced with a long list of stressors that can be prevented or reduced. The construct of burnout needs to be integrated into true theoretical approaches that allow us to discover the underlying laws and processes.

According to Lewin (1951, p. 268) "nothing is as practical as a good theory" but theoretical explanatory models of burnout syndrome have only taken partial aspects into account. Nevertheless, there has been a relative consensus amongst researchers regarding the MBI (Maslach Burnout Inventory) and Maslach and Jackson's definition (1984b), which certainly limits the focus on the three initial factors and perhaps prevents us from discovering other dimensions of the phenomenon.

The constructs of personality such as low self-esteem, lack of motivation and feelings of failure have been vaguely defined without giving details of behaviour or behavioural aspects that lead to this situation (Ortega and López, 2004). Furthermore, in many empirical studies, interest has focused more on looking at which dimension appears first: emotional exhaustion, depersonalization or lack of personal achievement. Why not consider that all dimensions are given at the same time? We have to recognise, however, that in the history of burnout, this consensus has had the significant merit of providing a common language, and in particular it has enabled rigorous comparisons between research studies and has been based on the accumulated knowledge derived from other studies.

Freudenberger and Richelson (1980) associate burnout with a way of life; Pines, Aronson and Kafry (1981) do not restrict it just to the occupational area; Shaufeli and Enzmann (1998) speak of the harsh daily reality; Farber (2000a) emphasises increasing external pressures that the subject has to bear. This way of life and increasing pressures coupled with the hard occupational and personal reality provide the ideal breeding ground for the development of burnout.

The volume of variables studied throughout the history of burnout (emotional exhaustion, low self-efficacy, demotivation, lack of fairness, low self-esteem, low personal resources, imbalance in the perception of what one gives and what one receives, etc.) and the disparity in the results makes us doubt which variables are the most representative of the syndrome of burnout (Sandín, 2003).

The different explanatory models of the syndrome show aspects that require a reconceptualisation of the explanation given to the phenomenon. The theoretical models examined above do not consider the uniqueness of the subjects studied but do specify the working conditions of the different groups. However, it is the interplay of personal conditions with the general and specific aspects of the profession in question that leads to the occurrence of burnout syndrome or "the straw that broke the camel's back". This syndrome is aggravated and changes according to the structure of the organization and the climate, but also depending on the inputs and personal stressors that each subject comes up against (Pascual, 2007) over time.

The potential stressful situations that necessarily occur in the occupational and personal environment, when poorly managed, can lead to physical and psychological problems due to not viewing burnout as an integrated or holistic whole. Faced with this situation, the subject adopts robotic behaviour to deal with work and personal demands. It is the answer to the "obligation" to continuously adapt to this ever-changing occupational and personal world in an attempt to avoid this phenomenon.

In these times of rapid changes, when the individual has to cope with a degree of increasing uncertainty, having the ability to adapt is a great quality, but must we ask the subject to continuously adapt through additional effort? The person must find their first job, keep it and find possible new jobs according to their capabilities, they must reconcile family and occupational life, and they must find time for social relations, etc.

The ideal is to have empathetic, assertive, flexible subjects with interpersonal skills, ultimately, with good cognitive and behavioural skills but it is an ideal to strive for more than a daily reality.

In conclusion, if we want healthy organisations and people, we must seek the improvement and the positive both in organisational and personal structures and this is achieved knowing and analysing burnout as an integral whole. The model we have presented here offers a more comprehensive vision of the phenomenon and allows us to discover, more specifically, the problems underlying burnout syndrome.

Logically, this model must be empirically contrasted to verify both the relationship between variables and the degree of involvement of these in the occurrence of the syndrome.

References

1. Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist, 44 (9), 1175-1184.         [ Links ]

2. Bandura, A. (1997). Self-efficacy: The exercise of control. Nueva York: W.H. Freeman and Company.         [ Links ]

3. Bandura, A. (1999). Ejercicio de la eficacia personal y colectiva en sociedades cambiantes. En A. Bandura (Ed.), Auto-Eficacia: cómo afrontamos los cambios de la sociedad actual (pp. 19-54). Bilbao: Desclée de Brouwer.         [ Links ]

4. Bobillier Chaumon, M. E. (2003). Evolution techniques et mutations du travail: emergence de nouveaux modèles d'activité. Le Travail Humain, 66, 163-194.         [ Links ]

5. Brummelhuis, L. L., Hoeven, C. , Bakker, A. B. y Peper, B.(2011). Breaking through the loss cycle of burnout: The role of motivation. Journal of Occupational and Organizational Psychology, 84 (2), 268-287.         [ Links ]

6. Buunk, B. P. y Schaufeli, W. B. (1993). A perspective from social comparison theory. En W. B. Schaufeli, C. Maslach y T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 53-69). Londres: Taylor & Francis.         [ Links ]

7. Carver, C. S., Scheier, M. F. y Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267-283.         [ Links ]

8. Cherniss, C. (1980). Professional burnout in the human service organizations. New York: Praeger.         [ Links ]

9. Cherniss, C. (1993). The role of professional self-efficacy in the etiology of burnout. En W.B. Schaufeli, C. Maslach y T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 135-149). Londres: Taylor & Francis.         [ Links ]

10. Coopers, C. L., Dewe, P.J. y O'Driscoll, M. P. (2001). Organizational stress. A review and critique of theory, research and applications. Thousand Oaks, California: Sage.         [ Links ]

11. Cox, T., Kuk, G. y Leiter, M. (1993). Burnout, health, work stress and organizational healthiness. En W. B. Schaufeli, C. Maslach y T. Marek (Eds.). Professional burnout: Recent developments in theory and research (pp. 177-193). Londres: Taylor & Francis.         [ Links ]

12. Cummings, G., Hayduk, L. y Estabrooks, C. (2005). Mitigating the impact of hospital restructuring on nurses: The responsibility of emotionally intelligent leadership. Nursing Research, 54 (1), 2-12.         [ Links ]

13. Dale, M. R. (1979). Preventing worker burnout in child welfare. Child Welfare, 58 (7), 443-450.         [ Links ]

14. Dunford, B. B., Shipp, A. J., Boss, R.W., Angermeier, I. y Boss, A. D. (2012). Is burnout static or dynamic?. A career transition perspective of employee burnout trajectories. Journal of Applied Psychology, 97 (3), 637-650.         [ Links ]

15. Edelwich, J. y Brodsky, A. (1980). Burnout: Stages of disillusionment in the helping profession. New York: Human Sciences Press.         [ Links ]

16. Emener, W. G., Luck, R. S. y Gohs, F. X. (1982). A theoretical investigation of the construct burnout. Journal of Rehabilitation Administration, 6, 188-96.         [ Links ]

17. Escriba-Agüir, V., Artazcoz, L. y Pérez-Hoyos, S. (2008). Efecto del ambiente psicosocial y de la satisfacción laboral sobre el síndrome de burnout en médicos especialistas. Gaceta Sanitaria; 22 (4), 300-308.         [ Links ]

18. Etzion, D. (1987). Burnout: The hidden agenda of human distress. Tel Aviv: Tel Aviv University.         [ Links ]

19. Farber, B. A. (2000a). Introduction: Understanding and treating burnout in a changing culture. Psychotherapy in Practice, 56, 589-594.         [ Links ]

20. Farber, B. A. (2000b). Treatment strategies for different types of teacher burnout. Psychotherapy in Practice, 56, 675-689.         [ Links ]

21. Fernández, B., Roldán, L. M., Guerra, A., Roldán, T., Gutiérrez, A. y De Las Mulas, M. (2006). Prevalence of burnout among anesthesiologists at Hospital Universitario Virgen Macarena de Sevilla. Revista Española Anestesiología Reanimación, 53, 359-362.         [ Links ]

22. Freudenberger, H. J. (1974). Staff burnout. Journal of Social Issues, 30, 159-165.         [ Links ]

23. Freudenberger, H. J y North, G. (1998). ¡No puedo más! Cómo puede la mujer reconocer y superar su agotamiento. Barcelona: Grijalbo.         [ Links ]

24. Freudenberger, H.J y Richelson, G. (1980). Burn-out: How to beat the high cost of success. New York: Bantam Books.         [ Links ]

25. Galit, A., Shirom, A. y Melamed, S. (2012). The big five personality factors as predictors of changes across time in burnout and its facets. Journal of Personality, 80 (2), 403-427.         [ Links ]

26. Gil-Monte, P. R. (2005). El síndrome de quemarse por el trabajo (Burnout). Una enfermedad laboral en la sociedad del bienestar. Madrid: Pirámide.         [ Links ]

27. Gil-Monte, P. R. (2008). El síndrome de quemarse por el trabajo (burnout) como fenómeno transcultural. Informació Psicológica, 91-92, 4-11.         [ Links ]

28. Gil-Monte, P. R., Carretero, N., Roldán, M. D. y Núñez, E. M. (2005). Prevalencia del síndrome de quemarse por el trabajo (burnout) en monitores de taller para personas con discapacidad. Revista de Psicología del Trabajo y de las Organizaciones, 21, 107-123.         [ Links ]

29. Gil-Monte, P. R. y Marucco, M. (2008). Prevalencia del "Síndrome de quemarse por el trabajo" (burnout) en pediatras de hospitales generales. Revista de Saúde Pública, 42 (3), 450-456.         [ Links ]

30. Gil-Monte, P. R. y Moreno, B. (2007). El síndrome de quemarse por el trabajo (burnout): grupos profesionales de riesgo. Madrid: Pirámide.         [ Links ]

31. Gil-Monte, P. R. y Peiró, J. M. (1997). Desgaste psíquico en el trabajo: el síndrome de quemarse. Madrid: Síntesis.         [ Links ]

32. Gil-Monte, P. R. y Peiró, J. M. (1999). Perspectivas teóricas y modelos interpretativos para el estudio del síndrome de quemarse por el trabajo. Anales de Psicología, 2, 261-268.         [ Links ]

33. Gil-Monte, P. R., Peiró, J. M. y Valcárcel, P. (1995). El síndrome de burnout entre profesionales de enfermería: una perspectiva desde los modelos cognitivos de estrés laboral. En L. González, A. de La Torre y J. de Elena (Comp.), Psicología del Trabajo y de las Organizaciones, Gestión de Recursos humanos y Nuevas Tecnologías (pp. 211-224). Salamanca: Eudema.         [ Links ]

34. Golembiewski, R. T., Munzenrider, R. F. y Carter, D. (1983). Progressive phases of burnout and their worksite covariants. Journal of Applied Behavioral Science, 19, 464-81.         [ Links ]

35. Gomero, R., Palomino, J., Ruiz, F. y Llapyesán, C. (2005). El síndrome de burnout en personal sanitario de los hospitales de la empresa minera de Southern Perú Copper Corporation: estudio Piloto. Revista Médica Herediana, 16 (4), 233-238.         [ Links ]

36. González, M., Lacasta, M. A. y Ordoñez, A. (2008). El síndrome de agotamiento profesional en oncología. Madrid: Médica Panamericana.         [ Links ]

37. Grau, A. y Suñer, R. (2008). El Síndrome de burnout en los trabajadores sociales. Agathos, 8 (1), 16-22.         [ Links ]

38. Grau-Alberola, E., Gil-Monte, P. R., García-Juesas, J. A. y Figueiredo-Ferraz, H. (2009). Efectos de los conflictos interpersonales sobre el desarrollo del síndrome de quemarse por el trabajo (burnout) y su influencia sobre la salud. Un estudio longitudinal en enfermería. Ciencia & Trabajo, 11 (32), 72-79.         [ Links ]

39. Grau-Alberola, E., Gil-Monte, P. R., García-Juesas. J. A. y Figueiredo-Ferraz, H. (2010). Incidence of burnout in Spanish nursing professionals: A longitudinal study. International Journal of Nursing Studies, 47, 1013-1020.         [ Links ]

40. Guéritault, V. (2004). La fatigue émotionnelle et physique des méres. Le burnout maternel. Paris: Odile Jacob.         [ Links ]

41. Guerrero, E. (2003). Análisis pormenorizado de los grados de burnout y afrontamiento del estrés docente en profesorado universitario. Anales de Psicología, 19 (1), 145-158.         [ Links ]

42. Hall, D. T. (1976). Careers in organizations. Pacific Palisades, CA: Goodyear.         [ Links ]

43. Hallsten, L. (1993). Burning out: A framework. En W.B. Schaufeli, C. Maslach y T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 135-149). Washington, D.C.: Taylor & Francis.         [ Links ]

44. Harrison, W. D. (1983). A social competence model of burnout. En B. A. Farber (Ed.), Stress and burnout in the human services professions (pp. 29-39). New York: Pergamon Press.         [ Links ]

45. Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualising stress. American Psychology, 44, 513-524.         [ Links ]

46. Hobfoll, S. E. (2001). The influence of culture, community and the nested-self process: Advancing conservation of resources theory. Applied Psychology: An International Review, 50, 337-421.         [ Links ]

47. Hobfoll, S. E. y Freedy, J. R. (1993). Conservations of resources: A general stress theory applied to burnout. En W. B. Schaufeli, C. Maslach y T. Marek (Eds.). Professional burnout: Recent development in theory and research (pp. 115-129). London: Taylor & Francis.         [ Links ]

48. Johnson, M. y Stone, G. L. (1987). Social workers and burnout: A psychological description. Journal of Social Service Research, 10, 67-80.         [ Links ]

49. Latorre, I. y Saéz, J. (2009). Análisis del burnout en profesores no universitarios de la región de Murcia (España) en función del tipo de centro docente: público versus concertado. Anales de Psicología, 25 (1), 86-92.         [ Links ]

50. Leiter, M. P. (1991). Coping patterns as predictors of burnout: The function of control and escapist coping patterns. Journal of Organizational Behaviour, 9, 297-308.         [ Links ]

51. Leiter, M. P. y Schaufeli, W. B. (1996). Consistency of the burnout construct across occupations. Anxiety, Stress and Coping, 9, 229-243.         [ Links ]

52. León-Rubio, J. M.; Cantero, F. J. y León-Pérez, J. M. (2011). Work conditions and differences in the role that self-efficacy plays in the burnout perceived by university staff. Anales de Psicología, 27 (2), 518-526.         [ Links ]

53. Lewin, K. (1951). Field theory in social science. New York: Harper and Row.         [ Links ]

54. Maicon, C. y Garcés de Los Fayos, E. J. (2010). El síndrome de burnout: evolución histórica desde el contexto laboral al ámbito deportivo. Anales de Psicología, 26 (1), 169-180.         [ Links ]

55. Manzano, G. (1998). Estrés en personal de enfermería. Tesis doctoral publicada. Bilbao: Universidad de Deusto.         [ Links ]

56. Marucco, M. A., Gil-Monte, P. R. y Flamenco, E. (2008). Síndrome de quemarse por el trabajo (burnout) en pediatras de hospitales generales, estudio comparativo de la prevalencia medida con el MBI-HSS y el CESQT. Informació Psicológica, 91-92, 32-42.         [ Links ]

57. Maslach, C. (1976). Burned out. Human Behavior, 5, 16-22.         [ Links ]

58. Maslach, C. y Jackson, S. E. (1981a). The measurement of experienced burnout. Journal of Occupational Behavior, 2, 99-113.         [ Links ]

59. Maslach, C. y Jackson, S. E. (1981b). The Maslach Burnout Inventory. Research Edition. Palo Alto, C. A.: Consulting Psychologists Press.         [ Links ]

60. Maslach, C. y Jackson, S. E. (1986). The Maslach Burnout Inventory. Manual (2nd ed.). Palo Alto, CA: Consulting Psychologists Press.         [ Links ]

61. Maslach, C. y Leiter, M.P. (1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco, C.A.: Jossey-Bass.         [ Links ]

62. Maslach, C. y Schaufeli, W. B. (1993). Historical and conceptual development of burnout. En W. B. Schaufeli, C. Maslach y T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 1-16). Washington, D.C.: Taylor & Francis.         [ Links ]

63. McNeese-Smith, D. K. y Crook, M. (2003). Nursing values and a changing nurse workforce. Values, age, and job stages. Journal of Nursing Administration, 33, 260-270.         [ Links ]

64. Moreno-Jimenez, B. (1998). La evaluación cognitiva de la personalidad. En G. Buela y J. C. Sierra (Eds.). Manual de evaluación psicológica. Madrid: Siglo XXI.         [ Links ]

65. Ortega, C. y López, F. (2004). El burnout o síndrome de estar quemado en los profesionales sanitarios: revisión y perspectivas. International Journal of Clinical and Health Psychology, 4 (1), 137-160.         [ Links ]

66. Pascual, E. (2007). El ama de casa y el burnout. Barcelona: Fundación La Caixa.         [ Links ]

67. Peinado, A. I. y Garcés, E. J. (1998). Burnout en cuidadores principales de pacientes con Alzheimer: el síndrome del asistente desasistido. Anales de Psicología, 14 (1), 83-93.         [ Links ]

68. Perlman, B. y Hartman, E.A. (1982). Burnout: Summary and future research. Human Relations, 35, 283-305.         [ Links ]

69. Pines, A. (1993). Burnout: An existential perspective. En W. B. Schaufeli, C. Maslach y T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 19-32). Washington, D.C.: Taylor & Francis.         [ Links ]

70. Pines, A. y Aronson, E. (1988). Career burnout: Causes and cures. New York: Free Press.         [ Links ]

71. Pines, A., Aronson, E. y Kafry, D. (1981). Burnout: From tedium to personal growth. New York: The Free Press.         [ Links ]

72. Pines, A. y Kafry, D. (1978). Occupational tedium in the social services. Social Work, 23, 499-507.         [ Links ]

73. Price, D. M. y Murphy, P. A. (1984). Staff burnout in the perspective of grief theory. Health Education, 8 (1), 47-58.         [ Links ]

74. Ruiz, V. (2009). Síndrome de burnout y estilos de afrontamiento al estrés del personal médico asistencial en una red urbana de servicios de salud de la comunidad de Monteria. Pensando Psicología, 5 (8), 15-22.         [ Links ]

75. Sandín, B. (2003). El estrés un análisis basado en el papel de los factores sociales. International Journal of Clinical and Health Psychology, 3, 141-151.         [ Links ]

76. Schaufeli, W. B. y Enzmann, D. (1998). The burnout companion to study and practice. A critical analysis. London: Taylor & Francis.         [ Links ]

77. Schaufeli, W. B., Maassen, G. H., Bakker, A. B. y Sixma, H.J. (2011). Stability and change in burnout: A 10-year follow-up study among primary care physicians. Journal of Occupational and Organizational Psychology, 84 (2), 248-267.         [ Links ]

78. Segura, J., Ferrer, M., Palma, C., Ger, S., Doménech, M., Gutiérrez, I. y Cebriá, J. (2006). Valores personales y profesionales en médicos de familia y su relación con el síndrome del burnout. Anales de Psicología, 22 (1), 45-51.         [ Links ]

79. Shirom, A. (1989). Burnout in work organizations. En C. L. Cooper y I. Robertson (Eds.), International review of industrial and organizational psychology (pp. 25-48). New York: Wiley.         [ Links ]

80. Soler, J. K., Yaman, H. y Esteva, M. (2008). Burnout in European general practice and family medicine. Social Behavior Personality, 35 (8), 1149-1150.         [ Links ]

81. Sturgess, J. y Poulsen, A. (1983). The prevalence of burnout in occupational therapists. Occupational Therapy Mental Health, 3, 47-60.         [ Links ]

82. Thompson, M. S., Page, S. L. y Cooper, C. L. (1993). A test of caver and Scheier's self-control model of stress in exploring burnout among mental health nurses. Stress Medicine, 9, 221-235.         [ Links ]

83. Tonon, G. (2003). Calidad de vida y desgaste profesional: una mirada del síndrome del burnout. Buenos Aires: Espacio Editorial.         [ Links ]

84. Tuesca, R., Iguarán, M., Suárez M., Vargas, G. y Vergara, D. (2006). Síndrome de desgaste profesional en enfermeras/os del área metropolitana de Barranquilla. Salud Uninorte, 22 (2), 84-91.         [ Links ]

85. Van Gelderen, B. R., Konijn, E. A. y Bakker, A. B. (2011). Emotional labor among trainee police officers: The interpersonal role of positive emotions. Journal of Positive Psychology, 6 (2), 163-172.         [ Links ]

86. Varela-García, C. (1992). El síndrome del ama de casa. Cuadernos de Medicina Psicosomática, 24, 35-43.         [ Links ]

87. Westman, M. y Etzion, D. (1995). Cross-over of stress, strain and resources from one spouse to another. Journal of Organizational Behavior, 16, 169-181.         [ Links ]

88. Winnubst, J. (1993). Organizational structure, social support and burnout. En W. B. Schaufeli, C. Maslach y T. Marek. (Eds.), Professional burnout: Recent developments in theory and research. London: Taylor & Francis.         [ Links ]

Correspondence:
Guadalupe Manzano García
Facultad de Ciencias de la Educación ]]> C/ San José de Calasanz, s/n
26004 Logroño (España)
E-mail: Guadalupe.manzano@unirioia.es

Artículo recibido: 25-1-2012
Revisado: 30-7-2012
Aceptado: 9-9-2012