special care unit (SCU) experienced less stress and burnout than staff who cared for such patients on traditional (integrated) units (Mobily et al., 1992). The principal area of stress reduction for nursing personnel working on the SCU involved staff knowledge, abilities, and resources. Similarly, subscale analysis indicated significantly less stress for staff who worked in the SCU with respect to residents' verbal and physical behavior. The SCU was designed specifically to provide the special environmental structures and support and service systems that are required to enhance functioning and decrease associated behavioral problems of patients. These may be important factors in reducing stress and burnout for staff caring for residents suffering from Alzheimer's disease (Mobily et al., 1992). The investigators also recommended that, whenever possible, staff who work with such residents be screened carefully and selected for their ability to be sensitive to their needs, their flexibility, their imagination, and their ability to respond to persons with impaired communication and ever-changing moods (Coons, 1991). Specialized training in the care of residents with Alzheimer's disease is also a critical factor.

High stress at work can create morale problems that ultimately detract from the staff member's job performance (Sheridan et al., 1990). The causal model developed from research on work-related stress and morale among nursing home employees highlights both antecedents and outcomes of work-related stress (Weiler et al., 1990). The outcomes of work-related stress are linked to adverse physical and psychological consequences (LaRocco et al., 1980). According to Weiler and colleagues (1990), these outcomes can include: (1) burnout, defined as a syndrome of emotional exhaustion, depersonalization, and lack of personal accomplishment; (2) depression, which is the degree of negative affect experienced by nursing personnel; (3) poor or low job satisfaction, which involves effective orientation of nursing personnel toward the work situation; and (4) work involvement, defined as the degree to which nursing personnel identify with their job.

Although burnout has been the focus of many studies (see, e.g., Pines and Maslach, 1978; Dolan, 1987; Husted et al., 1989; Berland, 1990; Oehler et al., 1991; Johnson, 1992; Kandolin, 1993; Duquette et al., 1994), a uniform definition of burnout has not been established. Proposed definitions range from a simple equation of burnout with staff turnover to effectively including all four of the outcomes identified above by Weiler and colleagues. Nevertheless, most definitions found by the committee tend to describe burnout as having psychological, physical, and behavioral components. Pines and Maslach (1978, p. 236) define burnout as "a syndrome of physical and emotional exhaustion involving the development of a negative self-concept, negative job attitude and loss of concern and feeling for clients." In the long-term care setting, Heine (1986) characterizes burnout as a loss of concern for residents and physical, emotional and spiritual exhaustion that may lead to indifference or negative feelings toward elderly residents, overuse of chemical or physical restraints, and heightened po-



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