PEDIATRICS Vol. 94 No. 6 December 1994, pp. 1074-1077
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Managing Stress and Burnout at Work: A Cognitive Group Intervention Program for Directors of Day-Care Centers

Talma Kushnir PhD1 and Varda Milbauer PhD2

1 Behavioral Medicine Unit, Occupational Health & Rehabilitation Institute at Loewenstein Hospital, Raanana, Israel
2 Tel Aviv University, Tel Aviv, Israel

There is considerable epidemiological evidence that occupational stress contributes to the etiology and expression of a wide variety of health and behavior outcomes such as cardiovascular disease morbidity and mortality, immunological processes, psychosomatic impairment, and affective disorders.1 As much as 60% of absence from work may be stress related.2 Recently, occupational burnout was found to be correlated with health problems ranging in severity from increased frequency of upper respiratory infections2 to increased risk for cardiovascular diseases.3 Such findings constitute the rationale for including stress- and burnout-prevention efforts in many health-promotion models. This paper describes a stress- and burnout-prevention workshop focusing on psychological coping skills for directors of child day-care centers. As far as we could tell, this program, which took place in Israel in 1991, was the only reported program within this particular work setting.

Directing a day-care center is highly demanding, entailing full responsibility for the effective functioning and well-being of staff and children. In Israel, this may amount to about 20 care givers and as many as 140 infants and children under 4 years of age. The centers, often geared to cater for young newcomers from developing countries and children from socially deprived neighborhoods, are open 8 to 9 hours a day, 6 days per week. Because the director has educational and administrative functions, she is closely supervised by two supervisors who frequently issue conflicting instructions. She also coordinates routinely with many governmental agencies and maintains close contact with parents. The job thus requires intense involvement with people, a feature that has been recognized as a major source of occupational burnout.4


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